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

Defatting the skin with acetone or ether is widely used in the regimen for disinfection of insertion sites of central venous catheters in total parenteral nutrition. The fatty acids secreted by normal skin play an important role in regulation of the cutaneous microbial ecosystem, and it can be questioned whether application of a solvent might paradoxically promote colonization by pathogenic microorganisms. The clinical value of defatting catheter insertion sites was prospectively studied in a controlled, randomized trial: 100 subclavian catheters inserted for total parenteral nutrition were given identical site care except that with one half of the catheters, the site was defatted with acetone prior to catheter insertion and as part of the every-other-day site care regimen. Cutaneous colonization was found in only 130 (24.5 percent) of 531 site cultures in both groups, but was strongly predictive of concordant colonization of the catheter (relative risk, 22.1, p less than 0.001) and catheter-related septicemia (all four cases). No significant differences were observed between the two groups in cutaneous colonization of sites (22.7 percent and 27.0 percent), in colonization of catheters on removal (four catheters [8 percent] in each group) or in catheter-related septicemia (two catheters [4 percent] in each group). However, pain or inflammation of the insertion site was twice as frequent in the acetone group (80 percent versus 35 percent, p less than 0.001). Defatting with acetone as part of the regimen for cutaneous disinfection does not improve microbial removal or reduce the incidence of catheter-related infection, but increases cutaneous inflammation and patient discomfort.
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PMID:Defatting catheter insertion sites in total parenteral nutrition is of no value as an infection control measure. Controlled clinical trial. 311 11

An oral colonic lavage solution containing sodium sulfate and polyethylene glycol was compared with whole-gut irrigation using saline via a nasogastric tube in a randomized blinded study of 34 consecutive well-matched patients undergoing elective colorectal surgery. Both methods were safe and rapid. Patients receiving oral colonic lavage, however, had significantly less (P less than 0.05) water retention, overall distress, cramps, and other complaints. No significant differences were found with regard to fullness, nausea, and rectal discomfort. The bowel cleansings were equally adequate, and most patients achieved a good-to-excellent preparation. Surgical complications appeared not to be related to the preparation used, and wound sepsis were equally frequent. Oral colonic lavage proved to be the most attractive preoperative cleansing method.
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PMID:Preparation for elective colorectal surgery. A randomized, blinded comparison between oral colonic lavage and whole-gut irrigation. 355 4

A consecutive series of 50 patients who underwent Hartmann's resection from 1967 to 1981 because of carcinoma of the rectum and sigmoid colon is reported upon herein. Indications for Hartmann's resection were palliation because of advanced disease (62 per cent of the patients), poor risk conditions and advanced age (24 per cent) and intraoperative complications or difficult primary anastomosis (14 per cent). The overall operative mortality and morbidity rates were 8 and 80 per cent, respectively--pelvic sepsis accounted for 37.5 per cent of the complications. The five year survival rate for patients with radical operations was 46 per cent. The choice of Hartmann's resection for patients with advanced disease was unfair because of the high postoperative morbidity and the discomfort of colostomy. The indications for intestinal resection without primary anastomosis because of general conditions or technical difficulties to perform the anastomosis are actually reduced by the improved perioperative care and by the confidence in using stapling guns. Hartmann's resection is still indicated in elderly patients, in instances of locally advanced tumors and when the primary anastomosis is judged to be unfeasible.
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PMID:Actual role of Hartmann's resection in elective surgical treatment for carcinoma of rectum and sigmoid colon. 372 24

A large-diameter indwelling subcutaneous right-atrial catheter was inserted in 25 patients with haematological malignancies and neutropenia to provide ready access to the venous system for all infusions and blood aspirations. The median duration of catheter placement was 70 days. In 23 patients (92%) the catheter was used successfully until remission or death. Catheter-related exit-site infectons, generally mild, occurred in 14 patients (56%), Staphylococcus epidermidis being the predominant organism cultured. Septicaemia occurred in 11 neutropenic patients (44%). In 2 patients the same organism was grown from blood and exit site. The use of this catheter greatly facilitates patient care and support, minimises discomfort, and is associated with an acceptable rate of complications.
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PMID:Use of modified subcutaneous right-atrial catheter for venous access in leukaemic patients. 610 86

A woman who had a copper 7 coil inserted without difficulty, in 1978 decided to have another baby, and in February 1980, she asked for the device to be removed. Her (GP) general practitioner could not find the threads so she was referred to me. She did mention to her GP that she had noticed the threads appearing at her anus after defecation. The GP did a rectal examination and reassured her, suggesting that she had a vivid imagination. I saw her later that month and found no abnormality apart from a retroverted uterus and could not feel the coil with the uterine sound or hook within the uterine cavity. An X-ray of the abdomen showed that the IUD was identifiable in the midline front of the sacrum, and would appear to be in the uterus. In May 1980, she was admitted to hospital for removal of the coil. She told my senior house officer that she had felt the strings rectally: this observation was dismissed and not recorded in the notes. At operation I found a normal pelvis with retroverted uterus but no coil. Laparoscopy revealed no adhesions and no evidence of pelvic infection, but something seemed to be distorting the cavity of the sigmoid colon. It was then that my senior house officer mentioned that it was this patient who had thought she had felt the strings coming out of the rectum. She was asked to return as an outpatient 2 weeks later for sigmoidoscopy, after full bowel preparation. On sigmoidoscopy, the coil threads were readily visible and the copper 7 was found embedded 1/2 under the mucosa of the sigmoid colon at 17 cm. I grasped the free end with biopsy forceps and withdrew the coil, considerable force being needed. I prescribed ampicillin and metronidazole for 4 days and warned her about possible complications. However, the procedure caused no discomfort and there were no complications. Assuming the coil had been inserted into the uterine cavity, it it suprising that it had perforated the uterus and the sigmoid colon without causing pelvic sepsis and withoutt leaving adhesions. Edelman et al., in their review found 10 cases of bowel perforation with IUDs (4 Dalkon shields, 3 Lippes loops, and 3 copper T's or copper 7's). All cases presented with pelvic sepsis apart from 1 case of small bowel perforation with a Dalkon shield, but even then at laparotomy extensive adhesions were found between the fundus of the uterus and the small bowel in which the coil was embedded.
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PMID:Unusual presentation of translocated intrauterine contraceptive device. 611 99

Postoperative outcome was compared for 235 patients who were sterilized by unipolar tubal electrocoagulation and for 269 patients who were sterilized by the application of Hulka Clemens spring-loaded tubal clips. Clip application patients had fewer complications but experienced more postoperative discomfort than electrocautry patients. All the sterilizations were performed by the same physician at the Aberdeen Royal Infirmary from 1976-1978. All the patients received general anesthesia, administered by the same anesthetist. Operating time for the tubal electrocautery technique was 7.5 minutes and 5.5 minutes for the tubal clip procedure. 14 of the electrocautery patients and 6 of the clip application patients experienced complications. For the electrocautery patients 1) 11 experienced tubal bleeding and laporotomy to stop bleeding was required for 2 of the patients; 2) 1 patient received bowel damage; and 3) 2 patients had uterine perforations. For the 6 tubal clip patients 1) 2 had uterine perforation; 2) 1 had pelvic sepsis; and 3) in 3 of the patients clips were lost and not retrieved. Only 1 pregnancy was reported, and in that patient adhesions had obstructed the tube during the operation. Immediately following surgery the majority of the patients experienced mild abdominal pain. 9.4% of the clip patients and 1.3% of the electrocautery patients experienced severe pain. 48.5% of the electrocautery patients and 36.0% of the clip patients experienced shoulder pain. Laparoscopic clip sterilization was recommended as a safer technique than electrocoagulation.
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PMID:Outpatient laparoscopic sterilisation: Comparison between electrocautery and clip application. 644 41

Eighteen pediatric patients with infective endocarditis (IE) were reviewed for "failure" of chemoprophylaxis; none had had a previous dental procedure. Surprisingly, published reports reveal a similarly low prevalence of dental extractions preceding IE, only 3.6% for 1,322 cases. Although bacteremia was associated with 40% of 2,403 reported extractions, it also was found in 38% of patients after mastication, and in 11% of patients with oral sepsis and no intervention. In a hypothetical month, ending with a single dental extraction, the cumulative exposure to these "physiologic" sources of bacteremia is nearly 1,000 times greater than it is from extraction. The current American Heart Association recommendations for intramuscular or intravenous chemoprophylaxis are impractical, and the discomfort and inconvenience may impede good dental care. The Committee also implies that gingival bleeding allows bacterial access to the blood stream, whereas experimental studies establish the lymphatics as the only access. Although oral chemoprophylaxis for major dental procedures appears prudent, the British regimen of a single dose of amoxicillin administered orally is much simpler and probably more effective. However, scrupulous oral and dental hygiene is undoubtedly superior in preventing IE than any chemoprophylaxis regimen.
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PMID:How important are dental procedures as a cause of infective endocarditis? 648 31

The study objective was to investigate the effectiveness of a synthetic hydrophilic polymer used as a cervical osmotic dilator before vacuum aspiration in 1st trimester abortion. Lamicel is a polyvinyl alcohol polymer sponge impregnated with magnesium sulphate and compressed to form a thin cylindrical tent. When inserted into the endocervical canal and left in position the Lamicel absorbs and retains fluid from the cervical tissue because of its hygroscopic properties. In the process the Lamicel swells to 4 times its original diameter and is converted from a hard rigid tent into a soft sponge. 60 nullipara who were having vacuum termination of pregnancy in the 1st trimester at the Queen's Medical Center and City Hospital, Nottingham, UK, were recruited into the study. The patients were randomly allocated to 1 of 5 groups each composed of 12 patients. 4 of the groups were treated with Lamicel for various periods before abortion; the 5th group was not treated with Lamicel and constituted a control group. In the 4 treated groups the Lamicel was left in position for periods of 2, 6, 12, or 24 hours in groups 2, 3, 4, and 5, respectively, before abortion. In the control group (group 1) lamicel was not inserted. After insertion the patients were monitored for evidence of discomfort, uterine cramps, sepsis, syncope, or bleeding. These observations were continued for 24 hours after the operation. The patients ranged in age from 14-28 years and gestation at termination ranged from 10-13 weeks. A comparison of the pressure recordings of the control group with each of the treated groups showed a highly significant difference. The reduction of cervical resistance occurred mainly in the first 2 hours after insertion of the Lamicel. There was further reduction in resistance up to 6 hours, but the difference between groups 1 (2 hours) and 2 (6 hours) was not statistically significant, and there were no significant differences between any of the treated groups. Insertion of 5mm Lamicel was achieved without difficulty in 43 (90%) of the patients. A 3mm Lamicel was chosen for the remaining 5 patients because of cervical resistance encountered at the internal os. During insertion 16 patients (33%) experienced mild discomfort. This resolved spontaneously within 5 minutes. There were no problems associated with the removal of the tents and no other side effects were noted. There were no differences in the amount of blood lost during the operation or in the incidence of postoperative pain and bleeding between the 5 groups.
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PMID:Lamicel: a new technique for cervical dilatation before first trimester abortion. 684 49

Ninety-three patients for whom a colorectal operation was planned had their bowel prepared mechanically by orthograde irrigation. The tube was sited in the duodenum via the pylorus under X-ray and TV control. The procedure was discontinued in 2 patients (2%), 15 patients (16%) experienced nausea and vomiting, while 76 patients (82%) experienced no discomfort. The mean duration of the irrigation was 216 min (90-476 min) and the mean volume of fluid used 10.21 (5.0 -15.0 1). There were no significant differences between pre-irrigation and post-irrigation blood chemistry. Twenty-three patients developed postoperative abdominal wound sepsis (26.7%), 4 (4.7%) had an intraabdominal abscess; 9 out of 12 patients (75%) had perineal wound sepsis. Escherichia coli and Bacteroides were the dominant species cultured from colorectal mucosa during operation as well as from infected abdominal and perineal wounds. Although the irrigation technique seems to clean the bowel to a degree not previously seen, this in itself is no guarantee of avoiding post-operative wound sepsis after colorectal operations.
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PMID:Septic wound complications after whole bowel irrigation before colorectal operations. 703 15

1,850 subcutaneous infusions were given to 270 elderly patients (average age, 82) in a hospital geriatric department and in two nursing homes. The side effects were few and not serious. In 4 patients there was anasarca of the gluteal and genital regions but this disappeared promptly after giving diuretics. In a case of disseminated intravascular coagulation, ecchymoses appeared in the thighs. Sepsis, shock, tissue necrosis and other dangerous side effect mentioned in textbooks were not observed. The method is acceptable to most elderly patients and causes less discomfort than does the intravenous method. Since the infusion last only 2 to 4 hours, it enables the patient to be out of bed most of the day. Infusion by the subcutaneous route can be safely administered by trained nurses in institutions without a resident medical staff. It seems to be the method of choice for giving fluid supplements to elderly patients in nonemergency situations.
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PMID:Subcutaneous infusions in the elderly. 731 43


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