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

The effect of hemodilution upon lymphocyte transformation was studied in vivo. 20 p.c. of circulating blood volume was replaced by Hydroxyethylstarch 450,000 6%, (HES 450) and 24 hours later but prior to surgery lymphocyte transformation using PHA was not substantially changed. These findings were in accord with previous in vitro studies. There appeared to be no significant change of the total lymphocyte count, alteration of serum proteins seemed to be proportional presenting a mere dilutional phenomenon. It can thus be concluded that hemodilution does not impair cellular immune defense nor increase the risk for patients prone to sepsis or spread of malignancy.
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PMID:Lymphocyte transformation and isovolemic hemodilution with hydroxyethylstarch 450,000. 619 Jul 50

The indications, pharmacology, adverse reactions, clinical studies, dosage, and cost of hetastarch are reviewed. Hetastarch is a plasma volume expander used in adults for the treatment of shock caused by hemorrhage, burns, surgery, sepsis, or other trauma. It is a heterogenous macromolecular agent derived from starch and is composed primarily of amylopectin. The usual dose of 6% hetastarch is 500-1000 ml; total dosage should not exceed 1500 ml/day (20 ml/kg). The dose of hetastarch should be adjusted for patients with severe renal impairment because its major route of elimination is the urine. Adverse reactions associated with its use are minor defects in coagulation produced with recommended doses and dose-related hematologic abnormalities with infusions greater than 1500 ml. Elevations in serum alpha-amylase and indirect bilirubin levels have also been reported. Hetastarch appears to be comparable with albumin as a plasma volume expander and is substantially cheaper. Few controlled studies with hetastarch have been published, and more data are needed to evaluate its effectiveness compared with other plasma volume expanders.
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PMID:Evaluation of hetastarch. 619 62

Hydroxyethylstarch (HES) is being used increasingly in clinical hemorrhagic shock. Since patients in shock are at high risk of subsequent infection, concern has been voiced about possible adverse effects of HES on the reticuloendothelial system (RES) and host defenses against sepsis. We examined this issue in male albino Holtzman rats given HES or saline (60 ml/kg) i.v. RES function was evaluated 24 and 48 h after HES administration by measuring the intravascular clearance rates (t/2) and organ retention of 131I-triolein lipid emulsion. Neither the intravascular clearance rates nor organ retention of the lipid emulsion was affected at 24 or 48 h after HES. In another group of rats, sepsis was produced by cecal ligation and puncture 2 d after HES or saline infusion. The survival rates were 41% and 43%, respectively, in the saline- and HES-treated animals. These studies reveal no deleterious effects of a clinically relevant volume of HES on either RES function or host resistance to sepsis.
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PMID:Hydroxyethylstarch administration does not depress reticuloendothelial function or increase mortality from sepsis. 620 35

Newer, minimally invasive catheter-based endovascular technology utilizing stent grafts are currently being evaluated for abdominal aortic aneurysm (AAA) repair. A retrospective review of all (3 years) consecutive, non-ruptured elective AAA repairs was undertaken to document the results of AAA surgical repair in a modern cohort of patients to allow a contemporary comparison with the evolving endoluminal data. One hundred twenty-one AAAs were identified in a male veteran population. Mean age was 68.5 +/-7.7 years. Medical history review showed hypertension in 55%, heart disease in 73.5%, peripheral vascular disease in 21%, stroke and transient ischemic attacks in 22%, diabetes mellitus in 7%, renal insufficiency in 10%, and smoking history in 80%. The AAA size was documented with ultrasound (5.2 +/-1.3 cm, n=40) and computed tomography (5.6 +/-1.3 cm, n=100). Fifty-nine percent had angiography. Intraoperative end points included an operative time of 165 +/-6.3 minutes from incision to dressing placement. A Dacron tube graft was used in 78%, the remaining were Dacron bifurcated grafts. A suprarenal clamp was used in 8% for proximal aortic control with juxtarenal aneurysms. A pulmonary-artery catheter was placed in 69%. A transverse incision was used in 69% of patients and a midline incision was used in the rest. Estimated blood loss was 1505 +/-103 mL; cell saver blood returned 754 +/-53 mL; crystalloid/Hespan 4771 +/-176 mL; banked packed red blood cells 0.75 +/-0.11 U. Time to extubation was, in the operating room (78.5%), on the day of the operation (5.0%), postoperative day (POD) 1 (12.4%), POD2 (1.7%), POD3 (0.8%), and one case was performed with epidural anesthesia only. Postoperative end points included a 30-day mortality rate of 1.6% (two patients). Postoperative morbidity included wound dehiscence 0.8%; sepsis, urinary tract infection, wound infection, leg ischemia, ischemic colitis, and stroke each had an incidence of 1.6%; myocardial infarction, congestive heart failure, pneumonia, re-operation for suspected bleeding, and ileus or bowel obstruction occurred with an incidence of 3.3%. No significant increase in serum creatinine levels was noted. Time to enteral fluids/nutrition was 3.5 +/-0.08 days. Patients were out of bed to a chair or walking by 1.3 +/-0.06 days postoperatively. The length of stay in the intensive care unit (ICU) was 2.0 +/-0.12 days and postoperative hospital stay was 6.6 +/- 0.33 days. Transfusion requirement for the hospital stay was 1.6 +/-0.2 U per patient. This review highlights a cohort of male veteran patients with significant cardiac co-morbidity who have undergone repair with a conventional open technique and low mortality and morbidity rates. This group had rapid extubation, time to oral intake, and ambulation. In addition, ICU and hospital stays were relatively short.
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PMID:Abdominal aortic aneurysm repair. 1156 37

Endotoxin is a potent stimulator of the inflammatory response and is believed to initiate the pathology in gram-negative sepsis. Agents are being searched for that bind and neutralize or block the effects of endotoxin. The aim was to study the anti-endotoxic effects of polymyxin-E (colistin) in endotoxaemic dogs. The study included a total of 30 endotoxaemic dogs, which were divided into two groups (control = 15; test = 15) of both sexes, different breeds and ages. Hetastarch colloid solution (Expahes,10 mL/kg, i.v.) with lactated Ringer's solution (20 mL/kg, i.v., Q12 h) was given to all dogs. While ampicillin was administered (Alfasilin, 10 mg/kg, i.m., Q12 h) as an antibacterial to the control group, colistin (12,500 IU/kg, i.m., Q12 h) + ampicillin were administered to the test group. The clinical examination (body temperature, pulse and respiration rates, capillary filling times, peripheral pulse qualities, dehydration degrees), hematological and biochemical examinations (WBC, RBC, HGB, HCT, thrombocyte, serum urea, creatinine and TNF-alpha) were performed both before the treatment, and 2, 4, 12 and 24 h after the treatment. In comparison with the control group, it was observed that test group had shorter capillary filling time at 24 h (P < 0.001). Moreover, the degree of dehydration in test group, was significantly improved at 24 h (P < 0.01). While the differences in peripheral pulse qualities significantly differed between 0 and 2 h in controls, at 2, 4, 24 h after treatment it was found to be significantly increased when compared with 0 h in the test group. Serum TNF-alpha concentrations were statistically decreased in the test group between 0 h and other times (P < 0.01). When compared with controls, serum TNF-alpha concentrations were lower at 2, 4, 12 and 24 h in test group (P < 0.05). Results of the study indicated that polymyxin-E (colistin) has an anti-endotoxic effect and is safe for the dogs with endotoxemia at the dosage used in this study.
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PMID:Evaluation of the anti-endotoxic effects of polymyxin-E (colistin) in dogs with naturally occurred endotoxic shock. 1572 May 16

Chronic kidney disease (CKD) often accompanies cardiovascular complications, causing postoperative morbidity and even mortality. Since fluid and electrolyte homeostasis is deregulated in CKD patients, fluid therapy itself may cause postoperative morbidity. Recent studies have shown that forced diuresis through fluid overload offers no renoprotective effect and instead has harmful consequences. Fluid overload should be avoided, and the volume load should be used as the rationale for controlling hemodynamics. The emerging concept of a "zero-fluid balance policy" may be beneficial even for CKD patients. Hydroxyethylstarch might not be preferentially used for CKD patients. Hydroxyethylstarch is not contraindicated for CKD patients except in cases with long-term accumulation caused by increased vascular permeability, such as cases with sepsis, as long as an efficient volume expansion is beneficial to the patient. The regulation of renal function through the endocrine system (i.e., renin-angiotensin-aldosterone and vasopressin) is a key target for protecting the kidney in CKD. The recent development of a receptor blocker targeting these endocrine systems may be beneficial for correcting the fluid balance caused by excess intraoperative fluid therapy. The main issue for fluid therapy in surgical CKD patients may not be the quantity of fluid, but rational intervention affecting the endocrine system.
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PMID:[Perioperative fluid therapy for surgical patients with chronic kidney disease]. 2436 71