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

The frequency, the treatment and the mortality of stress induced ulcers and erosions of the upper alimentary tract are surveyed. The experimental data concerning such ulcers and erosions are reported. Most important is the local mucosal ischaemia with a concomitant reabsorption of H-ions. Intravasal coagulation processes and a local diminution of the Vitamin A content may be additional factors. 37 stress induced bleedings observed in 460 patients of a surgical intensive care unit are analysed. The mortality of the conservatively treated group was 60% and higher than the mortality after operative treatment (42%). The high mortality was due to the associated states of shock, hypoxaemia and sepsis. A prospective study comporting 50 patients of a medical intensive care unit shows the little importance of intravasal coagulation for gastrointestinal bleedings during septicaemia. The possible influence of psychological factors for the induction of stress induced bleedings was analysed on 112 tetraplegics and paraplegics, all under the same conservative treatment comporting high doses of Dexamethason. The frequency of gastrointestinal bleedings was very high in complete traumatic tetraplegia (41%), smaller in complete traumatic paraplegia (16%), much lower in incomplete traumatic and complete non-traumatic lesions.
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PMID:[Stress ulcer: clinical aspects, pathogenesis, diagnosis and therapy]. 0 82

This study examines nutritional status and clinical outcomes, including pressure ulcers and death in 40 chronically tube-fed long-term care patients. Anthropometric, biochemical, clinical and dietary data were collected over a 3-month period, with follow-up of mortality at 1 year. Subjects' functional and cognitive status was generally poor. Adequate calories and protein were provided, with sample means exceeding standard means for energy, protein and micronutrients. Still, subjects showed weight loss and severe depletion of lean and fat body mass. Mean serum protein and micronutrient status measures were in the low normal range. Hemoglobin, hematocrit, and serum zinc and carotenoid levels were below normal in a sizable proportion of patients. Pressure ulcers were present in 65% of patients. Weight loss was associated with longer time on tube feeding and more pressure ulcers. Negative correlations with ulcer number were observed for cholesterol, albumin, zinc, retinol, alpha-tocopherol and iron. This study shows that despite administration of apparently adequate formula, micronutrient deficiencies and marasmic malnutrition exist in chronically ill patients. Causes may include the combined effects of chronic disease, sepsis, immobility, and severe neurologic deficits. Clinical outcomes may be expressions of an organism-wide diminution of protein synthesis, the cause of which is unknown. For clinical management, serial measures of weight, albumin, cholesterol, hemoglobin and hematocrit are recommended. Future research must address the many subsets of the population of chronically tube-fed patients.
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PMID:Prolonged tube feeding in long-term care: nutritional status and clinical outcomes. 161 83

The metabolic response to sepsis is characterized by increased proteolysis and gluconeogenesis, reduced protein synthesis, and negative nitrogen balance. The effects of a solution with a high proportion of branched-chain amino acids (BCAA) on the nutritional state of septic patients were evaluated. Eighty patients with peritonitis were divided into two groups of 40 patients; group 1 was administered a solution with 22.5% BCAA and group 2 with 45% BCAA. The following parameters were evaluated: anthropometrics, creatinine/height index, urinary 3-methylhistidine, nitrogen balance, stress index, albumin, prealbumin, transferrin, retinol binding protein, lymphocytes, delayed cutaneous sensitivity tests, studies of hepatic function, and plasma aminogram. In group 2 a more positive nitrogen balance, a greater drop in the stress index, a rise in plasma prealbumin and retinol binding protein levels, an increase in the creatinine/height index, and a more marked fall in the urinary excretion of 3-methylhistidine were found. When solutions with a high BCAA content were administered, there was an increase in the plasma concentrations of these amino acids in the BCAA/aromatic amino acid quotient and a decrease in the aromatic amino acids. Plasma concentrations of leucine and valine achieved very high, potentially toxic, levels at 15 days when solutions with high BCAA content were used. It is concluded that solutions with BCAA are advisable for use in the septic patient in the increased protein catabolic phase, where positive nitrogen balance, a reduction in muscle protein catabolism, and faster recovery of muscle and visceral protein were obtained.
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PMID:Prospective study on the efficacy of branched-chain amino acids in septic patients. 190 75

Serum immunoglobulins and some complement components (C1q, C3c, C4, factor B, C9) have been evaluated in 99 malnourished patients. The sole abnormality which seems related to protein calorie malnutrition is a C1q decrease significantly correlated to serum albumin, thyroxin binding prealbumin and retinol binding protein. The immunoglobulins modifications seem to be related to pathological conditions associated with malnutrition (sepsis, liver diseases).
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PMID:[Serum immunoglobulins and complement fractions in protein malnutrition]. 642 29

Vitamin A may play a role systemically and locally in controlling intra-abdominal sepsis. Adult male rats were divided into three groups. Group 1 ate a standard rat laboratory chow (not vitamin A deficient), group 2 ate the same chow supplemented with vitamin A, and group 3 ate the chow supplemented with beta carotene. All animals underwent cecal ligation, and the cecum was perforated either with a 27-gauge or an 18-gauge needle. Vitamin A dietary supplementation had a significant protective effect, which was manifested by improved survival in the animals whose cecum was perforated with an 18-gauge needle, prevention of postoperative hypothermia, maintenance of peripheral WBC counts at normal or above-normal values, and better localization of the intra-abdominal inflammatory process. Dietary supplementation with beta carotene had a lesser protective effect.
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PMID:Effects of vitamin A and beta carotene on intra-abdominal sepsis. 669 12

A prospective nutritional evaluation of 84 unselected patients admitted to a multidisciplinary ICU was performed using anthropometric measurements, creatinine height index (CHI), and serum protein assays. All values tested were significantly lower than those of 40 healthy controls. A matrix of correlation coefficients showed many similarities among the variables studied. Fatal outcome and poor prognosis indices, such as sepsis and renal failure, were analyzed separately. Anthropometric measurements and CHI were not different in the separate groups. Albumin (Alb) and transferrin (Tr) were not different in patients with or without sepsis. Retinol binding prealbumin was significantly higher in patients with renal failure. Thyroxin-binding prealbumin (TBPA) was significantly lower in all the groups. We emphasize the interest of this rapid turnover protein in evaluating nutritional status. We suggest: (1) a systematic nutritional assessment, and (2) an aggressive nutritional support in the ICU patient.
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PMID:Nutritional status in intensive care patients: evaluation in 84 unselected patients. 682 85

Acute infections of childhood are associated with an increased of xerophthalmia, apparently due to depletion of vitamin A stores. The mechanism responsible for this is not known. Recently, it has been reported that severe infections in adult patients (ie, sepsis and pneumonia) result in excretion of large quantities of retinol in the urine. In 44 children hospitalized for treatment of acute diarrhea we found mean urinary excretions of 1.44 mumol retinol/24 h on day 1 of hospitalization, 0.62 mumol retinol/24 h on day 2, and 0.23 mumol/24 h on day 3. Healthy control subjects matched for age did not excrete measurable amounts of retinol in the urine. Retinol excretion was associated strongly with rotavirus diarrhea and presence of fever. Furthermore, serum retinol concentration was negatively associated with duration of diarrhea before hospitalization, suggesting that urinary excretion of retinol may be an important contributor to vitamin A depletion.
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PMID:Urinary excretion of retinol in children with acute diarrhea. 776 30

Episodes of acute infection are thought to deplete body stores of vitamin A. The mechanism by which this might occur is not known, but increased metabolic requirements are presumed to play a role. We have found, however, that significant amounts of retinol and retinol-binding protein (RBP) were excreted in the urine during serious infections, whereas only trace amounts were found in the urine of healthy control subjects. The geometric mean excretion rate in 29 subjects with pneumonia and sepsis was 0.78 mumol retinol/d. Subjects with fever (temperature > or = 38.3 degrees C) excreted significantly more retinol (geometric mean = 1.67 mumol/d) than did those without fever (0.18 mumol/d; t = 3.53, P < 0.0015). Aminoglycoside administration and low glomerular filtration rates (< 35 mL/min) were also associated with higher rates of urinary retinol excretion. Thirty-four percent of patients excreted > 1.75 mumol retinol/d, equivalent to 50% of the US recommended dietary allowance. These data show that vitamin A requirements are substantially increased during serious infections because of excretion of retinol in the urine, and suggest that these losses are due to pathologic changes associated with the febrile response.
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PMID:Vitamin A is excreted in the urine during acute infection. 807 70

In order to verify whether rat hepatocytes are capable of producing leukotrienes, Percoll density gradient centrifugation to fractionize rat hepatocytes and a radioimmunoassay of leukotrienes in the reacting solution have been performed. Also, investigated was effect of retinol (Vitamin A) on inducing the production of leukotrienes in rat Kupffer cells and hepatocytes. Incubation with endotoxin (10 micrograms/ml) for 30-60 minutes induced the production of leukotrienes in rat Kupffer cells but did not induce any such production in rat hepatocytes. On the other hand, arachidonic acid (2-20 microM) or linoleic acid (10-50 microns) did induce hepatocytes to produce leukotrienes in a dose-dependent manner. Fifteen minutes of pre-incubation with 10(-8) M of retinol inhibited an endotoxic induction of leukotrienes production in rat Kupffer cells, whereas it did not inhibit an arachidonic acid induction in rat hepatocytes. Based on these results, we have concluded that a hepatic tissue injury during sepsis is probably mediated by leukotrienes produced by the Kupffer cells and its inhibition is the mechanism of tissue protective effect of retinol. However, in further severe state even the hepatocytes may produce leukotrienes and as a consequence, a widespread destruction of hepatic tissue will occur.
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PMID:[Production of leukotrienes in rat Kupffer cells and hepatocytes by various inducers]. 831 99

From 1984 through 1992, staff at The Marine Mammal Center (TMMC, Sausalito, California, USA) examined 207 northern elephant seals (Mirounga angustirostris) with a condition of unknown etiology called northern elephant seal skin disease (NESSD). The skin lesions were characterized by patchy to extensive alopecia and hyperpigmentation, punctate or coalescing epidermal ulceration, and occasionally, massive skin necrosis. Microscopic lesions included ulcerative dermatitis with hyperkeratosis, squamous metaplasia and atrophy of sebaceous glands. All diseased seals were less than 2 years of age and suffered from emaciation, depression, and dehydration. Mortality from septicemia increased significantly with severity of skin ulceration. Compared to 14 apparently unaffected seals, diseased seals had depressed levels of circulating thyroxine, triiodothyronine, retinol, serum iron, albumin, calcium, and cholesterol. Levels of alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, gamma glutamyl transpeptidase, blood urea nitrogen, and uric acid were elevated. Morphometrically, diseased animals were approximately 15% smaller than normal seals of the same sage. Serum and blubber concentrations of 36 polychlorinated biphenyl congeners (sigma PCB) and dichloro-diphenyl-dichloroethylene (p,p'-DDE) were negatively correlated with body mass. Mean concentrations of sigma PCB and p,p'-DDE in serum in diseased seals were elevated as compared to apparently normal seals. Etiology of this syndrome remains unknown, but the possibility of PCB toxicosis cannot be ruled out.
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PMID:Clinical and pathological characterization of northern elephant seal skin disease. 924 88


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