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

The results with a cuffed silicon rubber right atrial catheter for prolonged parenteral nutrition are reported. In 43 patients, 78 catheters were inserted; of these, 52 were removed for various reasons. The mean duration of catheter patency in 26 patients currently infusing at home is 9.4 months. The high incidence of catheter-related septicemia previously reported by others has been reduced to one for every 5.5 patient years. The combination of soft Silastic material, catheter design, localization and easy handling by the patient have all contributed to its longer life span. It can be used with impunity whenever long term access to the circulation is needed.
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PMID:Five years' experience with a right atrial catheter for prolonged parenteral nutrition at home. 82 Nov 60

A 52-year-old man was complicated with a left subphrenic abscess after total pancreatectomy and gastrectomy for advanced pancreatic cancer. A left subphrenic silicon tube penetrated the diaphragm and the bottom of the left lung as well, causing a bronchial fistula with bilateral aspiration pneumonia. Then bronchoscopically, the fistula was successfully treated by packing a few pieces of oxidized cellulose into the affected bronchus. One month later the patient died of sepsis due to multiple liver abscess. On autopsy, the bronchial fistula and any active inflammation were not recognized in the left lower lung area.
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PMID:[Oxidized cellulose occlusion of a peripheral bronchial fistula communicating to the left subphrenic abscess]. 143 99

Difficulties in creating vascular access in patients on hemodialysis are encountered in most dialysis centers. This is usually due to a lack of suitable peripheral vessels due to previous access surgery in patients on long-term hemodialysis, but also may be seen in some patients de novo, particularly diabetics and patients with peripheral vascular disease. Surgical techniques used to overcome this problem vary depending on patient characteristics and, to a certain extent, on local expertise/preference. We report our experience of using silicon dual-lumen hemodialysis catheters over a 3-year period; during this time, 54 catheters were inserted into 32 hemodialysis patients. The indication for this procedure in 52 catheters (31 patients) was either exhausted vascular access or obvious difficulty identifying a suitable peripheral blood vessel. Of the catheters inserted, 20 were placed into subclavian veins by primary insertion (ie, patients did not have existing subclavian catheter); 34 were replaced over a guidewire (a procedure used to allow technique salvage). The catheter survival rate was 72.7% at 90 days and 48.7% at 1 year. Corresponding rates at 90 days and 1 year for technique survival were 93.3% and 81.8%, respectively. The mean catheter and technique survival was 387 (95% confidence intervals [CIs], 273, 502) and 844 (95% CIs, 684, 1,005) days, respectively. Poor flow accounted for 70.4% of catheter failures and, despite 18 episodes of catheter-related sepsis, no catheters were lost due to infection. Factors identified as leading to reduced catheter survival were left-sided placement and catheter tip placement in the superior vena cava (as opposed to right atrial placement). We did not observe poorer survival or increased sepsis in catheters replaced over a guidewire, and would advocate this technique as a means of salvage in this group of patients.
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PMID:Long-term vascular access for hemodialysis using silicon dual-lumen catheters with guidewire replacement of catheters for technique salvage. 910 44

Intravenous access contributes significantly to the therapeutical success and to the comfort of oncologic patients. The highest risk for bloodstream infections, however, is vascular catheter-mediated. In oncology high mortality is associated with Pseudomonas aeruginosa, Candida albicans and Staphylococcus aureus sepsis. Besides established hygienic measures, the coupling or incorporation of antimicrobial substances to or into catheter materials may be a suitable way to prevent the development of catheter-associated infections. Here we present a risk- benefit evaluation of different models of antimicrobial catheter coated with silver, antiseptics or antibiotics. The controversial reports on clinical efficacy and the potential of adverse reactions due to silver and antiseptic coated catheters are discussed. The microbiological, pharmaceutical and physicochemical backgrounds of different types of coating are discussed in detail. Incorporation of antimicrobial agents into long-term silicon catheters providing a slow release of those substances through the external and internal surfaces of catheters may be the most effective technological innovation for reducing biomaterial-mediated nosocomial infections.
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PMID:Anti-infective catheters: novel strategies to prevent nosocomial infections in oncology. 985 69

Biomaterial surfaces may be modified to reduce bacterial adhesion. The susceptibility in mice to Staphylococcus epidermidis infection in tissue surrounding the commonly used catheter materials-silicon elastomer (SE), polyamide (PA), and their surface-modified polyvinylpyrrolidone (PVP)-grafted derivatives, SE-PVP and PA-PVP, respectively-was assessed. Abscesses developed around SE-PVP. Around SE, PA, and PA-PVP catheters, no signs of infection were observed, although mice carrying PA-PVP developed septicemia after 14-21 days. S. epidermidis was cultured from the tissue surrounding PA-PVP segments. Cells around PA-PVP segments containing large numbers of bacteria were identified as macrophages by use of immunohistochemistry and electron microscopy. This persistence of intracellular bacteria was also observed around SE-PVP, SE, and PA catheters, although to a lesser extent. The cytokine profiles around the 4 materials were different. Implanted biomaterial induces an inflammatory response favorable to the persistence of S. epidermidis. Intracellular persistence of bacteria inside macrophages may be a pivotal process in the pathogenesis of biomaterial-associated infection.
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PMID:Biomaterial-associated persistence of Staphylococcus epidermidis in pericatheter macrophages. 1076 65

In children with dilated cardiomyopathy the disease may progress so rapidly that they die during the waiting period before a suitable donor organ is found. Fifteen children of 4 months to 15 years of age had been in congestive heart failure with multiorgan failure due to dilated cardiomyopathy, where intensive medical treatment had failed. After resuscitation, a miniaturized pulsatile ventricular assist device for the mechanical replacement of heart function was implanted. The biventricular assist device ("Berlin Heart") consists of two extracorporeal pneumatically driven polyurethane blood pumps, with a multi-layer flexible membrane that separates a blood and an air chamber. Four silicon cannulae connect the blood pumps to the patient. A three-leaflet valve prevents blood reflux. The pumps are driven by a pulsatile electropneumatic system. In 12 of the 15 children the bridging to transplantation was successful with a support time of 1 to 98 days (mean 24 days). Nine of them were extubated and mobilized while assisted. Three children died during the support time due to hemorrhage, sepsis, and pulmonary failure. In addition, there was one infarction of the arteria cerebri media. To date seven of the transplanted children are in good condition on follow-up. The beneficial effects of ventricular assist device use are well known in adult patients and with special devices it can be transferred to infants and children in whom longer need for support is anticipated. Even in small infants it is an effective method for bridging to cardiac transplantation.
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PMID:[Artificial heart in terminal stage of dilated cardiomyopathy in childhood]. 1114 71

Intravenous catheters are used for the administration of medications and fluids and are an integral part of veterinary practice. The aim of catheter use is to optimise administration of medication and minimise complications such as thrombus formation, thrombophlebitis and sepsis. Catheters made from teflon are less flexible, less durable and stimulate more tissue reaction than polyurethane or silicon. However silicon catheters are more expensive and complicated to insert. Generally, for veterinary practice, the biostability and cost of polyurethane catheters make them preferable for short and long-term use. The smallest diameter catheter should be selected to minimise internal vessel wall contact and irritation without compromising medication delivery. The site of insertion varies with individual preference, vessel access and patient compliance. The jugular, cephalic, saphenous, ear, lateral thoracic and subcutaneous abdominal veins are accessible. Hair removal and a thorough aseptic skin preparation should be performed prior to catheter insertion. Daily maintenance is required to detect complications and maximise catheter longevity. Potential complications include thrombus formation, thromboembolism, bacterial colonisation and septicaemia, blood loss and air embolism. Permanent or transient skin dwelling bacteria are commonly isolated if sepsis occurs. The development of novel antiseptic and antibiotic impregnated catheters may reduce the complications associated with catheter infection in the future.
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PMID:Catheters: a review of the selection, utilisation and complications of catheters for peripheral venous access. 1508 Apr 25

Sepsis with subsequent multisystem organ failure after translocation of bacteria from the gut is a serious risk associated with stress situations. We showed that intestinal bacterial translocation could be one of the pathways for pathogenic Streptococcus suis infections in the pig. In 24 piglets weighing 10-14 kg, free of the extracellular factor (EF+) producing phenotype of S. suis serotype 2, a silicon canula was placed in the proximal jejunum to enable intestinal inoculation and bypassing the upper alimentary tract. The pigs were individually housed. After stress induction in 18 pigs by means of a truck drive in individual cages for 1h, pigs were inoculated through the intestinal canula either with S. suis type 2 EF+ or with growth medium only, and put back in their original housing. The six not transported pigs were also inoculated with the same strain. To prevent oral self-infection, faeces were collected in a bag that was glued around the anus. Clinical and behavioral symptoms were recorded for 72 h post inoculation, and then the animals were sacrificed for pathological and bacteriological examination. In three animals, the inoculation strain was re-isolated from mesenterial lymph nodes and typically affected organs. No S. suis type 2 EF+ was detected by specific polymerase chain reaction (PCR) in any of the tonsil-swabs and -homogenates. We concluded that infection of the organs had taken place after bacterial translocation out of the gut and that the intestinal tract can be a porte d'entree for S. suis type 2 EF+.
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PMID:Intestinal translocation of Streptococcus suis type 2 EF+ in pigs. 1538 Dec 63

Peripherally Inserted Central Catheters (PICC) represent an alternative for critical patient care, and are safer to implant in home patients. The authors report on their experience with the first 200 4 Fr Groshong PICC implanted during the last 18 months. The procedure can be easily applied at home (98% successful implant rate), without the need for fluoroscopic or ultrasound guidance. Moreover, the authors believe that the X-ray control after implant is not strictly necessary. After 11,570 days/catheters, only 5 devices were explanted because of complications: 4 because of sepsis and peripheral phlebitis, and the last was explanted by another medical staff for unclear reasons. The complications needing no explanation were a total of 32: for 12 of them the external portion of tube was damaged during use, while for the other 20 the internal clots were resolved with forced flushing. The authors conclude that Groshong PICC can be considered the gold standard for home care management of critical patients, taking into account the quality of pure silicon, the presence of a valve and the specially-made closed-tip.
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PMID:Groshong PICC and home care: an opportunity. Clinical experience after the first 200 implants. 1763 36

Benign tracheo-neo-esophageal fistula is a rare complication after esophagectomy. We report a 60-year-old man who presented 12 years after a McKeown esophagectomy with a fistula between the tracheal carina and the gastric conduit. In view of his severe sepsis and profound malnutrition, he underwent placement of a silicon Y-stent with a successful three-stage surgical repair consisting of duodenal exclusion with drainage gastrostomy. Six weeks later, the patient had closure of the fistula through a right thoracotomy. He finally underwent Roux-en-Y gastro-jejunostomy through a left thoraco-abdominal approach to restore the gastrointestinal continuity. Eighteen months postoperatively, he reports no dysphagia and has regained his premorbid weight.
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PMID:Staged repair of benign tracheo-neo-esophageal fistula 12 years after esophagectomy for esophageal cancer. 2248 2


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