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

The interrelationship between cytokines and their natural antagonists in patients with systemic sepsis are incompletely understood. We have followed the changes in serum levels of TNF-alpha and the two soluble receptors (TNF-sr) in a clinical model of post-operative sepsis. Serial blood samples were taken in patients undergoing percutaneous nephrolithotomy (PCNL) starting pre-operatively and continuing for 24 h thereafter. The levels of TNF-alpha and TNF-sr were raised in patients who became clinically septic and correlated well with the severity of sepsis (using the APACHE III score). In septic patients there was no difference in the pattern of changes in the two types of receptor (TNF-sr55 and TNF-sr75). However, in non-septic patients TNF-sr75 was higher in those with endotoxaemia than those without. This difference was not observed with TNF-sr55 which suggests a different mechanism of release or degree of sensitivity for the two soluble receptors. Regardless of severity of illness, the levels of all three molecules (TNF-alpha and the two receptors) appeared to start rising at about the same time point. The peak TNF-alpha level was reached earlier (2-4 h) than that of the two TNF-sr (4-8 h). The relative rise in TNF-alpha was greater than that of the soluble receptors and this difference was even more marked in those with more severe sepsis. The relationship between peak TNF-alpha and peak TNF-sr was non-linear and the concentration of each TNF-sr appeared to plateau at the higher levels of TNF-alpha. This suggests the exhaustion of a limited pool or saturation of the rate of release. Taken together, these results suggest sepsis develops because of delayed and insufficient secretion of TNF-sr compared with TNF-alpha.
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PMID:Kinetics of circulating TNF-alpha and TNF soluble receptors following surgery in a clinical model of sepsis. 905 Jul 53

In the relatively long history of man, surgery has been a comparatively recent development; the abdomen was first deliberately opened to remove an ovarian cyst by Ephraim McDowell in Kentucky in 1809. The first abdominal hysterectomy was performed by Charles Clay in Manchester, England in 1843; unfortunately the diagnosis was wrong and the patient died in the immediate post-operative period. The following year, Charles Clay was almost the first to claim a surviving patient, however she died post-operatively and it was not until 1853 that Ellis Burnham from Lowell, Massachusetts achieved the first successful abdominal hysterectomy although again the diagnosis was wrong. Vaginal hysterectomy dates back to ancient times. The procedure was performed by Soranus of Ephesus 120 years after the birth of Christ, and the many reports of its use in the middle ages were nearly always for the extirpation of an inverted uterus and the patients rarely survived. The early hysterectomies were fraught with hazard and the patients usually died of haemorrhage, peritonitis, and exhaustion. Early procedures were performed without anaesthesia with a mortality of about 70%, mainly due to sepsis from leaving a long ligature to encourage the drainage of pus. Thomas Keith from Scotland realized the danger of this practice and merely cauterized the cervical stump and allowed it to fall internally, thereby bringing the mortality down to about 8%. Hysterectomy became safer with the introduction of anaesthesia, antibiotics and antisepsis, blood transfusions and intravenous therapy. During the 1930s, Richardson introduced the total abdominal hysterectomy to avoid serosanguineous discharge from the cervical remnant and the risk of cervical carcinoma developing in the stump. Apart from this innovation, and the transverse incision introduced by Johanns Pfannenstiel in the 1920s, there was little advance in hysterectomy techniques until the advent of endoscopic surgery and the performance of the first laparoscopic hysterectomy by Harry Reich in Kingston, Pennsylvania in 1988. The refinement and increasing safety of laparoscopic hysterectomy suggests that it will be used increasingly in the future, although developments in pharmacology and photodynamic therapy and interventional radiology may reduce the traditional indications for the operation.
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PMID:Hysterectomy: a historical perspective. 915 33

12 surgical critically ill patients were studied for a better management of perioperative coagulation dysfunction. Their primary disease, clinical manifestation as well as some coagulation tests before and after therapy were retrospectively analysed. The result showed that secondary disseminated intravascular coagulation (DIC) is the main type of perioperative coagulation disorder, especially in decompensated hepatopathy and severe sepsis patients. It should be emphasized that: control of primary disease, effective drainage of focus, strict indication for 2nd surgical hemostasis and correct operation are required. For those hepatopathy with hypofibrinogenemia, some hemostatic drugs should be prohibited or very carefully used, in order to avoid the activation of plasmin and the exhaustion of fibrin. The early administration of heparin and aprotinin after the supplement of fibrinogen has shown a great potential benifit to stop the cascade of hypercoagulation and hyperplasminogenemia by enhancing the level of AT-III and fibrinogen in plasma.
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PMID:[Management of coagulation dysfunction in critically surgical patient]. 959 75

Access to the central venous circulation for hemodialysis has traditionally been achieved via the subclavian or jugular venous routes. With ongoing improvements in medical management, many hemodialysis recipients develop exhaustion of these routes and require alternative means of central venous access. Inferior vena caval (IVC) catheters have been placed with a percutaneous translumbar approach to allow central venous access for chemotherapy, harvesting of stem cells, and total parenteral nutrition. Translumbar placement of IVC catheters has become accepted by some as a useful and reliable alternative in patients who require long-term hemodialysis but have exhausted traditional access sites. IVC catheters have been placed in patients with IVC filters, and IVC filters have been placed in patients with IVC catheters. Complications include those associated with central venous catheters, for example, sepsis, fibrin sheaths, and thrombosis. A complication specific to placement of IVC hemodialysis catheters is migration of the catheter into the subcutaneous soft tissues, retroperitoneum, or iliac veins. Translumbar placement of IVC catheters is performed only in patients considered to have few or no other medical options and is not intended as a primary means of central venous access.
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PMID:Translumbar placement of inferior vena caval catheters: a solution for challenging hemodialysis access. 974 13

The small neutrophil reserve and exaggerated release of stored neutrophils are factors which predispose neonates to neutrophil reserve exhaustion during bacterial sepsis. Our objective is to try to improve in utero the myelopoietic function of the fetus before delivery. In the first series, recombinant human (rh) granulocyte colony-stimulating factor (G-CSF) (rhG-CSF; 100 microg/kg) was injected subcutaneously into rat fetuses at the indicated times to assess drug absorption and fetal response. In the second series, rhG-CSF (100 microg/kg) or saline (control) was injected into the fetuses once every other day to investigate the effect of repeated injections of rhG-CSF on enhancing fetal myelopoiesis preceding birth. Delivery was performed by cesarean section on embryonic day 21. The plasma concentration of G-CSF was determined by ELISA. The effect of rhG-CSF injection on granulopoiesis was assessed by measurement of the neutrophil count in the fetal peripheral blood and by histological examination of the fetal bone marrow, spleen, and liver. Fetally administered rhG-CSF enhanced fetal myelopoiesis preceding birth.
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PMID:Stimulation of fetal granulopoiesis by intrauterine injection of recombinant human granulocyte colony- stimulating factor into rat fetuses. 1032 40

This study was to evaluate the levels of the proinflammatory cytokine tumor necrosis factor alpha (TNF-alpha) and the cytokine inhibitors soluble TNF-alpha receptor (sTNFR) and interleukin (IL-1) receptor antagonist (IL-1ra), as well as the intensity of oxidative metabolism of peripheral blood polymorphonuclear leukocytes in the course of sepsis in newborns. An increase of TNF-alpha, sTNFR and IL-1ra concentrations was found in the blood serum of the patients at the time of diagnosis. This was further accompanied by polymorphonuclear leukocyte stimulation and, as a consequence of prolonged bacterial antigen stimulation, functional exhaustion of these cells and their diminished oxidative metabolism was observed. Within the same time period, an enhanced expression of p55 and p75 TNF-alpha receptors on polymorphonuclear leukocyte cell surfaces was found. It was indicated that the applied pharmacotherapy caused a decrease of the initially elevated concentrations of TNF-alpha and proinflammatory cytokine inhibitors (sTNFR, IL-1ra). The intensive therapy of sepsis was associated with the increased oxidative burst of polymorphonuclear leukocytes along with the decrease of p55 and p75 expression on their cell surfaces.
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PMID:Proinflammatory cytokine inhibitors, TNF-alpha and oxidative burst of polymorphonuclear leukocytes in the pathogenesis of sepsis in newborns. 1134 20

An estimated 15 million children under 5 die each year, most of them in developing countries. Some 1/2 million women die of causes related to pregnancy, leaving at least 1 million children orphaned. The World Fertility Surveys of the 1970s demonstrated the direct relationship between family planning and maternal-child health. Between 1985-2000, some 2 billion children are expected to be born, 87% of them in developing countries. Some 240 million will die before 5 years. The main causes of death in small children are acute diarrheal disease, respiratory infections, transmissible diseases preventable with vaccination, malaria, malnutrition, and high fertility. 3 aspects of reproduction have significant effects on child survival: spacing, parity, and maternal age. In 1986, approximately 2 million children under 5 died because of risks associated with rapid procreation, and it is estimated that 1/5 of all child deaths could have been prevented with longer birth intervals. Maternal exhaustion and the inability to give adequate care to several small children at once are believed to be the main causes. The problem of abortion or fetal death increases significantly beginning at the 3rd birth, and the proportion of low birth weight babies increases at the 4th birth. The risk of malnutrition increases in large families with limited resources. The safest ages for childbearing are 20-34 years; the worldwide infant mortality rate for mothers under 20 is about 126/1000. Adolescent mothers are at increased risk of problems in the pregnancy and delivery. Family planning can reduce risks related to spacing, family size, and maternal age, and also risk of congenital defects that increase for older mothers. According to the World Health Organization, each year there are some 500,000 maternal deaths, only 6000 of which occur in developed countries. Immediate causes of maternal death in developing countries include hemorrhage, sepsis, eclampsia, dystocic delivery, and induced abortion, but the underlying causes are related to the poor situation of the woman: poverty, illiteracy, lack of adequate prenatal health care, and childbearing at extreme ages. Estimates based on the World Fertility Survey suggest that if all women stating they wanted no more children used contraception, 30% of maternal deaths would be avoided. It is estimated that some 15 million women undergo induced abortions each year, with 100,000-200,000 resulting deaths.
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PMID:[Impact of family planning on maternal-child health]. 1215 88

A critical evaluation of the maternal deaths that occurred in the performance of 745 caesarean sections performed in the rural environment of India over the 1965-1973 period was conducted. During this period there were 20 maternal deaths, giving an incidence of 2.7%. In the series there were 11 moribund cases of placenta previa with history of internal examination done outside in 9 cases. Out of 5 deaths in obstructed labor, 4 were in group 2 (obstructed labor with pronounced effect on mother but with a living fetus) and 1 in group 3 (obstructed labor with dead fetus). Out of 4 deaths in secondary cervical dystocia, 3 were associated with prolapse and 1 with carcinoma cervix. The clinical condition at the time of section was severe anemia with shock and bleeding in 8 cases, features of exhaustion with or without evidence of sepsis in 10 cases and apparently normal in 2 cases. While there was no death in elective section, in emergency cases the mortality was 4.1%. With increasing duration of labor the risk was found increased from nil to as high as 6.8% where caesarean section was performed beyond 48 hours of labor. Shock, sepsis and embolism accounted for 75% of deaths. 7 of 20 deaths were within 6 hours of operation and as many as 9 deaths occurred after 72 hours. There were 13 stillbirths and 2 neonatal deaths out of 20 maternal deaths.
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PMID:A critical evaluation of maternal deaths in caesarean section met in rural obstetric practice. 1232 30

Hyperthrombinogenesis due to bacterial septicemia may aggravate the risk of irreversible septic shock. In 22 patients with septicemia complicating urinary or alimentary infections, daily assessment of hemostasis was performed throughout 1 week. Standard screening of hemostasis revealed significantly increased mean values of prothrombin time, fibrinogen, and fibrinogen degradation product (FDP) concentration. However, platelet counts, activated partial thromboplastin times (APTT), thrombin times, ethanol gelation tests, and antithrombin activity remained within the normal range. By contrast, except for insignificant changes in protein C activity and activated factor VII content, specific markers of plasma hypercoagulability, that is, thrombin-antithrombin (TAT) complexes, prothrombin activating factor F 1+2, activated factor XII (XIIa), and dimer D were all markedly increased. Pathologic levels of TAT and Xlla were found in 82% and 73% of all plasma samples, respectively. The augmentation of TAT correlated with prolongation of thrombin time and increases in F 1+2 levels. The increase in XIIa correlated with thrombocytopenia, prolongation of APTT, exhaustion of antithrombin, and accumulation of F 1+2 and FDP in the plasma. Moreover, a significant increase in XIIa, stronger positivity of the ethanol gelation test, a greater increase in FDP, and a more pronounced decrease in protein C activity were observed in 8 patients with fatal septic shock. This study suggests the usefulness of TAT and XIIa measurements in the early recognition of plasma hypercoagulation in serious infections.
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PMID:Plasma markers of hypercoagulability in patients with serious infections and risk of septic shock. 1236 Nov 99

The acronym DIC is commonly interpreted as "death is coming". This pessimistic view emphasizes the deficiency of available treatment options following diagnosis of disseminated intravascular coagulation. Clinically, DIC manifests as a systemic hemorrhagic disorder associated with widespread activation and eventual exhaustion of the coagulation system, although events underlying DIC also involve effectors of inflammation. DIC can be associated with diverse conditions including sepsis and major trauma and, when identified, signifies a significant worsening in prognosis and expected mortality. Although recent clinical studies have shown that activated protein C reduces mortality in patients with severe sepsis, there is a need for further investigation and a better understanding of the underlying mechanisms.
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PMID:Alternative treatments for disseminated intravascular coagulation. 1533 73


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