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

To determine the best palliation for nonpancreatic malignant obstruction of the biliary tract, we analyzed 36 patients with unresectable tumors who were treated from 1970 to 1986. Eleven men and 25 women were treated for 12 cholangiocarcinomas, ten carcinomas of the gallbladder, two advanced ampullary tumors and 12 metastatic tumors. Ten of the patients underwent biliary-enteric bypasses; 18 had stents placed, 11 operatively and nine percutaneously. The remaining eight patients received chemotherapy, radiation therapy or no treatment. Median survival time for patients was 209 days after discharge. Survival was not significantly prolonged for patients with bypass versus those with stents. Achieving and maintaining a bilirubin level of less than or equal to 4 were correlated with survival time (p less than 0.01, p less than 0.001). All ten patients with a bypass versus nine of 18 patients with a stent achieved a bilirubin level of less than or equal to 4 milligrams per deciliter (p less than or equal to 0.01). A multivariate analysis was done using 18 of 27 variables identified by univariate analysis. Albumin was found to be the primary predictor of over-all and hospital-free survival time and was a co-predictor of prolonged maintenance of low bilirubin levels along with biliary-enteric bypass. Placement of a stent was the only predictor of the number of episodes of sepsis and bypass was among the few predictors of length of hospitalization and of over-all morbidity (it was negatively correlated). We concluded that biliary-enteric bypass is the only effective means of palliation in that it improves the quality of life by maintaining low bilirubin levels and minimizing septic complications. Albumin is a strong predictor of survival and maintenance of low bilirubin values and should be a major factor in deciding which patient should undergo a bypass procedure.
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PMID:Palliation for nonpancreatic malignant obstruction of the biliary tract. 169 30

Septic shock from intraperitoneal (i.p.) injection of live Escherichia coli bacteria in rats induces marked pathophysiological changes, including 40% decrease in plasma volume (PV), cardiac output, and oxygen consumption with 100% mortality within 24 hr. The present study evaluates cardiac output and organ blood flow before and after treatment of septic shock with an effective antibiotic (AB), plasma volume (PV) expansion, and corticosteroids (CS), alone and in combination. Treatment was initiated at 5.5 hr after bacterial injection, at a time when AB therapy did not improve 24 hr survival rate. Cardiac output decreased from 28.6 +/- 3.1 (SD) to 15.4 +/- 2.8 ml/min/kg (P less than .01) in septic rats concomitant with redistribution of blood flow from carcass to the heart, brain, intestines, liver, and adrenal glands. Absolute arterial blood flow increased only to the adrenal glands and the liver to 158% (P less than .01) and 167% (P less than .01) of control values, respectively. AB, CS, and Ringer's lactate (RL) alone or in combination did not significantly improve any organ blood flow compared to untreated septic animals but increased survival significantly to about 60% (P less than .01). Albumin (ALB) and CS in combination expanded PV to 138% (P less than .01), restored cardiac output to 100%, and achieved supranormal blood flow values to the brain (109%), liver (125%), small intestine (147%) (P less than .01), and kidneys (190%) (P less than .01) of preshock levels. More importantly, survival at 24 hr was 90% (9/10) (P less than .001). It is concluded that a colloid diluted in an electrolyte solution, combined with CS, and an effective antibiotic agent are necessary therapeutic ingredients for the successful recovery of experimental E. coli sepsis.
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PMID:Cardiac output and organ blood flow in experimental septic shock: effect of treatment with antibiotics, corticosteroids, and fluid infusion. 174 57

Over a 3-year period, 156 of 815 patients admitted to a single institution with acute pancreatitis received total parenteral nutrition (TPN) for 2,572 patient days. Seventy had "simple" acute pancreatitis (group I) and 86 (group II) developed local complex disease (pseudocyst, abscess, or necrotic gland). In groups I and II, respectively, days without oral intake (NPO) were 13.6 +/- 1.5 (SEM) and 24.0 +/- 2.1 (p less than 0.005), hospital days were 19.8 +/- 1.7 and 35.8 +/- 3.2 (p less than 0.005), and duration of TPN was 10.9 +/- 1.0 and 21.0 +/- 2.3 days (p less than 0.005). Thirty-three patients in group I and 53 in group II required exogenous insulin. Alteration of standard formulas was necessary in 87 patients, but cessation of therapy was necessary in only one instance. Twenty catheters were removed for suspected sepsis with only 3 confirmed cases. Fat-based formulas were well tolerated in 15% of patients. During TPN, body weight rose from 95.0 +/- 2.4% to 97.4 +/- 4.3% of ideal in group I and remained at 90.5 +/- 1.8% in group II. Albumin rose from 3.36 +/- 0.10 to 3.50 +/- 0.08 g/dl in group I and from 3.01 +/- 0.07 to 3.35 +/- 0.07 g/dl in group II. The entire cohort differed from 10 randomly chosen patients who did not receive TPN in terms of days NPO (2.8 +/- 0.3) and hospital days (5.5 +/- 0.6). Variables associated with prolongation of hospital stay and time NPO were number of prognostic criteria, local complex disease, and underlying chronic pancreatitis only in select groups. We conclude that during acute pancreatitis, TPN can be administered safely but with careful monitoring and we recommend early aggressive therapy in the subgroups noted above and when underlying malnutrition exists. In the borderline patient, TPN may be administered by peripheral vein until the severity of disease is manifest.
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PMID:Total parenteral nutrition during acute pancreatitis: clinical experience with 156 patients. 212 3

Serum albumin concentration is commonly used as an index of nutritional status and as an indicator of nutritional response in hospitalized patients receiving total parenteral nutrition (TPN). One hundred thirty-nine cancer patients receiving TPN for at least two weeks were studied. Albumin intake, serum albumin, fluid balance, and weight change was monitored from 14 to 100 days of TPN. Patients were classified into three groups: A) patients receiving no exogenous albumin; B) patients receiving less than 25 grams of exogenous albumin; and C) patients receiving at least 25 grams of exogenous albumin during their course of TPN. Linear regression analysis of serum albumin levels vs. time on TPN showed a minimal positive correlation for patients in groups B and C (r = 0.154 and r = 0.183, respectively). Further analysis showed a significant elevation of serum albumin levels only in patients in group C (p less than or equal to 0.05). Contingency table analysis showed statistically significant increase in the incidence of sepsis in patients treated with exogenous albumin (X2 = 10.50, df = 2, p less than 0.01). There was no relationship between the change in serum albumin concentrations and the number of patient deaths. In addition, no relationship between tumor burden and subsequent response of serum albumin levels were identified. Serum albumin levels do not increase in cancer patients receiving TPN, unless exogenous albumin is given. Serum albumin appears to be a poor index of nutritional response in cancer patients receiving TPN.
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PMID:Serum albumin levels in cancer patients receiving total parenteral nutrition. 640 95

A prospective nutritional evaluation of 84 unselected patients admitted to a multidisciplinary ICU was performed using anthropometric measurements, creatinine height index (CHI), and serum protein assays. All values tested were significantly lower than those of 40 healthy controls. A matrix of correlation coefficients showed many similarities among the variables studied. Fatal outcome and poor prognosis indices, such as sepsis and renal failure, were analyzed separately. Anthropometric measurements and CHI were not different in the separate groups. Albumin (Alb) and transferrin (Tr) were not different in patients with or without sepsis. Retinol binding prealbumin was significantly higher in patients with renal failure. Thyroxin-binding prealbumin (TBPA) was significantly lower in all the groups. We emphasize the interest of this rapid turnover protein in evaluating nutritional status. We suggest: (1) a systematic nutritional assessment, and (2) an aggressive nutritional support in the ICU patient.
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PMID:Nutritional status in intensive care patients: evaluation in 84 unselected patients. 682 85

A study has been made of the influence of the nutritional situation on post-operative infections in a sample of 217 patients. A nutritional evaluation file was prepared for each of them, based on anthropometric and analytical tests and delayed hypersensitivity skin tests (PCHR) during the first 24 hours of hospital admission. The criteria whereby a post-operative infection was considered to be present were surgical wound infection, intra-abdominal infection, pneumonia and post-operative fever of 38.5 degrees C or more without a demonstrable septic focus. They were also evaluated quantitatively using Elebeute and Stoner's sepsis index. In the study of the anthropometric parameters, the relation was noted between the body mass index (BMI) and usual weight Percentage (HW%), and septic risk areas (RA) were defined, as a new anthropometric data. A total of 33 patients (15.2%) showed some type of post-surgical infection, manifested in this group by an alteration of the nutritional state revealed by a lower BMI, increased weight loss, a lower albumin rate than in the control group. The septic prognostic value of the RAS is confirmed: no relation was found between septic complications and the PCHR. Finally a multiple regression procedure was prepared between the Elebeute and Stoner sepsis index and all the nutritional parameters studied, to give the following nutritional sepsis risk prognosis index (RSN): NSR = 14,265 - 1,764 x Albumin - 1,427 x Risk Area.
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PMID:[The prediction of postoperative septic complications via nutritional parameters. I. The prognostic formulation]. 801 94

The etiology of hypertriglyceridemia associated with sepsis remains unclear, but we will attempt to elucidate its character by studying the hepatic production of apolipoproteins B and E. Male Lewis rats (260-330 g) were assigned to two groups, control (n = 5) and septic (n = 5). The septic group was injected with 2 x 10(8) live Escherichia coli colonies/100 g body wt. Food was removed from all rats after injections. Twenty-four hours later a recirculating in situ liver perfusion was performed for 120 min with KRB buffer, containing L-[35S]methionine. The production of apolipoprotein B (apo B), apolipoprotein E (apo E), albumin, and transferrin was determined by immunoprecipitation. The septic rats showed a protein-specific response to sepsis. The total protein secreted increased throughout each perfusion, septic greater than control. Apo B production was increased 2.6-fold in the septic versus control groups (P = 0.037), while apo E production was decreased by 2.9 times control (P = 0.036). Albumin production was decreased 2-fold in the septic group (P = 0.002). The increased hepatic production of apo B represents an increased number of very low density lipoprotein (VLDL) particles and contributes to the elevated VLDL triglyceride levels seen in sepsis. In contrast, decreased apo E production may result in a diminished ability for peripheral and/or hepatic receptor recognition of VLDL and VLDL remnants, respectively. Each of these changes are factors in the development of hypertriglyceridemia in sepsis.
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PMID:Altered hepatic production of apolipoproteins B and E in the fasted septic rat: factors in the development of hypertriglyceridemia. 823 Nov 64

Platelet-activating factor (PAF) may play a critical and primary role in the pathogenesis of acute pancreatitis and pancreatitis-associated distant organ injury. The present study evaluated the effect of a PAF antagonist, lexipafant (an (S)-4-methyl-2[methyl-imidazo[4,5-c]pyridin-1-ylmethyl)-benzene sulphonyl]-amino]pentanoic acid ethyl ester, BB-882; British Biotech Ltd.), on the potential prevention of gut barrier dysfunction, by measuring gut origin sepsis, bidirectional permeability of the intestinal barrier, and pancreatic capillary endothelial barrier integrity, in acute pancreatitis induced by intraductal infusion of 5% sodium taurodeoxycholate. Pancreatic endothelial permeability significantly increased in animals with acute pancreatitis, whereas pretreatment with lexipafant had a preventive effect (p < 0.05 vs. pancreatitis with saline). Similarly, alterations noted in hematocrit and plasma levels of lipase and calcium were counteracted by the PAF antagonist. It also prevented the increase in albumin leakage from blood to the mucosal interstitium and from blood to the intestinal lumen in acute pancreatitis. Albumin passage from the gut lumen to blood in animals with pancreatitis pretreated with saline increased from 3 h and on, and lexipafant prevented alterations in mucosal epithelial permeability. Bacterial translocation was commonly seen in pancreatitis, whereas only a few positive cultures were observed in pancreatitis animals given lexipafant. Microthrombosis in intestinal villi seemed less frequent after lexipafant pretreatment. We conclude that (a) PAF may play a role in the pathogenesis of pancreatitis-associated intestinal dysfunction, (b) PAF may be involved in the development of distant organ dysfunction by triggering endothelial barrier dysfunction, and (c) PAF antagonists may provide potential agents for preventing pancreatitis-associated gut barrier dysfunction.
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PMID:Effect of a platelet-activating factor antagonist on pancreatitis-associated gut barrier dysfunction in rats. 970 Sep 40

1. Albumin is often administered intravenously to critically ill patients as a volume expander, to combat hypoalbuminaemia, and to decrease hyperbilirubinaemia. There is, however, an ongoing debate concerning the therapeutic benefit of the former which is an expensive form of treatment.2. Albumin has several biological functions, in particular as a ligand binder. It also acts as an extracellular transition metal ion-binding and radical-scavenging antioxidant. These functions are influenced by the presence of an exposed thiol group (cys 34) on the surface of the albumin molecule. 3. The ability of infused albumin to influence the plasma thiol pool, and hence antioxidant potential, was investigated in patients with sepsis syndrome.4. Plasma thiol levels rose rapidly after albumin infusion and remained elevated even after plasma albumin levels had declined significantly, due to interstitial leakage. Data are suggestive of some form of thiol exchange in the plasma of these patients between albumin and molecules containing oxidized thiol groups.5. Administration of albumin to patients with sepsis syndrome leads to a sustained increase in plasma thiols. Thiols have several important antioxidant functions, and thiol repletion in these patients, who are known to suffer from oxidative stress, may have beneficial antioxidant effects. Antioxidant repletion may represent an important facet of clinically administered albumin.
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PMID:Administration of albumin to patients with sepsis syndrome: a possible beneficial role in plasma thiol repletion. 974 22

Albumin mRNA expression was studied by the use of reverse transcriptional polymerase chain reaction (RT-PCR) to determine the molecular mechanism in peritoneal infection. Albumin mRNA content markedly decreased. Endotoxin inhibited albumin mRNA expression in vivo probably by stimulating TNF,IL-1, and IL-6 production. Changes of the hormone levels were not the cause of hypoalbuminemia in infection. Reconbined growth hormone and astragalus polysaccharides alleviated inhibition albumin synthesis inhibition increasing albumin serum concentration in rats with peritoneal infection. The results suggested that hypoalbuminemia is associated with endotoxemia during sepsis, which inhibites hepatocytes albumin synthesis probably by stimulating nonparenchymal cells to produce TNF, IL-1, and IL-6.
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PMID:[Molecular mechanism and therapy of hypoalbuminemia in peritoneal infection]. 1037 87


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