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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Endoscopic injection sclerotherapy (EIS) frequently is used for patients with esophageal varices, both for controlling acute hemorrhage and for prophylaxis. An old technique, interest in EIS increased when other methods did not improve patient outcomes. Clinical trials of EIS for acute hemorrhage demonstrated efficacy and improved outcome, although some researchers disagree with these findings. Recent data on prophylaxis with EIS fail to support the value of EIS for this indication. Ethanolamine oleate compares favorably with other sclerosing agents, and is the only one currently approved for EIS. The intravariceal method is used more frequently than the paravariceal method because it has better efficacy and can be performed more rapidly. The percentage of patients developing significant complications from EIS may be as high as 15 percent; common complications include retrosternal pain, pyrexia, and sepsis. EIS is currently an important clinical tool in the management of esophageal varices.
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PMID:Sclerotherapy for esophageal varices. 227 Jun 96

From June 1978 to December 1987, 106 revision total hip arthroplasties (THA) for acetabular salvage were performed using a bipolar device. Bone grafting was necessary in most of the patients. Five patients were unavailable for follow-up examination, leaving 96 patients (101 hips), who were followed for an average of two years 11 months (range, two months to 8.5 years). Excellent or good results were obtained in 43 patients; fair results were achieved in 20 patients. Of the nine patients with poor results, five demonstrated roentgenographic evidence of subluxation, and four showed no roentgenographic changes that could explain their persistent pain. Twenty-nine of these bipolar revisions failed and required reoperation. Fourteen of these failures were revised using fixed, cementless devices in conjunction with bone grafting. Ten patients developed deep-wound infection. Nine were treated successfully; the tenth patient died of overwhelming sepsis, her case complicated by multiple infected joint arthroplasties. While the results of revision THA in the present series are not as satisfactory as those reported by others who used fixed cemented or fixed cementless acetabular components, they are superior to the results obtained with excisional arthroplasty, the only alternative in many of these cases.
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PMID:Acetabular salvage in revision total hip arthroplasty using the bipolar prosthesis. 229 2

Forty-one fused hips in thirty-eight patients were converted to total hip replacement. The average length of follow-up was seven years. The predominant indications for conversion were progressively disabling pain in the low back or the hip, or both; loss of function due to immobility or malposition of the hip; and progressive pain and instability of the knee (usually ipsilateral). The postoperative arc of flexion averaged 87 degrees. Limb-length discrepancies improved an average of 2.5 centimeters. Postoperative function of the abductor muscles depended on the preoperative quality of those muscles and on the accuracy of the biomechanical restoration. Postoperative strength of the muscles of the hip improved for two years or more in most patients. There was complete or major relief of pain, improved mobility of the hip, and decreased dependence on supports for walking. There were nine failures: four because of sepsis, four because of loosening of the femoral component, and one because of malposition of the acetabular component. The failures were predominantly in patients who were fifty years old or less at the time of arthroplasty, patients who had had two or more previous operations, and patients who had had an injury to the hip. The quality of the results approached that after primary hip arthroplasty in older patients who have not had multiple previous operations on the hip. Survivorship analysis of the spontaneously fused hips that were treated with conventional hip replacement predicted a probability of survival of the implant of 96 per cent at thirteen years postoperatively (p = 0.048).
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PMID:Joint replacement for ankylosed hips. 229 72

Fourteen patients were retrospectively reviewed to examine the role of arthroscopy in the diagnosis and treatment of the problem total knee arthroplasty (TKA), and to define parameters for indications, techniques, and results. All patients had undergone a previous TKA, and postoperatively had problems with pain and/or range of motion. Routine evaluation failed to reveal sepsis or aseptic loosening. Arthroscopy was used to evaluate and treat certain specific conditions. The arthroscope was successful in removing loose bodies, correcting patella subluxation with an arthroscopic lateral release, excising a symptomatic pseudomeniscus, and releasing intraarticular adhesions to improve motion and relieve pain. The postoperative knee score improved 73%. Arthroscopy is a valuable tool to evaluate a painful TKA, and can be used to treat certain conditions that would otherwise require an arthrotomy. The rehabilitation time is easier on the patient and much quicker. Arthroscopy of a TKA does not compromise any future procedures. However, it remains a technically demanding procedure whose indications and expectations are still being defined.
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PMID:The role of arthroscopy in the problem total knee replacement. 231 Apr 47

To identify cortical and subcortical structures in the brain which are associated with septic encephalopathy, local cerebral glucose utilization (LCGU) in the 31 discrete regions were evaluated with a quantitative (14C)-2.deoxyglucose autoradiographic method in the septic rat model. Sepsis was produced by cecal ligation and punctures. Forty rats were subjected to behavioral study and divided into two groups (control, n = 15; sepsis, n = 25). Septic rats died within 36 h, and the rats developed behavioral depression, and showed EEG slowing and an increase in pain threshold. The latter was evaluated by a tail flick method within 8 h after the surgical procedures, while control rats did not show significant change in either behaviors or pain threshold. In another study, LCGU was measured when behavioral depression, increase in pain threshold, and EEG slowing developed in the sepsis group (n = 7). In this group, the mean LCGU in auditory and parietal cortices, lateral geniculate, superior colliculus, hippocampus, and locus ceruleus was 95, 74, 67, 69, 72, and 53 mumol.100 g-1.min-1, being lower by 23%, 22%, 18%, 19%, 14%, and 27% than that in the sham-operated control group (n = 7), respectively. However, the mean LCGU in septal and raphe nuclei was 52 and 84 mumol.100 g-1.min-1, being significantly higher by 27% and 33% than that in the control group, respectively. These results suggest that septic encephalopathy is associated with metabolic changes in the discrete brain regions, which are related to the serotonergic or noradrenergic system.
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PMID:Local cerebral glucose utilization in septic rats. 231 53

Between 1980 and 1987, 44 total knee arthroplasties of the GUEPAR type were performed in 38 patients with severe degenerative joint disease. The patients have been followed up for 7 years and 70% of cases had a good or fair result. The 13 poor results included five cases of deep sepsis, three of whom subsequently underwent successful arthrodesis at this hospital. Other causes of a poor outcome were loosening and patellofemoral dysfunction. Radiological review of 27 knees showed that 80% had lucent lines at either cement/prosthesis or bone/cement interface, although these radiological findings were not associated with clinical evidence of loosening. The major long-term complication was shown to be retropatellar pain, which was recognized in 16% of all cases. However, this would seem to be the only significant long-term complication, and we believe that with the use of a patellar button the GUEPAR prosthesis should continue to be used in selected cases of severe degenerative joint disease.
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PMID:GUEPAR total knee prosthesis. Results and outcome of seven years' use in a district general hospital. 234 16

Solid organ transplant recipients can experience serious disease and death from infection due to the parasitic roundworm Strongyloides stercoralis. This parasite lives in soil contaminated with human feces. Domestic dogs and cats may be another reservoir. Larvae can penetrate the skin, are carried hematogenously to the lungs, migrate up the bronchial tree, and then can be passed to the upper small intestine. Autoinfection occurs in the setting of immunosuppression when invasive larvae penetrate the gut wall and cause disseminated infection. Polymicrobial sepsis is sometimes seen due to enteric organisms adhering to the parasite. Transplant recipients are at highest risk during the first 3 months posttransplant. Many organ systems may be affected. Pulmonary symptoms include cough, wheezing, sputum production, dyspnea, hemoptysis, tachypneas, and pleuritic pain. Hyperinfection, an augmentation of the normal skin-lung-intestine life cycle, occurs in roughly two-thirds of infected transplant recipients, with dissemination in the remainder. Diagnosis is made primarily by examination of the stool or intestinal secretions for ova and parasites. Occasionally, parasites are noted in the sputum. New serologic tests show promise. The parasite may remain in the host for over 25 years before immunosuppression causes either dissemination or hyperinfection. Thiabendazole given for 3 to 7 days is the treatment of choice for organ transplant recipients. Repeat courses may be needed to eradicate infection.
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PMID:Strongyloides infections in transplant recipients. 234 6

Posttraumatic acute cholecystitis is a serious complication which can occur in multitrauma patients. Predisposing factors may include fasting, hypotension, transfusions, sepsis, and narcotics. Common signs and symptoms include right upper-quadrant pain or tenderness, nausea and vomiting, and fever. Symptoms began 26 days and 108 days posttrauma in the two patients studied while they were on the rehabilitation service. The recommended treatment is immediate cholecystectomy. Conservative management results in much higher mortality.
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PMID:Posttraumatic acute cholecystitis on the rehabilitation service. 236 1

One hundred and four cases of osteoradionecrosis (ORN) of the mandible following irradiation of head and neck cancer are reported. Conservative management for ORN failed in all cases. Indications of hemimandibulectomy included intractable pain, severe trismus, pathological fracture, oro-cutaneous fistula and persistent exposure of bone. Surgical approach was intra-oral in 100 cases and extra-oral in four. Immediate soft tissue reconstructions were carried out in 20 per cent cases. Post-operative complications included minor sepsis (8.6 per cent), major sepsis (2.9 per cent), haemorrhage (2.9 per cent) and fistula (3.8 per cent). Major complications occurred only in patients treated exclusively by external irradiation at doses equal to or higher than 65 Gy. Relief from pain and trismus was obtained and normal swallowing was established following radical surgery.
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PMID:Osteoradionecrosis of the mandible: study of 104 cases treated by hemimandibulectomy. 237 Apr 51

Sixty-eight patients at the University of Illinois, Cook County, and the West Side Veterans Administration hospitals underwent pelvic exenteration for advanced pelvic malignancies during the 15-year period from 1969 to 1984. Thirty-two had colorectal cancers, eleven cervical, seven bladder, and six vulvar; in twelve the cancers were in miscellaneous pelvic sites. Forty-five exenterations were done with intent to cure, and twenty-three for palliation of patients with bulky, necrotic tumors that had caused symptomatic fistulae, local sepsis, chronic bleeding, or severe localized pain. The total 30-day postoperative mortality was 4.4% (3/68). The 5-year survival rate of patients who underwent curative exenteration was 33% (median 27 months). Pelvic exenteration appears to be a feasible surgical procedure for a variety of advanced malignancies as well as for palliation of severely symptomatic patients.
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PMID:Pelvic exenteration. 241 58


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