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

Cholecystitis is uncommon in individuals under 21 years of age and, when present, usually is associated with pregnancy, sepsis, metabolic defects, hemolytic anemia, or hereditary disorders. Over the past 4 1/2 years, 92 patients 20 years of age and younger have been admitted to our institution with gallbadder disease. Of these patients, 88 were female and 76 were of Mexican-American origin. Only two of these individuals had associated hemolytic anemia. Seventy-six of these females had been pregnant at least once, and 57 were more than 10 pound overweight. Cholecystectomy was done on 88 of these patients, and cholelithiasis was found in 86. There were 28 explorations of the common bile duct, 18 of which were positive. This series represents an earlier onset of cholelithiasis in this population.
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PMID:Gallbladder disease in patients 20 years of age and under. 98 5

In order to test the efficiency of wound protecting ring drapes and incisional drapes we carried out a prospective study of 283 patients, who underwent larger operations of the gastrointestinal tract from 1975 to 1979. Whilst complications of wound healing following operations of the upper gastrointestinal tract were not reduced, a reduction of the rate of secondary wound healing by 20% was achieved after operations on the large bowel. Overweight did not cause a higher rate of wound sepsis as it is usually the case when wound protecting drapes are not used. A further significant reduction of complicated wound healing could be observed after preoperative systemic application of antibiotics. This effect could not be stated when antibiotic prophylaxis was started after the operation.
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PMID:[Prevention of surgical wound infections by means of ring drapes]. 699 27

We assessed the clinical characteristics of newly-diagnosed diabetic patients presenting to the Mulago Hospital Diabetic Clinic for the first time between 1 January 1993 and 10 August 1994. There were 252 patients: 117 men and 135 women. Mean age at onset of diabetes was 45 years (range 2-87 years) and peak incidence was at 40-49 years. Body mass index (BMI) was available in only 71 patients, of whom 53.5% (33.8% female, 19.7% male) were overweight (BMI > 25 in women, in > 27 men) and 11.3% (8.5% men, 2.8% women) were underweight (BMI < 20). Obesity was more marked in young women. Almost all patients presented with the classical symptoms of diabetes, and the majority were severely hyperglycaemic. A family history of diabetes was identified in 16%. Concurrent illnesses at diagnosis of diabetes were unusual. Sepsis was commonest (11.9%), followed by malaria (7.8%), tuberculosis (1.2%), AIDS (1.2%) and pancreatitis (0.8%). Peripheral neuropathy was present in 46.4% of patients, hypertension (BP > 150/100) in 27.3%, impotence in 22.2% of the men, proteinuria in 17.1%, ischaemic heart disease in 4.8%, foot ulcers in 4.0% and cataracts in 3.2%. Insulin was the most commonly prescribed treatment (52.8%); 31% of patients received oral hypoglycaemic agents, only 15.1% were managed on diet only, and 1.2% opted for herbal medicine.
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PMID:The presentation of newly-diagnosed diabetic patients in Uganda. 891 47

Recurrence of hepatitis C virus (HCV) after orthotopic liver transplant (OLT) may be mild or may lead to progressive liver disease requiring retransplantation (re-OLT). Results of re-OLT for hepatitis C are not well known. We analyzed outcomes in 14 patients retransplanted for recurrent hepatitis C. All had evidence of recurrent hepatitis on multiple biopsies. Polymerase chain reaction (PCR) was performed in blood or tissue samples from 12 patients when recurrence was suspected; all 12 were positive for HCV-RNA. Explants showed chronic hepatitis with bridging necrosis in 3 patients, hepatitis with transition to cirrhosis in 2, hepatitis and cirrhosis in 3, and cirrhosis alone in 2. In 2 patients, in whom immunosuppression had been withheld for 4 to 6 weeks, there was also evidence of chronic rejection. Four died of sepsis perioperatively (median, 32.5 days; range, 9-59); pre-OLT, 3 of 4 had renal failure, and 1 had fever with no obvious source of infection. Ten patients did well early after OLT and were discharged. One patient was readmitted 6 weeks after discharge and died of cytomegalovirus (CMV) infection 127 days after re-OLT. One patient with concomitant vanishing bile duct syndrome, probably due to chronic rejection, developed recurrent hepatitis and died of progressive liver failure 161 days after re-OLT. Eight patients are well at a median of 926 days (range, 315-1930) after re-OLT. Three have evidence of mild recurrent hepatitis on liver biopsy, one is overweight with severe steatosis on biopsy, and four have no evidence of recurrent hepatitis. Retransplantation for hepatitis C should be considered a viable option for patients who develop end-stage hepatic dysfunction secondary to recurrent disease and should be performed before development of infectious complications and renal insufficiency.
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PMID:Retransplantation for recurrent hepatitis C. 934 26

Questionnaires intended to determine the factors involved in deaths in infants under 1 year have been completed in the province of Havana, Cuba, since 1980. The questionnaires are completed by obstetricians and pediatricians of the municipal health areas and analyzed at the secondary care level. This work examines the factors present in the 133 infant deaths occurring in Havana Province in 1983. The infant mortality rate in the province in 1983 was 14.1/1000 live births, the lowest ever recorded in the province. 74 of the deaths occurred in the early neonatal period, 13 in the late neonatal, and 46 in the postneonatal period. 22 of the early neonatal deaths were due to intrapartum anoxia, 15 to hyaline membrane disease, 10 to prematurity, 7 to bronchoaspiration, 3 to sepsis, 1 to bronchial pneumonia, and 13 to malformations. In the late neonatal and postneonatal periods, 11 deaths were attributed to acute diarrheal disease, 6 to meningitis, and 5 to accidents. 8 of the mothers were under 17 years old, 30 were 18-20, 57 were 21-30, and 16 were 31 or over. Maternal age was unknown for 22. 22 of the mothers were overweight, 29 were malnourished, 55 were of normal nutritional status, and the status of 27 was unknown. 67.7% of the early neonatal deaths were in low birth weight babies. Low educational level and rural residence were social factors in infant mortality.
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PMID:[Factors influencing infant mortality. Havana Province, 1983]. 1231 79

Surgical management of patients with concomitant carotid and coronary artery stenosis remains controversial. Our policy was always to perform at the same time carotid endarterectomy (CE) and coronary artery bypass grafting (CABG), but it was also considered that extracorporeal circulation (ECC), because of full heparinization, hemodilution, pulsatile flow, and hypothermia could provide better cerebral protection during CE. Retrospective data of 124 patients undergoing simultaneous CE and CABGs between January 1994 and December 2001 were reviewed. CE was performed prior to ECC in 65 patients (Group 1-mean age: 70.4 years; sex ratio: 49 male/16 female) and under ECC, prior to CABGs in 59 patients (Group 2-mean age: 69.9 years; sex ratio: 46 male/13 female). Overall hospital mortality was 7.3% (9/124): cardiac-related in 5 patients, or due to septicemia (1 patient), or ARD syndrome (1 patient), or stroke in two others. Univariate analysis demonstrated overweight, unstable angina, and emergency to be significant risk factors. Bilateral carotid stenosis was a significant risk factor of neurologic event when CE was performed prior to ECC (p < 0.05). In Group 1, mortality was 9.2% (6/65), and the incidence of neurologic events was 10.7% (7/65), and was responsible for two of the early deaths in patients with bilateral carotid stenosis. In Group 2, mortality was 5.1% (3/59) but never related to CE, while the neurologic morbidity was 1.7% (1 transient ischemic attack). It is concluded that (1) hospital mortality in patients undergoing simultaneous CE and CABGs was mainly cardiac-related. (2) The combined approach of both localizations appears to be mandatory, when carotid stenosis, even asymptomatic, was hemodynamically significant, or with ulcerative lesions likely to be responsible for embolism. (3) CE, first performed under ECC, appears to be a safe procedure, combining, in terms of cerebral protection, the benefits previously called up. This approach is all the more interesting when carotid stenosis is bilateral; hypothermia < or = 28 degrees C during the carotid clamping time is obviously the optimal method for cerebral protection when ipsilateral or contralateral supply is reduced, or even absent.
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PMID:Extracorporeal circulation as an additional method for cerebral protection in simultaneous carotid endarterectomy and coronary artery surgical revascularization. 1538 52

The problem of obesity has reached epidemic proportions in the USA. More than 50% of adults are obese or overweight. The only therapeutic intervention that provides effective long-term weight loss for the severely obese is bariatric surgery. Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the USA. Anastomotic leaks can cause life-threatening sepsis in the immediate postoperative period or delayed presentations with fistulas. Fibrin sealant and bovine pericardium have been used to reinforce the anastomosis in order to decrease the rate of this dreaded complication. This review will summarize current literature on the subject.
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PMID:Staple-line buttressing material in gastric-bypass surgery. 1629 71

An understanding of energy expenditure in hospitalized patients is necessary to determine optimal energy supply in the care of individuals who require nutritional support. A review was conducted of 19 studies in which resting energy expenditure (REE) had been measured using indirect calorimetry and compared with estimated basal energy expenditure (BEE) from the Harris-Benedict equation. Studies of patients with burns, head injuries, and fever were excluded because REE is known to be increased in these conditions. The studies reported data on 1256 patients with the following diagnoses: postoperative (28%), trauma or sepsis (26%), cancer (18%), pulmonary disease (9%), cardiovascular disease (2%), miscellaneous (9%), and unspecified (6%). The average REE in the 19 studies was 113% of the BEE. The mean +/- SD REE/BEE ratio was higher in 11 studies in which the REE was measured during feeding than in 5 studies in which the measurement was made during fasting (117% +/- 3% vs 105% +/- 4%; P = .047). In those 11 studies, overfeeding may have contributed to higher REE values than otherwise would have been observed. Some evidence indicated that the REE/BEE ratio is higher in more severe illness, but results were inconsistent. Unfortunately, little information is available concerning total energy expenditure, which includes the contribution of physical activity. It appears that most patients can be fed adequately with energy equal to 100% to 120% of estimated BEE. Hypoenergetic feeding may be appropriate in some overweight and obese individuals. Additional research in hospitalized patients on total energy expenditure and on the relationship between severity of illness and energy expenditure is needed.
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PMID:Energy expenditure in hospitalized patients: implications for nutritional support. 1677 Sep 81

Polytrauma mortality rates are continuously decreasing over the last years. Due to rising prevalence of obesity, patients with overweight and obesity are rising in numbers within the polytrauma collective. The body mass index (BMI) provides information about the nutritional status. Varying results have been reported concerning the effect of BMI on polytrauma outcome. Both obesity and underweight are independent risk factors for increased polytrauma mortality. While underweight is associated with early polytrauma mortality, obesity shows higher rates of multi organ failure and sepsis and is associated with late polytrauma mortality.
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PMID:[Nutritional status influences trauma outcome]. 2203 65

Metformin is generally recommended as first-line treatment in type 2 diabetes, especially in overweight patients, but in recent years new indications for its use have emerged. Metformin has been found to be safe and efficacious both as monotherapy and in combination with all oral antidiabetic agents and insulins. If metformin use during pregnancy and the lactation period is supported by few data, it could be indicated for women with polycystic ovary syndrome, since it could diminish circulating androgens and insulin resistance, thus ameliorating the ovulation rate. Metformin seems to reduce cancer risk, which appears to be increased in diabetics, and is a promising agent for oncoprevention and chemotherapy combinations. Moreover, metformin could find a place in the treatment of non-alcoholic fatty liver disease. Lactic acidosis could be decreased by avoiding metformin use in patients with hypovolemia, sepsis, renal impairment, hypoxic respiratory diseases and heart failure, in the preoperative period and before intravenous injection of contrast media.
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PMID:Metformin and its clinical use: new insights for an old drug in clinical practice. 2318 3


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