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

Experiments were conducted to test the hypothesis that the previously demonstrated depression in ventricular function of rats with hyperdynamic sepsis was a result of depressed high energy phosphate levels or altered myocardial substrate utilization. Rats were inoculated with a pooled fecal homogenate, and 48 hr later their hearts were removed and studied using the Langendorff preparation. The coronaries were perfused with a hydrostatic pressure of 90 mmHg, and hearts were paced at 310-320 beats/min. Substrate oxidation was determined by supplying 14C-labeled glucose, lactate, or palmitate in physiologic concentrations, ie, 5.5, 1, and 0.6 mM, respectively. Hearts were frozen either in situ or after 40-50 min of perfusion for the determination of tissue metabolite levels. Myocardial content of high energy phosphates, total adenine nucleotides, and creatine were similar in septic animals and time-matched controls both in situ and after perfusion. Oxidation of exogenous substrates accounted for the total myocardial O2 consumption in both groups of perfused hearts. Palmitate oxidation was responsible for approximately 50% of the total O2 consumption of the heart, with glucose accounting for approximately 20% and lactate for the remainder. The percentage contribution of the three substrates to oxidative metabolism was similar in hearts from septic and time-matched controls; therefore, myocardial substrate preference was not altered by sustained sepsis. These studies also indicate that ischemia and the concomitant fall in high energy phosphates do not contribute to the myocardial dysfunction of hyperdynamic sepsis.
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PMID:Substrate utilization and high energy phosphate levels of hearts from hyperdynamic septic rats. 369 11

We studied 12 newborn infants (gestational ages 26-39 wk [mean +/- SD, 30.6 +/- 4.7]; birth weight 640-2700 g, [mean, 1,322 +/- 688]; postnatal age 1-24 days [mean, 9.6 +/- 8.5]) who received clindamycin phosphate for suspected or proven necrotizing enterocolitis (ten patients) or suspected anaerobic septicemia (two patients) in doses of 3.2-11 mg/kg every six hours. Range of mean serum concentration of clindamycin at steady state was between 12.7 and 40 micrograms/ml (therapeutic range = 2-10 micrograms/ml). High concentrations could be attributed to elimination T1/2 (6.3 +/- 2.1 hr) 100% longer than in older children or adults. Clindamycin clearance (61.6 +/- 31.6 hr ml/kg/hr) was lower than in older children or adults. Because of the observed prolongation in T1/2 and correspondingly lower clearance, the IV dose of clindamycin in newborn infants should be reduced to 15-20 mg/kg/day given in four daily doses.
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PMID:Pharmacokinetics of intravenous clindamycin in newborn infants. 373 73

Malassezia furfur, a recently described agent of catheter-associated sepsis, requires long-chained fatty acids for in vitro growth. To determine optimum conditions for recovery of the organism from blood culture, we compared a radiometric (BACTEC) with a lysis centrifugation-direct agar plating (Isolator) blood culture method. When blood culture isolates of M. furfur were suspended in phosphate-buffered saline and used as inocula, the BACTEC system detected the organisms radiometrically only when bottles were supplemented with lipid compounds; detection was often delayed (greater than or equal to 72 h) when small inoculum sizes were tested. The Isolator pediatric tube system detected growth of M. furfur within 48 h of plating onto a lipid-supplemented agar medium. Simulated blood culture experiments showed that the addition of whole human blood and Intralipid to the BACTEC 6B bottle was associated with rapid lysis of erythrocytes, accumulation of a chocolate brown sediment in the bottles, and fungicidal activity to the M. furfur isolates. In contrast, suspensions of M. furfur in whole human blood were stable for at least 8 h in Isolator tubes and quantitatively recoverable after plating onto agar. Of the two systems studied, the Isolator tube system provided a more suitable procedure for isolation of M. furfur from blood culture.
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PMID:Methods for optimal recovery of Malassezia furfur from blood culture. 377 59

Energy-consuming, ATP-dependent step of transmembrane transmission of the signal for chemotaxis was studied at the pathway between receptors of formylpeptide and membrane kinase of polymorphonuclears leukocytes. Some peptides, particularly formylmethionyl leucylphenylalanine (FMLP), were demonstrated to have a property of chemostimulation, i.e. they had an ability to stimulate phagocytosis in human and animal neutrophils due to presence of specific receptors on the cell surface. Isolation, identification and use of the membrane ATP, synthesized in presence of the chemotactic peptide FMLP, is described. The ATP was produced within 1 min on the surface of polymorphonuclear leukocytes during aerobic phosphorylation from ADP and inorganic phosphate, coupled with transmission of electrons and protons. The ATP-producing activity of polymorphonuclear leukocytes, stimulated by the formylpeptide, was distinctly decreased in the patients with various forms of purulent surgical infections--sepsis, pyo-resorptive fever. The ATP, synthesized in plasmatic membranes of polymorphonuclear leukocytes, appears to serve as a translator of the chemotactic, energy-consuming signal.
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PMID:[Formation of signal ATP in plasma membranes of polymorphonuclear leukocytes activated by formyl-methionyl-leucyl-phenylalanine]. 377 22

The effect of dexamethasone sodium phosphate on visceral organ glucose metabolism was studied in order to gain further understanding of the altered glucose dynamics that occur following catabolic states. Glucose, glutamine, and alanine exchange across the gastrointestinal (GI) tract, liver, and kidneys was determined in 25 awake dogs that were catheterized on a long-term basis during a control period and after dexamethasone sodium phosphate treatment (0.44 mg/kg/day) for two (dexamethasone 2) and nine (dexamethasone 9) days. The GI tract consumed glucose in control dogs but switched to an organ of balance or slight release with dexamethasone. Simultaneously, gut glutamine consumption increased markedly, as did intestinal alanine release. Hepatic glucose production more than doubled with dexamethasone at a time when hepatic alanine uptake was greatly increased. The kidneys demonstrated glucose balance in control animals, but released glucose with dexamethasone 9. The gut and kidneys may play an important role in the altered glucose dynamics seen in patients with sepsis and other catabolic diseases.
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PMID:Gut-liver interaction during accelerated gluconeogenesis. 383 33

A total of 209 strains of Staphylococcus aureus isolated from infections and 23 strains from nose cultures of healthy laboratory personnel were compared for relative surface hydrophobicity in the salt aggregation test (Lindahl et al., Biochim. Biophys. Acta 677:471-476, 1981). In the standard method, bacterial cell suspensions from blood agar-grown cultures were tested for visible aggregation by "salting out" in serial dilutions of ammonium sulfate (0.1 to 1.6 M [final concentration]). Bacteria were defined as extremely hydrophobic when showing autoaggregation in saline or in 0.002 M sodium phosphate buffer (pH 6.8). Using this definition, we found a large number of strains isolated from various infections to be very hydrophobic: 123 of 135 strains from patients with septicemia (91%), 54 of 60 strains from wound infections (90%), and 12 of 14 strains from urinary tract infections (86%). In contrast, only 9 of 23 strains from nose cultures of healthy carriers (39%) were autoaggregating. A total of 12 autoaggregating strains were grown on various solid and liquid media. Only growth on hematin agar was found to completely suppress surface hydrophobicity as revealed by our salt aggregation test method, and growth in liquid media prevented the expression of hydrophobicity in most strains. Growth at 20 or 42 degrees C or under anaerobic conditions did not affect hydrophobicity. Cells harvested from various phases of growth did not differ significantly in surface hydrophobicity. Heating washed cell suspensions at 56 degrees C did not affect the salt aggregation test values, whereas heating the cell suspensions at 80 and 100 degrees C caused a significant decline in hydrophobicity. The addition of ethylene glycol (25% [vol/vol] final concentration) prevented the autoaggregation of 10 of the 12 strains. Likewise, treating the cell suspensions with proteolytic enzymes decreased the surface hydrophobicity, indicating that surface proteins contribute to high surface hydrophobicity of autoaggregating strains.
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PMID:High surface hydrophobicity of autoaggregating Staphylococcus aureus strains isolated from human infections studied with the salt aggregation test. 388 53

The reviewed studies support the contention that during the high flow or hyperdynamic phase of gram-negative septicemia, cardiac reserve is compromised because of intrinsic myocardial dysfunction. The latter is not referable to coronary hypoperfusion or peripheral pooling or decreased venous return. Although, under resting, nonstressed conditions, indices of myocardial function may appear normal or even elevated, a decreased reserve is evident when additional stress is imposed on the myocardium. Hearts removed from septic rats during the hyperdynamic stage and perfused in vitro (using the isolated perfused working heart preparation) showed a rightward and downward shift in work function curves, indicating a severe depression in cardiac function. Possible mechanisms for the observed dysfunction are discussed. No significant alterations in high energy phosphate production or substrate utilization were observed, indicating that altered myocardial metabolism is not likely to be a significant contributor to the dysfunction. Our results suggest that cardiac dysfunction is partially due to an elevation in the cytosolic calcium concentration which may slow the rate of ventricular relaxation. These studies emphasize that intrinsic cardiac function is depressed early during the course of the septic episode at a time that precedes the onset of circulatory shock.
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PMID:The effect of hyperdynamic sepsis on myocardial performance. 399 94

Nine patients with severe sepsis were studied to determine causes for any alterations in oxygen dissociation. Seven of the patients had oxyhemoglobin curves shifted to the left of expected and diminished DPG levels. These deficiences were not corrected in one case. The other eight patients survived or expired with normal to elevated P(50T) and DPG levels. In this study, three factors occurring either individually, in concordance, or in sequence were present when P(50T) was decreased. Correction of these deficiencies lead to normalization and, in one case, exceedingly high P(50T) and DPG levels. Where hypophosphatemia, acidosis, and transfusion of DPG deficient blood were avoided, no such change occurred. Hypophosphatemia is a common occurrence in the seriously ill patient whether or not hyperalimentation is used and may occur in spite of phosphate supplementation. Blood transfusions with CPD as the preservative are effective in reducing the severity of this disorder by the addition of an inorganic phosphate load. Septic shock itself had no untoward effect on oxygen dissociation. This held true even in the terminal stages of the disease process.
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PMID:The left shifted oxyhemoglobin curve in sepsis: a preventable defect. 484 83

Hypertension, phosphate retention, hyperfiltration hyalinosis and the natural course of the underlying are well known factors leading to progression of chronic renal failure. Acute bacterial interstitial nephritis occurring in a previously diseased kidney, although well documented in experimental animals, has not been shown to aggravate chronic renal failure in man. We report on 3 cases of acute suppurative interstitial nephritis, due to E. coli urinary infection complicated by septicemia. All had rapid aggravation of previously mild renal failure secondary to chronic interstitial nephritis. Sepsis originated from the urinary tract which in 2 instances had been temporarily obstructed. Renal biopsy disclosed a diffuse interstitial infiltrate containing numerous polymorphonuclear leukocytes. This was superimposed on chronic tubular and interstitial lesions. In 1 case there were glomerular lesions with crescents and mesangial C3 deposits. A 2nd biopsy performed in 2 cases was of prognostic interest. In one case it showed active lesions and the necessity of continuing the treatment and in the other a satisfactory healing allowing cessation of therapy. Treatment was guided by antibiograms, the clinical and urinary signs of activity, renal biopsy findings and antibiotics known to be concentrated in renal tissue. The duration of treatment seemed important for the regression of acute renal lesions. Hematogenous bacterial interstitial nephritis should be considered as a possible cause of aggravation in chronic renal failure.
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PMID:[Acute hematogenic interstitial nephritis of urinary origin: an unrecognized factor in the exacerbation of chronic kidney failure]. 634 71

A number of changes in therapy of uncontrolled diabetes have occurred in recent years. These include low-dose insulin regimens, often routine phosphate repletion, more cautious bicarbonate replacement, infusion of larger fluid volumes, the use of hypotonic solutions in hyperosmolar states, and recently magnesium repletion. These modalities (with the exception of routine magnesium repletion) have been employed at North Central Bronx Hospital since its opening in 1976. Through this retrospective analysis of 275 cases of uncontrolled diabetes we have tried to answer the following questions: What is the outcome of all episodes of uncontrolled diabetes in a municipal hospital population with a uniform treatment protocol? What are the results of treatment with new modalities in various age groups? Are the causes of death different from those tabulated in previous reports? Our results indicate a good outcome in those under the age of 50 yr regardless of the diagnosis of hyperosmolar nonketotic coma (HNC) or diabetic ketoacidosis (DKA). Mortality from DKA was 2% in those under age 50 yr and 26% in the older age group. Surprising was the low mortality in the hyperosmolar group with 0% mortality under age 50 yr and 14% in patients over this age. The major categories of causes of death in the series included sepsis, adult respiratory distress syndrome (ARDS), metabolic, cardiovascular, and shock. With the exception of ARDS, these categories were not different from other reported series. There were few thromboembolic events in this series.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Uncontrolled diabetes mellitus in adults: experience in treating diabetic ketoacidosis and hyperosmolar nonketotic coma with low-dose insulin and a uniform treatment regimen. 641 94


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