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

Enteral nutrition (EN) has several advantages over parenteral nutrition (PN) for postoperative/posttrauma patients. Modern technologies for tube-feeding have made early EN possible. Jejunal tube-feeding has advantages over gastric tube-feeding: faster metabolic recovery, less vomiting, and less risk of regurgitation and aspiration. Immediate or early EN stimulates the splanchnic and hepatic circulations, improves mucosal blood flow, prevents intramucosal acidosis and permeability disturbances, and eliminates the need for stress ulcer prophylaxis. Saliva containing important antimicrobial substances and gastric acidity are important in sepsis prevention. Chewing, saliva, and gastric acidity support gastric nitric oxide (NO) release, important for mucosal blood flow, gastrointestinal (GI) motility, mucus formation, and bacteriostasis. An oral supply of NO-donating substances and chewing of nitrate-rich food, such as lettuce or spinach, can be useful. Oral and mucosa-protective lipids are recommended. H2 blockers and saliva-inhibiting drugs are avoided. Immediate EN should be given, starting with 25 ml/hr and increasing to 100 ml/hr over 24 to 48 hours. For the immunocompromised patient special attention should be given to the purity of water. Bottled water can contain bacteria such as Pseudomonas. Food antioxidants such as glutathione, vitamin E, and beta-carotenes are important. Ingredients for the colonic mucosa are important. Approximately 10% of caloric need is satisfied by so-called colonic food (prebiotics), fermented at the level of the colonic mucosa to produce colonic mucosa nutrients and to prevent gut origin sepsis. More than 10 g of fiber per day is recommended. The fermenting flora (probiotic flora) is deranged owing to disease or antibiotic treatment, and resupply of flora is important. A new concept of ecoimmune nutrition is presented for enteral supply of mucosa-reconditioning ingredients: new surfactants, pseudomucus, fiber, amino acids such as arginine, and mucosa-adhering Lactobacillus plantarum 299.
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PMID:Nutritional support to prevent and treat multiple organ failure. 866 38

The authors report two cases of pulmonary valve endocarditis which required emergency surgical treatment. A 74 year old patient with trivalvular endocarditis (pulmonary, aortic, mitral), due to Sptreptococcus D bovis, developed cardiogenic shock with acute pulmonary oedema and underwent double aortic and pulmonary valve replacement with Carpentier-Edwards prostheses and simple resection of a mitral valve vegetation. Another 36 year old drug addict developed isolated pulmonary valve endocarditis due to Staphylococcus aureus infection complicated by pulmonary regurgitation with right ventricular failure and by septic pulmonary embolism with persistent sepsis: he underwent pulmonary valve replacement with a Bravo 300 bioprosthesis. The postoperative course was uncomplicated in both cases, with interruption of the infection and normalisation of the haemodynamic status. The insidious and severe nature of pulmonary valve endocarditis is demonstrated by these two cases, confirming previous reports which have underlined the poor prognosis of this condition. Surgery has been shown to be effective and well tolerated and should be integrated early in the therapeutic strategy, the results being all the better when an aggressive attitude is taken.
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PMID:[Pulmonary valve replacement for endocarditis. Apropos of 2 cases]. 876 8

From 1985 to 1995, 12 patients with native valve endocarditis underwent valve repair instead of replacement. Mean age was 41.9 years (range from 5 to 79 years). Eight patients had active and 4 patients inactive infection. The mitral valve was involved in 6 patients, the aortic valve in 1, both valves in 2, the tricuspid valve in 2, and the mitral and pulmonary valves in 1. The pathological findings were as follows: leaflet perforation in 2 patients, chordal rupture in 3, and vegetations in 10. Valve sparing procedures were carried out on the mitral valve in 8 patients, on the aortic valve in 1, on the tricuspid valve in 2, and on the pulmonary valve in 1. The following repair techniques were used: vegetectomy in 10 patients, leaflet patching in 2, posterior mitral leaflet resection in 3, mitral annuloplasty in 4, and pulmonary valve repair in 1. Uncontrolled sepsis, progressive heart failure, peripheral embolism, and echocardiographically demonstrated vegetations were the indications for surgery. There was no operative or late mortality and all infections were cured with no recurrences. One patient required valve replacement following aortic valve repair because of progressive aortic regurgitation. Postoperative Doppler echocardiography showed trivial to no regurgitation in 11 patients after valve repair. The overall outcome was favorable during the mean follow-up period of 39.3 months (range from 1 to 120 months). Reparative or reconstructive approaches for native valve endocarditis should be considered and can be successfully performed. Their advantages include (1) improved hemodynamics, (2) no recurrence, (3) no mortality, and (4) favorable long-term results.
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PMID:Valve repair in infective endocarditis. 877 57

In 49 patients aged 2.2-34.8 (mean 11) years, homografts (20 aortic, 29 pulmonary) were implanted in the right ventricular outflow tract as an isolated procedure or part of corrective surgery for congenital heart disease: tetralogy of Fallot with pulmonary stenosis (23 cases), pulmonary atresia with ventricular septal defect (10 cases) truncus arteriosus (8 cases) or transposition of the great arteries with pulmonary stenosis (8 cases). Previous palliative procedures had been performed on 34 patients, and 37 had undergone repair of right ventricular outflow tract, with one to four sternotomies prior to homograft implantation. Homograft valve sizes ranged from 14 to 25 mm internal diameter. Concomitant intra- or extracardiac procedures were performed in 29 cases. Follow-up was complete at a mean of 3 +/- 0.3 (0-8) years. Early and total mortality was 2.0% (1/49), due to sepsis and multi-organ failure unrelated to the homograft. At follow-up all but one of the patients had an improved New York Heart Association function class. Eight patients (16.3%) with a mean age of 9.2 +/- 1.8 (2.8-15.5) years at implantation had homograft malfunction (stenosis in three, regurgitation in two and combined in three) at follow-up, averaging 4.1 +/- 1.0 (0.4-6.9) years, with no significant difference between aorta and pulmonary homograft subsets. Freedom from structural valve deterioration was 46.6 +/- 22% for pulmonary and 32.3 +/- 21.3% for aortic homografts at the 7-year follow-up (difference not significant). In two patients an aortic homograft was uneventfully replaced. In conclusion, homograft implantation in patients with right ventricular outflow tract obstruction improves function class and can entail low mortality and morbidity, even after multiple previous median sternotomies.
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PMID:Homografts for right ventricular outflow tract reconstruction in congenital heart disease. 945 84

Bacterial cholangitis is a clinically defined syndrome caused by the regurgitation of infected bile into the circulation. The pathogenic mechanism is unclear, and systemic sepsis may not occur. Prerequisite conditions are the presence of microorganisms in the bile and increased biliary pressure. Bacteria that commonly cause cholangitis are Escherichia coli, Klebsiella, Enterococcus, Enterobacter, Pseudomonas, and anaerobes. Although most infections are polymicrobial, this situation may not always prevail. Successful treatment depends on relieving biliary obstruction and administering antibiotics effective against bacteria in the circulation and the bile. The causes of biliary obstruction that predispose to bacterial cholangitis are myriad. Common conditions include biliary stones and benign strictures. In many parts of the world, biliary parasites are an important factor. Biliary parasites cause necrosis, inflammation, fibrosis, strictures, and cholangiectasis of the bile ducts by several mechanisms: (1) as a direct result of the irritating chemical composition of the parasite, parasitic secretions, or eggs; (2) physical obstruction of the bile ducts; (3) induction of formation of biliary stones; and (4) introduction of bacteria into the biliary system during migration from the duodenum. Therefore, bacterial cholangitis has an important and frequently dominant role in the pathogenesis and clinical course of biliary disease due to these parasitic infestations. Common biliary parasites include the nematode Ascaris lumbricoides, the trematodes Opisthorchis viverrini and felineus, Clonorchis sinensis, and Fasciola hepatica, and the cestodes Echinococcus granulosus and multilocularis. The epidemiologic, pathologic, and clinical manifestations of these parasitic infestations are reviewed.
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PMID:Bacterial and parasitic cholangitis. 958 92

The patient is 61-year-old woman who underwent partial left ventriculectomy, (Batista procedure) due to dilated cardiomyopathy and multiple thromboembolism. Although postoperative course was uneventful, she has had clinical symptoms of the left heart failure due to the increased mitral valve regurgitation at the early postoperative period, gradually. Even though mitral valve regurgitation was severe, it was not apt to re-dilatate the left ventricular capacity evaluated by echocardiography. She underwent the mitral valve replacement on the 92nd postoperative day, and was once possible for weaning from cardiopulmonary bypass under the support of IABP. However, she died on the 19th postoperative day caused by sepsis. It is important to evaluate the accurate mitral valve regurgitation preoperatively for Batista procedure. Although there was the mild mitral valve regurgitation, it is essential to repair or replace the mitral valve for Batista procedure.
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PMID:[Progressive mitral regurgitation which is necessitated the mitral valve replacement after partial left ventriculectomy (Batista procedure): a case report]. 1047 46

The study evaluated the results of the tricuspid valve autograft technique, consisting of transferring the posterior tricuspid leaflet and subvalvular apparatus towards the mitral valve to reconstruct a destroyed commissure. Twenty patients entered the study. Etiology was degenerative in 12 patients (mean age, 55 +/- 21 years). Nine patients had endocarditis, 8 were rheumatic. Echocardiography results and secondary events were reviewed. Mean follow-up was 44 +/- 17 months. One patient died from sepsis. Survivors were in sinus rhythm. Predischarge echocardiography showed trivial or no mitral regurgitation in all but one patient (mild). Mean transmitral gradients were 3 to 6 mm Hg, and valvular surface was 4.3 +/- 2.1 cm(2). On the tricuspid valve, regurgitation was zero to mild, gradients 4 to 7 mm Hg. One patient developed recurrent endocarditis at 18 months with moderate regurgitation. Results were stable in all the other patients. The tricuspid autograft is an attractive technique for a selected group of patients with commissural destruction. The 6-year results are very encouraging.
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PMID:Tricuspid autograft for repair of a destroyed mitral commissure. 1180 48

The short-term results after aortic root replacement with 11 cryopreserved aortic homografts was examined. Since 1998, the University of Tokyo Tissue Bank has supplied 11 aortic homograft valves. Nine of the recipients were male, and the average age was 51.2 years. Nine out of 11 patients had suffered from a serious condition of native or prosthetic valve infectious endocarditis. All of the patients underwent aortic root replacement, and the blood type between the patient and the homograft was matched in 8 of the patients. Only 1 patient died (9.1%) in the short-term due to sepsis. The preoperative degree of aortic valve regurgitation in all of the cases was third or fourth while the regurgitation disappeared after the operation in all of them. Thinking of the serious condition of our cases preoperatively, the 9.1% operative mortality was quite acceptable. Long-term follow-up is necessary to estimate the quality of the homografts.
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PMID:Short-term result of aortic valve replacement with cryopreserved homograft valve in the University of Tokyo Tissue Bank. 1200 Apr 42

We present here a patient with acute myeloid leukemia (M2) who developed fatal infective endocarditis. On admission, the patient (67-year-old male) had mitral stenosis and atrial fibrillation. Complete remission was achieved after induction chemotherapy. During the course of consolidation therapy, he developed sepsis caused by coagulase-negative staphylococcus, which was successfully treated with antibiotics. Thereafter, blood culture yielded multidrug-resistant staphylococcus epidermidis. An echocardiogram revealed mitral valve regurgitation with vegetation. He was diagnosed as having infectious endocarditis. In spite of prolonged antibiotic therapy, destruction of the mitral valve progressed, and the patient underwent valve replacement therapy. He died of cardiac tamponade 5 days after the surgery.
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PMID:[Acute myeloid leukemia with infective endocarditis]. 1241 86

A 19-year-old woman with a history of drug addiction suffered from sepsis and heart failure. Blood culture was positive for Streptococcus viridans. An operation was indicated because the echocardiography showed massive vegetation on the anterior leaflet of the tricuspid valve and severe regurgitation even though the endocarditis was healed with drug therapy. At operation all of the anterior leaflet of the tricuspid valve was resected with the vegetation. Using the technique of cusp commissuroplasty, the disrupted commissure was reconstructed by approximating the septal and posterior cusps at the level of their normal closure, forming a zone of apposition by using a single stitch. Leaflet apposition resulted in a defect between the apposed leaflets and the tricuspid annulus, which was patched with autologous pericardium. The tricuspid valve was reconstructed to function as a unicommissural bicuspid valve. The patient was stable during the follow-up period of two years without any medical treatment.
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PMID:Cusp commissuroplasty for tricuspid valve endocarditis. 1465 May 93


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