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

Eighteen pediatric patients with infective endocarditis (IE) were reviewed for "failure" of chemoprophylaxis; none had had a previous dental procedure. Surprisingly, published reports reveal a similarly low prevalence of dental extractions preceding IE, only 3.6% for 1,322 cases. Although bacteremia was associated with 40% of 2,403 reported extractions, it also was found in 38% of patients after mastication, and in 11% of patients with oral sepsis and no intervention. In a hypothetical month, ending with a single dental extraction, the cumulative exposure to these "physiologic" sources of bacteremia is nearly 1,000 times greater than it is from extraction. The current American Heart Association recommendations for intramuscular or intravenous chemoprophylaxis are impractical, and the discomfort and inconvenience may impede good dental care. The Committee also implies that gingival bleeding allows bacterial access to the blood stream, whereas experimental studies establish the lymphatics as the only access. Although oral chemoprophylaxis for major dental procedures appears prudent, the British regimen of a single dose of amoxicillin administered orally is much simpler and probably more effective. However, scrupulous oral and dental hygiene is undoubtedly superior in preventing IE than any chemoprophylaxis regimen.
Am J Cardiol 1984 Oct 01
PMID:How important are dental procedures as a cause of infective endocarditis? 648 31

To assess the efficacy of surgical revascularization for postinfarction angina within 30 days of acute infarction, the clinical course of 103 patients treated surgically from January 1979 to July 1982 was reviewed. There were 84 men (82%) and 19 women (18%) with a mean age of 58 years (range 34 to 80). Group A (11 patients) underwent surgery within 24 hours of infarction, Group B (21 patients) within 7 days and Group C (71 patients) within 30 days. Eighty-four patients (82%) had subendocardial infarctions and 19 patients (18%) had transmural infarction. Transmural infarction was more common in patients in Group A (36%) than in those in either Group B (19%) or Group C (15%). There were two deaths, both in Group C (1.9%), within 30 days of surgery. The use of intraaortic balloon or inotropic support and the occurrence of major arrhythmias or perioperative infarction was noted in 30 patients (29%) (64% in Group A, 33% in Group B and 18% in Group C). The average time in the intensive care unit was 3.2 days, with an average total hospital stay after surgery of 8.3 days. Late follow-up (mean 15.4 months, range 1 to 39) is complete for 97 patients (97%). There were no late myocardial infarctions and 93 patients (96%) were essentially free of angina. The only late death (1.0%) was caused by septicemia from delayed sternal wound infection. This study suggests that myocardial revascularization within the first 30 days after myocardial infarction can be accomplished with an acceptable operative mortality in selected patients with postinfarction angina refractory to medical management.
J Am Coll Cardiol 1983 Nov
PMID:Postinfarction angina: results of early revascularization. 663 Jul 65

Systemic candidiasis developed in a seven-week-old premature baby after 6 weeks treatment with antibiotics for suspected septicemia. At that time the echocardiogram showed a dense layer of echoes posteriorly to the anterior tricuspid leaflet during atrial systole. The diagnosis of Candida endocarditis with vegetations on the tricuspid valve and with right atrial thrombus secondary to the Candida infection was verified by autopsy.
Pediatr Cardiol
PMID:Echocardiographic diagnosis of Candida endocarditis of the tricuspid valve and of the right atrium in a young infant. 668 50

Despite recent advances in antimicrobial therapy infective endocarditis (IE) still remains a major surgical problem. All patients undergoing surgical treatment for IE at our Institution since 1970 were reviewed; among these in 40 IE was considered to be active at time of operation. Thirty patients were males and 10 females, ranging in age from 11 to 66 years (average 41); indications for operation were heart failure in 31, mycotic emboli in 5, and sepsis in 4. Nine were in NYHA functional class 11, 18 in NYHA class III, and 13 in class IV. Aortic valve replacement (AVR) was performed in 24 cases, mitral valve replacement (MVR) in 5 and multiple valve replacement (PVR) in 11. Overall hospital mortality was 15% (4.2% in the AVR group, 40% in the MVR group, and 27% in the PVR group). Postoperative follow-up was available in all survivors. Four patients died in the late postoperative period for not infective causes. Almost long-term survivors show, from 7 months to 10 years (average 58 months) postoperatively, a significant improvement. No complications related to the initial infective process were recorded. According to the results of the present study the following conclusions can be drawn: 1) active IE does not represent a contraindication to open heart surgery and prosthetic valve replacement; 2) the surgical results depend not only on the degree of cardiac failure, but mainly on its duration; 3) early surgical intervention affects favourably the prognosis, especially in cases of isolated aortic valve involvement; 4) the surgical management of IE removes the focus of infection.
G Ital Cardiol 1981
PMID:[Surgical treatment of infectious endocarditis in the active phase. Experience in 40 cases]. 689 99

In a retrospective study of 50 patients with infective endocarditis (IE), we found an overall mortality of 44%: among the 26 patients with natural valves (NV) the mortality was 19%; among the 24 with prosthetic valves (PV) it was 71%. Congenital heart disease was recognized in 17 of our cases, with a significant clustering in the NV group (50% vs 17%, p = 0.029); the most frequently encountered malformation was the bicuspid aortic valve. The incidence of rheumatic heart disease was 46% in the NV group and 83% in the PV group (p = 0.015). Manifestations of IE were protean and multisystemic. We calculated an average of 4.6 symptoms and 4.7 signs for each patient. Although sepsis was abated with appropriate antibiotics, death often ensued from multiple complications: congestive heart failure, arrhythmia, stroke, embolic myocardial infarction, valvular destruction or dehiscence, coagulopathy. New features of natural valve infective endocarditis are a rising incidence in the elderly and a survival rate seemingly at its peak. Features of prosthetic valve infective endocarditis include overwhelmingly frequent embolization to the central nervous system (p = 0.004), spleen (p = 0.009) and kidney (p = 0.010). Advances in therapy for this disease may come from early surgery in late prosthetic valve endocarditis and from future prospective studies to define how the host response influences the outcome.
Acta Cardiol 1981
PMID:Infective endocarditis update experience from a heart hospital. 697 38

A group of 19 patients with acute respiratory failure (ARF) of diverse etiology received as a part of their treatment positive and expiratory pressure (PEEP). All of them were evaluated clinically and with several respiratory parameters. The response to treatment, complications and mortality rates are analyzed. The addition of PEEP in the management of this patients was accompanied by a significant increase of the PAO2 (p < 0.001) and a simultaneous decrease in the following parameters: FiO2/PaO2 index, Alveolo-arterial oxygen gradient (A-aDO2) and the pulmonary shunt (Qs/Qt). No hemodynamic deterioration was observed. None of the clinical parameters such as: blood pressure, heart rate and diuresis was significantly modified; neither a significant change in the arterious-venous oxygen gradient (a-vDO2) was detected. Pneumothorax as a complication of the use of PEEP was present in the 10.4% of the patients. The course of the ARF was toward the improvement in most of them at the end of the evolution. The high mortality rate in this study was considered to be secondary to uncontrollable sepsis and also to the presence of multiple organ failure. In none of the cases the poor outcome was secondary to refractory acute hypoxemia. PEEP which is one of the varieties of continuous positive pressure ventilation (CPPV) represents one of the most importants therapeutic advances in the last decade in the management of patients with acute respiratory failure.
Arch Inst Cardiol Mex
PMID:[Use of final positive expiratory pressure (FPEEP) in the management of acute respiratory insufficiency]. 700 26

The medical records of 100 patients who received 113 temporary transvenous pacemakers were reviewed to determine the incidence of complications and malfunction. Malfunction, defined as failure to capture or sense, or both, occurred in 42 (37 percent) of 113 temporary pacemakers. The initial malfunction occurred within 24 hours in 21 (50 percent) and within 48 hours in 36 (86 percent) of the 42 pacemakers. Although the incidence of malfunction was not significantly different for brachial and femoral venous pacing catheters, 7 (37 percent) of 19 brachial venous pacemakers required repositioning or replacement compared with 8 (9 percent) of 91 femoral venous catheters (p = 0.005). Thirty-seven complications occurred in 23 (20 percent) of 113 episodes of pacing; ventricular tachycardia during catheter insertion, fever and phlebitis were the most common complications. No complication resulted in death. The incidence of complications and perforation was greater for brachial than for femoral venous pacemakers (p less than 0.05). Sepsis, local infection and pulmonary embolus occurred only with femoral venous pacemakers. Sepsis, phlebitis and pulmonary embolus were more common with temporary pacemakers in place for 7 hours or longer (p = 0.04). Recognition to the problems peculiar to each pacing catheter site and shortening the duration of pacing should help minimize problems with temporary pacing.
Am J Cardiol 1982 Feb 01
PMID:Analysis of pacemaker malfunction and complications of temporary pacing in the coronary care unit. 705 46

The hypoplastic left heart syndrome is a very severe congenital heart disease dependent on patency of ductus arteriosus in the newborn. The survival after neonatal period, without surgical treatment, is exceptional. Nowadays, there are basically two types of therapeutic procedures: Palliation with the Norwood operation and/or cardiac transplantation. Both methods have showed advantages and disadvantages; at present, there is not consensus of them. In our hospital, we have recently begun a medical-surgical therapeutic program for the management of neonates with hypoplastic left heart syndrome. Because of this, we report our little experience. We have treated three children in the last year: The first of them dead in the operating room; the second was exitus due to a sepsis two months after surgery, and the third, who is three-month-old now, remained well and was discharged to home.
Rev Esp Cardiol 1994 Aug
PMID:[The hypoplastic left heart syndrome. Initiation of a therapeutic program]. 752 24

A major determinant of survival in patients with advanced viral or bacterial infection, or following severe trauma or burns complicated by multiple organ failure, is the combination of clinical signs termed the systemic inflammatory response syndrome (SIRS). SIRS is characterized by hypotension, tachypnea, hypo- or hyperthermia and leukocytosis as well as other clinical signs and symptoms, including a depression in myocardial contractile function. Heart failure complicating systemic sepsis or other causes of SIRS is usually not accompanied by coronary artery ischemia due to hypotension, myocardial necrosis, or marked cardiac interstitial inflammatory infiltrates, and thus the cause of cardiac contractile dysfunction in this syndrome has remained unclear. However, recent evidence has implicated an endogenous nitric oxide (NO) signalling pathway within cardiac myocytes and other cellular constituents of cardiac muscle, including the microvascular endothelium, as a possible contributor to the pathogenesis of heart failure in this syndrome. Cardiac myocytes are now known to express both constitutive NO synthase (cNOS) and inducible NO synthase (iNOS) activities. Activation of cNOS appears to modulate cardiac myocyte responsiveness to muscarinic cholinergic and beta-adrenergic receptor stimulation. Induction of iNOS by soluble inflammatory mediators, including cytokines, causes a marked depression in myocyte contractile responsiveness to beta-adrenergic agonists. Thus, inappropriate activation of cNOS or excessive or prolonged induction of iNOS in the myocardium may contribute to cardiac dysfunction complicating SIRS.
J Mol Cell Cardiol 1995 Jan
PMID:Myocardial contractile dysfunction in the systemic inflammatory response syndrome: role of a cytokine-inducible nitric oxide synthase in cardiac myocytes. 753 82

A 42 year-old woman with terminal chronic lung disease underwent to left lung transplantation. Extracorporeal membrane oxigenation (ECMO) was required because dysfunction of transplanted organ occurred and was non-responsive to conventional therapy. The time of assistance was 47 hours and after this, the dysfunction of the transplanted lung reversed and the patient was weaned from the oxigenator. During hospital stay, she developed sepsis and died. In conclusion, ECMO was decisive to the treatment of pulmonary dysfunction, allowing time to the resolution of lung lesion.
Arq Bras Cardiol 1994 Oct
PMID:[Prolonged respiratory support with extracorporeal membrane oxygenation in lung transplantation]. 777 48


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