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

Continuous intravenous epoprostenol improves exercise capacity, haemodynamics, and survival in severe primary pulmonary hypertension. Pulmonary hypertension can also be life-threatening in patients with connective tissue diseases. In a prospective open monocentre uncontrolled study, the effects of epoprostenol were evaluated in patients with severe pulmonary hypertension secondary to connective tissue diseases who were unresponsive to oral vasodilators (including calcium channel blockers) and continued to be in the New York Heart Association (NYHA) functional class III or IV despite conventional medical therapy. Seventeen patients received epoprostenol administered by a portable infusion pump associated with conventional therapy (oral anticoagulants, diuretics, supplemental oxygen). During the first six weeks of therapy, two (12%) patients died, of pulmonary oedema (n = 1) and severe sepsis (n = 1). In the fifteen remaining subjects, clinical and haemodynamic parameters improved significantly at six weeks. These patients were subsequently monitored for 80+/-48 (range 14-154) weeks after initiation of epoprostenol. Five (33%) patients died, of right heart failure (n = 2), severe sepsis (n = 2) or syncope (n = 1) and two patients were successfully transplanted 24 and 52 weeks after initiation of epoprostenol. Seven of the remaining eight patients had a persistent clinical improvement. Short-term epoprostenol therapy is effective in some patients with connective tissue diseases as demonstrated by better clinical status and haemodynamics at six weeks. However, this study reports several cases of early and late major complications including severe sepsis and pulmonary oedema. Additional information is needed to evaluate the benefit: risk ratio of long-term epoprostenol therapy in pulmonary hypertension secondary to connective tissue diseases.
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PMID:Short-term and long-term epoprostenol (prostacyclin) therapy in pulmonary hypertension secondary to connective tissue diseases: results of a pilot study. 1044 11

Ten patients (aged 0-9 years) with the diagnosis of automatic atrial tachycardia (AAT) from August 1997 to August 2000 were reviewed. Three patients had paroxysmal (repetitive) AAT and the tachycardia was incessant in six (defined as presence of AAT for more than 90% of the time). The type of AAT in one patient was unknown. Four patients presented with congestive heart failure (CHF), one with pre-syncope, one with palpitation, and four were asymptomatic. Six patients (60%) had depressed left ventricular ejection fraction. All patients with CHF had incessant AAT with atrial rate > 220/min and ventricular rate > 200/min at admission. After treatment with antiarrhythmic medications, all patients had adequate control of the AAT (9 had complete elimination of AAT and 1 partial control). Amiodarone (alone, or in combination with digoxin) was effective in 5 of 6 cases (83%), although complete elimination of the AAT was usually delayed (median = 5 days, range 30 minutes to 17 days). Other effective medications were digoxin, digoxin + propranolol and atenolol (all in patients who did not have CHF on presentation). At the time of this report, 3 patients had no AAT off antiarrhythmic medication, 5 patients were still receiving treatment (with good control) and 2 patients died from sepsis during the same admission even though AAT was controlled. All surviving patients had normal ventricular ejection fraction on follow-up. AAT in children is rare, but when it occurs in persistent form at a fast rate, it is usually associated with CHF and is difficult to treat. Amiodarone (+/- digoxin) effectively controls the arrhythmia in the majority of cases, although full effect may take several days. With successful treatment, most patients do well and some can be taken off the medication(s) without recurrence of the arrhythmia.
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PMID:Atrial tachycardia from enhanced automaticity in children: diagnosis and initial management. 1180 Mar 7

Pulmonary arterial hypertension is a life-threatening disease for which continuous intravenous prostacyclin has proven to be effective. However, this treatment requires a permanent central venous catheter with the associated risk of serious complications such as sepsis, thromboembolism, or syncope. Treprostinil, a stable prostacyclin analogue, can be administered by a continuous subcutaneous infusion, avoiding these risks. We conducted a 12-week, double-blind, placebo-controlled multicenter trial in 470 patients with pulmonary arterial hypertension, either primary or associated with connective tissue disease or congenital systemic-to-pulmonary shunts. Exercise capacity improved with treprostinil and was unchanged with placebo; the between treatment group difference in median six-minute walking distance was 16 m (p = 0.006). Improvement in exercise capacity was greater in the sicker patients and was dose-related, but independent of disease etiology. Concomitantly, treprostinil significantly improved indices of dyspnea, signs and symptoms of pulmonary hypertension, and hemodynamics. The most common side effect attributed to treprostinil was infusion site pain (85%) leading to premature discontinuation from the study in 8% of patients. Three patients in the treprostinil treatment group presented with an episode of gastrointestinal hemorrhage. We conclude that chronic subcutaneous infusion of treprostinil is an effective treatment with an acceptable safety profile in patients with pulmonary arterial hypertension.
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PMID:Continuous subcutaneous infusion of treprostinil, a prostacyclin analogue, in patients with pulmonary arterial hypertension: a double-blind, randomized, placebo-controlled trial. 1189 47

We describe the case of a 64-year-old patient admitted to our hospital because of syncope and suspicion of cardiac tamponade. At admission he had temporary alteration of conscience with clinical evidence of sepsis without chest pain. There was a mild pericardial effusion in absence of clinical and echocardiographic signs of cardiac tamponade. About 36 hours later we found evidence of an aortic dissection and in the blood culture an isolation of Clostridium fallax that we consider the probable cause of this lesion.
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PMID:[Type-A aortic dissection without chest pain in a patient with Clostridium fallax infection]. 1278 61

Rapid diagnosis of stroke is necessary for the timely delivery of thrombolysis and evaluation of novel therapies such as neuroprotection. An accurate clinical history and competent examination are key to identifying which patients are likely to have had a stroke and arranging and interpreting neuroimaging. Stroke symptoms are typically acute in onset, but are highly variable depending on the vascular territory affected. Common presenting symptoms are limb weakness, and speech and visual disturbances. Common stroke mimics are seizures, space occupying lesions, syncope, somatization and delirium secondary to sepsis. Stroke recognition instruments can help nonspecialists in the early diagnosis of stroke, with studies reporting sensitivity of over 90% and specificity of approximately 85% for some instruments. In patients with a clinical diagnosis of stroke, brain computed tomography or MRI is required to exclude some stroke mimics and differentiate ischemic from hemorrhagic stroke, which is key to providing appropriate therapies such as thrombolysis. In the future, plasma biomarkers may improve clinical diagnosis of stroke, but prospective studies are required to establish their utility. Clinical trials of acute stroke therapies need to ensure rapid accurate diagnosis of stroke using structured clinical assessments and appropriate imaging to achieve early treatment and avoid entry of stroke mimics into trials.
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PMID:Misdiagnosis of stroke. 1767 94

Left cardiac myxoma and consecutive embolization into the brain is well documented, whereas the association of myxoma with multiple fusiform cerebral aneurysms is rare. A 48-year old female with chronic renal failure had complained of syncope after receiving hemodialysis. An echocardiogram showed a 3 x 4 cm sized myxoma and brain MRI displayed multiple fusiform aneurysms. The myxoma was successfully removed. Postoperatively, she developed status epilepticus. Unfortunately, the patient did not recover and expired due to sepsis.
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PMID:Multiple cerebral aneurysms associated with cardiac myxoma in a patient with chronic renal failure: how can we resolve multiple cerebral aneurysms? 1916 97

We herein report the rare complication of sepsis caused by endoscopic clipping for colonic diverticular bleeding. A 78-year-old man with a 12-h history of near syncope and painless hematochezia was admitted to our hospital. Following the transfusion of 4 U of blood and continued hematochezia, a colonoscopy was performed. Active bleeding was seen as continuous arterial spurting from a single diverticulum located in the middle ascending colon. This diverticulum was seamed by four endoclips. The next day, the patient became febrile with a temperature of 39.2 degrees C. Laboratory data included a white blood cell count of 18 100/mm(3) and a C-reactive protein level of 3.4 mg/dL. He was diagnosed with sepsis since Escherichia coli was detected in the blood culture. Antibiotics were started. Four days later his fever had improved and laboratory data improved 9 d later.
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PMID:Sepsis caused by endoscopic clipping for colonic diverticular bleeding: a rare complication. 1967 26

A 78-year-old man with a history of aorta-femoral graft operation was admitted to the hospital with symptoms of syncope, melena and haematemesis. He reported several episodes of melena during the previous year for which he underwent repeated gastro-intestinal endoscopic examinations, which were unable to show the site of the gastro-intestinal bleeding. The third upper gastro-intestinal endoscopic examination disclosed a yellowish ulcerative lesion with irregular borders in the third part of the duodenum, which was considered to be a fistula, between the aorta and the duodenum. The patient underwent an explorative operation that revealed an intact aortic graft, firmly adherent to the duodenal wall, and the duodenum that was eroded in the third portion. The duodenum was transected and a duodenoduodenostomy was performed. Although re-bleeding did not occur, the patient died of sepsis eight days after the operation. Aorto-enteric fistulae can be missed due to the common practice of limiting the endoscopic examination to the second part of the duodenum and not considering them in the differential diagnosis of gastro-intestinal bleeding because of their rarity. Possibly, a number of prior endoscopic examinations may be inconclusive until a correct diagnosis is reached in most of the cases.
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PMID:Aorto-enteric fistula: a dilemma for the endoscopist as a rare cause of gastro-intestinal bleeding. 1980 76

Acute esophageal necrosis (AEN), commonly referred to as "black esophagus", is a rare clinical entity arising from a combination of ischemic insult seen in hemodynamic compromise and low-flow states, corrosive injury from gastric contents in the setting of esophago-gastroparesis and gastric outlet obstruction, and decreased function of mucosal barrier systems and reparative mechanisms present in malnourished and debilitated physical states. AEN may arise in the setting of multiorgan dysfunction, hypoperfusion, vasculopathy, sepsis, diabetic ketoacidosis, alcohol intoxication, gastric volvulus, traumatic transection of the thoracic aorta, thromboembolic phenomena, and malignancy. Clinical presentation is remarkable for upper gastrointestinal bleeding. Notable symptoms may include epigastric/abdominal pain, vomiting, dysphagia, fever, nausea, and syncope. Associated laboratory findings may reflect anemia and leukocytosis. The hallmark of this syndrome is the development of diffuse circumferential black mucosal discoloration in the distal esophagus that may extend proximally to involve variable length of the organ. Classic "black esophagus" abruptly stops at the gastroesophageal junction. Biopsy is recommended but not required for the diagnosis. Histologically, necrotic debris, absence of viable squamous epithelium, and necrosis of esophageal mucosa, with possible involvement of submucosa and muscularis propria, are present. Classification of the disease spectrum is best described by a staging system. Treatment is directed at correcting coexisting clinical conditions, restoring hemodynamic stability, nil-per-os restriction, supportive red blood cell transfusion, and intravenous acid suppression with proton pump inhibitors. Complications include perforation with mediastinal infection/abscess, esophageal stricture and stenosis, superinfection, and death. A high mortality of 32% seen in the setting of AEN syndrome is usually related to the underlying medical co-morbidities and diseases.
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PMID:Black esophagus: acute esophageal necrosis syndrome. 2061 76

A 76-year-old man was admitted to our hospital with severe diarrhea and syncope. Abdominal computed tomography (CT) showed a mass 7 cm in diameter mimicking a seminal vesicle tumor and magnetic resonance imaging showed a heterogeneously enhanced mass with an unclear borderline to the rectum. The differential diagnosis of the lesion included a tumor arising from a seminal vesicle, a local recurrence of rectal cancer, a rectal GIST, and a mesenchymal tumor. Transrectal needle biopsy revealed non-Hodgkin's malignant lymphoma (diffuse large B cell lymphoma). Chest and abdominal CT showed no specific findings except the lesion for the seminal vesicle lesion, but positron emission tomography showed accumulations in the gastrointestinal tract, pleura, and lymph nodes. The patient was thus determined to have stage IV malignant lymphoma and was given two courses of combination chemotherapy including RCHOP. The tumor responded to one course, but the patient died of neutropenic sepsis during the second course.
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PMID:[A case of malignant lymphoma mimicking a seminal vesicle tumor]. 2072 15


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