Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The provision of adequate nutritional support to ventilator patients (VP), although important, is still overlooked in many hospitals. All VP in our intensive care unit from July 1977 to June 1979 were reviewed; only those who were on ventilators for 3 or more days (range 3-25) were included, but those ventilated after cardiac arrest with possible brainstem damage were excluded. Group A included 33 VP (22 surgical, 11 medical) who received a protein-free, energy-deficient routine IV diet (1650 kJ/day as dextrose in water or electrolyte solution); group B had 14 VP who received nutritional support as TPN or nasogastric tube feeding (8300-12600 kJ/day with optimum nitrogen). In group A, 18 (54.5%) of the 33 VP were able to be weaned off the ventilator compared to 13 (92.8%) of the 14 VP in group B (p less than 0.05). Of medical VP, 10 (90.9%) of 11 in group A were weaned compared with 3 (100%) of 3 in group B (not significant). However, of surgical VP, only 8 (36.3%) of 22 in group A were able to be weaned off mechanical ventilation compared with 10 (90.9%) of 11 in group b (p less tha 0.01); this was likely highly significant in surgical patients because of greater metabolic demand for wound healing and more severe sepsis.
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PMID:Effect of nutritional support on weaning patients off mechanical ventilators. 678 32

Low serum levels of zinc and copper have recently been reported in association with TPN and the fasting state. A prospective study during May 1977 through November 1978 was performed in 28 patients undergoing TPN. Serum and urinary Zn and Cu levels were detected; the patient population was divided in septic and non septic groups and each was subdivided according to plasma administration. In both groups low serum Zn and Cu levels were detected. The urinary losses were greater in the group with sepsis. Three patients had clinical manifestations of Zn deficiency, in two it was reversible with the administration of diet or oral Zn. The third one died of sepsis. The low serum levels found in our patients suggested that plasma administration might be insufficient to cover the daily requirements of such elements. This requirement is augmented by the increased urinary losses seen in septic postoperative stages.
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PMID:Zinc and copper abnormalities in fasting patients undergoing total parenteral nutrition. 679 8

This paper reports on technical problems involved in pancreatoduodenectomy. Twenty cases of periampullary carcinoma underwent pancreatoduodenectomy. Pancreatic fistula developed in five cases: three of these patients recovered using simple drainage and TPN; one underwent a second operation in which a new pancreatico-jejunostomy was performed and another patient died (5% of the series) from sepsis and liver failure. After reviewing various techniques used in performing pancreatico-jejunostomy, it is concluded that the most suitable management of the pancreatic stump seems to be the duct-to mucosa anastomosis. But in cases in which this type of reconstruction is impossible, invagination yields satisfactory results.
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PMID:Technical problems in pancreatoduodenectomy. 687 16

Our experience with clinical intestinal transplantation under FK 506 immunosuppression showed that 50% of the recipients were able to be independent from TPN after transplantation, but 10% require partial TPN with functioning grafts, 10% needed total TPN after graft removal, and 30% of the recipients died postoperatively, mostly from sepsis due to severe graft rejection. For further improvement in patient survival and in the quality of life for patients after intestinal transplantation, it is mandatory to establish a new strategy for treatment and prevention of graft rejection and systemic infection.
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PMID:Intestinal transplantation at the University of Pittsburgh. 751 36

Multivisceral transplantation, combined liver-intestine transplantation, and isolated small bowel transplantation are very similar procedures that were first developed in the 1950s. If the viscera can be conceptualized as a cluster of grapes hanging from its arterial stems, the three procedures are characterized by virtually identical vascular anastomoses, with exclusion or inclusion of as many viscera (grapes) as necessary; however, these procedures languished for nearly four decades because of the imperfect immunosuppressive regimens of the 1960s, 1970s, and 1980s. Finally, after the development of FK506, pediatric patients may undergo intestinal transplantation with the hope for long-term survival. These procedures are reserved for TPN-dependent children with permanent intestinal insufficiency. Candidacy for transplantation is also predicated on development of potentially fatal TPN complications such as cholestasis, recurrent sepsis, or thrombosis of access sites. Since 1990, 32 pediatric patients have undergone intestinal transplantation at the University of Pittsburgh, with an overall survival of 65%. Immunosuppression has been accomplished with a combination of corticosteroids, FK506, and prostaglandin E1. Although GVHD has not been a major problem, most patients have experienced rejection episodes requiring intensification of immunosuppression with a steroid bolus, a steroid recycle, an increase in FK506 dosage, or addition of OKT3. CMV has caused little morbidity, but EBV-related PTLD has affected 20% of all patients. It has not been possible to discontinue immunosuppression in the face of PTLD without engendering severe small intestinal rejection. Other problems have included recurrent sepsis, intestinal dysmotility, and persistent food avoidance. Future therapeutic trends are likely to include the performance of combined bone marrow-visceral transplant to induce a chimeric tolerogenic state and to lessen the need for long-term immunosuppression.
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PMID:Small bowel transplantation in infants and children. 769 29

ECW, and particularly its interstitial component, expands easily with malnutrition, sepsis, and trauma and after aggressive intravenous fluid therapy. In this scenario, hypoalbuminemia is usually the result of both an increased capillary escape rate due to leaky endothelium and increased distribution volume; this can be worsened by artificial intravenous nutrition with sodium, water, and glucose. Monitoring ECW is essential during TPN. Short-term changes in weight and serum albumin concentration are helpful to control ECW volume and prevent ECW expansion. Tetrapolar bioimpedance analysis is a promising technique for accurate bedside measurement of changes in body fluid compartments.
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PMID:Extracellular volume, nutritional status, and refeeding changes. 770 4

A study was made of the possible influence of sepsis on liver protein synthesis in septic and control rats, fed either parenterally (TPN) or with water and feed available "ad libitum". Liver protein synthesis was determined using the single massive dose method. In experiment I, the septic and control animals received TPN for twenty-four hours: in experiment II water and food was available to them "ad libitum". Twenty-four hours after the sepsis occurred, the animals were injected with a massive dose of 14C-labelled leucine, and slaughtered by decapitation. The septic animals with water and feed available "ad libitum" were fasted voluntarily without any intake. This group of fasted septic animals was the only one which lost weight. Liver protein synthesis increased in septic animals in comparison with the control animals, whether receiving TPN (112.2 +/- 8/78.5 +/- 13) or with "ad libitum" nutrition (97.2 +/- 15/60.8 +/- 8). The increased liver protein synthesis in the septic animals was modified (although with reduced significance) by parenteral nutrition (112.2 +/- 8/97.2 +/- 15). Our results suggest that sepsis increases liver protein synthesis, and that this protein synthesis may be enhanced by parenteral nutrition.
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PMID:[The effect of sepsis on liver protein synthesis]. 811 Aug 71

The objectives of these experiments were to investigate the effect of Gln supplementation on protein metabolism and immune function in septic rats. (Experiment 1): 73 SD female rats were catheterized for TPN into the jugular vein on day 1. On day 4, the rats were randomized into 4 group: 1) control (C)+Standard TPN (STPN), 2) (C)+Gln TPN (GTPN), 3) sepsis (S)+STPN, 4) S+GTPN. Sepsis was induced by injection of 10(10) C. Coli/kg from the TPN catheter. U-14C-leucine or 15N2-Urea was given before sacrifice on day 5. (Experiment 2): 48 SD male rats were randomized into 3 groups, 1) normal control rat (NC), fed as lib. 2) peritonitis (P)+STPN, 3) P+GTPN. On day 1, 34 rats were catheterized and either STPN or GTPN was begun. On day 3, 6 hours after serum cecum ligation and puncture, resuscitation was done. On day 5, rats were sacrificed. The results were as follows: 1) FSR of ileum, proximal colon, distal colon and muscle were augmented by GTPN, 2) Sepsis caused a significant increase of urea production, but GTPN prevented this increase, 3) lymphocyte blastogenation was decreased with sepsis, but GTPN improved this reduction, 4) Phagocytic index was higher with GTPN than STPN. We concluded that Gln supplementation would prevent from leading the patients with severe infection to the multiple organ failure.
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PMID:[Glutamine (Gln) supplementation in septic rats]. 823 82

An evaluation is made of liver malfunctions in patients receiving TPN over a period of > or = 15 days between 1989 and 1991. Use was made of the monitoring records on patients undergoing TPN and, subsequently, of clinical records, with analysis of diagnoses and type of intervention, the biochemical parameters (SGOT, SGPT, GGT, FA, LDH, and total and direct bilirubin), and the type and degree of malnutrition, nutritional backup, associated medication, etc. A group of patients was excluded from the study on the basis of the following criteria: liver-biliary disease, cardiac insufficiency, liver metastasis, sepsis, kidney insufficiency and hepatotoxic drugs. Of 237 patients, 75 (31.64%) had liver alterations: following application of the exclusion criteria, 24 patients (10.12%) were taken with liver alterations attributable to the TPN. Macro- and micronutrients were included in the TPN. We found no relation between the kcal/kg of weight, nor with the quantity of glucose and fats nor of nitrogen, calculated according to individual requirements: they remained within the limits established. No serious case of cholestatic jaundice was encountered. Moderate to severe malnutrition was found in 50% of patients, so that this must be treated as a risk factor. GGT is the first enzyme to alter; this occurred in the largest proportion of patients (91.66%), followed by SGPT. FA and GOT are altered in the same percentage of patients. Biochemical parameter monitoring is essential in patients undergoing TPN, not only for appraisal of the nutritional state but also to prevent or correct potential serious metabolic complications.
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PMID:[Liver dysfunction associated with total parenteral nutrition]. 844 68

The treatment of small bowel fistulas remains a difficult problem. Spontaneous closure rates of 30% are currently being achieved after 4 to 6 weeks of conservative therapy with bowel rest, TPN, octreotide, and control of sepsis. Resection of the fistulous bowel is warranted if fistula closure has not occurred by 4 to 6 weeks.
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PMID:Small bowel fistulas. 884 71


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