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

We have encountered two cases of late calcification of the porcine heterograft. A patient in chronic renal failure died of sepsis and endocarditis fifteen months after replacement of the mitral and tricuspid valves. At postmortem examination, both heterograft valves exhibited severe calcification and thrombosis. A second patient with rheumatic heart disease and sickle cell disease underwent mitral valve replacement for severe regurgitation. Thirty months later, cardiac catheterization revealed prosthetic valve stenosis. The valve was replaced successfully, and the excised heterograft exhibited severe calcification with restriction of leaflet motion. Although calcification of the porcine heterograft is known to occur in patients with infection or disorders of calcium metabolism, dysfunction of the heterograft is rare in our experience.
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PMID:Calcific stenosis of the porcine heterograft. 45 40

Complications after heart valve replacement remain a substantial source of morbidity and mortality despite continuing advances in surgical care and prosthetic design. Infectious endocarditis occurs in about 4 percent of patients and may appear early (within 60 days) or late after operation. Endocarditis of early onset is commonly due to staphylococcal, fungal or gram-negative organisms and is fatal in 70 percent or more of cases. Infection of late onset is more often of streptococcal origin and the mortality rate is lower, about 35 percent. With either type, prompt recognition, vigorous and appropriate antimicrobial therapy and early consideration of surgical intervention are crucial. The postperfusion and postpericardiotomy syndromes are relatively common and relatively benign syndromes associated with postoperative fever. Their recognition is important to prevent confusion with endocarditis or sepsis and thus to reassure the patient and physician. Treatment is primarily symptomatic. Intravascular hemolysis occurs with most prosthetic heart valves but is more common with certain prostheses and with paraprosthetic valve regurgitation, with significant hemolytic anemia in 5 to 15 percent. Oral iron replacement therapy is effective in the majority of patients, but occasionally blood transfusion or reoperation for leak around the prosthesis is necessary. Prosthesis dysfunction due to thrombus may be recognized clinically by recurrence of heart failure, syncope, cardiomegaly and altered prosthetic valve sounds or new murmurs. Hemodynamic studies verify the diagnosis, and prompt reoperation is indicated for this potentially lethal problem. Systemic embolization has decreased markedly with the introduction of cloth-covered prostheses and is frequently related to erratic or ineffective anticoagulant therapy. We continue to recommend anticoagulant therapy for all patients with prosthetic heart valves unless there is a major contraindication.
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PMID:Diagnosis and management of complications of prosthetic heart valves. 109 75

The pre- and intra-operative care of patients with acute intestinal obstruction is reviewed. The most important pre-operative problems are hypovolaemia, sepsis, electrolyte and acid-base imbalances. The evaulation and treatment of these disorders are discussed. The importance of preventing regurgitation and inhalation of stomach contents is emphasised and the methods which are used are described. The safest techniques of induction and maintenance of anaesthesia as well as muscle relaxation and intra-operative fluid therapy are indicated.
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PMID:[Anesthesia for patients with intestinal obstruction]. 115 44

A 13-year-old girl was admitted to a hospital because of fever and sore throat. Staphylococcus aureus was obtained on blood culture, and she was treated with antibiotics under the diagnosis of sepsis and DIC. Echocardiography showed huge vegetation attached to the posterior leaflet of mitral valve and severe mitral regurgitation. CT scan revealed multiple heterogeneous high density areas in her brain. She was transferred to our hospital for further examination and treatment. Large verrucae on the mitral valve, severe regurgitation and repeated embolism urged us to the emergency mitral valve replacement. Debridement of abscess on the posterior wall of the left atrium and ventricle necessitated patch plasty of those structures and mitral ring as well. Operative and postoperative examination showed mycotic aneurysm of right coronary artery, multiple brain hemorrhage, arterial obstructions of extremities and splenic infarction. Sooner she recovered except for slight macular degeneration caused by retinal embolism.
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PMID:[A case of infective endocarditis with multiple embolic complications]. 140 96

Optimum surgical management of the hypopharyngeal diverticulum is controversial. The authors discuss 48 consecutive patients (average age 72.1 years) with documented hypopharyngeal diverticula who were treated by cricopharyngeus myotomy, leaving the diverticula in situ. All came to the hospital with dysphagia; other symptoms included postdeglutitive cough, regurgitation, aspiration, and weight loss. Seven patients had had previous surgery for a Zenker's diverticulum with recurrence. Aspiration pneumonia was treated in 9 patients; 28 patients had concurrent chronic obstructive pulmonary disease or cardiovascular disease. Thirty-nine patients had cricopharyngeus myotomy under local anesthesia, 5 had cricopharyngeus myotomy under general endotracheal anesthesia, and 4 patients underwent myotomy with a cervical esophagostomy. There was one mortality (2.1%) and no incidence of postoperative bleeding, sepsis, or cranial nerve injury. Follow-up was done with 30 patients via telephone an average of 64 months after operation. Twenty-one of 30 patients reported excellent relief of symptoms, 5 reported improvement with occasional symptoms, and 4 patients described persistent dysphagia. Cricopharyngeus myotomy under local anesthetic is a safe and effective approach to the patient with a hypopharyngeal diverticulum. The awake patient can swallow on command, which enables the surgeon to identify the upper esophageal sphincter (UES) and to perform an accurate, complete myotomy. The absence of a pharyngeal suture line eliminates the risk of leakage and mediastinal sepsis, and allows early, postoperative feeding and discharge.
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PMID:Treatment of Zenker's diverticula by cricopharyngeus myotomy under local anesthesia. 148 6

A successful repair of infective endocarditis of the tricuspid valve in a drug abuser is reported. A 25-year-old woman with a history of drug addiction was referred to our hospital complaining of high fever despite antibiotic therapy. Blood cultures showed staphylococcal septicemia, and echocardiography revealed large vegetations attached to the tricuspid annulus and massive regurgitation of the tricuspid valve. Blood studies showed renal failure and hematological abnormalities due to septicemia and right ventricular failure. Excision of the vegetation and the posterior leaflet was performed along with annuloplasty (Kay's procedure). The patient's postoperative course was uneventful and subsequent echocardiographic examination disclosed no evidence of recurrence, and insignificant tricuspid valvular regurgitation. Local excision of vegetation and leaflet repair by annuloplasty may be performed in cases with well-circumscribed vegetation and minor leaflet damage.
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PMID:[A case of infective endocarditis of the tricuspid valve repaired by vegetectomy and annuloplasty]. 163 50

To evaluate the results of palliative surgery for hypoplastic left heart syndrome, we reviewed the records of 57 infants who underwent first-stage reconstruction at our institution between July 1983 and April 1989. Of the 57 infants, 12 (21%) are long-term survivors and 45 (79%) have died. Thirty-one infants died within the first 30 days after surgery. Twenty-six of the 31 early deaths occurred within the first 24 hours after surgery. Causes of early mortality were low cardiac output (23), sepsis (two), sudden death (two), pulmonary vein atresia (three), and cardiac transplant (one). Late death occurred in 14 infants due to sepsis (three), sudden death (four), and death at reoperation (seven - three after Fontan procedure, three after shunt replacement, and one after transplant). Of the 31 patients who survived more than 24 hours, the complications noted by echocardiography and confirmed by catheterization when reoperation was indicated were significant arch obstruction (13%), branch pulmonary artery stenosis (23%), small atrial septal defect (16%), inadequate shunt (26%), neoaortic regurgitation (13%), tricuspid regurgitation (13%), ventricular dysfunction (29%), thrombus (6%), and superior vena cava obstruction (3%). Of the 31 patients who survived more than 24 hours, 16 additional palliative surgical procedures were performed in eight patients. These procedures included arch reconstruction (four), additional shunt (four), Glenn shunt (three), atrial septectomy (two), coarctation balloon angioplasty (two), and pulmonary artery reconstruction and reshunting (one). Of the 12 long-term survivors, four have had a successful Fontan procedure, one has had a transplant, and seven are awaiting a second-stage procedure. Thus, 69% of all deaths occurred within the first 30 days of surgery, and 58% of all deaths occurred within the first 24 hours due to cardiovascular collapse.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Longitudinal results after first-stage palliation for hypoplastic left heart syndrome. 169 84

Sepsis and tricuspid valve regurgitation developed in a 29-year-old man with Crohn's disease after implantation of an intravenous port device for parenteral nutrition. A thrombus, caused by Staphylococcus epidermidis, had grown along the catheter and prolapsed through the valve without affecting it. Complete removal in an open heart procedure led to quick recovery.
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PMID:Infected intravenous port device causing tricuspid valve regurgitation. 190 54

A 17-year-old woman with mitral and tricuspid valve prolapse and myxomatous degeneration presented puerperal infection by Staphylococcus aureus with clinical picture of sepsis and multiple septic embolism (right eye, left thumb, spleen, and left calf). She underwent total hysterectomy on the 10th day postdelivery and right eye enucleation on the 16th. Temporary total AV block occurred on the 14th day with temporary external pacing during the next couple of days. Acute endocarditis with acute mitral regurgitation was diagnosed on the 13th day, demanding immediate valve replacement. On the 46th day she developed moderate tricuspid valve regurgitation due to another episode of endocarditis. Final clinical discharge took place on the 62nd day after antibiotic therapy completion.
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PMID:[Staphylococcus aureus endocarditis in a puerperal woman with mitral and tricuspid valve prolapse]. 209 20

Since July 1985, cryopreserved homograft prostheses have been used for aortic valve replacement in 10 patients, aged 2 to 77 years, with active endocarditis. Five patients had positive bacterial cultures from excised valves, and all had clinical findings of uncontrolled infection while receiving appropriate antibiotics. Homograft valves (four) or valved conduits (six) were implanted for treatment of sepsis (6 patients), congestive heart failure (3) or recurrent emboli (1 patient), and complicating native (5 patients) or prosthetic valve (5) endocarditis. Staphylococci (6 patients), streptococci (3), and Candida (1) were infecting organisms. Preoperatively, Doppler echocardiography showed aortic regurgitation in all patients. At operation, 9 patients had gross vegetations, 9 had single or multiple abscess cavities, and 5 had pericarditis. Complex reconstruction of the aortic valve and annulus with homograft conduits was necessary in 6 patients (3 with previous aortoventriculoplasty). Two early deaths (ventricular failure, perioperative stroke) occurred. Mean follow-up of all operative survivors was 2.1 years (range, 0.6 to 3.6 years), and one late death resulted from arrhythmia. Homograft valve regurgitation increased in 1 patient, and 7 late survivors are asymptomatic. No patient has had recurrence of endocarditis. We conclude that cryopreserved homograft aortic valve/root replacement is an effective method for management of active endocarditis complicated by annular destruction.
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PMID:Results of homograft aortic valve replacement for active endocarditis. 232 58


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