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

The early and late results were retrospectively evaluated in 57 cases of double or triple valve replacement or repair performed in 1970-1983. The causes of the valvular lesions were rheumatic fever (43 cases), bacterial endocarditis (6), syphilis (1) and unknown (7 cases). The preoperative NYHA classification was III in 29 patients and IV in 28, due mainly to dyspnea of effort. Cardiomegaly (mean radiologic volume 880 cm3/m2) and atrial fibrillation were the dominant clinical findings. Surgery was on emergency indications in five cases. Cold cardioplegia combined with external cardiac cooling has been used for myocardial protection since 1977. The valve replacements were 56 aortic, 50 mitral and 2 tricuspid. In addition there were three closed and two open mitral commissurotomies, two mitral plastic repairs, three tricuspid valve anuloplasties (DeVega) and one aortic anuloplasty. Follow-up (0.3-13, mean 3.5 years) was supplemented with a check-up including two-dimensional echophonocardiography and hematologic tests. The operative mortality (10/57 patients) fell from 26% in 1970-1976 to 12% in 1977-1983. The causes of death were low cardiac output in preoperatively ill patients (5), myocardial infarction (2), technical failure (2) and sepsis (1 case). There were 11 late deaths (6.7/100 patient-years of observation), the commonest cause (5 patients) being congestive heart failure. The respective incidences of thromboembolism, paravalvular leak and postoperative endocarditis were 2.1, 4.2 and 2.1 episodes/100 patient-years.(ABSTRACT TRUNCATED AT 250 WORDS)
Scand J Thorac Cardiovasc Surg 1985
PMID:Combined multiple-valve procedures. Factors influencing the early and late results. 401 39

Over the last 5 years, we have performed 34 axillopopliteal bypasses to salvage threatened limbs of patients in whom standard anatomic or extra-anatomic bypasses had either failed or were not feasible. The indications for these axillopopliteal bypasses, all of which were performed with 6 mm polytetrafluoroethylene grafts, were: (1) severe atherosclerotic disease of the common, superficial and deep femoral arteries which precluded use of these vessels for inflow or outflow for a standard vascular procedure (15 cases); (2) failed aortofemoral bypass with sufficient fibrosis or disease progression in the profunda femoris artery to prevent its use in a reoperation (7 cases); (3) insufficient hemodynamic improvement and failure to heal a foot lesion after an axillofemoral bypass (9 cases); and (4) sepsis in the groin from a previously infected bypass (3 cases). Graft patency was determined by objective measures. Cumulative life table graft patency rates were 77% at 1 year, 51% at 3 years, and 45% at 5 years. Although these rates are not as good as those for our axillofemoral bypasses (75% at 5 years), 22 limbs revascularized by axillopopliteal bypasses were salvaged with function for 1 year and 9 were salvaged with function for 2 years or longer in situations in which no option other than amputation was available. This justifies the continuing use of axillopopliteal bypass in an effort to salvage those limbs imminently threatened with amputation and in which no standard reconstruction is feasible because of disease or infection.
J Cardiovasc Surg (Torino)
PMID:Five year experience with axillopopliteal bypasses for limb salvage. 401 74

Breakdown of the closure of the main-stem bronchus after pneumonectomy is a dreaded complication, and empyema and bronchopleural fistula frequently develop in patients who survive. Management of these fistulas remains a formidable therapeutic challenge, which has been approached with a variety of surgical techniques. We report our experience with anterior transpericardial closure, emphasizing the ability to expose either main-stem bronchus by this approach. The case histories of three patients who had bronchopleural fistula after pneumonectomy are presented. The first patient had left pneumonectomy for complicated tuberculosis; the second had right pneumonectomy for neoplasm; and the third had right pneumonectomy for trauma. All fistulas were treated surgically via a median sternotomy and transpericardial approach to the distal trachea. The posterior pericardium was divided between the superior vena cava and aorta. In-continuity staple closure (with two lines of staples) of the proximal main-stem bronchus was employed in all cases. Two patients remain clinically well 21 and 17 months after the operation. The third patients did well initially but developed a recurrent bronchopleural fistula 2 1/2 months after the operation and has required repeat closure with pedicled muscle flaps. In postpneumonectomy bronchopleural fistula, the anterior, transpericardial approach to bronchial closure has several advantages: the relatively well-tolerated median sternotomy, the avoidance of dealing directly with areas of postoperative scarring and the devascularized bronchial stump, the avoidance of areas of chronic sepsis, and the avoidance of thoracoplastic surgical deformity of the chest wall, with possible associated compromise in pulmonary function. Our experience also indicates that either main-stem bronchus is accessible through an approach between the superior vena cava and aorta, without division of either pulmonary artery.
J Thorac Cardiovasc Surg 1985 Dec
PMID:Treatment of bronchopleural fistula after pneumonectomy. 406 31

The finding of mycotic aneurysms creates a major problem in surgery for both active bacterial endocarditis and prosthetic valve endocarditis. The value of local treatment of such aneurysms by a suspension of fibrin glue and an antibiotic was examined in an animal study since a previous in vitro investigation had indicated that such a suspension may discharge sufficient quantities of the antibiotic for up to 12 days. In 3 groups of 6 rabbits each, the entrance to the left atrial appendage was occluded subtotally. The endothelium within the cavity thus created was mechanically injured and the tip of a thin transthoracic catheter was placed in the cavity. In all animals, aliquots of staphylococcus aureus were injected through the catheter. All rabbits developed fever, and positive blood cultures were obtained in 16. The animals in group 1 were left without treatment. All 6 animals lost weight progressively, 4 animals died from sepsis, 2 rabbits were sacrificed after 6 days. Active endocarditis was demonstrated by histology and bacteriology in each animal. In group 2, 12.5 mg cephalotin were injected via the catheter 24 hours after the infection. Four animals died from sepsis, one rabbit had a positive tissue culture, and only one animal was free of infection on postoperative day 10. In group 3, 12.5 mg cephalotin suspended in fibrin glue was injected via the catheter 24 hours after the infection. All animals survived, became afebrile and resumed gain of weight. At autopsy after 10 days no infection was detectable. We conclude that a suitable antibiotic suspended in fibrin glue may allow for the sterilization of mycotic aneurysms in bacterial endocarditis.
Thorac Cardiovasc Surg 1984 Dec
PMID:A suspension of fibrin glue and antibiotic for local treatment of mycotic aneurysms in endocarditis--an experimental study. 608 32

Traumatic aneurysms and arteriovenous fistulas may be as common in the developing and less industrialized countries as they are in the developed countries. In a 4 year period 12 cases of traumatic aneurysms and arteriovenous fistulas were seen at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Nine of these resulted from civilian injuries while 3 were due to military activities. The femoral vessels were involved in 7 cases while the extracranial carotid arteries were injured in 2 cases. Gunshots accounted for 6 lesions. Metal fragments and knife stabs were responsible for 2 cases respectively. All the 3 arteriovenous fistulas involved the femoral vessels--2 superficial and one deep. The vascular lesions were assessed by arteriography in 9 cases. All but one case were treated by excision, the vessels being reconstructed in 7 cases. There was one death due to septicemia.
Thorac Cardiovasc Surg 1980 Aug
PMID:Traumatic aneurysms and arteriovenous fistulas in Nigeria. 615 30

Twenty-six patients with tricuspid atresia (15), univentricular heart (7), and single ventricle (4) underwent 27 Fontan or modified Fontan procedures between 1975 and 1981. The age of the patients varied between 4 and 26 years. Twenty patients had had a total of 33 palliative operations prior to correction. The original Fontan procedure was performed in 10 patients from 1975 to 1977. According to the various anatomical findings modifications of the Fontan procedure, such as direct anastomosis or implantation of a valveless conduit, were introduced in 1977. Early mortality among all the patients was 22% (6 patients died). Three deaths occurred in the initial period 1975 to 1977. Among the last 20 patients (1978 to 1981) there were 3 early deaths. Three patients with single ventricle survived, one died due to pulmonary failure. There were 2 late deaths (sepsis, sudden cardiac death). Postoperative cardiac catheterization performed in 17 patients revealed excellent results in 13 patients; the remaining 4 displayed diminished arterial oxygen saturation, three of them had Glenn palliation prior to corrective surgery. Postoperative right atrial mean pressure varied from 10 to 23 mmHg. The left ventricular parameters were within the normal range.
Thorac Cardiovasc Surg 1981 Dec
PMID:Fontan procedure--indication and clinical results. 617 16

The results of 100 patients with primary active infective endocarditis treated surgically are presented. Hospital and late mortalities as well as postoperative complications in patients operated electively and not showing paravalvular infection approach those of routine procedures while frank circulatory failure and uncontrolled sepsis were associated with high death and complication rates. Paravalvular extension of the infection was associated with frequent postoperative leakage, reoperations and mortality. The present operative choices in eradicating paravalvular disease are described and the great importance of early operation is stressed.
Thorac Cardiovasc Surg 1982 Dec
PMID:Surgery for active infective endocarditis. 618 90

The incidence and causes of infectious complications after pleuro-pulmonary surgery occurring in our institution before 1968, from 1968 to 1975, and from 1978 to 1979 are compared. Soft tissue infections occurring in the operative region, in the pleural cavity and in the remaining lung tissue are assessed separately. From these data it is concluded, that infections of soft tissue have markedly decreased from 7 to 2% while secondary wound healing without purulent infection has fallen from 21% to 5%. The risk of infection thus has decreased below the average figures of general surgery. A comparatively high number of wound infections however, have to be expected after decortication of thoracic empyema. The incidence of postoperative empyemas predominantly related to postoperative bronchial fistulae after lung resection has decreased from 4% to one percent in segmental or lobar resections. Serious infections of the remaining lung with abscess formation have become rare indeed (0.2%). Inflammatory atelectasis caused by bronchial obstruction has remained at a constance level of one to 2% throughout the years. There were 2 cases of lethal bacterial sepsis in 1,566 pulmonary procedures before 1973, but none thereafter. Increasing attention will have to be paid to mycotic superinfections rather than to primary bacterial infections since such superinfections of the tracheo-bronchial tree and of the pleural cavity have increased from less than one percent to approximately 3% during the recent 10 years.
Thorac Cardiovasc Surg 1983 Apr
PMID:Infections after pleuro-pulmonary surgery. 619 Feb 53

Over a 2 year period ending in April, 1981, 268 premature infants with birth weight below 1,750 gm underwent operation for a "hemodynamically significant" patent ductus arteriosus. Operations were performed in 13 centers participating in a collaborative study, which was primarily designed to evaluate the role of indomethacin in the management of patent ductus arteriosus. No patient died during the operations, which were done at a median age of 10 days. Eight infants (3%) died within 36 hours after operation. In only one was the death directly attributable to the operative procedure. Hospital mortality (23%) and postoperative morbidity, which included bronchopulmonary dysplasia, pneumothorax, and sepsis, were unrelated to birth weight, age at operation, and degree of preexisting pulmonary disease or preoperative treatment of the infant with indomethacin. Results indicate that surgical ligation is a safe and effective procedure for treating patent ductus arteriosus with large left-to-right shunting in small premature infants.
J Thorac Cardiovasc Surg 1984 Jun
PMID:Surgical closure of patent ductus arteriosus in 268 preterm infants. 637

To evaluate the effect of antibiotic prophylaxis in pacemaker surgery, 100 patients were randomly assigned to a prophylaxis group receiving cloxacillin or to a control group with no antibiotics. Cloxacillin was given intravenously (2 g) 2 hours before operation, followed by 1 g every 6 hours for 2 days and the same dose perorally for 8 more days postoperatively. Adequate plasma concentrations were obtained in all patients. The follow-up time was 1-43 months. The infection rate was 2% (1/50) in the prophylaxis group and 14% (7/50) in the control group (p less than 0.05). The interval from operation to manifest infection was 9-35 days. In the control group the causal microorganism was Staphylococcus aureus in two patients, Staphylococcus epidermidis in two and unknown in three patients. In the only patient with infection in the prophylaxis group, a methicillin-resistant S. epidermidis was isolated. Infection was initially localized to the pacemaker pocket in seven patients, but septicemia developed in one of them and endocarditis in another. In one patient septicemia appeared initially, without local signs of infection. This study suggests that cloxacillin prophylaxis is of value in routine pacemaker surgery.
Scand J Thorac Cardiovasc Surg 1984
PMID:Antibiotic prophylaxis in pacemaker surgery--a prospective study. 639 39


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