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

Thirteen out of 268 children (less than 18 years old) underwent hepatic transplantation (OLT) for end-stage liver disease (ESLD) associated with arteriohepatic dysplasia (AHD). Seven children are alive and well with normal liver function. Six children died, four within 11 days of the operation and the other two at 4 and 10 months after the OLT. Vascular complications with associated septicemia were responsible for the deaths of three children. Two died of heart failure and circulatory collapse, secondary to pulmonary hypertension and congenital heart disease. The remaining patient died of overwhelming sepsis not associated with technical complications. Seven patients had a portoenterostomy or portocholecystostomy early in life; five of these died after the OLT. Severe cardiovascular abnormalities in some of our patients suggest that complete hemodynamic monitoring with invasive studies should be performed in all patients with AHD, especially in cases of documented hypertrophy of the right ventricle. The improved quality of life in our surviving patients confirms the validity of OLT as a treatment of choice in cases of ESLD due to AHD.
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PMID:Liver transplantation for arteriohepatic dysplasia (Alagille's syndrome). 162 41

Tumor necrosis factors (TNF) alpha and beta are structurally related cytokines that mediate a wide range of immunological, inflammatory, and cytotoxic effects. During bacterial infection of the bloodstream (sepsis), TNF-alpha induction by bacterial endotoxin is thought to be a major factor contributing to the cardiovascular collapse and critical organ failure that can develop. Despite antibiotic therapy, these consequences of sepsis continue to have a high mortality rate in humans. Here we describe a potent TNF antagonist, a TNF receptor (TNFR) immunoadhesin, constructed by gene fusion of the extracellular portion of human type 1 TNFR with the constant domains of human IgG heavy chain (TNFR-IgG). When expressed in transfected human cells, TNFR-IgG is secreted as a disulfide-bonded homodimer. Purified TNFR-IgG binds to both TNF-alpha and TNF-beta and exhibits 6- to 8-fold higher affinity for TNF-alpha than cell surface or soluble TNF receptors. In vitro, TNFR-IgG blocks completely the cytolytic effect of TNF-alpha or TNF-beta on actinomycin D-treated cells and is markedly more efficient than soluble TNFR (24-fold) or monoclonal anti-TNF-alpha antibodies (4-fold) in inhibiting TNF-alpha. In vitro, TNFR-IgG prevents endotoxin-induced lethality in mice when given 0.5 hr prior to endotoxin and provides significant protection when given up to 1 hr after endotoxin challenge. These results confirm the importance of TNF-alpha in the pathogenesis of septic shock and suggest a clinical potential for TNFR-IgG as a preventive and therapeutic treatment in sepsis.
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PMID:Protection against endotoxic shock by a tumor necrosis factor receptor immunoadhesin. 166 Jan 40

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

Profound nonhemorrhagic shock developed in one postoperative and two trauma patients. Cardiovascular collapse was characterized by severe hypotension (systolic blood pressure less than 80 mm Hg), hyperdynamic cardiac indices (CI greater than 4 L/min/m2), low systemic vascular resistance (SVR less than 500 dyne.sec/cm5.m2), and multiple organ failure. Sepsis was not found by culturing of specimens or visual inspection at laparotomy. Screening cortisol levels were low (less than 2 micrograms/dL in two patients) and did not respond appropriately to synthetic ACTH (cosyntropin) challenge. Administration of exogenous glucocorticoids promptly and dramatically reversed shock and organ failure in two patients. Oral glucocorticoid and mineralocorticoid supplementation were required at hospital discharge. Acute adrenal insufficiency is rare after trauma, but may produce life-threatening cardiovascular collapse, mimicking the "septic" shock state. Cosyntropin stimulation testing confirms the diagnosis and is accurate in traumatized patients. Outcome is dependent upon early recognition and exogenous glucocorticoid administration. Appropriate endocrine evaluation prevents unnecessary use of steroids in a population of trauma patients who are already in a state of immunosuppression.
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PMID:Acute adrenal insufficiency presenting as shock after trauma and surgery: three cases and review of the literature. 173 82

The majority of life-threatening injuries secondary to the placement of central venous catheters, such as bleeding and pneumothorax, occur at the time of initial insertion. When a catheter extravasates in the neck, edema of the neck wall or chest is usually seen, and the pump indicates occlusion. We present four cases in which an uneventful, successful placement of four central lines (three superior vena cava, one inferior vena cava) were followed at greater than 48 hours by either hydrothorax or hydroperitoneum, which resulted in either cardiorespiratory collapse or intraabdominal sepsis. In reviewing these cases, all showed both a change in catheter location on a subsequent x-ray and poor or no blood return on aspiration; paradoxically, the infusion pump in each case did not sense a catheter malposition or occlusion. We conclude that, although the success of central line placement may be documented on insertion, a continual reappraisal of both the function and location of the line is necessary.
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PMID:Life-threatening fluid extravasation of central venous catheters. 181 72

Tumor necrosis factor (TNF) is a potent cytokine mediator of the shock states associated with sepsis and burn injury. This experimental study was done to determine whether circulating TNF plays a major role in the vasomotor collapse seen following experimental hemorrhage and blunt injury. Twenty anesthetized pigs were divided into two groups. Ten animals were bled 60% of their calculated blood volume in 15 minutes. Animals in Group IA (n = 5) had no treatment, and Group IB animals (n = 5) were given twice the shed volume as crystalloid 30 minutes after hemorrhage. The other animals, groups IIa and IIb (n = 5 each), were first subjected to a blunt injury to the thigh sufficient to cause a midshaft femur fracture, then bled and similarly treated. In both groups, mean arterial pressure (MAP), cardiac output (CO), and serum TNF activity by L929 bioassay were measured at 15-minute intervals for 120 minutes after hemorrhage or hemorrhage and blunt injury. An additional three animals were infused with 4 x 10(8)/kg heat-killed E. coli to validate the TNF assay. All bled animals sustained a fall in MAP and CO to a mean of 33% of baseline values, with or without fracture. Group IB and IIB animals responded to fluid resuscitation by restoration of MAP and CO to 85%-97% of the baseline values. Tumor necrosis factor was not detectable before injury and remained undetectable in all these animals during the 120 minutes of the experiment despite hemorrhage alone or combined hemorrhage and blunt trauma, with or without fluid resuscitation. The test animals receiving the E. coli responded with markedly elevated TNF levels, which peaked at 90 minutes after injection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Experimental hemorrhage and blunt trauma do not increase circulating tumor necrosis factor. 187 32

A closed system of percutaneous cardiopulmonary bypass (PCPB) with centrifugal pump and membrane oxygenator was applied for 2 patients with circulatory collapse caused by acute reclosure of left anterior descending coronary artery after PTCA in case 1 and acute myocardial infarction due to left main coronary artery lesion in case 2. Both patients were brought to operating room under the circulatory support of PCPB and successful coronary artery bypass was performed. Case 1 survived and case 2 died from sepsis due to mediastinitis inspite of satisfactory recovery of cardiac function. PCPB was confirmed as a useful method for emergency circulatory support and a bridge to cardiac surgery in patients with cardiogenic circulatory collapse.
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PMID:[Percutaneous cardiopulmonary bypass as a bridge to coronary artery bypass surgery in 2 cases of circulatory collapse caused by severe myocardial ischemia]. 189 93

Malaria is diagnosed in 50-70 patients each year in Norway. Severe malarial infection with cerebral involvement as well as hypoglycaemia, circulatory collapse and renal failure is often difficult to diagnose since the condition is only rarely seen in Scandinavia. This report describes a 49 year old seaman, who was admitted to hospital with a clinical picture of sepsis with multiorgan involvement including cerebral affection. Subsequently, it turned out that the patient had a severe infection with Plasmodium falciparum, involving more than 50 per cent of the red blood cells. Despite being comatose for one week with repeated attacks of grand mal type, and requiring 11 days mechanical ventilation plus dialysis for 4 weeks, he recovered uneventfully and was dismissed from hospital with only minor neurological sequelae. Even severe malaria with cerebral involvement can result in full restitution if the diagnosis is made early and exchange transfusion plus treatment with relevant drugs are instituted promptly.
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PMID:[Exchange transfusion in cases of falciparum malaria]. 194 97

Rheumatoid arthritis remains a chronic disabling disorder in which medical and surgical intervention may provide amelioration but not cure. In this study a cohort of 123 rheumatoid patients were followed for a period of 10 years from the time of prescription of their initial second-line agent. The workload involved in managing articular, extra-articular and intercurrent disease in these patients has been documented and outcome in relation to continued use of 'disease modifying' therapy evaluated. At 10 years 24 patients (20 per cent) had died and 7 (5 per cent) were not traced; of the 92 (75 per cent) who were assessed, three had become wheelchairbound, two for reasons other than rheumatoid arthritis. Seventy-one per cent of patients required joint surgery, 36 per cent management of peptic ulcer and 45 per cent experienced major episodes of sepsis. Analysis of the results in the 92 patients who were evaluated at 10 years showed significant improvement in Ritchie articular index, pain score, morning stiffness, haemoglobin, platelets, ESR, total globulins, IgG and IgM. Grip strength and Lee functional index showed a trend towards deterioration which did not reach significance. Sixty-seven (73 per cent) of the 92 patients remained on a second- or third-line agent at 10 years (median duration of treatment 107 months); 25 (27 per cent) were not receiving such therapy (median duration of second- and third-line therapy 13 months). The group remaining on treatment showed significant improvement similar to that of the total study group. Those not on treatment improved only for articular index; Lee functional index deteriorated significantly. There was a correlation between area under the curve for ESR over 10 years and radiological progression of disease in hands (r = 0.29, p = 0.026) and in knees and hips (r = 0.3748, p = 0.012) over the 10 year period. Radiographic score correlated well with Lee functional index at the outset and at 10 years and also with the change in the radiographic score over the 10-year period. Unlike the results of previous studies, there was no morbidity from vertebral collapse; this may be related to the low dose of corticosteroids in this cohort (seven patients received systemic corticosteroids). Thus while the aim of treating patients for prolonged periods with second- or third-line therapy was achieved in the majority with no overt evidence of cumulative toxicity, sustained medical and surgical intervention was and will be needed in order to minimize disability in these and other patients with rheumatoid arthritis.
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PMID:Rheumatoid arthritis: workload and outcome over 10 years. 194 27

Diabetic patients exhibit a higher incidence of post-surgical sepsis, as well as a higher rate of mortality from sepsis, than their non-diabetic counterparts. This may be a result of cardiovascular deterioration associated with diabetes mellitus. This study was designed to characterize the cardiovascular sequelae associated with endotoxin shock in a canine model of diabetes. Diabetes was induced with alloxan (50 mg/kg) and streptozotocin (30 mg/kg) in dogs weighing 19-25 kg. Thirty days later, anaesthetized dogs were instrumented to obtain blood pressures, blood samples, left ventricular chamber diameter, circumflex arterial blood flow, and aortic blood flow. Metabolic parameters were calculated according to the Fick principle, and myocardial inotropic state assessed with the end-systolic pressure-diameter relationship. After stable baseline measurements, Escherichia coli endotoxin (1 mg/kg) was infused over 1 h, and measurements were obtained every 30 min. After endotoxin administration diabetic dogs became more hypotensive than the non-diabetic dogs. Cardiac performance parameters were also depressed to a greater degree. These changes could be attributed to depressions in vascular resistance and myocardial inotropic state in diabetic dogs. Cardiac dysfunction occurred in association with a relative decrease in the supply to demand ratio for oxygen in the diabetic dogs, suggesting functional ischemia. Data indicating a decrease in pre-load and vascular resistance in the diabetic group suggest a greater degree of vascular collapse, vascular pooling, or extravasation of fluid than occurred in the non-diabetic group. These data support the hypothesis that the cardiovascular system of diabetic subjects cannot tolerate a septic insult as well as their non-diabetic counterparts.
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PMID:Cardiovascular sequelae of endotoxin shock in diabetic dogs. 195


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