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

Since Shumway carried out the first successful heart-lung transplant (HLT) in Stanford in 1981, HLT has become a new therapeutic means for patients with end-stage pulmonary disease or arterial hypertension. However, it is still rarely carried out because of a lack of donors and the complexity of the surgery and postoperative course. This review described the criteria for proper donor and recipient selection, as well as the anaesthetic and postoperative management of HLT patients at Marie Lannelongue Hospital. The lack of suitable organ grafts results, at least in part, from improper donor management. Pulmonary oedema by fluid overloading and excessive haemodilution should be carefully prevented. Low doses of catecholamines and vasopressin maintain circulatory stability and convenient organ function. The indications for HLT (primary pulmonary hypertension, Eisenmenger's complex, and end-stage bronchopulmonary disease) are all characterized by severe pulmonary hypertension, hypoxaemia and cardiac failure. Careful anaesthetic induction is required to avoid circulatory collapse. Cardiopulmonary bypass (CPB) should be started early, so that mediastinal dissection may be carried out in satisfactory haemodynamic conditions. After unclamping the aorta, circulatory support with fluid and catecholamine infusion is often required. High inspired oxygen fraction and end-expiratory positive pressure may be required because of reperfusion pulmonary oedema. Blood transfusion is often needed as there are major blood losses due to dissection of the posterior mediastinum during CPB. Postoperative catecholamine administration is prolonged over several days. Negative fluid balance is often necessary to reduce pulmonary oedema. Improvement in surgical technique, early extubation, and late prescription of steroids have reduced the incidence of tracheal complications. Acute renal failure often occurs as a result of prolonged CPB, hypovolaemia, drug nephrotoxicity and sepsis. Bacterial complications (pneumonia, mediastinitis) are the main causes of early death. After the 15th postoperative day, opportunistic infections and allograft rejection are the main complications. Since 1981, major advances in HLT recipient management resulted in improved survival rates (70-80% at 1 year, and 60-70% at 2 years for the best teams). Despite the complexity of management, and the longterm threat of obliterative bronchiolitis, HLT is, at present time, the only possibility for these young patients to recover a normal quality of life.
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PMID:[Anesthesia and intensive care for heart-lung transplantation]. 205 32

Septic shock in obstetrics is a major cause of mortality. Postpartum endometritis is often the first step of bacterial colonization inside the uterus which becomes the nidus of infection. Rapid spread into general circulation is favoured by hemodynamics patterns of pregnancy. Bacteremia would result in cardiovascular collapse and a myocardial depressant factor has been proposed to explain the fall in cardiac output. Later, endotoxin activates the substances of malignant intravascular inflammation and multiple systems organ failure may be observed in uncontrolled sepsis. Eight cases are reported hospitalized at Morelia's General Hospital, SSA, with septic shock and MSOF. Presumably because of aggressive acute resuscitation nobody succumbed during acute cardiac failure and hypotensive episode but two patients died later with multiple system organ failure. The mortality was 25%. Fluid, resuscitation, and vasoactive drugs are the most effective way to reduce mortality. Antibiotics, specific treatment of MSOF and taking away the nidus of infection are critical components of therapy.
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PMID:[Septic shock in obstetrics]. 207 37

Fifty-six neonates with enterococcal septicemia in a single hospital from 1977 through 1986 were studied. The incidence was low and constant until 1983, when an increase, attributable to infections in infants older than 7 days of age (late-onset), was noted. These infants were more premature (mean gestational age 29.5 vs 36.9 weeks) and had lower birth weights (mean 1250 vs 2700 g) than those with early-onset enterococcal sepsis, and in most the infections were characterized by a nosocomial origin. Infants with early-onset infection had a mild illness with respiratory distress typical of other etiologic agents or diarrhea without focal infection. By contrast, late-onset enterococcal sepsis was heralded by severe apnea, bradycardia, circulatory collapse, and increased ventilatory requirements. Focal infections, including scalp abscess or catheter-related infection (23% each), meningitis or pneumonia (15% each), were common. Rapid clinical improvement and clearance of bacteremia resulted from therapy with an aminoglycoside and either ampicillin or vancomycin, but only if abscesses were drained and intravascular catheters were removed. Mortality rates for early-onset, late-onset, and necrotizing enterocolitis-associated infection were 6, 8, and 17%, respectively. Enterococcus is a frequent cause of late-onset septicemia in premature neonates, and empiric therapy should include appropriate antimicrobial agents.
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PMID:Enterococcal sepsis in neonates: features by age at onset and occurrence of focal infection. 210 74

The paper is a unique pathological description of a bilateral, symmetric, anterior, temporal ischemic optic neuropathy with the morphological characteristics of cavernous optic atrophy initially described by Schnabel in glaucomatous eyes. The 80-year-old woman had suffered from cardiac insufficiency and diabetes mellitus for many years. She died from sepsis and circulatory collapse due to ischemic colitis, intestinal perforation, and peritonitis. There was widespread arteriosclerosis but no evidence of giant-cell arteritis. Cell loss was demonstrated in both retinas, the chiasm, and in the central lateral geniculate body. These represent a retrograde, descending and ascending optic atrophy, with transsynaptic degeneration in the LGB. A small craniopharyngioma was found by chance in the infundibulum. Neither clinically nor morphologically were there any signs of glaucoma.
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PMID:[Histopathology of the retina, optic fascicle and lateral geniculate body in chronic, bilateral symmetric ischemic Schnabel's cavernous optic atrophy]. 224 78

The catastrophe theory evolved by Thom and Zeeman proposes a mathematical definition for the abrupt or 'catastrophic' changes that can suddenly occur in normally well-ordered and smooth-running systems. We have integrated this theory with our own PAF/cytokine feedback network hypothesis to explain the control and dysfunction of the inflammatory response. This process involves the activation of cells and factors such as proteases, and is coordinated by mediators such as PAF, cytokines and growth factors, minute amounts of which can prime cells to respond in an enhanced manner to subsequent agonistic stimuli. PAF and certain cytokines also possess the unique property of being able to induce the release of each other and their own generation in vivo. This 'singularity' may enable a self-generating feedback network to become established. The priming ability of these mediators indicates the extreme sensitivity of the inflammatory process and importance of a homeostatic equilibrium between the vectors involved in the priming and feedback processes and internal suppressive mechanisms. In pathological conditions, one can consider the phenomenon of PAF and cytokine autogeneration as a 'fold' in the feedback network and an expression of the singularity characteristic of the catastrophe hypothesis. This may lead to systemic toxicity and microcirculatory collapse, a characteristic feature of shock, sepsis, asthma, ischemia and graft rejection. A combination of drugs antagonizing the various feedback components may inhibit this catastrophic process and thus provide more successful therapy of these conditions.
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PMID:PAF/cytokine auto-generated feedback networks in microvascular immune injury: consequences in shock, ischemia and graft rejection. 251 89

Percutaneous cardiopulmonary bypass (CPB) was used in 22 patients: 7 patients with cardiac arrest due to acute myocardial infarction; 4 patients in cardiac arrest because of failed angioplasty; 1 patient for high-risk elective angioplasty; 1 patient with massive pulmonary emboli; 2 patients with hypothermia; 2 pediatric patients (1 with sepsis and 1 in combination with extracorporeal membrane oxygenator support); 1 patient with refractory arrhythmia; and 4 patients with trauma. Percutaneous CPB involves a modified Seldinger technique that is easily applied. All patients except those with massive trauma were resuscitated with the use of percutaneous CPB. One patient requiring a very difficult proposed angioplasty received percutaneous CPB support while triple-vessel angioplasty was performed. Percutaneous CPB appears to be beneficial in resuscitating patients with refractory cardiac arrest or other forms of circulatory collapse except trauma. Limited use for brief periods in high-risk patients having elective angioplasty might be applicable.
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PMID:Percutaneous cardiopulmonary bypass: application and indication for use. 252 42

Pyogenic osteomyelitis of the spine is an uncommon disease. A series of 16 cases is reported. The site of involvement includes the lumbar, cervical, and thoracic segments, in that order of frequency of occurrence. Drug addiction and diabetes mellitus are important predisposing factors. The spectrum of clinical presentation is described. Late presentation is usually masked by old age, debilitation, and previous antibiotic treatment. Rapid progression with septicemia is also encountered. The importance of differentiating this condition from tuberculosis spondylitis is emphasized. Definitive diagnosis should depend on bacteriological, histological, and, with the recent introduction of antituberculosis antibody test, serological studies. Timely surgical intervention is indicated in complicated cases. Radical excision and anterior spinal fusion yields early and complete eradication of the infected material plus arthrodesis, which prevents late collapse of the spine.
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PMID:Pyogenic osteomyelitis of the spine--a review of 16 consecutive cases. 298 Jan 42

Infusion of Escherichia coli (LD100) was followed by coagulopathic and cell injury responses, cardiovascular collapse, and death in 18 to 32 hr in four out of four baboons. Infusion of AT-III in sufficient amounts to achieve AT-III levels of more than 4 units/ml of plasma before and during the infusion of E. coli reduced the intensity of the coagulopathic and cell injury response and prevented vascular collapse and death in four out of four baboons. Failure to achieve AT-III levels of more than six units/ml at T +60 min during the infusion of E. coli resulted in failure to prevent its lethal effects in three out of three baboons even though levels as high as 10 units/ml were achieved later in the course of the experiment. These studies suggest that thrombin and/or its products can contribute to the inflammatory response to E. coli and that AT-III is of potential value as a prophylactic but not as a therapeutic agent in the treatment of patients at high risk of developing gram negative sepsis.
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PMID:Antithrombin-III prevents the lethal effects of Escherichia coli infusion in baboons. 306 81

In a prospective, randomized study we compared cefotaxime (C) with tobramycin plus cefazolin (C + T) in the treatment of Enterobacterial septicemia. Twenty-five patients received C and twenty two C + T. There are 8 treatment failures, in C + T group, 3 in C group. We observed 5 adverse effects, 2 in the C group (1 reversible collapse and 1 Pseudomonas aeruginosa superinfection) and 3 in the C + T group (acute renal failures). We conclude that C may be more effective and less toxic than cefazolin plus tobramycin for patients with Enterobacterial septicemia.
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PMID:[Comparison of the efficacy of cefotaxime alone and the combination cefazolin-tobramycin in the treatment of enterobacterial septicemia]. 330 68

Bacterial infection of the mammalian bloodstream can lead to overwhelming sepsis, a potentially fatal syndrome of irreversible cardiovascular collapse (shock) and critical organ failure. Cachectin, also known as tumour necrosis factor, is a macrophage-derived peptide hormone released in response to bacterial lipopolysaccharide, and it has been implicated as a principal mediator of endotoxic shock, although its function in bacterial sepsis is not known. Anaesthetized baboons were passively immunized against endogenous cachectin and subsequently infused with an LD100 dose of live Escherichia coli. Control animals (not immunized against cachectin) developed hypotension followed by lethal renal and pulmonary failure. Neutralizing monoclonal anti-cachectin antibody fragments (F(ab')2) administered to baboons only one hour before bacterial challenge protected against shock, but did not prevent critical organ failure. Complete protection against shock, vital organ dysfunction, persistent stress hormone release and death was conferred by administration of antibodies 2 h before bacterial infusion. These results indicate that cachectin is a mediator of fatal bacteraemic shock, and suggest that antibodies against cachectin offer a potential therapy of life-threatening infection.
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PMID:Anti-cachectin/TNF monoclonal antibodies prevent septic shock during lethal bacteraemia. 331 66


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