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

Renal atrophy with an ectopic drainage of the ureter is an uncommon malformation. Zinder described in 1914 a cystic dilation of the seminal vesicle in association with an ipsilateral renal agenesis. Usually, these patients present lower urinary tract symptoms with perineal discomfort and fever. The most accurate diagnosis is given by the MRI, while CT and ultrasonography are less precise. We present a case of a patient who goes into hospital because of left lumbar pain and urinary sepsis data, whose CT detects an ectopic drainage of the left uereter in the seminal vesicle. He underwent a successful laparoscopic surgical treatment.
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PMID:[Left renal atrophy and ureteral abouchement in seminal vesicle. Laparoscopic surgical treatment]. 1946 31

This report of a recreational athlete who had arm discomfort, fever, headache, and emesis frames a discussion of the diagnosis and treatment for primary upper-extremity deep vein thrombosis (PUEDVT). An unusual aspect of the case was sepsis without typical risk factors. Treatment of PUEDVT usually involves immediate anticoagulation and local thrombolysis followed by evaluation for postthrombosis management; septic thrombophlebitis usually responds to intravenous antibiotics. Postthrombosis management is somewhat controversial, but first-rib resection is frequently recommended for patients who have thoracic outlet compression. This patient returned to unrestricted athletics without surgical intervention.
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PMID:Effort thrombosis with sepsis. 2008 20

Pressure ulcers (pressure sores) continue to be a common health problem, particularly among the physically limited or bedridden elderly. The problem exists within the entire health framework, including hospitals, clinics, long-term care facilities and private homes. For many elderly patients, pressure ulcers may become chronic for no apparent reason and remain so for prolonged periods, even for the remainder of the patient's lifetime. A large number of grade 3 and 4 pressure ulcers become chronic wounds, and the afflicted patient may even die from an ulcer complication (sepsis or osteomyelitis). The presence of a pressure ulcer constitutes a geriatric syndrome consisting of multifactorial pathological conditions. The accumulated effects of impairment due to immobility, nutritional deficiency and chronic diseases involving multiple systems predispose the aging skin of the elderly person to increasing vulnerability. The assessment and management of a pressure ulcer requires a comprehensive and multidisciplinary approach in order to understand the patient with the ulcer. Factors to consider include the patient's underlying pathologies (such as obstructive lung disease or peripheral vascular disease), severity of his or her primary illness (such as an infection or hip fracture), co-morbidities (such as dementia or diabetes mellitus), functional state (activities of daily living), nutritional status (swallowing difficulties), and degree of social and emotional support; focusing on just the wound itself is not enough. An understanding of the physiological and pathological processes of aging skin throws light on the aetiology and pathogenesis of the development of pressure ulcers in the elderly. Each health discipline (nursing staff, aides, physician, dietitian, occupational and physical therapists, and social worker) has its own role to play in the assessment and management of the patient with a pressure ulcer. The goals of treating a pressure ulcer include avoiding any preventable contributing circumstances, such as immobilization after a hip fracture or acute infection. Once a pressure ulcer has developed, however, the goal is to heal it by optimizing regional blood flow (by use of a stent or vascular bypass surgery), managing underlying illnesses (such as diabetes, hypothyroidism or congestive heart failure) and providing adequate caloric and protein intake (whether through use of dietary supplements by mouth or by use of tube feeding). If the ulcer has become chronic, the ultimate goal changes from healing the wound to controlling symptoms (such as foul odour, pain, discomfort and infection) and preventing complications, thereby contributing to the patient's overall well-being; providing support for the patient's family is also important. Recent advances in wound dressings allow for greater control of symptoms and prevention of complications, and have also enabled the affected patient to be integrated more readily into the family setting and in the community at large. Ethical and end-of-life issues must also be addressed soon after the wound has become chronic. This article discusses the pathogenesis of pressure ulcer development in the elderly in relation to concomitant diseases, risk factor assessment and the management of such ulcers.
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PMID:Assessment and management of pressure ulcers in the elderly: current strategies. 2035 62

Adrenal insufficiency (AI), a life-threatening disorder, usually starts with variable nonspecific symptoms and signs of poor appetite, fatigue, fever, and gastrointestinal discomfort, and may progress to adrenal crisis with complications of electrolyte imbalance, change of consciousness or even shock. Epidemiological data about AI in the elderly population are limited. Based on nationwide hospitalization datasets in Taiwan, we retrospectively analyzed the annual incidence of AI among the elderly population (> or = 60 years old), as well as co-morbidities. The prevalence of AI increased from 6.5/10(5) (n = 1,293) in 1996 to 20.8/10(5) (n = 4,681) in 2007. In 2006, AI was newly diagnosed in 3,494 patients (1,701 women and 1,793 men), which represented an incidence of 15.5/10(5) in the whole population. Nearly four fifths (1,349 women and 1,429 men) of the patients were 60 years old and over, corresponding to an incidence of 92.4/10(5) in the elderly population. The most common co-morbidities were pneumonia (8.6%, n = 238) and urinary tract infections (6.9%, n = 193). Within the one-year observation after discharge, pneumonia was also the most frequent diagnosis in subsequent hospitalizations; besides, 178 (6.5%) patients died in the hospital and the common causes of death were respiratory failure (n = 34), septicemia (n = 23), pneumonia (n = 16), and chronic obstructive pulmonary disease (n = 9). In conclusion, the majority of the elderly have co-morbidities when AI was initially diagnosed. Infectious and pulmonary diseases as the most common co-morbidities also play a major role in subsequent hospitalizations and in-hospital deaths.
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PMID:Adrenal insufficiency in the elderly: a nationwide study of hospitalizations in Taiwan. 2064 43

Neck injuries resulting from motor vehicle collisions (MVC), often referred to as whiplash trauma and injury, often demonstrate little or no evidence of significant tissue damage. In rare instances, however, serious injury to the anterior neck organ injuries can result from such trauma. The present study describes esophageal injury associated with rear-impact collisions, based on a unique case report, review of the scientific literature and a query in the National Automotive Sampling System (NASS) database of the US National Highway Traffic Safety Administration. The Medline search and present case study totaled five cases of rear-impact collision-related serious esophageal injury (laceration or rupture). In the four published cases all patients survived, whereas in the presented case study, the patient died due to mediastinitis and sepsis. The NASS query revealed an additional three cases out of a total of 55,926 investigated crashes. All three cases were associated with fatalities. Although no anatomical or bioengineering studies have presented data on the behavior of the esophagus during rear-impact whiplash loading, sudden tensile and/or compressive forces is the likely explanation of injury, often in combination with a local fracture of a vertebral body. In these 8 cases significant esophageal injury carried a substantial (50%) risk of mortality. Clinicians should be aware of the potential for significant complications in the whiplash trauma-exposed patient who complains of chest pain, mid-thoracic pain, discomfort in the neck and throat, respiratory distress, or hoarseness. For those forensic specialists involved in whiplash cases these study results highlight the need to consider esophageal injuries as a rare but potential consequence of whiplash trauma.
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PMID:Esophageal injury in fatal rear-impact collisions. 2093 95

Ileus development has been associated with a wide range of complications among hospitalized patients, ranging from increased patient pain and discomfort to malnutrition, aspiration, delayed rehabilitation, and sepsis. This article examines factors that appeared to correlate with an increase in ileus development among patients in a trauma/surgical intensive care unit, with the goal of preventing the condition through nursing practice changes.
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PMID:Ileus development in the trauma/surgical intensive care unit: a process improvement evaluation. 2147 14

Endoanorectal ultrasonography (EARUS) may be used for diagnosing various anorectal disorders. EARUS is easy to perform, has a short learning curve, and causes less discomfort than routine digital examination. Anal sphincters can be clearly visualized, and one can easily distinguish between the internal (hypoechoic) and external (hyperechoic) anal sphincters. Other pelvic floor structures, like the puborectalis muscle, can also be visualized. The use of contrast agents can increase the accuracy of EARUS in the assessment of perianal fistulae. In addition, EARUS is an excellent alternative to expensive magnetic resonance imaging. Besides its use in incontinence and perianal sepsis, the presence of slight or massive submucosal invasion in early rectal cancer may be imaged in greater detail. With 3-dimensional EARUS, it is possible to diagnose the anorectal diseases, in multiplane, with high spatial resolution, adding important information about the therapeutic decision. The normal sonographic anatomy of the anorectum, sonographic findings of anorectal diseases, and indications and limitations of endosonography with complementary techniques such as transvaginal and transperineal ultrasound are reviewed in this article.
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PMID:Endoanorectal ultrasonography. 2160 91

Streptococcus pneumoniae is a cause of significant morbidity and mortality worldwide. There are many different serotypes of the organism which may be carried by up to 50% of children under the age of 6 years, as well as many adults. The organism is associated with both pneumonia and invasive pneumococcal disease, which may result in septicemia or meningitis. It is also a principal cause of otits media and sinusitis, which are not life-threatening, but generate a lot of discomfort, loss of schooling or working days, and around 60 000 GP consultations per year in the UK. Vaccination is a safe and effective way to prevent this infection from causing significant ill health.
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PMID:Pneumonia part 2: signs, symptoms and vaccinations. 2239 39

Malignant ascites (MA) accompanies a variety of abdominal and extra-abdominal tumors. It is a primary cause of morbidity and raises several treatment challenges. MA has several symptoms, producing a significant reduction in the patient's quality of life: loss of proteins and electrolyte disorders cause diffuse oedema, while the accumulation of abdominal fluid facilitates sepsis. Treatment options include a multitude of different procedures with limited efficacy and some degree of risk. A Pubmed, Medline, Embase, and Cochrane Library review of medical, interventional and surgical treatments of MA has been performed. Medical therapy, primarily paracentesis and diuretics, are first-line treatments in managing MA. Paracentesis is widely adopted but it is associated with significant patient discomfort and several risks. Diuretic therapy is effective at the very beginning of the disease but efficacy declines with tumor progression. Intraperitoneal chemotherapy, targeted therapy, immunotherapy and radioisotopes are promising medical options but their clinical application is not yet completely elucidated, and further investigations and trials are necessary. Peritoneal-venous shunts are rarely used due to high rates of early mortality and complications. Laparoscopy and hyperthermic intraperitoneal chemotherapy (HIPEC) have been proposed as palliative therapy. Literature on the use of laparoscopic HIPEC in MA includes only reports with small numbers of patients, all showing successful control of ascites. To date, none of the different options has been subjected to evidence-based clinical trials and there are no accepted guidelines for the management of MA.
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PMID:Malignant ascites: pathophysiology and treatment. 2246 Jul 78

External fixation is a well-established mode of treatment within orthopaedics; however, despite continued research, pin site infection is still a problem. Pin site infection may cause pain and discomfort to the patient, and result in osteomyelitis or sepsis if minor infection is not managed in a timely and appropriate manner. Fundamental issues such as the assessment and reporting of infection are important in dealing with pin site infection, as is the ongoing management of the pin site itself. Many types of care are evident, with varying evidence to support their use in clinical practice. This article will discuss the identification and classification of pin site infection and the methods of care.
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PMID:Pin site infection in orthopaedic external fixation devices. 2258 52


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