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

The typical factors responsible for post operative jaundice are: 1) increased pigment load; 2) hypoperfusion; 3) sepsis and 4) drugs. In the patient evaluation, one should carefully review the patients chart for hypotensive episode during surgery, the drugs being administerd and the evolution of the illness which will facilitate the identification of the causal factors. Aside the aminotransferase, alkaline phosphatase and bilirubin levels, the risk of hemolysis, of sepsis, the synthetic function of the liver and the integrity of the biliary tree must be established. Post-operative jaundices appear quite often in a context of multiple etiology. However, it is very important to know when surgery is hazardous and when it is mandatory and lifesaving.
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PMID:[Diagnosis of post-operative jaundice (author's transl)]. 11 38

Chronic neutrophilic leukemia is a rare, infrequently recognized, myeloproliferative disorder. It usually manifests as a leukemoid reaction, with mostly mature granulocytes in the peripheral blood, with rare to occasional immature forms, and sometimes with normoblasts. The clinical manifestations also include hepatosplenomegaly, elevated leukocytic alkaline phosphatase, elevated serum vitamin B12 and serum vitamin B12 binder ("R" fraction), and elevated serum uric acid. Distinction from a leukemegaly, the absence of sepsis, usually normal erythrocytic sedimentation, and the absence of fever. Leukemoid reactions may be associated with elevated serum vitamin B12 and uric acid, but the levels are usually lower than those found in chronic neutrophilic leukemia. Many patients have gouty symptoms, especially after treatment with Busulfan, and many have an unexplained hemorrhagic tendency, making major operations a risk. The authors add two cases to the 11 previously described.
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PMID:Chronic neutrophilic leukemia. Report of two cases and review of the literature. 28 88

Ceforanide, a new cephalosporin antibiotic with a long half-life (3 h), can be administered twice daily. We evaluated its antimicrobial activity, pharmacology, and clinical efficacy. Twenty-seven patients with infections due to susceptible organisms received ceforanide, 0.5, 1, or 2 g, intramuscularly or intravenously every 12 h for 6 to 28 days. In vitro studies with the clinical isolates from 27 patients treated plus 263 additional isolates showed that ceforanide was active against cephalothin-susceptible gram-positive and gram-negative microorganisms. In addition, ceforanide inhibited 65% of cephalothin-resistant Escherichia coli and 65% of Enterobacter spp. at </=12.5 mug/ml. After a single 1-g intramuscular dose, the mean peak plasma concentration at 1 h was 48.9 mug/ml and that at 12 h was 4.7 mug/ml. Plasma accumulation occurred in some patients. The infections included 10 pneumonias, 3 with bacteremia and 1 with empyema; 11 soft tissue infections, 4 with abscesses and 3 with sepsis; and 3 urinary tract infections. One case each of endocarditis, osteomyelitis, and septic thrombophlebitis, all due to Staphylococcus aureus, were treated. Clinical response was satisfactory in all patients; bacteriological response was satisfactory in 26 of 27 patients. Ceforanide was well tolerated. Three patients developed mild increases in liver enzymes, and one developed slight eosinophilia. In another case, the antibiotic was discontinued because of a fivefold rise in serum glutamic-oxalacetic transaminase (aspartate aminotransferase) and serum glutamic-pyruvic transaminase (alanine aminotransferase) and a twofold rise in lactic acid dehydrogenase and alkaline phosphatase.
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PMID:Ceforanide: in vitro and clinical evaluation. 50 95

This is a report of our experience with 13 patients who had a distal common duct stricture associated with chronic relapsing pancreatitis. All patients, when first seen, had an elevated alkaline phosphatase level; eight of 13 patients also had an elevated serum bilirubin level. Five of the jaundiced patients had a febrile course; a preoperative diagnosis of acute cholangitis was made in four of these. Eight of the 13 patients have had a choledochoduodenostomy for relief of biliary obstruction; seven of these patients are living and well; one died of continued alcoholism and pancreatitis. One patient had a loop cholecystojejunostomy; decompression was inadequate and death due to septicemia secondary to ascending cholangitis ensued. Four patients have not yet had an operation. Two are symptomatic, but elective operation has been refused. Two have been lost to follow-up. We recommend investigation of the biliary tract in patients known to have chronic relapsing pancreatitis who also have persisting abdominal symptoms and an elevated alkaline phosphatase. If a stricture of the distal common bile duct is identified in the absence of acute pancreatitis, choledochoduodenostomy should be performed.
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PMID:Chronic pancreatitis: a cause of biliary stricture. 88 95

To determine whether or not kinin activation in the blood during severe infection with gram-negative bacteria may be related to hemodynamic abnormalities encountered, blood prekallikrein, kallikrein inhibitor and kinin values in 2l surgical patients with sepsis were compared with those in normotensive and hypotensive states. Because of reduced prekallikrein synthesis in patients with hepatic insufficiency, the normotensive and hypotensive groups were each subdivided according to the presence or absence of liver dysfunction, as indicated by elevated blood bilirubin, serum glutamic-oxalacetic transaminase or alkaline phosphatase levels. The mortality was zero in group 1, normotensive normal liver function; 80 per cent in group 2, hypotensive-normal liver function; 20 per cent in group 3, normotensive liver dysfunction, and 67 per cent in group 4, hypotensive liver dysfunction. Ultimately, the majority of deaths were due to respiratory failure. Although the blood prekallikrein level, was below normal in all groups and was significantly less in all patients with liver dysfunction, it was reduced proportionately in hypotensive patients to less than 30 per cent of the values noted in the two normotensive groups. This finding suggests prekallikrein consumption in the hypotensive groups to be the result of the process of activating kallikrein and bradykinin. This concept is supported by finding elevated kinin values, above 3 nanograms per milliliter of plasma, in only 28 per cent of those in group 1 and 12 per cent of those in group 3, while in the hypotensive patients, groups 2 and 4, the kinin level was elevated in 60 and 66 per cent, respectively.
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PMID:Kinin activation in the blood of patients with sepsis. 95 70

Jaundice developing in critically ill or injuried patients should probably be thought of as a manifestation of severe sepsis until proven otherwise. Septic jaundice occurs in about 50 to 60 per cent of patients with generalized peritonitis. Biochemically, jaundice associated with bilirubin (particularly the direct fraction) and liver enzymes (particularly the alkaline phosphatase) and a decrease in the serum albumin. Histologically there is intrahepatic cholestasis. The etiology of these changes in unknown, but they appear to be due to an end organ response to sepsis. Optimal treatment involves control of the sepsis and maintenance of a glood flow of well-oxygenated blood to the liver.
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PMID:Hepatobiliary complications of sepsis. 104 57

Studies of the clinical value of the limulus amebocyte lysate test for the detection of endotoxemia are inconsistent. In an attempt to define the value of this test, a total of 237 plasma samples from 111 patients were tested for endotoxin with seven different lysate preparations. A total of 48 plasma samples yielded a positive test with one or more of the seven preparations. Two of eight samples positive with all seven preparations were from ambulatory patients. A significant positive correlation of the test with bacteremia, neutrophilia and elevated serum alkaline phosphatase was found. Only three of the 48 positive tests occurred by four hours of incubation, and only 12 were associated with positive blood cultures (eight contained gram-negative bacteria). The test now available has no clinical usefulness in the detection of endotoxemia or gram-negative septicemia.
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PMID:Lack of clinical usefulness of the limulus test in the diagnosis of endotoxemia. 115 76

The authors report the clinical, biochemical, histological and etiologic characteristics of 24 patients with the syndrome of benign intra-hepatic post-operative cholestasis. Jaundice appeared early in the post-operative period, from the first to the 12th post-operative day. All patients had received blood transfusions. In 23 patients, the post-operative course was complicated, chiefly by local infection or septicemia. Hyperbilirubinemia ranged from 2 to 28 mg per 100 ml and was mainly conjugated; serum alkaline phosphatase activity was normal or moderately elevated; in 3 patients, it was markedly elevated; serum glutamic-pyruvic transaminase activity was normal on 7 patients, moderatly increased in 15, and markedly increased in one. Liver histology was normal in 6 patients, and showed minimal lesions (cholestasis and slight portal inflammatory changes) in 3. Jaundice did not appear to modify the final outcome. It appears to be due both to increased production of bilirubin (as a result of blood transfusions) and to decreased excretion of bilirubin by the liver (as a result of the surgical operation and of infection).
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PMID:[Benign postoperative intrahepatic cholestasis]. 117 77

In a study of fifty patients subjected to cardiac surgery nine (18%) had immediate post-operative liver complications. These included persistente jaundice, an increase in hepatomegaly and elevation of the alkaline phosphatase. In these and the rest of the cases there were extra-hepatic complications such as hyposystole, infarct, the post-pericardiotomy syndrome as related to the heart. Pulmonary complications were of infectious nature and a general complication was sepsis. These complications were sufficiently important to relate them etiologically to the hepatic disorder. Especially important is right hyposystole and it or tricuspid insufficiency can be blamed for the hepatic disorder in some of these patient. Nonetheless, these hepatic complications are seen less frequently now that we are giving effective treatment to the tricuspid insufficiency during the surgical intervention. We observed the clinical picture known as "benign postoperative cholestasis" in only two patients. Hepatitis with jaundice was seen in four patients during one to three months postoperatively. This was HB hepatitis and its course was more prolonged than that usually seen in Mexico, and it turned into chronic hepatitis in four patients. Biopsies done in one case a six months and in the other at nine months post-operatively showed the picture of chronic aggresive hepatitis. In those patients who did not have hepatic complications a late liver evaluation showed an improvement as compared to the pre-operative condition which was parallel to the hemodynamic improvement.
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PMID:[Hepatic complications in the postoperative of cardiac surgery]. 123 73

In a series of 78 patients with acute cholangitis, 48 were associated with common duct stones, and in one-third of these, the stones were believed to be primary common duct stones. Even though the clinical presentation of acute cholangitis can be nonspecific with a remarkable absence of physical signs, almost all patients had elevations of serum bilirubin, transaminase and alkaline phosphatase levels, an indication of disease of the biliary tree. Initially, all of the patients were treated with antibiotics and most responded rapidly. Escherichia coli and klebsiella were the organisms involved in more than 85 per cent of the positive cultures, and penicillin and an aminoglycoside are recommended as the drugs of choice in acute cholangitis. Diagnostic procedures were then performed, and laparotomy was often not carried out for several days after admission. Eleven of the 78 patients died. Six of the 11 deaths in this series were from continuing or recurrent sepsis, and at postmortem examination, a retained stone or inadequately treated stricture was found. This points out the need for adequate diagnostic procedures prior to exploration.
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PMID:Clinical management of acute cholangitis. 125 17


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