Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective study of 17 episodes of septic shock was made. In most patients, intravenous treatment involving a 2 gram bolus of Solu-Medrol produced a precipitous fall in temperature within four hours. Accompanying the temperature change was an improvement in their general physical condition. The hypothermic effect usually lasted approximately 30 hours, after which the temperature would reach a level below the presteroid temperature or would return to the presteroid level. If the sepsis was overwhelming and the patient did not survive, thetemperature response was not as dramatic and lasted approximately eight to ten hours, with no clinical improvement.
 ...
PMID:Steroid hypothermia. 65 72

Orthotopic cardiac transplantation has become established for selected infants with severe forms of congenital heart disease. This study reviews the combined experience and intermediate term results of infants undergoing orthotopic cardiac transplantation from Children's Memorial Hospital, Chicago, and Kosair Children's Hospital, Louisville. From June 1986 through December 1989, 20 orthotopic cardiac transplantations were performed in 19 patients. Sixteen patients had variants of hypoplastic left heart syndrome. One infant had anomalous origin of the left coronary artery with severe ischemic cardiomyopathy. Two infants had aortic stenosis with endocardial fibroelastosis, and one had extracorporeal membrane oxygenation as a bridge to transplantation. Immunosuppression included cyclosporine, azathioprine (Imuran), and corticosteroids with an effort to wean the patients from steroids by 6 months to 2 years. Three early deaths resulted--from technical errors in two patients and from hyperacute rejection in one patient at 3 days. Four late deaths have occurred. Two patients died at 2 and 13 months of acute rejection. One patient died at 15 months of acute rejection after retransplantation. One patient died at 7 months of respiratory syncytial viral pneumonia. The remaining 12 patients are surviving 5 to 47 months (means 20 months) after orthotopic cardiac transplantation. Rejection surveillance in the first 6 months is by clinical signs supplemented by echocardiography, electrocardiography, and cell cycle analysis; endomyocardial biopsy is used after 6 months of age. For the cumulative series, 24 episodes of suspected rejection have been treated during 277 at-risk patient months with intravenous methylprednisolone (Solu-Medrol) (n = 18) and monoclonal antibody (OKT3) (n = 6), for an incidence of 1.04 episodes of rejection per patient per year. Serious posttransplantation infections including endocarditis, catheter sepsis, meningitis, and colonic perforation were successfully treated in four patients. Subjectively, their quality of life is excellent as shown by normal growth and developmental milestones and a low hospital readmission rate (1.4 episodes per patient per year). These encouraging intermediate term results warrant continued application of infant orthotopic cardiac transplantation for severe forms of congenital heart disease.
 ...
PMID:Intermediate term results of infant orthotopic cardiac transplantation from two centers. 190 39

Live E. coli were infused i.v. in cats to induce gastrointestinal mucosal injury and the gastric mucosa was exposed to bile and a luminal pH of 1. A gastric lesion index was calculated and intestinal injury was graded. The effects of i.v. methylprednisolone before and after induction of bacteremia were compared with those of intragastric misoprostol combined with i.v. superoxide dismutase (SOD) and catalase and with a control group. Methylprednisolone, but not misoprostol/SOD/catalase, significantly reduced the gastric lesion index (p less than 0.05). The duodenum/small intestine was significantly injured in 4/6, 2/6 and 4/6 cats in the misoprostol/SOD/catalase, methylprednisolone and control groups, respectively (NS). End gastric luminal pH was 3.9, 2.7 and 4.5 in the respective groups (p less than 0.05), with systemic arterial pH 7.15, 7.15 and 7.32 (NS). Mean arterial pressure and cardiac output were improved with methylprednisolone. Misoprostol/SOD/catalase reduced late hypotension. Pulmonary arterial pressure rose to c. 200% of basal in all groups. Methylprednisolone, but not misoprostol/SOD/catalase, thus protected the gastric mucosa from sepsis-induced gastric injury concomitant with reduced disappearance of protons from the gastric lumen, but did not significantly affect small-bowel damage. Hemodynamic responses were significantly improved in methylprednisolone-pretreated cats.
 ...
PMID:Feline E. coli bacteremia--effects of misoprostol/scavengers or methylprednisolone on hemodynamic reactions and gastrointestinal mucosal injury. 211 Jul 10

Using a continuous i.v. infusion of E. coli endotoxin in spontaneously breathing pigs under ketamine anesthesia we have developed a lung injury model which closely mimics the pathophysiological and morphological changes of early ARDS induced by sepsis in man. Pretreatment with high doses of methylprednisolone largely prevented the pulmonary, cardiovascular and morphological features induced by the endotoxin. Methylprednisolone treatment initiated 2 h after starting the endotoxin abolished further derangements in pulmonary and cardiovascular functions and there was a restoration towards normal values. Both pretreatment and delayed treatment with methylprednisolone improved survival. Although one should be extremely cautious in extrapolating these data to the more complex clinical situation, the implications are that high doses of methylprednisolone, given early in the course of sepsis in man, may help to prevent both the pulmonary and cardiovascular derangements of this disease.
 ...
PMID:High-dose methylprednisolone in a porcine model of ARDS induced by endotoxemia. 391 10

Plasma fibronectin (PFN) depletion has been associated with poor outcome in patients with sepsis or those who have experienced trauma; restoration of normal levels appears beneficial. PFN synthesis is increased after cecal ligation even in malnourished animals with sepsis, implying that stimulation of endogenous PFN synthesis is possible. One hundred rats received either a single therapeutic agent (gelatin, heparin, indomethacin, urokinase, captopril, or endotoxin) or the combination of a cecal ligation and a single agent (cimetidine, methylprednisolone, epsilon-aminocaproic acid (EACA), or transaminomethyl cyclohexane carboxylic acid. PFN levels were measured by enzyme-linked immunosorbent assay at 0, 24, and 48 hours. Only endotoxin alone caused significant PFN elevation at 24 to 48 hours (p less than 0.01); however, its multiplicity of effects precludes localization of regulatory pathways. Methylprednisolone results in an accelerated rise in PFN levels after operation (p less than 0.05), probably through an intracellular augmentation PFN synthesis. EACA attenuates the postoperative response while transaminomethyl cyclohexane carboxylic acid augments the PFN rise. This effect of EACA implies the existence of a proteolytic fragment capable of stimulating PFN synthesis. If a nontoxic factor can be identified, the use of exogenous PFN may be avoided.
 ...
PMID:Modulators of plasma fibronectin response during sepsis. 637 57

The treatment for pulmonary edema with the adult respiratory distress syndrome is aimed at the early supportive management of hypovolemic shock. The addition of massive corticosteroid dosage, Methylprednisolone Succinate, of 30 mg/kg body wt/dose ever six hours for a 24-48 hour period has been shown in our investigation to be efficacious, particularly in the traumatic and septic shock groups of patients but not in patients with multiple system diseases. Ventilator care utilizing constant positive pressure breathing or constant positive airway pressure in the patient who has spontaneous respirations is of prime importance. The recent utilization of hyperalimentation has also been very effective as an adjunctive therapy and should be used in the management of this problem in the future in conjunction with the steroids. Hemodynamic monitoring employing the specific parameters as delineated in our discussion are all major steps that should be pursued on a routine basis in the vast majority of these patients. The most important factor in the prognosis of this condition is the severity and number of injuries that have occurred at the time of the initial trauma. Other factors affecting the outcome are age, prolonged shock, associated degenerative cardiovascular disease, metabolic imbalance, severe multiple system involvement, and sepsis. We now feel that the utilization of massive corticosteroid therapy is indicated with the first earliest clinical signs of this condition in order to attempt to prevent complications and probably improve survival rate.
 ...
PMID:Acute pulmonary edema with respiratory failure--newer concepts in therapy. 675 Nov 64

To test the hypothesis that sepsis causes in vivo changes in nutrient microcirculatory blood flow to gastric surface epithelium, cellular oxygenation (PO2), and transmembrane potential difference, measured by an ultramicroelectrode, were studied before, during, and after a 1-h intravenous infusion of live E. coli organisms. A "high-dose" infusion (1.0-1.4 x 10(10) organisms/kg) resulted in a hyperdynamic septic state; a "low-dose" infusion (0.3-0.7 x 10(10) organisms/kg) caused no significant systemic hemodynamic changes except a decline in mean arterial blood pressure. Both doses, however, caused a significant and persistent decline in epithelial PO2 and potential difference. The rate of fall was dose-related but was not related to total gastric blood flow, which remained normal with both high- and low-dose infusions. Treatment with methylprednisolone 30 min after the start of infusion ameliorated mucosal hypoxia and restored potential difference to normal; recovery was maintained for 2 h after the septic insult. Light microscopy of the gastric mucosa subjected to high-dose infusion showed focal and confluent interstitial edema with evaluation of surface epithelium away from dilated capillaries in the lamina propria near the apices of the faveoli. Methylprednisolone treatment completely prevented these changes. We conclude that hypoxia of gastric surface epithelium at a time when total gastric blood flow is normal reflects impairment of nutrient subepithelial microcirculatory blood flow. Decline in transmembrane potential difference before cellular PO2 reaches rate-limiting concentrations indicates that sepsis has a dual effect: direct inhibition of epithelial metabolism as well as redistribution of microcirculatory blood flow. Methylprednisolone provided dramatic protection to the canine gastric mucosa, enhancing microcirculatory blood flow to apical gastric epithelium, maintaining normal capillary permeability and protecting cellular function during and after sepsis.
 ...
PMID:Hypoxia of canine gastric mucosa caused by Escherichia coli sepsis and prevented with methylprednisolone therapy. 700 94

A prospective double blind crossover study was carried out in 65 patients comparing methylprednisolone (Medrol) and prednisone as immunosuppressive agents in clinical renal transplantation to determine their relative merits vis-a-vis graft survival, hypertension, weight gain, sepsis and patient preference in the posttransplant period. Patients receiving renal allografts were randomly assigned to receive initial treatment with one of the drugs. Once maintenance doses were employed, the drug was switched for a 3-month period. There was no difference in overall graft survival at 1 year, 68% versus 56% (p greater than 0.4), for the two patient groups. Likewise, there was no difference in blood pressure during the maintenance therapy crossover period, mean BP 129/86 during Medrol therapy and 129/86 during prednisone therapy. Overall weight gain was not statistically different with the two drugs, 3.8 kg with prednisone and 2.3 kg with Medrol, p greater than 0.1. However, when Medrol was used in the late posttransplant period, the patient had a significantly smaller weight gain, 0.95 kg versus 3.5 kg with prednisone, p greater than 0.05. The incidence of bacterial sepsis was significantly greater (p less than 0.02) during the early posttransplant period in those patients treated with Medrol. Finally, the majority of patients (65%) had no preference for either drug. Of those with a preference, the majority (69%) preferred Medrol. We conclude that therapy with Medrol does not offer superior graft survival, less hypertension or overriding patient preference but does apparently lead to an increased incidence of bacterial sepsis in the early posttransplant period. Thus it appears that prednisone is the initial drug of choice as an immunosuppressive steroid in clinical renal transplantation.
 ...
PMID:A prospective study of methylprednisolone and prednisone as immunosuppressive agents in clinical renal transplantation. 702 49

One hundred forty-seven patients with hematologic diseases and treated by allogeneic marrow transplants received graft-versus-host disease (GVHD) prevention with methotrexate and cyclosporine. In addition, 73 of the 147 patients were randomized to receive methylprednisolone during the first 35 days after transplant to improve GVHD prevention, whereas 74 patients were randomized not to receive methylprednisolone. The randomized trial enabled us to examine whether methylprednisolone increased the risk of infection after marrow grafting. Charts of study patients were analyzed retrospectively for infection events including bacteremia, septicemia, and fungemia. The randomization was stratified by diagnosis, patient age, genotypic HLA identity, and assignment to laminar airflow room isolation. All patients were given a short course of methotrexate (no longer than 11 days) and cyclosporine for no longer than 180 days after marrow transplantation. Methylprednisolone was begun on the day of marrow grafting at a dose of 1 mg/kg body weight intravenously in divided AM and PM doses through day 22. Methylprednisolone was administered at a dose of 0.5 mg/kg in divided doses from days 22 through 35, and then discontinued. Infections were analyzed for the time interval ending on day 65 after transplantation, which included the period of methylprednisolone administration and 1 month thereafter. Seventy-one episodes of first infection events were observed in patients receiving methylprednisolone compared with 47 episodes in patients not receiving the drug. Predominant infections were bacteremias, followed in descending order by fungemias and septicemias. The most prevalent organisms cultured were gram-positive bacteria, especially coagulase-negative Staphylococcus and Streptococcus species. Pseudomonas species were the most common gram negative bacteria, and the most prevalent fungus was Candida albicans. Multivariable Cox regression analysis showed that patients receiving methylprednisolone had a 1.5 times higher risk of infection (P = .03), with acute GVHD being another independent risk factor for infections (P = .005). Methylprednisolone, when added to GVHD prevention by methotrexate and cyclosporine, increases the risk of infection during the early posttransplantation period.
 ...
PMID:Increased risk of infection in marrow transplant patients receiving methylprednisolone for graft-versus-host disease prevention. 804 48

Sclerosing encapsulating peritonitis (SEP) is recognized as a serious complication of peritoneal dialysis. However, recovery is possible if an appropriate diagnosis and treatment are made. The term SEP is used most often, but is inaccurate, particularly the reference to peritonitis. A more accurate description would be "encapsulating peritoneal sclerosis" (EPS). From the therapeutic perspective, the diagnosis should be established before EPS develops. Early diagnosis is important. Furthermore, it is also important to determine the therapeutic tactics for EPS according to the disease stage. Most cases of EPS develop with manifestations of fever, increased levels of C-reactive protein (CRP), and slight ileus symptoms, accompanied by increased ascites ("inflammatory stage"). Following precise identification of the inflammatory stage, steroid administration should be initiated immediately with the onset of EPS. Methylprednisolone pulse therapy is recommended during the early stage. If the EPS is not relieved, or if it recurs within 1 month, the steroid dose should be decreased and the patient should be managed by total parenteral nutrition (TPN) ("encapsulating stage"). If ileus symptoms remain despite the absence of inflammatory findings and decreased ascites, laparotomy and enterolysis should be considered within 6 months ("ileus stage"). However, it is important that the enterolysis be performed without damaging the capsule-covered intestine. To date, we have successfully treated EPS in 18 of 19 patients using these options. In 3 patients, EPS was relieved by steroid administration. In 15 patients, EPS was relieved by total intestinal enterolysis. Enterolysis patients had satisfactory operative outcomes and eventually returned to their previous social activities. One patient experienced perforation of the small intestine and pan-peritonitis, and died of sepsis. In summary, EPS is not an incurable disease. It can be completely overcome by active diagnosis and treatment.
 ...
PMID:Treatment options for encapsulating peritoneal sclerosis based on progressive stage. 1151 Feb 76


1 2 Next >>