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

To assess the mechanism of insulin resistance in sepsis, we investigated insulin receptor binding and glucose uptake in isolated rat epididymal adipocytes. Male Sprague-Dawley (SD) rats weighing 200-220 g were submitted to cecal ligation under chloral hydrate anesthesia, followed by double punctures with 18-G needle into the ligated portion to produce peritonitis. Age-matched SD rats without operation were used as the controls. After starvation for 16 h, blood samples were taken from the inferior vena cava for bacterial culture and assayed for plasma glucose and IRI levels, and then adipocytes were isolated from the dissected epididymal fat tissues. Plasma levels of both glucose and IRI in septic rats were higher than those in the controls. The [125I]-insulin binding rate of the adipocytes in septic rats was similar to that of the controls. However, [3H]-2-deoxy-D-glucose uptake by adipocytes was markedly decreased in the septic group (approximately 45% of the control group at the plateau). In conclusion, this study suggests that insulin resistance in the septic state results, at least partly, from impairment in the post-binding level of the insulin receptor.
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PMID:Sepsis inhibits insulin-stimulated glucose transport in isolated rat adipocytes. 157 21

Endotoxin in the form of a lipooligosaccharide (LOS) plays a key role in the development of shock in meningococcal sepsis. To examine hemodynamic and biochemical alterations during meningococcal endotoxic shock, we established a rabbit model. Thirty-nine rabbits, weighing 2.5-4.4 kg, were studied. After anesthesia with intramuscular ketamine (20 mg/kg) and xylazine (4 mg/kg), femoral venous and arterial catheters were inserted. Control animals received only saline, while rabbits in each of four additional groups were given LOS in 10-fold increments from 0.1 microgram/kg to 100 microgram/kg. Mean arterial pressure (MAP), heart rate (HR), respirations (RR), temperature (T), urine output, and arterial blood gases (pH, PCO2, PO2, and bicarbonate) were determined at baseline and hourly. Endotoxin levels and TNF levels were measured at 30, 60, 120, 180, 240, 300, and 360 min post-LOS. Survival was recorded. One-way analysis of variance (ANOVA) and the Scheffe procedure, paired samples t-test, two-tailed t-test, and Fisher's exact test were used. Pearson's coefficients were calculated. Animals receiving meningococcal LOS developed tachycardia and compensated metabolic acidosis with an initially normal pH and MAP. With progression of the shock state, the pH decreased and hypotension ensued. Maximal levels of endotoxin were measured 30 min after LOS injection and declined during the ensuing 6 hr. TNF rose from undetectable to markedly elevated levels and peaked at 60-120 min post-LOS. Increasing the amount of injected endotoxin produced more profound degrees of shock until a dose of 10.0 micrograms/kg was reached. There was no correlation between serum TNF at 60 min and survival at 6 hr or 24 hr.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of meningococcal endotoxin in a rabbit model of shock. 158 1

A prospective cohort of 126 patients having long-term central venous catheterization was collected over a 10-month period. The patients were preoperatively assessed for the following risk factors: previous catheter placement, an absolute neutrophil count less than 500/mm3, a platelet count less than 50,000/mm3, a BUN value greater than 60 mg/dL or a serum creatinine level greater than 2.5 mg/dL, a prothrombin time greater than 1.5 times control, recent sepsis, and a Western blot test positive for HIV. The incidence of perioperative complications was 23%. Complications included pneumothorax, arterial puncture, tunnel hematoma, unsuccessful initial placement, and reaction to local anesthesia or blood products. No single risk factor had any statistical significance in predicting a complication. In the subpopulation of patients having two or more risk factors, the complication rate was 50%, with the majority of these being failed placement attempts. We conclude that inserting a permanent central venous catheter is not a benign procedure, but it can be safely done in critically ill patients. Furthermore, evaluation of preoperative risk factors in candidates for catheterization can be helpful to the surgeon with respect to counseling and operative planning.
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PMID:Perioperative complications of long-term central venous catheters in high-risk patients: predictors versus myths. 158 2

Carotid loop (CL) surgery involves the permanent externalization of a common carotid artery in a skin tube. The CL facilitates repeated access to the systemic arterial system for blood sampling and blood pressure measurement in laboratory sheep. It eliminates the need for arterial cut-downs and chronic indwelling catheters, reduces the risk of sepsis and infection, and adds flexibility to research protocols. The surgical procedure is aseptically performed under general anesthesia and involves isolation of the common carotid artery, creation of a bipedicled skin tube, and permanent envelopment of the artery in the skin tube. The primary complication is ischemic necrosis with sloughing of the middle of the loop and is usually due to failure to adhere to the critical length-to-width ratio (2.5:1). We have performed 150 CL procedures with an overall success rate of 94%. Nine CL ablations were required, due to necrosis with exposure of the artery (7/9) or stricture formation with loss of patency (2/9). Twenty-two CLs developed complications secondary to partial necrosis, but did not require ablation. Results indicate that the CL is a reliable method to ensure repeated access to the systemic arterial system in sheep. A modification of the standard CL procedure in which the artery is surrounded by a skin tunnel rather than enclosed in a skin loop was performed in 10 sheep. Preliminary results indicate significant reduction in the incidence of complications associated with the standard CL.
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PMID:Review of the carotid artery loop procedure in sheep. 161 Jul 44

Eight patients with large panniculi are described where severe problems with hygiene, immobility, and chronic infection were caused by the lymphedematous, chronically infected pannus. Protracted nonsurgical management of the infected panniculus had failed in all 8 patients. Wedge resection without fat undermining removed diseased tissue. Infection and sepsis were eliminated and ambulation was restored in all patients. Formerly immobile patients were returned to normal activity. Significant self-induced weight loss was not observed in a 2-year follow-up period; weight gain, however, was not experienced. The primary anesthetic method was thoracic epidural reducing the requirements for general endotracheal anesthesia. The chronically infected pannus is a surgical problem deserving earlier recognition and resection.
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PMID:Panniculus morbidus. 162 20

Although gut permeability increases and bacterial translocation occurs under certain pathological conditions, it remains unknown whether gut absorptive capacity (GAC) is altered early after the onset of sepsis. The aim of the present study was to investigate this and also to determine whether diltiazem has any effect on GAC in early sepsis. Rats were lightly anesthetized and cecal ligation and puncture (CLP) was performed. A nasogastric tube was inserted, cannulation of various blood vessels was carried out, and the animals were allowed to recover from anesthesia. One hour after CLP, one group of animals received a 1-ml bolus of normal saline intravenously, and another group received diltiazem, 400 micrograms/kg body wt. Sham animals had no CLP performed. GAC was determined by the D-xylose absorption test at 2 and 4 h after CLP. One hour after the administration of D-xylose via the nasogastric tube, its concentration in portal blood was determined colorimetrically. Results show that GAC is significantly depressed at 2 and 4 h after CLP despite the maintenance of normal blood pressure, central venous pressure, and portal pressure. Administration of diltiazem restored GAC to normal levels at 4 h after CLP. Thus diltiazem is a useful adjuvant in the treatment of sepsis because it restores gut absorptive capacity to normal and allows for early enteral nutrition.
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PMID:Sepsis produces early depression of gut absorptive capacity: restoration with diltiazem treatment. 163 86

Bacterial translocation is the passage of viable bacteria from the lumen of the gastrointestinal tract through the intestinal mucosa to other sites. It is believed that bacterial translocation may lead to infection and septicemia. The purpose of this study was to determine what factors in experimental surgical trauma lead to bacterial translocation. Two-month-old Wistar albino rats were divided into five groups: (A) control; (B) anesthesia (ether inhalation); (C) anesthesia and surgery (median laparotomy and transient compression of the intestines); (D) fasting only; and (E) anesthesia, surgery, and fasting. After 48 hours, ileum, mesenteric lymph nodes, and blood were cultured for aerobic and anaerobic organisms. In each group the number of animals with bacteria overgrowth was calculated. The incidence of bacterial translocation to mesenteric lymph nodes and blood in groups B and D were similar to the controls (P greater than .01). There was a significant increase in the number of animals with bacterial translocation in groups C and E (P less than .001). The majority of translocating bacteria were E coli.
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PMID:The effect of surgical trauma on the bacterial translocation from the gut. 164 Mar 20

This is a report of our experience with 22 cases of large unruptured omphaloceles treated by amnion inversion during the period 1973 through 1990. The method is characterized by three stages: (1) a silastic sheet is sutured directly to the skin around the amniotic membrane, under local anaesthesia, without dissection between the skin and the amnion; (2) the reduction of herniated viscera into the abdominal cavity is achieved by squeezing the sheeting using a specially modified stapler; and (3) the amniotic membrane is preserved intact, and inverted into the abdominal cavity at the time of abdominal wall closure. Of the 22 infants, 19 survived with satisfactory results. Two patients died of multiple associated anomalies, and the remaining patient died of sepsis arising at the time of the final abdominal closure. This procedure has proved to be effective and safe for high-risk patients with congenital heart diseases, anal atresia, tracheoesophageal fistula, or bronchial stenosis and prematurity. The practical aspects of the procedure, as well as its advantages and pitfalls, are illustrated.
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PMID:Advantages and pitfalls of amnion inversion repair for the treatment of large unruptured omphalocele: results of 22 cases. 164 Mar 38

Infection of Pekin ducks with duck hepatitis B virus is a useful model for studying the hepadenoviruses, of which human hepatitis B virus is the prototype. The utility of this model has been limited, however, by the difficulties associated with anesthetizing and obtaining liver biopsies from ducks. We developed a technique using Telazol (13 mg/kg) to anesthetize ducks before surgical biopsy of the liver in ducks infected with duck hepatitis B virus. Eight Pekin ducks infected with duck hepatitis B virus underwent serial biopsies at 4- to 5-week intervals. There was one perioperative death in 34 surgical procedures with no evidence on intra-abdominal sepsis or wound complications. Telazol can be used safely and humanely to anesthetized ducks without the need for general endotracheal anesthesia.
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PMID:A technique for liver biopsy performed in Pekin ducks using anesthesia with Telazol. 166 51

The Wallstent biliary endoprosthesis is a mesh of stainless steel that is delivered percutaneously over a 7-French catheter but expands to achieve a 1-cm lumen when released across a bile-duct stricture. The small transhepatic track required makes insertion easier, less painful, and probably safer when compared with plastic stents, and the large internal lumen reduces the rate of occlusion by encrusted bile. Wallstent endoprostheses were inserted under local anesthesia in 41 consecutive patients with malignant obstructive jaundice. Biliary drainage was considered the treatment of choice in all of these patients. The diagnosis was based on biopsy results in 32 patients and on radiologic appearances in nine. The patients were followed up in outpatient clinics for 16 months and had repeated radiologic examinations only if they had symptoms suggesting stent occlusion. No cases of hemobilia due to damaged hepatic vessels occurred. Two patients had septicemia treated with antibiotics. Three patients had recurrent jaundice due to growth of tumor below or above the stents. Endoprosthesis migration was not seen. No cases of stent occlusion due to encrustation of bile occurred. The median survival of patients was 105 days (range, 10-545 days). Our experience shows that Wallstent endoprostheses can be inserted with little discomfort for the patient and with relatively few complications. They provide good palliation in patients with malignant obstructive jaundice.
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PMID:Self-expandable stainless steel endoprostheses for treatment of malignant bile duct obstruction. 170 74


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