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)

Morbidity, mortality and discomfort related to gastrectomy has led some investigators to treat patients with stage I-II primary gastric high-grade lymphoma (PGL) with a conservative strategy. Here we report a retrospective series of 21 patients with PGL treated with primary chemotherapy alone or followed by radiation therapy and analyze previously reported series, focusing on therapeutic results, treatment-related morbidity and stomach preservation rate. All 21 patients with stage I-II PGL received an initial anthracycline-containing chemotherapy, which was followed by involved field-radiation therapy in 8 cases. Data regarding toxicity, response and relapse rates and survival of this patient group and 14 previously published series, involving 316 patients treated with conservative modality, were also analyzed. In the present series two patients did not complete the planned treatment, while the remaining 19 achieved a complete remission (response rate: 90%). Three patients relapsed, all of whom had been treated with chemotherapy alone. Two patients died of lymphoma, one of sepsis and the other of lung cancer while still relapse-free. The survival rate at 50 months is 81%, and the 5-year actuarial cause-specific survival is 82%. The stomach preservation rate is 100%. Previously reported series showed a response rate ranged between 76% and 100%. Gastrointestinal bleeding was observed in only 3% of cases, while no cases of gastric perforation were reported. Treatment mortality rate was 2.5%. 5-year actuarial survival ranged between 73% and 90% and stomach preservation rate was 97%. Short-term chemotherapy obtained similar results to more prolonged treatment. In conclusion, conservative treatment with primary chemotherapy followed by involved field-radiation therapy should be used for the first-line treatment of patients with stage I/II PGL considering that it is associated with a high response and survival rates, and with an insignificant risk of bleeding or perforation, high stomach preservation rate and good quality of life.
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PMID:Non-surgical treatment with primary chemotherapy, with or without radiation therapy, of stage I-II high-grade gastric lymphoma. 1034 80

The authors conducted a prospective study, with a subsequent review of case-notes and follow-up of patients, to review the results of insertion of gentamicin beads for the prevention and treatment of infection in vascular surgery. In particular, special reference was given to leaving chains of beads permanently implanted in the body. There were thirty-five patients in whom gentamicin beads were used in 62 sites. These were implanted completely in 45, left protruding for removal in 15 and in open wounds in two. Forty-two chains of beads were left permanently implanted, and these patients were followed up for 1-44 months (median 15) later. There was no further infection at 60% of the sites where gentamicin beads were used to treat proven graft sepsis, and 50% of sites in various sinuses. Infection developed at 16% of the sites where gentamicin beads were used prophylactically. Adverse effects were observed in three cases of long-term implantation: one chain of beads caused discomfort that required removal, the skin failed to heal over one chain, and one may possibly have caused a bypass graft to kink and occlude. In conclusion, gentamicin beads are a useful adjunct in the management of vascular graft infection and in prophylaxis for some high risk cases. Chains of beads can be implanted long term with few adverse sequelae.
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PMID:Gentamicin beads in vascular surgery: long-term results of implantation. 1043 May 29

Epidermolysis bullosa is a group of hereditary blistering disorders for which there is no definitive therapy. Wound care is an important component of management. Regular dressing changes are required to protect blistered and eroded skin, and to prevent secondary infection and sepsis. These dressing changes can be very painful for patients with extensive erosions. We report our experience of pain management in an 11-year-old boy with severe junctional epidermolysis bullosa. Amitryptiline and cognitive behavioral techniques were effective in relieving chronic pain and discomfort. Oral midazolam 0.33 mg/kg administered 20 minutes prior to baths and dressing changes substantially improved his tolerance of wound care.
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PMID:Pain management of junctional epidermolysis bullosa in an 11-year-Old boy. 1063 47

Arthrodesis was performed to treat septic arthritis of the proximal interphalangeal joint of 8 horses. Records of the horses were reviewed to determine outcome and possible factors that influenced success or failure. All horses were female. Seven horses had 1 joint treated and 1 horse was treated for bilateral pelvic limb involvement. The duration of sepsis before surgery ranged from 1 to 66 days. Bone lysis and production was radiographically apparent in 7 horses before surgery. Six horses had multiple bacterial organisms cultured from bone or synovial tissues; 2 horses had single isolates identified. After aggressive curettage, arthrodesis was accomplished with 3 parallel screws in 1 horse, 2 divergent narrow dynamic compression plates in 3 horses, and a single broad dynamic compression plate in 4 horses. Casts were applied to all horses for 1 to 6 weeks. Four horses survived to successful brood mare status. Four horses were euthanized during hospitalization because of continued discomfort or complications of sepsis. Arthrodesis of the proximal interphalangeal joint affected with septic arthritis appears to be an acceptable alternative to euthanasia for some horses.
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PMID:Arthrodesis of the proximal interphalangeal joint affected with septic arthritis in 8 horses. 1072 97

We report on two recipients of multi-visceral grafts who exhibited sudden onset of acute abdomen discomfort 2 weeks post-transplantation after a fairly uneventful immediate post-operative course. Both patients were shown to have pneumatosis intestinalis and one had air in the portal vein. Both patients underwent exploration, which showed non-viable intestine (terminal ileum and colon in the first patient and the entire small intestine distal to the ligament of Treitz in the second patient). There was no vascular thrombosis. The necrotic intestine was resected in both cases. The first patient developed sepsis and died 15 days later despite the rescue efforts. The second patient was re-transplanted twice and is doing well. The histopathology of the segments involved revealed cryptitis, vasculitis, and features of transmural necrosis. Accordingly, both clinical and pathologic features are diagnostic of necrotizing enterocolitis. To our knowledge this is the first report of this complication following intestinal or multi-visceral transplantation.
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PMID:Graft failure secondary to necrotizing enterocolitis in multi-visceral transplantation recipients: two case reports. 1093 23

In restorative proctocolectomy the use of a stapling technique to construct an ileal pouch with anal anastomosis offers an alternative to the hand-sewn technique following mucosectomy; a temporary defunctioning loop ileostomy may reduce the consequences of an anastomotic leakage, however it may entail discomfort for the patient, an additional operation, possible complications, and longer total hospital stay. This prospective study evaluated the peri- and postoperative courses in 86 consecutive, referred patients receiving ileal pouch-anal anastomosis using the stapling technique to construct the ileal pouch and ileoanal anastomosis, omitting the defunctioning loop ileostomy except in cases of increased risk of ileoanal anastomotic insufficiency according to defined criteria. Follow-up time was 36-96 months. Patients undergoing primary loop ileostomy stayed a median of 19 days in hospital, as opposed to a median of 9 days in those who did not. Eight patients developed pelvic sepsis that demanded a secondary defunctioning loop ileostomy, and five showed symptoms arising from relapsing inflammation in residual rectal mucosa; in three of these, a secondary transanal mucosectomy covered by a loop ileostomy was necessary. During the follow-up period ten patients had bowel obstructions that demanded surgery; two developed late pouch-vaginal fistulas, and one a fistula from the J-limb to the abdominal scar. There was one case of pouch procidentia. At 12-month follow-up the median evacuation frequency was 6 per 24 h, the incidence of minor incontinence was about 10%, and urgency to evacuate occurred in about 10%. None of the patients experienced any major incontinence. The stapling technique and omission of the defunctioning loop ileostomy in restorative proctocolectomy were thus a comparatively reliable and time-saving method with short total hospital stay. In patients at increased risk of anastomotic complications, however, a defunctioning loop ileostomy is recommended. We believe it is important to perform an exact dissection into the anal canal to avoid a residual rectal mucosa that may be inflamed or even become dysplastic.
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PMID:Stapled ileoanal pouches without loop ileostomy: a prospective study in 86 patients. 1151 81

Maggot debridement therapy (MDT) was first introduced in the US in 1931 and was routinely used there until mid-1940s in over 300 hospitals. With the advent of antibacterials, maggot therapy became rare until the early 1990s, when it was re-introduced first in the US, and later in Israel, the UK, Germany, Sweden, Switzerland, Ukraine and Thailand. Sterile maggots of the green bottle fly, Lucilia (Phaenicia) sericata, are used for MDT. Up to 1000 maggots are introduced in the wound and left for 1 to 3 days. MDT could be used for any kind of purulent, sloughy wound on the skin, independent of the underlying diseases or the location on the body for ambulatory as well as for hospitalized patients. One of the major advantages of MDT is that the maggots separate the necrotic tissue from the living tissue, making a surgical debridement easier. In 80 to 95% of the cases, a complete or significant debridement of the wound is achieved. As therapy progresses, new layers of healthy tissue are formed over the wounds. The offensive odor emanating from the necrotic tissue and the intense pain accompanying the wound decrease significantly. In a significant number of patients, an immediate amputation can be prevented as a result of MDT. In other cases, a more proximal amputation could be avoided. It is also possible that in patients with deep wounds, where septicemia is a serious threat, this can be prevented as a result of MDT. The majority of patients do not complain of any major discomfort during the treatment. Psychological and esthetic considerations are obvious. Maggots can occasionally cause a tickling or itching sensation. Approximately 20 to 25% of the patients with superficial, painful wounds, complain of increased pain during treatment with maggots, and are treated with analgesics. MDT has been proven to be an effective method for cleaning chronic wounds and initiating granulation. It is a simple, efficient, well tolerated and cost-effective tool for the treatment of wounds and ulcers, which do not respond to conventional treatment and surgical intervention.
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PMID:Clinical applications for maggots in wound care. 1170 49

Gastrointestinal fistulae most frequently occur as complications after abdominal surgery (75-85%) although they can also occur spontaneously--for example, in patients with inflammatory bowel disease (IBD) such as diverticulitis or following radiation therapy. Abdominal trauma can also lead to fistula formation although this is rare. Postoperative gastrointestinal fistulae can occur after any abdominal procedure in which the gastrointestinal tract is manipulated. Regardless of the cause, leakage of intestinal juices initiates a cascade of events: localised infection, abscess formation and, as a result of a septic focus, fistulae formation. The nature of the underlying disease may also be important, with some studies showing that fistula formation is more frequent following surgery for cancer than for benign disease. Fistula formation can result in a number of serious or debilitating complications, ranging from disturbance of fluid and electrolyte balance to sepsis and even death. The patient will almost always suffer from severe discomfort and pain. They may also have psychological problems, including anxiety over the course of their disease, and a poor body image due to the malodorous drainage fluid. Postoperative fistula formation often results in prolonged hospitalisation, patient disability, and enormous cost. Therapy has improved over time with the introduction of parental nutrition, intensive postoperative care, and advanced surgical techniques, which has reduced mortality rates. However, the number of patients suffering from gastrointestinal fistulae has not declined substantially. This can partially be explained by the fact that with improved care, more complex surgery is being performed on patients with more advanced or complicated disease who are generally at higher risk. Therefore, gastrointestinal fistulae remain an important complication following gastrointestinal surgery.
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PMID:The relevance of gastrointestinal fistulae in clinical practice: a review. 1187 90

Lung and breast cancer are responsible for the majority of malignant pleural effusions. The diagnosis of a malignant pleural effusion signifies a limited survival for most patients. During their final months, dyspnea is the most common symptom and requires palliation. A decision relating to palliation and the modality of therapy should be based on total assessment of the patient and not a single variable. Local treatment remains the most common and effective palliation. Assessing the response to therapeutic thoracentesis determines the degree of relief of dyspnea and the time-course of recurrence. Lack of a beneficial effect suggests the patient may have a trapped lung, atelectasis, lymphangitic carcinomatosis, or tumor embolism. Short-term chest tube drainage has variable results and is not recommended. Chemical pleurodesis through a standard chest tube or small-bore catheter is a commonly used and effective treatment. Talc slurry consistently produces the highest success rates, followed by the tetracyclines and bleomycin. Although acute respiratory failure has been reported following talc pleurodesis, these episodes represent a very small percentage of the total reported cases of talc poudrage and slurry pleurodesis. Whether acute respiratory failure is directly related to talc in the absence of other risk factors remains unclear. Other possible causes for acute respiratory failure following pleurodesis include re-expansion pulmonary edema, excessive premedication, severe comorbid disease, and sepsis from unsterile talc or poor chest tube technique. Factors that need to be considered before recommending chemical pleurodesis include response to therapeutic thoracentesis, general health of the patient, performance status, pleural space elastance, the primary malignancy, and pleural fluid pH. Chronic indwelling catheters have been shown to be effective alternatives to chemical pleurodesis. Pleuroperitoneal shunting can provide palliation to patients with a trapped lung, a malignant chylothorax, or others who have failed pleurodesis. Parietal pleurectomy should be reserved only for patients who have failed chemical pleurodesis or have a trapped lung with an expected survival > 6 months. To provide the highest quality of life for patients with malignant pleural effusions, the least invasive, morbid and costly therapy should be used. Success of the initial procedure is important, as repeat procedures are associated with additional hospitalization, patient discomfort, and increased expense; therefore, the selection of patients for palliation and the modality utilized is critical to avoiding further hardship to the patient.
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PMID:Management of malignant pleural effusions. 1188 96

Perianal Crohn's disease usually is associated with involvement of another primary site of Crohn's disease. However, there is conflicting evidence on the relationship between proximal disease activity and perianal symptoms. Therefore, although it is reasonable to treat active proximal disease, symptomatic perianal disease may have to be treated on its own right. Hemorrhoids and anal fissures are best treated medically. Fistulae and abscesses are treated with control of sepsis and resolution of inflammation while preserving continence and quality of life. Abscesses require surgical drainage, which needs to be prolonged for healing to be complete. Fistulae may be treated with medications first, especially if the rectum is diseased. Refractory fistulae respond better to surgical treatment and sometimes require fecal diversion. The medical management of patients with perianal Crohn's disease consists of rectal mesalamine, systemic antibi-otics, immunosuppressive agents, and infliximab. The role of infliximab is evolving and it may reduce the need for surgical intervention in some cases. Perianal hygiene and skin protection help to reduce local discomfort.
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PMID:Perianal Crohn's Disease. 1200 14


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