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

Stress ulcer is a condition seen after major trauma and surgery, sepsis, shock and extensive burns so its prevention is very important. Cimetidine and antacids are the drugs most often administered for prevention. Sometimes these drugs are insufficient and complications and side-effects appear. In order to prevent stress ulcers, experimental administration of intragastric glucose has been tested. A 30% dextrose solution given intragastrically decreased both luminal acidity and mean ulcer index. Similar results were obtained with intragastric 0.9% NaCl. The results showed that a luminal factor, not identified in this experiment, is present.
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PMID:Prevention of stress ulcer by intragastric glucose. An experimental study. 292 73

Tumor necrosis factor (TNF) is a macrophage-derived peptide mediator released during endotoxemia and sepsis. We examined the systemic and visceral hemodynamic response to low doses of human recombinant TNF in rats. Each animal received a 30-minute intravenous infusion of either saline solution (n = 8) or TNF (n = 8) in a dose of 0.25 mg/kg or 1.0 mg/kg. Thermodilution cardiac output, blood pressure, pulse, vascular resistance, effective hepatic blood flow (galactose clearance), and effective renal plasma flow (p-aminohippurate clearance) were determined at time = 2 hours. The 0.25-mg/kg dose had no apparent effect on systemic hemodynamics. The 1.0-mg/kg dose produced a hyperdynamic systemic circulatory response with an elevated cardiac output, tachycardia, and a diminished systemic vascular resistance. Effective hepatic blood flow was exquisitely sensitive to even the lowest dose of TNF, with a 29% reduction despite the normal cardiac output. Renal flow was unaffected by either dose. Tumor necrosis factor-induced systemic and visceral hemodynamic changes are remarkably similar to those seen in gram-negative sepsis, suggesting that TNF may occupy a proximal position in the pathogenesis of overwhelming infection.
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PMID:Recombinant human tumor necrosis factor produces hemodynamic changes characteristic of sepsis and endotoxemia. 293 Mar 53

Variceal hemorrhage is frequently a lethal event. Mortality among patients who have bled is high, with survival over the short term of only 25% to 50%. We retrospectively reviewed the records of 177 patients in whom variceal bleeding was treated with variceal sclerosis during a 5-year period from 1981 to 1986. All patients were treated by freehand injection of 25% sodium morrhuate with 35% dextrose, 4 ml per injection, through a fiberoptic endoscope. Of this group, 46 patients were treated with sclerosis followed by liver transplantation (group 1). These were compared to 36 nonalcoholic Child's class B and C patients treated with sclerosis alone (group 2). Survival at 4 years was poor in group 2 (17%). Liver failure and continued gastrointestinal bleeding were the most frequent causes of death. Survival among the liver-transplant group was significantly better (73%, p less than 0.001). Causes of death in this group were primarily due to sepsis, often in the setting of acute graft rejection. Group 1 patients were younger (39.8 +/- 10.8 vs 49.8 +/- 16.5 years, p less than 0.01); this difference is influenced by the deliberate selection of younger patients for liver transplantation. We conclude that sclerotherapy followed by liver transplantation significantly improves survival compared to conventional therapy in selected patients with advanced liver disease and portal hypertension. Donor organ availability will seriously limit the applicability of this approach to patients with bleeding esophageal varices.
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PMID:Bleeding esophageal varices: treatment by sclerotherapy and liver transplantation. 305 93

Fat emulsions are increasingly utilized as intravenous calorie sources in patients requiring total parenteral nutrition. In the United States, they are traditionally administered separate from the dextrose/amino acid solution because of concern regarding physical stability and clinical safety when fat emulsions are administered, having been mixed with the dextrose solution. The separate infusion entails multiple manipulations of the infusion system with increased risk of contamination and sepsis and increased cost in maintaining two infusion lines. This prospective sequential two-phase clinical study evaluated solution compatibility and clinical safety of an admixture of fat emulsion (Intralipid 20%), dextrose, amino acids (Veinamine 8%), electrolytes, vitamins, and trace minerals. Continuous infusion of this solution in 25 adult patients from 2 to 35 days did not result in any adverse clinical reactions or abnormal laboratory parameters. Gross, visual examination and in vitro analysis of the admixture solutions revealed no physical instability or changes in fatty acid composition in admixture solutions stored at 4 degrees C for up to 6 weeks.
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PMID:Parenteral infusion with an admixture of amino acids, dextrose, and fat emulsion solution: compatibility and clinical safety. 310 77

In vitro and in vivo experiments with Balb/c mice and Pseudomonas aeruginosa ATCC 27853 supported our hypothesis that bacterial lectins play an important role in the organotropy of infectious diseases. In vitro and in vivo adhesion of P. aeruginosa was mediated by N-acetylneuraminic acid (NANA) receptors. Blocking of the binding sites (lectins) on the bacterial surfaces with competitive specific carbohydrates (NANA) completely prevented the bacterial adhesion process in vitro. In vivo the number of adherent organisms in various organs decreased dramatically in the presence of NANA, whereas non-related carbohydrates (e.g. D-galactose) just showed negligible effects. Additionally, the application of NANA-treated organisms protected the animals from septicemia and death. Therefore, blocking of bacterial lectin receptors with specific carbohydrates might be of clinical relevance to prevent bacterial attachment to organ cells.
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PMID:In vitro and in vivo inhibition of lectin mediated adhesion of Pseudomonas aeruginosa by receptor blocking carbohydrates. 311 98

Fat emulsions (FE) support microbial growth when inoculated in vitro; dextrose/amino acid solutions (D/AA) do not. Can FE be safely added to D/AA when delivered over 24 hrs? We attempted to answer this question by culturing both conventional (C) total parenteral nutrition (TPN), in which the FE and D/AA are given separately, and the 3-in-1 admixture TPN, in which all components are delivered in one bag. Two-hundred TPN fluid cultures were obtained serially by collecting 1 ml of fluid from the distal-most connection when the TPN was changed every 24 hrs. Quantiative and qualitative cultures were obtained. One hundred sixty-six (83%) were negative. Of the 34 (17%) positive cultures, 15 (17% of 88) were from the conventional system whereas 19 (17% of 112) were from the 3-in-1 system. Six clinically septic patients furnished 11 TPN fluid specimens which grew greater than 400 colonies/ml. Seven (8% of 88) of these were from the conventional system whereas four (3.6% of 112) were from the 3-in-1 system. All had distant sites of sepsis. The 23 remaining positive TPN fluid cultures grew less than 25 colonies/ml, with 20 growing Staphylococcus epidermidis. All of these patients were clinically well and there was no significant difference in the distribution of positive cultures between the conventional system (9%) and the 3-in-1 system (13%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Answering the fat emulsion contamination question: three in one admixture vs conventional total parenteral nutrition in a clinical setting. 313 44

Total hepatic protein synthesis was measured in vivo with a flooding-dose technique, and the production of total secreted proteins, albumin, complement component C3, and seromucoid fraction was measured in perfused livers of septic rats that received one of three different solutions infused intravenously; Group 1 received 16.4% dextrose; Group 2 received Aminosyn (25% BCAA) in 10.6% dextrose, and Group 3 received Freamine HBC (45% BCAA) in 10.6% dextrose. All solutions were isocaloric, and the amino acid solutions were isonitrogenous. The solutions were administered for 18 or 48 hours after the induction of sepsis. There were no significant differences in mortality rates in the three treatment groups. The negative nitrogen balance seen in the dextrose-infused animals was reversed to the same degree by the two different amino acid solutions. There were no significant differences in hepatic protein synthesis rates in vivo between the three groups of rats. Synthesis rates of secreted proteins in perfused liver were similar in the different treatment groups in the 18-hour experiments, whereas in the 48-hour experiments, synthesis rates of total secreted proteins, C3, and the serumucoid fraction were higher in Group 1 than in Groups 2 and 3. The results suggest that administration of an amino acid solution improves nitrogen balance in sepsis, but that this effect is not caused by stimulated hepatic protein synthesis. The nitrogen-sparing effect during sepsis of a branched chain amino acid (BCAA)-enriched solution does not seem to be superior to that of a balanced amino acid solution.
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PMID:Administration of balanced or BCAA-enriched amino acid solution in septic rats. Effects on protein synthesis in the liver. 314 20

Complement, activated during infection and injury, has been implicated as a mediator of microvascular injury and obstruction. This study examines how two potent activators of complement, zymosan, and cobra venom factor (CVF), affect systemic and visceral perfusion. Rats were injected with either saline (1 ml/kg), zymosan (5 mg/kg) or CVF (5 units/kg) at t = 0 and 30 minutes. Thermodilution cardiac output, mean arterial pressure, heart rate, systemic vascular resistance, and hematocrit were determined at t = 2 hours. Effective hepatic and renal blood flows, by clearance of galactose and p-aminohippurate respectively, were determined over the next hour. The per cent change in total hemolytic complement from t = 0 to t = 3 hours was determined by immune hemolysis of sheep erythrocytes. There was no difference in systemic hemodynamic parameters between the three groups. Hepatic blood flow was depressed in both the zymosan (3.83 +/- 0.23 ml/min/100 g) and CVF (3.72 +/- 0.20 ml/min/100 g) groups compared with controls (4.62 +/- 0.19 ml/min/100 g, P less than 0.05). Renal blood flow in the zymosan-treated group (6.40 +/- 0.24 ml/min/100 g) increased over control (4.80 +/- 0.40 ml/min/100 g, P less than 0.05) but was unchanged in the CVF group (5.06 +/- 0.23 ml/min/100 g). The amount of complement activated correlated with the change in hepatic (r = -0.419, P less than 0.05) but not renal (r = -0.008, P = 0.917) flow. Complement activation may occupy a proximal position in the pathogenesis of hepatic ischemia associated with trauma and sepsis.
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PMID:Visceral perfusion abnormalities following complement activation. Clues to the mediators of organ ischemia in trauma and sepsis. First place winner: Conrad Jobst Award. 319 44

The authors studied 302 hospitalized patients, 164 males and 138 females aged 15-88 years (average 66 years), with severe infections. Cefotetan was administered to 278 of them at the dose of 1 or 2 g, b.i.d. or a single daily dose i.m. Other patients [24] were treated with a continuous intravenous infusion of cefotetan (3 g daily in 5% dextrose). Of these patients 121 were treated for urinary tract infections (UTI); 114 for respiratory tract infections (RTI); 41 for liver biliary duct infections (BDI); 17 for skin or skin structure infections (SKI); 6 for fever of unknown origin and 3 for sepsis. The following Gram-positive organisms [156] were isolated: Streptococcus pneumoniae, Staphylococcus aureus and Streptococcus group D; and the following Gram-negative organisms [122]: Escherichia coli, Proteus vulgaris, Proteus mirabilis, Serratia spp., Klebsiella spp., Haemophilus influenzae and Pseudomonas aeruginosa. The overall eradication rate for Gram-positive organisms was 74% and for Gram-negative organisms it was 88%. The clinical response was satisfactory in 87.7% of patients (specifically, cefotetan was effective in 90% of UTI, 84.2% of RTI, 97.5% of BDI and 82.3% of SKI). The drug was well tolerated and side-effects (such as skin rash, diarrhoea, purpura and pain at the site of injection) occurred in only 4% of patients treated with cefotetan. In conclusion, cefotetan appears to be safe and highly effective for the treatment of severe infections in hospitalized patients.
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PMID:Bacteriological and clinical evaluation of cefotetan in the treatment of severe infections in hospitalized patients. 321 8

Impaired immune competence leading to decreased resistance to sepsis is a major cause of death in burn patients. We have previously shown that increased mortality from a septic challenge correlated with impaired splenocyte interleukin-2 (IL-2) production and response to T cell mitogens in mice subjected to a 25% surface area scald burn. We report now that the addition of recombinant (r) IL-2 (100 U/ml) in vitro to splenocytes from burned animals restored mitogen responses to normal. Burned mice intraperitoneally received 16,000 U of rIL-2 (selected on the basis of dose-response experiments) once daily in 0.5 ml 5% dextrose (5% D) on days 1 through 6 after thermal injury and were compared with burned mice treated with only 5% D. Both groups were subjected to cecal ligation and puncture 10 days after burn; 4 days later, there were no survivors in the 5% D group, whereas 45% of the rIL-2 group remained alive (p = 0.001; Gehan statistic). We found that rIL-2 treatment at the dose selected resulted in no apparent toxicity in burned mice. Finally, splenocytes from rIL-2-treated burned mice showed improved responses to T cell mitogens in vitro compared with 5% D-treated controls. We conclude that rIL-2 therapy may have a role in the restoration of immune competence after thermal injury.
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PMID:Recombinant interleukin-2 (rIL-2) improves immune response and host resistance to septic challenge in thermally injured mice. 326 Oct 49


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