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

The electrically driven Novacor implantable left ventricular assist device has been implanted in six patients (four men and two women) since Sept. 7, 1984. In four of the six patients (67%) the device was a successful bridge to cardiac transplantation. One patient died of multiple organ failure and Candida sepsis after 16 days of support with the device. One patient died in the operating room of uncontrollable hemorrhage and biventricular failure caused by severe cardiac rejection. Three patients are alive with cardiac transplants 38, 17, and 10 months after transplantation. One patient died after cardiac transplantation of presumed sepsis. The Novacor left ventricular assist device performed in all cases without mechanical or electrical failure. Excluding the intraoperative death, assist duration ranged from 2 to 16 days. The cardiac index (synonymous with device output) ranged from 2.4 to 3.4 L/min/m2. No embolic events (cerebrovascular or systemic) occurred during assistance with the device. Minimal red cell hemolysis was documented during the period of support. The Novacor left ventricular assist device is a safe and effective bridge to cardiac transplantation in patients with refractory cardiogenic shock.
J Thorac Cardiovasc Surg 1988 Jul
PMID:Isolated left ventricular assist as bridge to cardiac transplantation. 329 May 89

Widespread use of antibiotics and change in pathogenesis altered the bacteriology of infected aortic aneurysms. In the past, bacterial endocarditis was the major source of emboli infecting the aorta. Now, gram-negative sepsis in elderly patients is often the initiating event of infection in atherosclerotic aneurysms. Four cases of gram-negative infection in aortic aneurysms were treated. The etiology, presentation, and surgical management are reviewed. Three abdominal aortic aneurysms were infected during urinary tract sepsis and one infection occurred with Salmonella septicemia. The clinical triad of fever, abdominal pain, and a pulsatile abdominal mass led to a preoperative diagnosis in three of four patients. Debridement of infected tissue and bypass through non-infected tissue planes remain the cornerstones of modern surgical management. Despite prompt diagnosis and proper surgical management, the mortality of gram-negative aortic infection remains high because of early rupture and extensive atherosclerotic disease.
J Cardiovasc Surg (Torino)
PMID:Gram-negative bacterial infection of aortic aneurysms. 329 84

Thirteen myoplasties using the sartorius muscle were performed on 12 patients from 1980 to 1985 for "healing problems" in the groin with subjacent synthetic grafts. Persistant aseptic lymphorrhea was the indication for 4 patients. In 3 other cases, bacterial cultures from the wound were positive. In 2 other patients there was clinical evidence of sepsis with purulent discharge from the wound and an exposed graft. In 3 cases myoplasty was used as a preventive measure after reoperation on patients in poor general condition. Follow-up extends from 3 to 54 months. There was only one recurrence observed at 19 months which was successfully treated by segmental resection of the infected graft and insertion of a new prosthesis through the obturator canal. No recurrence was observed among the other patients as judged by clinical observation and biological tests for inflammation, echotomography, CT scan and indium scintigraphy. The treatment of choice for an infected prosthesis should be removal of the graft and extra-anatomic bypass in the majority of cases. However in some situations, excision of the wound and myoplasty using the sartorius muscle may be of some value and needs further evaluation.
J Cardiovasc Surg (Torino)
PMID:Treatment of lymphorrhea with exposed or infected vascular prosthetic grafts in the groin using sartorius myoplasty. 333 77

In a patient who died of complications of severe pulmonary hypertension, right ventricular failure, and sepsis, antemortem two-dimensional (2-D) echocardiography and magnetic resonance imaging (MRI) studies demonstrated a right ventricular mass which at autopsy proved to be thrombus. The diagnostic features of this mass as imaged by these two methods are compared. This case was complicated in that the patient had a history of right atrial myxoma that had been successfully removed three years previously, and a history of several prior pulmonary emboli. Gated MRI depicted the size, shape, and surface characteristics of the mass more clearly than 2-D echocardiography because MRI provided better contrast and spatial resolution. Both techniques were useful in localizing the mass and showing if it was fixed or mobile. Depiction of tumor attachment was unclear with echocardiography but very clear with MRI. MRI also showed a left pulmonary artery thrombus that was not visualized by 2-D echocardiography. Both techniques provided chamber dimension measurements showing enlargement of the right atrium and ventricle. This case demonstrates that gated MRI provides high-quality images of cardiac anatomy and masses. Gated cardiac MRI should be considered at least complementary and potentially superior to two-dimensional echocardiography in the evaluation of intracardiac masses in certain patients.
Cathet Cardiovasc Diagn 1988
PMID:Comparison of gated cardiac magnetic resonance imaging and two-dimensional echocardiography for the evaluation of right ventricular thrombi: a case report with autopsy correlation. 339 69

Polyvinylpyrrolidone-iodine (PI) is a widely used antiseptic agent, safe and effective, in the treatment and prophylaxis of wound sepsis. By continuous irrigation it is frequently used to treat suppurative mediastinitis after median sternotomy. We describe a 63 year old woman with a suppurative mediastinitis, treated with continuous PI irrigation who developed an acute oliguric renal failure. The withdrawal of PI was followed by a complete improvement of renal function. Herein we present our case and a review of the literature about the systemic toxicity of PI.
J Cardiovasc Surg (Torino)
PMID:Acute renal failure in a patient treated by continuous povidone-iodine mediastinal irrigation. 341 39

Secondary aortoenteric fistula may be treated directly by local repair or by excision of all prosthetic material with extra-anatomic revascularisation. We have reviewed our experience with 14 aorto-enteric fistulae encountered between 1960 and 1984. Two patients who were not treated surgically died. Direct repair was attempted in seven patients, two of whom had no prosthetic material present and survived. Five patients had prosthetic grafts which were not removed and four died from recurrent aortic haemorrhage. There were five other patients who had prosthetic grafts which were removed prior to extra-anatomic reconstruction. Three of these died in the peri-operative period, two from sepsis but only one from aortic stump bleeding. The operative mortality was 58%. The overall survival was only 36% (5 of 14 patients) but there was less chance of recurrent aortic haemorrhage when all prosthetic graft material was removed and direct repair avoided.
J Cardiovasc Surg (Torino)
PMID:Lessons learnt in the management of aortoenteric fistulae. 349 41

In a randomized prospective study, two different regimens of antibiotic prophylaxis have been tested: four-day cefazolin prophylaxis (Kefzol 0.5 gr every 6 h) compared with two-day cefuroxime administration (Zinacef 1.5 gr every 12 h). A total of 569 patients in the two groups were studied in a 10 month period. Haematological, liver function, serum creatinine and urea measurement were made preoperatively and repeated daily for the first four days and after one week. At least five chest X-rays were taken during the hospitalisation. Body temperature was measured regularly every two hours in the ICU and a least twice a day thereafter. The wounds were examined daily and the patients were carefully observed for other infections. Bacteriological examinations of the tips of all inserted catheters and pacemaker wires were undertaken on removal in the first four months of the trial. Swabs of any tracheal or wound secretion or pus taken for bacteriological examinations as also blood cultures in any suspected septicaemia. Of the 569 patients three had to be withdrawn from the study. Of the assessable ones 285 received cefuroxime and 281 were given cefazolin. Seven patients (1.2%) died postoperatively. The total infection rate was 5.5%: 5.7% in the cefazolin group and 5.3% in the cefuroxime group. The overall wound infection rate was 1.8%: 2.5% in the cefazolin group and 1.1% in the cefuroxime group. Septicaemia occurred in 0.5% of the cases. Pneumonia occurred in 11 (1.9%) patients; 1.5% in the cefazolin and 2.5% in the cefuroxime group. Seven patients (1.2%) developed a urinary tract infection; 1.4% in the cefazolin group and 1.1% in the cefuroxime group.(ABSTRACT TRUNCATED AT 250 WORDS)
J Cardiovasc Surg (Torino)
PMID:Perioperative antimicrobial prophylaxis in cardiovascular surgery. A prospective randomized trial comparing two day cefuroxime prophylaxis with four day cefazolin prophylaxis. 351 30

Improvements in both mechanical circulatory support devices and immune therapy promise a wider use of sequential mechanical support as a bridge to orthotopic cardiac transplantation. The intra-aortic balloon pump, the left and right ventricular assist pumps, and the pneumatic artificial heart represent the range of devices capable of keeping a patient alive who is awaiting a donor organ. The major difficulty in using circulatory support devices is infection, which is caused by their required percutaneous tubes. We report here our experiences with mechanical circulatory support devices as a bridge to cardiac transplantation. In a series of 31 consecutive transplant procedures, six patients have required preoperative mechanical circulatory support. The intra-aortic balloon pump was used in two patients for 2 and 14 days, respectively, before transplantation. Both patients are well 10 and 11 months after the transplant procedure. Two patients required the left ventricular assist device for 11 and 21 days and are alive 3 weeks and 8 months, respectively, after transplantation. One patient was supported by the pneumatic artificial heart for 10 days before a donor heart became available but died of septic shock 17 days after transplantation. A second patient received a pneumatic artificial heart 7 days after transplantation when the heart transplant failed. He has been in stable condition for 45 days but is recovering from renal failure. Our early experiences indicate that either partial or total mechanical support as a bridge to transplantation is successful if overwhelming sepsis or renal failure can be avoided.
J Thorac Cardiovasc Surg 1986 Dec
PMID:Mechanical support of the circulation followed by cardiac transplantation. 353 35

Ten infants with critical aortic stenosis underwent transventricular valvotomy between November 1983 and September 1984. The ages of the patients ranged from 1 to 38 days (mean 21.2 days). Three patients were less than 1 week of age. One had undergone a previous valvotomy performed with inflow occlusion. Most infants were critically ill when admitted to the hospital, six required inotropic and ventilatory support, and two had peritoneal dialysis before the operation. Transventricular valvotomy was performed through a left thoracotomy with Hegar dilators. Postvalvotomy peak-to-peak gradients ranged from 0 to 35 mm Hg. Three patients died at 2, 3, and 6 weeks after operation. A severe degree of endocardial fibroelastosis was present in one patient, and a second patient died of septicemia caused by wound infection, empyema, and a bronchopleural fistula. Severe left ventricular hypertrophy, with moderate fibroelastosis, was found at autopsy in the third patient. Aortic incompetence was not detected postoperatively. One patient required reoperation 7 months after the transventricular valvotomy. Transventricular valvotomy has proved to be a simple and effective technique to relieve aortic stenosis in sick infants. It permits the correction of associated coarctation of the aorta and avoids a median sternotomy. Results are comparable with the results obtained with either cardiopulmonary bypass or inflow occlusion as seen in both our experience and in the experience of others.
J Thorac Cardiovasc Surg 1987 Apr
PMID:Transventricular aortic valvotomy for critical aortic stenosis in infants. 356 Oct 1

Fifteen pediatric patients (ages 5-17 years) with renovascular hypertension (RVH) are reported. The diagnosis was made by arteriogram in all patients as the intravenous pyelogram was not helpful in this group. Five patients had a coarctation of the abdominal aorta. Four of these had associated renal artery stenosis. Renal artery stenosis alone was present in 14 patients, unilateral in 8, and bilateral in 6. Three of the former had a contralateral hypoplastic kidney. A nephrectomy was performed in 2 patients, both of whom continue to be hypertensive. Renal revascularization was performed in 13 patients; one of these died of sepsis. Eight are normotensive, 2 are improved (normotensive with diuretics), and 2 remain hypertensive. The follow-up is from 1 to 15 years.
J Cardiovasc Surg (Torino)
PMID:Renovascular hypertension in pediatric patients. 365 34


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