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

The morbidity and mortality of hemodialysis by internal central venous catheterization in the subclavian and internal jugular positions are reviewed. A follow-up study was performed in our unit over 10 years (786 catheterizations). The most frequent complications were inadequate flow (7.6%) inadvertent withdrawal (5.6%) and bacteremia (5.1%). The overall complication rate was 27.2%. Kinking (p less than 0.001), bleeding (p less than 0.01) and bacteremia (p less than 0.05) occurred more frequently in patients with chronic renal failure, compared to patients with acute renal failure. Inadvertent withdrawal was the only complication observed more frequently in the internal jugular than in the subclavian position (10.8 vs. 4.3%; p less than 0.01). Bacteremia occurred more frequently after prolonged periods of catheterization (greater than 10 days). No fatal complications were observed. To obtain a more accurate idea about mortality, two supplementary large groups were studied: a review of 11 published series (1,542 catheterizations) and a questionnaire-based survey of 16 dialysis centers (approximately 4,000 catheterizations). Six fatalities were registered: 1 due to septicemia (in the literature review) and 3 due to traumatic perforation of the cardiac or the vessel wall, 1 to septicemia and 1 to air embolism (in the questionnaire-based survey). Based on the three different groups studied, the mortality of catheter dialysis could be estimated to be between 0 and 1.25/1,000 catheterizations.
Nephron 1987
PMID:Morbidity and mortality of central venous catheter hemodialysis: a review of 10 years' experience. 369 29

We have evaluated the incidence, prevalence, predisposing factors and evolution of urinary tract infection (UTI) developing late after transplantation in 63 patients whose graft had lasted at least 3 months and whose follow-up averaged 7 years. Beyond 3 months after transplantation incidence of UTI decreases progressively, from 25 to 0%, 50% of the patients remaining free of infection throughout the period of observation. Neither the original kidney disease except perhaps diabetic nephropathy nor the presence of vesicoureteral reflux were predisposing factors. Incidence and prevalence in females were twice that in male. Late UTI did not affect graft or patient survival, or graft function at 5 years. Most UTI were asymptomatic and had a benign course. However, in 3 patients septicemia or graft dysfunction ensued demonstrating the need for continuous monitoring of urine cultures.
Nephron 1985
PMID:Late urinary tract infection after transplantation: prevalence, predisposition and morbidity. 388 73

Two hundred subclavian dialysis catheters were placed in 148 patients who kept them in place for a total of 2,798 days. Catheterization time ranged from 1 to 79 days with an average of 14.0 +/- 1.0 days per catheter and 18.9 +/- 1.0 days per patient. Twenty nine catheters were infected, 17 of which were the source of bacteremias due to Staphylococcus epidermidis in 13 cases and to Staphylococcus aureus in 4 cases. The incidence of sepsis was not significantly greater in diabetic patients, in patients with corticotherapy or in patients presenting an underlying systemic disease. On the contrary, the incidence was greater in hospitalized patients (15 bacteremias during 1,948 catheter days) than in ambulatory patients (2 bacteremias during 850 catheters-days) as well as during a period corresponding to a greater number of untrained nurses enrolled in the dialysis team. During this period, 6 sepsies occurred in 19 catheters (other periods: 7 sepsies/116 catheters, p less than 0.01). 6 of 28 nurses had less than 3 months of professional experience (other periods: 1 of 25, p less than 0.01). These data underline the key role of nurse training in the prevention of catheter-related infections.
Nephron 1986
PMID:Infections associated with subclavian dialysis catheters: the key role of nurse training. 394 49

Diffuse crescentic glomerulonephritis was observed in a 40-year-old male patient who had a ventriculoatrial shunt implanted after a traffic accident 10 years previously. Immediately after treatment with immunosuppressants and plasma pheresis, signs of meningitis and septicemia developed. The responsible organism isolated was Staphylococcus albus. After the shunt was removed, clinical signs and renal function improved, associated with normalization of hypocomplementemia and disappearance of cryoglobulin and circulating immune complexes. Repeat renal biopsy performed 5 months after the removal of the shunt revealed mild mesangial proliferative and sclerotic glomerulonephritis with fibrous crescents. No apparent deposits observed in the initial biopsy were found on ultrastructural and immunofluorescent examinations. The reported cases with serial renal biopsies before and after the removal of the shunt were reviewed.
Nephron 1985
PMID:Shunt nephritis: histological dynamics following removal of the shunt. Case report and review of the literature. 400 Mar 30

Urine protein excretion patterns have been studied in 42 patients with sepsis and compared with that in 21 healthy controls. Patients with sepsis were shown to have highly significant increases in fractional clearances for beta 2-microglobulin, albumin, amylase and immunoglobulin G as compared with the controls. Analysis of the pattern of protein excretion demonstrates that the proteinuria is of the tubular rather than the glomerular type. There was no evidence that administration of aminoglycoside antibiotics contributed to the production of tubular proteinuria, and in particular these drugs did not appear to affect the excretion of beta 2-microglobulin.
Nephron 1982
PMID:Patterns of urinary protein excretion in patients with sepsis. 618 21

We describe 26 pregnancies in 19 patients with lupus nephritis. There were 4 spontaneous abortions, 2 therapeutic abortions, 4 stillbirths and 1 neonatal death. 10 deliveries were preterm and 2 fetuses were small for gestational age. 8 pregnancies were not accompanied by change of renal symptoms. Mild signs of renal involvement appeared during pregnancy in 4 patients. 6 patients showed an increase in proteinuria already present before pregnancy without renal function deterioration. A moderate worsening of renal function was observed in 3 patients. 4 patients, 3 of whom had an apparent onset of systemic lupus erythematosus during pregnancy, developed anuric acute renal failure after delivery or after late spontaneous abortion. 2 of them died from sepsis and disseminated intravascular coagulation while 2 had complete recovery of renal function. A high rate of complications was observed in patients not adequately treated during pregnancy. Renal biopsy before gestation was not predictive of the outcome of nephropathy during pregnancy, and change of histology in repeated biopsies was frequently observed.
Nephron 1984
PMID:Lupus nephropathy and pregnancy. A study of 26 pregnancies in patients with systemic lupus erythematosus and nephritis. 669 Oct 1

Monoarticular septic arthritis without disseminating sepsis occurred in 4 patients following renal transplantation. The septic arthritis was preceded by an infection with the same organism in an extraarticular location (3 urinary tract, 1 upper respiratory). All patients were on prednisone-azathioprine immunosuppressive regimen but none had granulocytopenia. Prompt antibiotic therapy resulted in quick resolution of the joint infection in 3 patients. Impaired host defenses, possible inadequate prior antibiotic therapy, and intrinsic joint alterations are potential contributing factors to the development of septic arthritis following renal transplantation.
Nephron 1982
PMID:Septic arthritis following renal transplantation. 704 16

The outcome and metabolic control was studied in 60 critically ill patients with acute renal failure (ARF) treated by continuous arteriovenous hemodiafiltration (CAVHD) in a single surgical intensive care unit. Mean age (+/- SEM) was 60 +/- 2 years with a male predominance (80%). The majority of patients required mechanical ventilation (83%) and/or vasopressor support (70%) and suffered from multiorgan failure [mean number of organ system failures 3.3 +/- 0.3 (range 1-6)]. CAVHD resulted in a rapid decline of serum urea and creatinine levels during the first 72 h (urea 47.4 +/- 2.3 to 30.3 +/- 1.4 mmol/l, p < 0.05, and creatinine 572 +/- 27 to 361 +/- 23 mumol/l, p < 0.05); thereafter, controlled steady-state levels were achieved with serum urea levels kept below 30 mmol/l with full protein alimentation and often despite hypotension, surgery and septicemia. Significant electrolyte derangements could be easily corrected and maintained within normal limits. Bicarbonate homeostasis could be restored within 48 h in patients with severe metabolic acidosis (HCO3- < 20 mmol/l) with use of bicarbonate as a buffering anion (17 +/- 0.5 to 23.2 +/- 0.6, p < 0.05). CAVHD allowed rapid removal of excess body and lung water (up to 5 liters/day) without hemodynamic instability. Despite a mean pretreatment APACHE II score of 26.5, 26 patients (43%) survived until discharge from the intensive care unit, of whom 23 (38%) survived to leave hospital. Requirement of mechanical ventilation or vasopressor support, higher APACHE II scores and septicemia were all associated with a poor prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)
Nephron 1995
PMID:High-risk surgical acute renal failure treated by continuous arteriovenous hemodiafiltration: metabolic control and outcome in sixty patients. 756 1

Although depressed endothelium-dependent relaxation occurs during early sepsis, the precise mechanism responsible for this remains unknown. Because the elevated levels of plasma tumor necrosis factor (TNF) play a major role in the pathophysiology of sepsis, we investigated whether TNF-alpha administration alters endothelium-dependent relaxation. To study this, recombinant TNF-alpha (1.2 x 10(7) U/mg) was infused intravenously (0.25 mg/kg body wt) for 0.5 h in normal rats, and mean arterial pressure was monitored. At 1 h after the completion of TNF-alpha or vehicle infusion, the aorta and a pulmonary artery were isolated, cut into 2.5-mm rings, and placed in organ chambers. Norepinephrine (2 x 10(-7) M) was applied to achieve near-maximal contraction, and dose responses for an endothelium-dependent vasodilator, acetylcholine, and an endothelium-independent vasodilator, nitroglycerine, were determined. In additional studies, aortic rings from normal animals were incubated with TNF-alpha for 2 h in vitro, and vascular reactivity was determined. The results indicate that TNF-alpha administration significantly reduced acetylcholine-induced vascular relaxation both in vivo and in vitro. Such a reduction was sustained at least 80 min after the completion of 2-h incubation with TNF-alpha. In contrast, TNF did not alter nitroglycerine-induced vascular relaxation. Thus TNF-alpha depresses endothelium-dependent relaxation in vitro as well as in vivo. Because TNF-alpha infusion increases plasma TNF levels without decreasing mean arterial pressure, the depressed endothelium-dependent relaxation observed during early sepsis may be due to the elevated circulating levels of TNF.
 ...
PMID:Administration of tumor necrosis factor-alpha in vivo depresses endothelium-dependent relaxation. 802 16

The association of a spondyloepiphyseal dysplasia and disproportionate short stature with focal glomerular sclerosis is reported in two girls. Renal disease manifested by proteinuria at the age of 2.5 and 11 years, leading to treatment-resistant nephrotic syndrome over 15 and 45 months, respectively. One patient went into end-stage renal failure shortly after nephrotic syndrome developed, the other died from sepsis. The association of spondyloepiphyseal dysplasia and focal glomerular sclerosis with nephrotic syndrome may represent a distinct disease entity.
Nephron 1994
PMID:Focal glomerular sclerosis and nephrotic syndrome in spondyloepiphyseal dysplasia. 813 43


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