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)

The case studies of four patients with post-transplantation calcinosis are presented. Three of the four patients died of inanition and sepsis secondary to infection of extensive soft tissue ulcers and diffuse cutaneous vascular calcification with gangrene. The fourth patient survived following removal of all four parathyroid glands and autografting of approximately one-half of one gland. Common to the patients was secondary hyperparathyroidism, elevated mean serum calcium levels after transplantation, and radiographic evidence of small and medium vessel calcification. No other differences could be found between these patients and other patients with post-transplantation hyperparathyroidism without calcinosis. In the face of apparently minor complaints of lower extremity discomfort, elevated parathyroid hormone levels (PTH) and positive xerography may indicate subtotal parathyroidectomy regardless of the serum calcium level.
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PMID:Lethal post-transplantation calcinosis. 37 90

One hundred forty patients with carcinoma of the esophagus treated over a 12-year period at Queens Hospital Center were reviewed. Comparable numbers of patients were assigned at random to radiation therapy alone, surgical treatment with radiation, or treatment with combinations of radiation and chemotherapy pre- or postoperatively. Surgical mortality (survival 1 month or less) was 9 patients of 34, or approximately 26%. Mean survival including the early deaths was 7.5 months. Deaths were primarily due to respiratory tract complications, either alone or in combination, with three cases of anastomotic leaks, sepsis, inanition, and progressing carcinoma. Fifty-two patients received radiation therapy alone. Although there were only six deaths (10%) within the first month of treatment, average survival was 8.4 months, only marginally greater than those treated by surgery. Of 13 patients treated with combined radiation and chemotherapy, no deaths occurred within the first month of treatment, but the average survival was only 6.5 months. Of nine patients treated with chemotherapy alone, no deaths occurred within the first month of treatment, but mean survival of this small group was only 4.9 months. Efficacy of chemotherapy and radiation therapy as definitive, adjuvant, or palliative therapy, in spite of recent somewhat optimistic reports, remains to be proven. Exploratory surgery should be retained as an essential staging and therapeutic modality in those patients in whom definite evidence establishing inoperability is lacking; ie, tumor fixation to vital structures, distant metastases, and other medical contraindications to surgery. Endoscopic instrumentation with the yttrium aluminum garnet laser appears to have a future as preliminary to surgery or definitive (palliative) management of obstructing esophageal carcinoma.
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PMID:Carcinoma of the esophagus seen in a 12-year period at Queens Hospital Center. 169 95

Six patients with end-stage emphysema (age 44 +/- 2 years) underwent double lung transplantation (Tx) from June 1988 through May 1990. All suffered from severe inanition and required oxygen therapy. The ischemic time was 193 +/- 28 minutes. Post-Tx immune suppression was OKT3 (14 days), cyclosporine (trough levels of 150 +/- 25 ng/ml), azathioprine to keep WBC at 3,000 to 5,000/cu mm (1 to 3.0 mg/kg/day) and following OKT3, a tapering prednisone regimen. Two rejection episodes that occurred in two patients on post-Tx day 5 and 10 were treated with bolus doses of methylprednisolone. The mean hospital stay was 32 +/- 7 days (range, 20 to 69 days). Four patients required treatment of cytomegalovirus (CMV) infection: gastritis (+donor, +recipient) in one and CMV pneumonia in two (+donor, -recipient). A fourth (+donor, -recipient) had right-sided Candida empyema six weeks post-Tx, developed CMV and staphylococcal sepsis, and died 64 days post-Tx. One patient required pyloroplasty eight weeks post-Tx and one patient underwent tracheal suture line repair at eight weeks. During a follow-up of 81 patients months (range, 8 to 24 months), one patient had developed Epstein-Barr viral (EBV) induced lymphoproliferative disease in the lung and one patient had developed EBV lymphoma. Three patients are at work, one is continuing rehabilitation, and one is at home. Double lung Tx offers a definitive benefit to patients with emphysema; however, a prolonged postoperative course can be expected. Viral infections remain serious but treatable problems.
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PMID:Treatment of end-stage chronic obstructive pulmonary disease with double lung transplantation. 184 23

Treatment of the cachetic, hypoalbuminemic, peritoneal dialysis patient represents a vexing patient management problem. In the past, when the cause of inanition was intractable vomiting secondary to gastroparesis, the solution was to create a transperitoneal percutaneous enterogastrostomy. This endoscopic procedure bypassed the nonfunctioning stomach and allowed for adequate nutrition. When hypoalbuminemia is present, the patient is predisposed to the possible complications of peritoneal sepsis, dialysis fluid leak, and wound dehiscence. The authors report a unique, enteric feeding tube that is a solution to the problem of continuing adequate, complication-free dialysis in a cachetic, hypoalbuminemic peritoneal dialysis patient with no available site for either temporary or permanent hemodialysis vascular access. The procedure does not violate the peritoneal cavity and has proven to be effective, acceptable to the patient, apparently safe, and easy for both staff and patient use.
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PMID:Retroperitoneal feeding tube for peritoneal dialysis patients. 251 71

Between January 1982 and December 1986, among the 750 patients with the acquired immunodeficiency syndrome (AIDS) who were treated at two adjacent hospitals in New York City, 78 (10.4 percent) needed evaluation for renal disorders. Reversible acute renal failure due to nephrotoxic injury, ischemic injury, or both was present in 23 patients (30 percent) (Group I). The remaining 55 (70 percent) had massive proteinuria, azotemia, or both (AIDS-associated nephropathy; Group II), and irreversible uremia developed in 43. In an additional 18 patients, all of whom had a history of intravenous narcotic drug use, AIDS was diagnosed after the initiation of maintenance hemodialysis for chronic renal failure (Group III). Survival for more than six months after the onset of chronic uremia occurred in only two subjects in Group II; all patients in Group III died within three months of the diagnosis of AIDS. Death in the patients in Groups II and III followed a syndrome of "failure to thrive" characterized by inanition unresponsive to intensive nutritional support and hemodialysis. In contrast, 8 of 17 patients with acute renal failure (Group I) and a serum creatinine concentration above 6 mg per deciliter regained renal function (serum creatinine level, less than 2.0 mg per deciliter). Four of the seven lived for 10 to 24 months, whereas the other four died of sepsis within a month. Our observations suggest that maintenance hemodialysis is not effective in prolonging life either in patients with AIDS-associated nephropathy and uremia or in patients with end-stage renal failure in whom AIDS develops during the course of maintenance dialysis. Hemodialysis may be useful in the management of potentially reversible acute renal failure in patients with AIDS.
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PMID:The types of renal disease in the acquired immunodeficiency syndrome. 356 58

Cachexia as a consequence of a catabolic state (stress metabolism) and cachexia as a consequence of too small food intake (inanition metabolism) have to be distinguished from each other fundamentally. A typical amino acid distribution in plasma, muscle, and liver can be observed in the protein catabolic patient. The glutamine metabolism seemed to be of special interest in the severe catabolic patient (e. g. sepsis). Glutamine is the amino acid with the biggest part of the free amino acid pool. This glutamine pool is reduced in the protein catabolic patient. A connexion seems to exist between the lower muscle glutamine concentration and the prognosis of the patient. The parenteral nutrition can stimulate the protein synthesis, but not suppress the protein hydrolysis. Perhaps catabolic factors as, for instance, interleucine I take part in that. These stimulate the protein hydrolysis over the prostaglandin metabolism.
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PMID:[Changes in protein metabolism in cachexia and catabolism]. 403 25

Eighteen patients with established malignant esophagorespiratory fistulas due to primary esophageal cancer were managed by substernal gastric bypass and isolation of the cancerous esophageal segment. Seven fistulas were esophagotracheal and 11 were esophagobronchial. Ten patients died in the hospital between two days and six weeks after operation. Eight patients left the hospital, surviving an average of 3 1/2 months, but 2 patients lived 5 and 7 months, respectively. Unrelenting respiratory infection and clinical inanition caused 7 hospital deaths in patients reestablished on oral alimentation with their fistulas disconnected. Anastomotic leaks occurred in 5 patients; three of these leaks closed. In the other 2 patients, cervicomediastinal sepsis and bilateral pneumonia with respiratory failure caused death. One patient died of anoxic cardiac arrest 48 hours postoperatively. Fifteen of the 18 patients resumed oral alimentation, but the overall results of palliative surgical therapy achieved in this series were not observably worthwhile for the majority.
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PMID:Pessimism concerning palliative bypass procedures for established malignant esophagorespiratory fistulas: a report of 18 patients. 619 80

Familial visceral neuropathy is a rare cause of chronic intestinal pseudo-obstruction. It is characterized by progressive destruction of the gastrointestinal myenteric plexus resulting in dysmotility and associated early satiety, post-prandial bloating, recurrent nausea and vomiting, abdominal distension, chronic diarrhea, weight loss, and malnutrition. In its varying forms, there may be neuronal destruction in other parts of the peripheral and central nervous system. We report on four siblings who presented in their third or fourth decades with initial clinical features of chronic intestinal pseudo-obstruction and eventual progressive diffuse neuronal disease, characterized by leukoencephalopathy and peripheral neuropathy. Within 5 yr of presentation, all four patients died from inanition and sepsis, despite aggressive nutritional support. Their clinical and pathological features are characteristic of familial visceral neuropathy of the autosomal recessive form. This presentation may represent a unique syndrome characterized by a tetrad of polyneuropathy, ophthalmoplegia, leukoencephalopathy, and intestinal pseudo-obstruction.
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PMID:Familial visceral neuropathy as part of a diffuse neuronal syndrome: four fatal cases in one sibship. 817 58

Six out of seven cuttlefish acquired by the Smithsonian National Zoological Park in July 1998 died before 1 November 1998. Postmortem examinations showed mantle ulcers, secondary bacterial infections, inanition, and cuttlebone fractures. The surviving cuttlefish developed a progressive focal mantle ulcer, was treated with oral chloramphenicol intermittently for 9 wk, and maintained a normal appetite and growth rate until death at 7 mo of age. The National Zoological Park pathology database showed signalments, histories, and causes of mortality of 186 common cuttlefish, each 1-14 mo old, that received gross and histologic examinations; for example, the largest group of cuttlefish of known sex, age, and body weight at postmortem were 7-9 mo old and weighed an average of 376.2 g (males, n = 18) and 299.0 g (females, n = 15). Many cuttlefish had multiple pathologic diagnoses. Significant diseases included inflammation and secondary bacterial infections, especially gastrointestinal, cardiovascular, respiratory, reproductive, and ophthalmic, and septicemia due to Vibrio spp. or other gram-negative bacteria. Mantle lesions, including ulceration/dermatitis, abscess/granuloma, necrosis/fibrosis/cellulitis, and laceration/abrasion/erosion, were also identified, along with inanition, cuttlebone lesions, and trauma. Mantle lesions were associated with secondary bacterial infections and death. On the basis of this information, if captive cuttlefish behavior creates risk for development of mantle lesions, administration of antibiotics effective against gram-negative bacteria may delay or halt disease progression. Cuttlefish exhibits require proper design, husbandry, economic resources, and staffing to minimize disease syndromes and mortality.
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PMID:Common cuttlefish (Sepia officinalis) mortality at the National Zoological Park: implications for clinical management. 1142 1

Causes of morbidity and mortality and a survey of infectious disease agents were collated from wild and colony-raised endangered Amargosa voles (Microtus californicus scirpensis). Six voles from the wild and 295 voles in the captive-breeding colony were included in the study upon identification of an infectious agent during screening, identification of clinical signs of disease, or finding a pathological condition or infectious agent on necropsy. Findings included 28 significant or incidental pathological conditions of seven organ systems and 19 parasitic, viral, bacterial, or fungal agents. Several voles captured in the wild had fungal osteomyelitis of the tail that disseminated systemically in a vole brought from the wild to the colony and may have been caused by a Penicillium sp. Three voles reintroduced from the colony to the wild experienced inanition and subsequent severe hepatic and moderate renal tubular lipidosis. The most common significant pathological conditions in colony-reared voles were chronic interstitial nephritis with proteinosis; cardiomyopathy; trichobezoars that, in intestines or cecocolic junctions, sometimes induced local rupture or infarction with peritonitis; multifocal gastrointestinal ulceration and colibacillosis; acute renal tubular necrosis or nephritis; sepsis; hepatic and renal lipidosis; molar apical elongation sometimes progressing to invasion of the calvarium; and mammary tumors. Uncommon diagnoses included intervertebral disc disease; microvascular dysplasia; and multifocal bacterial abscessation. Common or clinically important infectious agents included Demodex sp. mites in hair follicles, Demodex sp. in esophageal mucosa, and an outbreak of tropical rat mites thought to have been introduced via the straw bedding; gastrointestinal Helicobacter sp.; attaching and effacing Escherichia coli; and Citrobacter braakii, a possible zoonotic bacterium. This survey of species-specific diseases and pathogens was possible because the established health surveillance program that is part of the species recovery plan allowed for monitoring of voles throughout the duration of their natural life spans in captivity.
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PMID:DISEASE AND PATHOLOGICAL CONDITIONS OF AN ENDANGERED RODENT, MICROTUS CALIFORNICUS SCIRPENSIS, IN A CAPTIVE-REARING FACILITY AND IN THE WILD. 3192 5


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