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

Irreversible sepsis, in spite of advancements in topical therapy and antimicrobial agents, remains the leading cause of death in major thermal injury. A defect in intracellular bactericidal capacity in leukocytes from severely burned patients appears to correspond with increases in bacterial wound colonization and ultimate sepsis. This leukocyte defect has been demonstrated by abnormally low nitroblue tetrazolium reduction (NBT) and oxygen consumption of white cells in patients with major thermal injury. The subcellular mechanisms responsible for decreased bactericidal capacity were therefore investigated. Nicotinamide-adenine dinucleotide (NADH) and nicotinamide-adenine phosphodinucleotide (NADPH) oxidase activity was measured in patients with major burns, controls (normals), and in patients with nonburn stress or infection. NADH and NADPH oxidase levels in leukocytes from burn patients were not significantly different from those of normal nonchallenged controls but were significantly lower than the leukocyte values found in the patients with nonburn infections or stress. This NADH and NADPH defect in the subcellular leukocyte fraction suggests that it may be a significant factor in the reduced bactericidal function of the intact leukocyte in thermally injured patients.
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PMID:The role of NADH-NADPH oxidase activity in the leukocyte function of burned patients. 76 16

Oxygen-sensitive anaerobic bacteria comprise the largest group of organisms among the human endogenous microflora. The oral cavity, vagina and colon are the areas where obligate anaerobes are predominant and can be isolated in very high numbers. Sepsis following surgery of any of these organs is frequently due to the escape of endogenous bacteria during the course of the operative procedure. To isolate and successfully identify most of these anaerobic microorganisms from clinical exudate, special collection and bacteriologic techniques are necessary. The acceptable anaerobic collection techniques mentioned above minimize exposure of the clinical specimen to atmospheric oxygen during collection and transfer. Clinical clues indicating anaerobic sepsis include a putrid odor of the exudate and evidence of abscess, necrosis or associated gas formation. The importance and value of the Gram stain in early identification of surgical sepsis is stressed. Treatment of infectious complications includes surgical drainage and specific antibiotics.
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PMID:Clinical aspects of anaerobic infections in the surgical patient. 76 29

Oxygen-sensitive anaerobic bacteria comprise the largest group of organisms among the human endogenous microflora. The oral cavity, the vagina and the colon are areas where the obligate anaerobes are predominant and can be isolated in high numbers. Clinical clues that indicate anaerobic sepsis include a putrid odor of the exudate and evidence of abscess, necrosis or associated gas formation. A Gram stain is highly valuable in early identification. Surgical drainage and appropriate antibiotics are essential.
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PMID:Anaerobic Infections. 79 Sep 28

Although obese patients have been shown to represent a particularly high risk group with respect to hypoxemia both pre and postoperatively, no data exist to delineate the intraoperative arterial oxygenation pattern of these patients. Furthermore, no one has studied the effects of a change in operative position or a subdiaphragmatic laparotomy pack on arterial oxygenation (PaO2). Sixty-four adults undergoing jejunoileal bypass for morbid exogenous obesity, with a mean weight of 142.0 +/- 31.4 kg and a mean age of 33.3 +/- 10.4 years, were studied. Twenty-five patients (Group I) were maintained in the supine position throughout the operative procedure, while the remaining 39 patients (Group II) were changed to a 15 degrees head down position 15 minutes after a control blood sample was taken. Four additional markedly obese patients were studied to determine the effect of an abdominal pack of PaO2 values. The following findings were demonstrated: 1) 40% oxygen did not uniformly produce adequate arterial oxygenation for intra-abdominal surgery in otherwise healthy obese patients; 2) placement of a subdiaphragmatic abdominal laparotomy pack without a change in operative position resulted in a consistent fall in PaO2 in each patient to less than 65 mm Hg even though 40% oxygen was being administered; and 3) a change from supine to a 15 degrees head down operative position resulted in a significant (P less than 0.001) reduction in mean PaO2 (73.0 +/- 26.3 mm Hg). Seventy-seven per cent of these patients demonstrated PaO2 values of less than 80 mm Hg on 40% oxygen. Because of these findings, serious consideration should be given to the routine use of the Trendelenberg position intraoperatively in obese patients. However, if one elects this posture, prudence would dictate careful monitoring and maintenance of arterial oxygenation. Certainly, in obese patients, the intraoperative combination of the head down position and a subdiaphragmatic laparotomy pack should be avoided. In addition, since our data were collected in obese but otherwise healthy, young patients free of cardiorespiratory disease, special attention should be directed at the continuous measurement of arterial oxygenation in the older obese patient with either intrinsic dysfunction of vital organs (heart, lung, liver, kidney) or surgical disorders (peritonitis, sepsis).
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PMID:Intraoperative arterial oxygenation in obese patients. 93 16

A case of Clostridium perfringens sepsis and gas gangrene complicating chemotherapy for gestational choriocarcinoma is reported. The infection was eradicated using antibiotics, surgery, and hyperbaric oxygen therapy. The pathophysiology, diagnosis, and treatment of this unusual but often lethal complication are reviewed.
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PMID:Clostridium perfringens infection complicating chemotherapy for choriocarcinoma. 94 77

The adult pulmonary distress syndrome is a disease of many etiologies and significantly contributes to the post-traumatic and postsurgical mortality and morbidity. Pulmonary insufficiency associated with shock and hemorrhage is characterized by its relatively short duration, less severe alterations of pulmonary functions, and normal pulmonary vascular resistance. The judicious use of fluids and emphasis in the early use of blood during resuscitation will minimize the magnitude of the pulmonary insult. Severe changes in oxygenation and ventilation, increases in pulmonary vascular resistance, the need for long-term respiratory assistance, and an increase in mortality and morbidity are characteristic of the adult pulmonary distress syndrome that follows severe systemic sepsis. Early aggressive pulmonary support is required in all life-threatening surgical conditions. Endotracheal intubation is preferred to tracheostomy, and the use of a volume respirator will facilitate the control of ventilation and oxygenation. Significant decreases in the functional residual capacity are responsible for refractory hypoxemia and the use of high concentrations of oxygen can be circumvented by the use of positive end expiratory pressure. PEEP is sometimes associated with a decrease in cardiac output and an increase in the pulmonary shunt and occasionally pneumothorax. Continued hemodynamic and pulmonary monitoring of patients is mandatory when using PEEP. Discontinuance of ventilatory assistance is usually possible if the pulmonary shunts are less than 25 per cent, the tidal volumes greater than 5 cc per kg, and the vital capacity at least twice the tidal volume. Recovery from pulmonary insufficiency is predicated on adequate pulmonary management, nutritional support, and the control of the underlying contributory conditions.
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PMID:The lung: responses to trauma, surgery, and sepsis. 98 95

Twenty-nine patients, divided into three groups: 1) chronic obstructive pulmonary disease; 2) acute or chronic pulmonary disease with left heart failure; 3) respiratory insufficiency after peritonitis, pancreatitis, and/or sepsis, were studied during respirator treatment with regard to gas exchange, breathing mechanics and central circulation. The dead space ventilation was somewhat greater in group 1 than in the other groups. The alveolar-arterial oxygen tension difference was least in group 1, greater in group 2 and extremely high in group 3. Neither dynamic compliance of the thorax nor inspiratory resistance showed any significant differences between the groups. The cardiac output had the highest values in group 3. The venous admixture was generally small in group 1 and extremely large in group 3. The pulmonary artery pressures were highest in group 2. Three variables proved to be valuable when assessing the prognosis of a patient: a large venous admixture; a large alveolar-arterial oxygen tension difference, and a high pulmonary artery pressure indicated a less favourable prognosis.
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PMID:Studies on pulmonary function in patients during respiratory treatment. Diagnostic and prognostic evaluations. 99 53

Oxygen-sensitive anaerobic bacteria comprise the largest group of organisms among the human endogenous microflora. The oral cavity, the vagina, and the colon are the areas of the human body where the obligate anaerobes are predominant and can be isolated in very high numbers. Sepsis following surgery of any of these organs is frequently due to the escape of these endogenous bacteria during the course of the operative procedure. To enable the isolation and successful identification of most of these anaerobic microorganisms from clinical exudate, special collection and bacteriologic techniques are necessary. The acceptable anaerobic collection techniques have been reviewed in this paper. All of these techniques minimize the exposure of the clinical specimen to atmospheric oxygen during collection and transfer. The modern equipment used in sophisticated anaerobic bacteriologic workup has been discussed. Clinical clues that indicate anaerobic sepsis include a putrid odor of the exudate and evidence of abscess, necrosis, or associated gas formation. The importance and value of the gram-stain in the early identification of surgical sepsis has been stressed.
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PMID:Modern approach to the diagnosis of anaerobic surgical sepsis. 109 Oct 11

The indications for transfusions are anemia compromising delivery of oxygen, acute blood loss, cardiopulmonary bypass, exchange transfusion, maintenance of hemostasis, and sepsis associated with granulocytopenia. When transfusion therapy is indicated, only that component of whole blood which is needed for correction of the problem should be given. The options for use each component have been discussed.
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PMID:Use of blood and blood components. 109 59

Twenty patients with acute dermal gangrene following surgery, trauma or sepsis are described. In 12 the skin became gangrenous secondary to a necrotizing process affecting the subdermal fascia, and in 8 the condition arose primarily in the skin. In the first group mortality was high unless radical excision of the necrotic fascia was performed at an early stage; in 3 of the recent patients the overlying skin was removed, defatted and stored for later grafting. In the second group, incision and adequate drainage combined with antibiotics seemed to suffice. Hyperbaric oxygen was of dubious value in the first group but appeared to contribute to arrest of the lesion in the second group.
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PMID:Diagnosis, clinical course and treatment of acute dermal gangrene. 109 10


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