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

The mortality rate and causes of death after a hip fracture were studied in 493 consecutive patients with a hip fracture. All patients were treated in three hospitals in Utrecht, The Netherlands. The mortality rate following hip fractures is high and age dependent. Forty-five patients, 38 women and 7 men, died during the period of hospitalization (9.1%). One year after the date of hip fracture 23.6% of the women had died and 33.0% of the men. Four years after the date of hip fracture the mortality rates in women and men were 44.4% and 55.3%, respectively. Male sex, concomitant illnesses and in-hospital complications are negative determinants of survival. The in-hospital mortality was due to: cerebrovascular accident (n = 7), cardiac decompensation (n = 12), myocardial infarction (n = 4), pulmonary infection (n = 6), intestinal bleeding (n = 1) and sepsis (n = 5). From the registration of death causes we learned that 54 deaths were directly due to the hip fracture, 4 due to bed sores, 34 due to infectious diseases, 62 due to cardiovascular disease, 22 due to cerebrovascular accidents, 14 due to diabetes mellitus, and 33 due to neoplasm. The high mortality rate within the first 8 weeks after the date of hip fracture was mainly attributed to the hip fracture.
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PMID:Mortality and causes of death after hip fractures in The Netherlands. 140 39

Gastro-intestinal bleeding from peptic and stress ulcers is serious and life-threatening. Critically ill patients in intensive care units have many of the risk factors associated with bleeding from peptic and stress ulcers, including trauma, burns, sepsis, shock and multiple organ failure. This study investigated the results of treatment with famotidine, administered intravenously twice daily, to those in a control group that received treatment before the introduction of H2-receptor antagonists. The study was designed to determine whether famotidine reduced the need for emergency surgery in patients with bleeding ulcers and whether a reduction in mortality was associated with its use. The overall efficacy rate of famotidine was greater than 88%. The percentage of patients with a bleeding ulcer undergoing surgery was 24.5% compared with 50.3% in the historical control group. Twice daily intravenous administration of famotidine effectively stopped bleeding in patients with moderate to severe peptic ulcer and stress ulcer. Drug therapy for the treatment of upper gastro-intestinal bleeding, however, has limitations. Criteria for the use of famotidine include reduced mortality, rate of recurrent bleeding and rate of emergency surgery.
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PMID:Treatment of upper gastro-intestinal bleeding with the H2-receptor antagonist famotidine. 256 42

This report is concerned with a short review of 3 reported cases in which rare successive complications occurred in various lapses of time after vascular reconstructive operations. In one, 38 year old man, in a 12 year period after primary endarterectomy of aortic bifurcation and common iliac arteries the following complications occurred consecutively: an aneurysmal formation in the iliac artery with urethero-aneurysmal fistula and severe bleeding from the urinary tract, entero-prosthetic fistula with severe gastro-intestinal bleeding, occlusion of the left iliac artery with severe left leg ischaemia. They were surgically corrected each time with a satisfactory result. In another, a 25 year old man, a traumatic lesion of the iliac artery with false aneurysmal formation took place. After an emergency excision of the aneurysm with graft replacement, early bleeding occurred from the operative wound. It was treated conservatively, which resulted in infection of the graft and crawling sepsis which lasted 6 months. Urethero-prosthetic fistula and occlusion of the femoral artery occurred. It was corrected surgically with a satisfactory result. The last case concerned a 53 year old man with atherosclerotic occlusion of the abdominal aorta, external iliac and femoral arteries. An aorto-bilateral femoral bypass graft was instituted in him. In 10 days, complete gangrene of the sigmoid colon with perforation occurred. Sigmoidectomy with colostomy were performed. After that, further complications developed: (1) massive venous thrombosis of the left leg and (2) progressive left buttock necrosis. The last complication resulted in septicemia and death of this patient after 3 months of treatment.
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PMID:Multifarious complications after vascular reconstructive surgery. Diagnostic and therapeutic errors. 324 87

There were 220 patients studied, of which 44 were considered "critical" according to pre-established factors. In all of them, intra-gastrical pH in serious forms was detected, establishing that 45% of the "non-critical" patients had a pH factor less than 4. In these 61 patients and in the 44 "critical" patients a gastric alkalinization was sought, using between 1.2 and 2.4 grams of cimetidina daily, to which alkalines were added when necessary. Nine percent of the critical patients (4 of 44) had H.D.A., while 11 of 33 (33%) of the critically ill from a previous series that had not been treated had pronounced gastro-intestinal bleeding lesions (p less than 0.01.) The potential difference of gastric mucous in critical patients was measured likewise, being significantly less (means = 17.37 +/- 1.13) than in the non-critical patients (means = 30.2 +/- 1.13) (p less than 0.005). The use of cimetidina as an inhibitor of gastric secretion in a dosage of 1.2 grams was effective in 73% of the non-critical patients and in only 29% of the critical patients. Despite an increase in the dosage up to 2.4 grams in 9% of the critical and 22% of the non-critical patients, it was necessary to add alkalines. This lack of response shows a correlation between the amount of risk factors (3 of 10 patients had 3 factors) and the existence of hepatitic insufficiency (5 out of 16 patients and 5 out of 26 of sepsis).
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PMID:[Prophylaxis of acute gastroduodenal lesions in critically ill patients]. 704 31

A 64-year-old woman was diagnosed as having myelodysplastic syndrome (MDS) at 45 months after receiving radiotherapy for advanced carcinoma of the uterine cervix. We chose low dose therapy of SPAC and ACR because of the diagnosis as therapy-related MDS and the existence of radiation colitis. She obtained minor response, but two months later she transformed to AML (M2). The interval between low dose therapies was getting shorter and shorter, so we tried intensive chemotherapy consisting of BHAC, ACR and 6MP. Blast numbers were reduced, but she died of sepsis and intestinal bleeding. The patients of MDS with t(8;21) and the patients of therapy-related AML (tAML) with t(8;21) are very rare. According to the literature, only karyotype is a prognostic factor in AML/MDS with t(8;21). And diagnosis by the criteria of FAB classification is of little value regarding clinical progress. That is to say, if the patient has only t(8;21) or karyotypic abnormalities which are of little value in prognosis, such as the loss of a sex chromosome, it must be treated as de novo AML, but if patient has karyotypic abnormalities such as -5, 5q-, -7, 7q-, and/or multiple (complicated) abnormalities, we must accept that the prognosis is poor and must treat it as ordinary MDS/tAML.
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PMID:[Therapy-related leukemia with t(8;21) initially diagnosed as MDS (RAEB in T)]. 756 9

Twenty-two patients with recurrent or refractory non-Hodgkin's lymphoma were treated with a combination chemotherapy of mitoxantrone, etoposide, carboplatin, and prednisolone (MECP). Of 22 evaluable patients, 11 (50%) responded to MECP and 7 (32%) achieved complete remission. Particularly in relapsed cases, 9 (75%) responded and 6 (50%) achieved complete remission. Myelosuppression was the major toxicity. Thirteen patients (59%) experienced WBC counts under 1,000/microliters, and thrombocytopenia under 50,000/microliters was seen in 12 patients (55%). During myelosuppression, 2 patients developed sepsis and 1 showed intestinal bleeding. Other gastrointestinal toxicities were well tolerated. There was no death due to chemotherapy. These results show that MECP is a well-tolerated treatment regimen, and effective for recurrent or refractory non-Hodgkin's lymphomas.
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PMID:[A combination chemotherapy of mitoxantrone, etoposide, carboplatin, and prednisolone (MECP) in recurrent or refractory non-Hodgkin's lymphomas]. 831 95

Neutropenic colitis is a complication of the treatment of hematologic malignancies and, less commonly, of other disease entities. The septic, inflammatory process has a predilection for the terminal ileum and right colon. While the pathogenesis is not clear, mucosal injury caused by several different mechanisms and local opportunistic infection play significant roles. An association has been recognized between neutropenic colitis and sepsis caused by C. septicum. Patients present with fever, diarrhea, and acute abdominal pain and tenderness often localized in the right lower quadrant. Sonography and CT are helpful in demonstrating colonic wall thickening and pericolic fluid. Peritoneal lavage has been used to exclude perforation in these critically ill patients. Although there has been debate about whether medical or operative management is best, the optimal initial therapy includes supportive care with gastric decompression, fluid and blood product replacement, and broad-spectrum antibiotics. The indications for surgery include continued intestinal bleeding despite correction of coagulopathy and pancytopenia, free intraperitoneal air, and uncontrolled sepsis. At operation, a right colectomy with ileostomy and mucous fistula or, in selected patients, primary anastomosis is the procedure of choice. Timely return of functioning neutrophils and the eventual prognosis of the primary disease are crucial to the overall success or failure of treatment of neutropenic colitis.
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PMID:Collagenous colitis, eosinophilic colitis, and neutropenic colitis. 837 36

An open, prospective study was carried out on 45 patients with multiple injuries to compare the mortality and incidence of sepsis between those given early total enteral nutrition (TEN) when sedated with propofol and historical controls who had been given total parenteral nutrition (TPN) and sedated with midazolam. TEN was instituted immediately after surgery via gastrostomy and/or jejunostomy tube inserted during laparotomy or via an endoscope and was continued for the whole stay in the intensive care unit (ICU). Dramatic reductions in both mortality (24.4% vs 35.1% in the controls; p = 0.025) and the incidence of sepsis (8.9% vs 23.8% in the controls; p = 0.025) were found when early enteral feeding was given. The absence of pressure sores and gastro-intestinal bleeding (for example, stress ulcus), which had previously been a common occurrence in this intensive care unit, was remarkable with the introduction of TEN and propofol sedation. Tolerance problems (mainly diarrhoea) arose in only 17% of patients in the study group.
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PMID:Long-term sedation in the ICU: enteral versus parenteral feeding. 1015 May 49

Acute liver failure is a rare but potentially fatal disease. Adult definition of fulminant hepatic failure, which includes the development of hepatic necrosis and encephalopathy within 8 weeks of onset of liver disease does not apply to acute liver failure in children particularly if secondary to autoimmune or metabolic liver disease. The etiology of acute liver failure varies with the age of the child. In neonates, infection or an inborn error of metabolism are common, while viral hepatitis and drug induced liver failure are more likely in older children. The clinical presentation of acute liver failure includes jaundice, coagulopathy and encephalopathy. In neonates, encephalopathy may be subclinical. The management of acute liver failure includes assessment of prognosis for liver transplantation; prevention and treatment of complications while awaiting hepatic regeneration or a donor liver and hepatic support. The major complications of acute liver failure are sepsis, gastro-intestinal bleeding, cerebral edema, renal and cardiac failure. Selection for liver transplantation depends on the etiology of the disease, prognostic factors, the presence or absence of multisystem disease and/or reversible brain damage. Prognostic factors for survival are less well established in children than in adults but children with metabolic liver disease, prothrombin time > 50 seconds, rising bilirubin and falling transaminase, grade II or higher grade of hepatic coma indicate poor prognosis. Most children receive a reduced or split liver graft. Living related donations for acute liver failure are also carried out by some centres. Survival post liver transplantation for acute liver failure has improved and most recipients can expect a 70% five year survival.
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PMID:Acute liver failure. 1113 56

A case of recurrent nonocclusive mesenteric ischemia in a patient with isolated internal iliac artery aneurysm penetrating the sigmoid colon is described. On the day after the aneurysm and the sigmoid colon had been resected, the patient developed necrosis of the left hemicolon. Fourteen and nineteen days after left hemicolectomy, massive intestinal bleedings occurred, requiring ileectomy. On the basis of operative findings of good pulsation of visceral arterial branches; angiography showing patent mesenteric vessels with some spasms; and pathological findings suggesting mesenteric ischemia, these ischemic events were diagnosed as nonocclusive mesenteric ischemia. Low-output syndrome induced by massive intestinal bleeding and atrial fibrillation and sepsis were responsible for the establishment of the nonocclusive mesenteric ischemia. Development of disseminated intravascular coagulation and continuous administration of diuretics for acute renal failure seemed to have further perturbed the mesenteric circulation. The patient died of subsequent multiple organ failure 4 months after the first operation. We should pay more attention to nonocclusive mesenteric ischemia in patients with mesenteric ischemia, and strict circulatory management during the perioperative period is essential in these patients.
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PMID:Recurrent nonocclusive mesenteric ischemia after resection of iliac artery aneurysm. 1242 76


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