Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Butyrate analogues have been shown to increase fetal hemoglobin (HbF) production in vitro and in vivo. Sodium phenylbutyrate (SPB), an oral agent used to treat individuals with urea-cycle disorders, has been shown to increase HbF in nonanemic individuals and in individuals with sickle cell disease. We have treated eleven patients with homozygous beta thalassemia (three transfusion dependent) and one sickle-beta-thalassemia patient with 20 g/d (forty 500-mg tablets) of SPB for 41 to 460 days. All patients showed an increase in the percent of F reticulocytes associated with treatment, but only four patients responded by increasing their Hb levels by greater than 1 g/dL (mean increase, 2.1 g/dL; range, 1.2 to 2.8 g/dL). None of the transfusion-dependent thalassemia subjects responded. Increase in Hb was associated with an increase in red blood cell number (mean increase, 0.62 x 10(12)/L), and mean corpuscular volume (mean increase, 6 fL). Changes in percent HbF, absolute HbF levels, or alpha- to non-alpha-globin ratios as measured by levels of mRNA and globin protein in peripheral blood did not correlate with response to treatment. Response to treatment was not associated with the type of beta-globin mutation, but baseline erythropoietin levels of greater than 120 mU/mL was seen in all responders and only two of eight nonresponders to SPB. Compliance with treatment was greater than 90% as measured by pill counts. Side effects of the drug included weight gain and/or edema caused by increase salt load in 2/12, transient epigastric discomfort in 7/12, and abnormal body odor in 3/12 subjects. Two splenectomized patients who were not on prophylactic antibiotics developed sepsis while on treatment. We conclude that SPB increases Hb in some patients with thalassemia, but the precise mechanism of action is unknown.
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PMID:Oral sodium phenylbutyrate therapy in homozygous beta thalassemia: a clinical trial. 752 72

Initiation of intravenous (i.v.) infusions in hospital wards is a common surgical procedure. Unfortunately many of these infusions will fail due to phlebitis and/or extravasation. Such failure may cause considerable patient discomfort, interfere with i.v. therapy and increase the nurse's workload. I.v. problems with adults have been evaluated extensively, however little attention has been given to children. Heparin is effective in reducing thrombus formation and studies have demonstrated other properties as well, such as anti-inflammatory, anti-irritant, maintenance of endothelial integrity and homeostasis, and tissue healing. The purpose of this study was to determine if the addition of low-dose heparin to infusate would prolong infusion site survival in children. An experimental design was used whereby patients were randomly allocated into control and treatment groups. The treatment group received pre-mixed fluids containing 1 unit/ml of heparin whilst the control group received standard fluids. Data were collected using a standard form and information such as type and size of cannula, sex, age, date and time of cannulation, site, signs of phlebitis/extravasation, reasons for cannula removal and type of fluids and drugs infused, were recorded. Failure incidence was analysed by Cox's multivariate hazards model, life-table method and log rank tests. The results showed a highly significant difference (Chi 2 20.42, p < 0.0001) in decreasing infusion failure with the addition of low-dose heparin to infusate. Nursing implications could include a decrease in the incidence of extravasation and phlebitis, an increase in effective vein usage, fewer problems with i.v. flow rates, a reduction in medical/nursing hours associated with re-cannulations, less likelihood of systemic sepsis, and less patient worry and discomfort due to local venous reactions and re-cannulations.
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PMID:Nursing implications of low-dose heparin to infusate to improve infusion site survival in children. 813 25

To evaluate two different methods of managing segmental skeletal defects, 15 patients treated with the open bone graft (Papineau) technique were compared with 17 patients who had intercalary bone transport (Ilizarov) management. The treatment time was identical for both groups: 1.9 months in fixation for each centimeter of defect reconstructed. Both techniques shared several fixator-associated problems such as implant site sepsis and patient discomfort. Each method of treatment, however, had its own unique problems. For the bone grafted group, limited graft availability, donor site morbidity (three patients), and graft fractures (two patients) occurred. For the bone transport group, the main problems were failure of the docking site to unite without a supplementary graft (seven patients) and joint contractures (seven patients). A new synthesis of both techniques is described.
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PMID:Skeletal defects. A comparison of bone grafting and bone transport for segmental skeletal defects. 815 61

Thirty-nine Yucatan miniature swine were used in three fetal surgical experimental protocols. They involved antiarrhythmic administration, pacemaker implantation, and in-utero diagnosis of ventricular septal defect by intraoperative echocardiography. Because of problems encountered with surgical protocols in the initial stages, modifications were made to prevent fetal hypothermia and intraoperative mortality. These modifications included environmental temperature support, staple surgical techniques to reduce operative time, and development of fetal catheters designed to facilitate cannulation of small vessels. Postoperative care protocols were intensive and included antibiotics, analgesics, and supportive care designed to reduce discomfort and prevent abortion and sepsis. Thirty-seven of 39 sows survived the surgical procedures; experiments were performed on 117 fetuses. Twenty-two fetuses died either intraoperatively or postoperatively because of complications related to the experimental protocols. Modification of surgical and postsurgical protocols for these projects demonstrates the feasibility of using miniature swine as a model for fetal surgery, when their use was appropriate for anatomic and physiologic reasons.
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PMID:Fetal surgical protocols in Yucatan miniature swine. 869 29

Embryologically, the allantois connects the urogenital sinus with the navel. Normally, the allantois is oblitered before the birth and is represented by a fibrous cord, called urachus, extending from the dome of the bladder to the navel. Urachal formation is directly related to bladder descent. Incomplete obliteration sometimes occurs. Disease rarely occurs in urachus, but adenocarcinoma is the most fearful and rare, and it represents the 0.01% of the whole adult carcinoma, the 0.17-0.34% of the whole bladder malignancy, and the 20-30% of the bladder adenocarcinoma. Yet urachus may be seat of other kinds of benign pathologies characterized by incomplete obliteration of its lumen. Only if the ends of the urachus seal off, a cyst of that body may form and may become quite large, presenting a low midline abdomen mass. Adenocarcinoma may occur in a urachal cyst, particularly at its vescical extremity. Cystis usually have an asymtomatic course. Occasionally these cystis can be discovered during sonographic examination. If the cyst becomes infected, signs of general and local sepsis will develop, sometimes involving the peritoneum. Sometimes, in these cases, it is difficult to diagnose the presence of an adenocarcinoma and, particularly, its cystic variant. By using the common diagnostic instrumental device, we cannot reach a certain diagnosis, essential to perform a correct medical or surgical treatment. The case reported concerns a twenty-five years old man, over and over again examined, complaining of ipo-mesogastric abdominal pain, mild fever, increment of flogosis index and transaminasis, microscopic hematuria and urinal discomfort. Sonographic suprapubic examination, performed during urological consultation, showed an urachal neoplasm. Cystoscopy and TC evaluation didn't permit a certain preoperative diagnosis. A surgical explorative operation was performed and the neoplasm, a part of a bladder dome, omental flap and a part of rectus muscles, were removed. In order to reconstruct the abdominal wall we used a large Polypropilene patch. The hystological report outlined a large urachal cyst, a flogosis and a purulent necrosis invading the surrounding tissue and the peritoneum. The patient was discharged after twenty-five days and he had a good functional performance. In the light of the reported case, the surgical treatment seems to be the best solution before the onset of complications that should expose patients to difficult and demolitive surgical operations and that should protract the hospitalization.
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PMID:[Complicated urachal cyst: a difficult differential diagnosis]. 927 86

A total of 112 patients were operated on for severe complicated sigmoid diverticulitis, Hartmann's procedure was performed due to local or generalised peritonitis, 80% to them as emergency surgery. There was a mortality of 18.8% due to the sepsis or other complications. Sixty-two of the remaining 80 patients underwent a restorative procedure without any mortality and low morbidity (11 died after discharge not related to the colon disease). Resection and primary anastomsis is always the first choice, but in cases of severe peritonitis there is no discomfort or risk for the patient if Hartmann's procedure with restorative surgery is chosen.
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PMID:[Discontinuity resection in therapy of complicated sigmoid diverticulitis]. 957 78

Tazobactam/Piperacillin (TAZ/PIPC) is a newly developed intravenous antibiotics, in which TAZ, a new potent inhibitor of beta-lactamases, is combined with PIPC, a well-established beta-lactam antibiotics, at the ratio of 1:4. In this study, we clinically evaluated efficacy of the drug in 14 pediatric patients with various infections, and pharmacokinetic study was applied to 3 patients. Range of age was from 1-month to 15 1/4-year. Patients consisted of 9 cases of pneumonia, 3 urinary tract infection, 1 acute otitis media, and 1 left sacroiliitis with sepsis. Standard dose of TAZ/PIPC was 50 mg/kg/dose and administered 2-4 times per day with intravenous injection or drip infusion. Two cases of pneumonia were excluded because of non-bacterial infection. Nine causative pathogens including 3 Gram-positive cocci and 6 Gram-negative bacilli were detected in 7 patients, of which 5 Gram-negative strains produced bete-lactamase. All of cases showed 100% of efficacy rate and bacteriological eradication rate. It was noted that beta-lactamase-producing E. coli and B. catarrhalis were eradicated efficiently by TAZ/PIPC, which should be resistant to PIPC alone according to MIC data. Non-serious diarrhea and discomfort of back with nausea were observed in one each patients as side effects. Both of side effects were transient, and improved with anti-diarrheic agent or cessation of the drug, respectively. As abnormal laboratory test results, moderate increases of the eosinophils and platelets counts as well as moderate elevation of the transaminases were observed in 2 separate patients. Pharmacokinetics study showed that Cmax, T1/2, and AUC were similar to the data reported in adult patients. Urinary recovery rate in the first 6 hours also resemble the data from adult patients. Based on above results, TAZ/PIPC is a useful agents pediatric infections by beta-lactamase producing strains also.
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PMID:[Clinical studies of tazobactam/piperacillin (TAZ/PIPC) in pediatric patients]. 969 64

A 60-year-old man was admitted to a hospital for evaluation of intermittent fever, dysphagia, hoarseness, and general chest discomfort. Great vessel mycotic aneurysm was suspected when antibiotic trials failed and chest X-ray showed paraaortic mass with pleural effusion mimicking mediastinitis. Although the correct diagnosis of mycotic aneurysm of innominate artery was made thereafter and vigorous treatment was initiated immediately, this patient succumbed to overwhelming sepsis, probably due to a 2-week delay in another hospital. This case is reported to remind readers of the possibility of this unusual location of mycotic aneurysm. A high index of suspicion should be maintained to make an earlier diagnosis and obtain better prognosis. Computed tomography and 3D magnetic resonance angiography also significantly improve the diagnosis when mycotic aneurysm location is unusual and presentation is equivocal.
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PMID:Subclavian mycotic aneurysm presenting as mediastinal abscess. 982 58

Pressure sores remain a significant problem in hospitals and domestic settings, affecting people of all ages, social class and race. Associated complications may be life threatening, e.g. sepsis and osteomyelitis. Other less dangerous, but nevertheless compromising outcomes such as pain, discomfort and low self-esteem and body image can cause personal suffering, and may add extra demand for limited resources. The exact state of pressure sore occurrence remains difficult to determine, particularly in the community. Recent trends in pressure area management present a multidisciplinary approach, eroding traditional perceptions of pressure sores as a solely nursing problem. Written from nursing perspective, this article summarizes principles of good practice relating to pressure sore prevention and therapy, emphasizing the importance of documenting observed events, rather than assumptions or opinions, and the need for healthcare professionals to approach problems and needs from a collaborative stance. Pressure sore risk assessment and classification are discussed, and an overview of nutrition, moving a handling, selecting support surfaces, principles of wound management, and skin care are considered.
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PMID:Nursing aspects of pressure sore prevention and therapy. 984 52

The efficacy of implantable third generation cardioverter defibrillators has been well established for the treatment of patients with malignant ventricular arrhythmias and survivors of cardiac arrest. However, many patients have been reluctant or unwilling to endure the discomfort of an open chest procedure, despite their need for the device. Furthermore, morbidity (pneumothorax, pneumonia, sepsis, pleural effusion, hemorrhage, pericarditis, etc.) and mortality associated with the application of epicardial lead systems is of concern. Finally, the mean overall expense of $80,433 for the epicardial method of defibrillator implantation is a consideration in an era of increasing cost-awareness in health care. Fortunately, the recent market-release of a single lead transvenous defibrillation system [Endotak, Cardiac Pacemakers, Inc. (CPI), St. Paul, Minnesota] may address these pressing issues. The specific purpose of this report is to demonstrate the patient benefit derived from interfacing a single endocardial lead system with a biphasic third generation defibrillator.
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PMID:A new approach: a single triple electrode lead system interfaced with a third generation defibrillator. 1015 76


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