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)

Optimum surgical management of the hypopharyngeal diverticulum is controversial. The authors discuss 48 consecutive patients (average age 72.1 years) with documented hypopharyngeal diverticula who were treated by cricopharyngeus myotomy, leaving the diverticula in situ. All came to the hospital with dysphagia; other symptoms included postdeglutitive cough, regurgitation, aspiration, and weight loss. Seven patients had had previous surgery for a Zenker's diverticulum with recurrence. Aspiration pneumonia was treated in 9 patients; 28 patients had concurrent chronic obstructive pulmonary disease or cardiovascular disease. Thirty-nine patients had cricopharyngeus myotomy under local anesthesia, 5 had cricopharyngeus myotomy under general endotracheal anesthesia, and 4 patients underwent myotomy with a cervical esophagostomy. There was one mortality (2.1%) and no incidence of postoperative bleeding, sepsis, or cranial nerve injury. Follow-up was done with 30 patients via telephone an average of 64 months after operation. Twenty-one of 30 patients reported excellent relief of symptoms, 5 reported improvement with occasional symptoms, and 4 patients described persistent dysphagia. Cricopharyngeus myotomy under local anesthetic is a safe and effective approach to the patient with a hypopharyngeal diverticulum. The awake patient can swallow on command, which enables the surgeon to identify the upper esophageal sphincter (UES) and to perform an accurate, complete myotomy. The absence of a pharyngeal suture line eliminates the risk of leakage and mediastinal sepsis, and allows early, postoperative feeding and discharge.
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PMID:Treatment of Zenker's diverticula by cricopharyngeus myotomy under local anesthesia. 148 6

During a 12 mth period in a newborn unit (NBU), Serratia marcescens was isolated from 3 fatal cases of meningitis, 5 cases of septicemia, 5 of pneumonia, 4 or urinary tract infection and 15 of conjunctivitis. At the peak of the outbreak a 95% incidence of rectal colonization with S. marcescens was observed in the NBU. Polyacrylamide gel electrophoresis of sodium dodecylsulphate disrupted Serratia (SDS-PAGE) established that all isolates were identical.
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PMID:Serratia marcescens in a newborn unit--microbiological features. 637 83

Optimum management of intraabdominal sepsis requires the judicious use of appropriate surgical procedures and simultaneous antibiotic administration. A number of appropriate antibiotics and antibiotic combinations are available for intraabdominal sepsis, but most data still favor combinations of an antiaerobic drug, most often an aminoglycoside, and an antianaerobic drug--and possibly a third agent effective against enterococci.
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PMID:Antibiotics for intraabdominal sepsis. Selection of an effective combination. 672 39

In acute hypoxemic respiratory failure of term and near-term neonates, extra- and intrapulmonary right-to-left shunting contribute to refractory hypoxemia. Inhaled nitric oxide (NO) decreases pulmonary arterial pressure and improves ventilation-perfusion mismatch in a variety of animal models and selected human patients. We report on 10 consecutive term and near-term newborns with severe acute hypoxemic respiratory failure due to diaphragmatic hernia, meconium aspiration syndrome, group B streptococcus sepsis, pneumonia or acute respiratory distress syndrome, who received increasing doses of inhaled NO (up to 80 ppm) to improve the arterial partial pressure of oxygen (PaO2). The response to NO and the optimum NO concentration which improved PaO2 varied considerably between patients. Improvement of PaO2 was absent or poor (less than 10 mm Hg) in the 4 newborns with meconium aspiration syndrome and in 1 patient with congenital diaphragmatic hernia, while in the other 5 patients inhaled NO increased the mean (+/- SE) PaO2 from 41 +/- 6 to 57 +/- 9 mm Hg (P < 0.05). Optimum NO concentrations determined by dose-response measurements performed during the first 8 hr of NO inhalation were 8-16 ppm except for 2 newborns with congenital diaphragmatic hernia who required 32 ppm to effectively increase PaO2. Four of the 5 patients in whom the PaO2 rose by more than 10 mm Hg received inhaled NO for extended periods of time (5 to 23 days) with no signs of tachyphylaxis. The optimum NO concentration dropped to less than 3 ppm after prolonged mechanical ventilation or when intravenous prostacyclin was given concomitantly.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Dose-response to inhaled nitric oxide in acute hypoxemic respiratory failure of newborn infants: a preliminary report. 756 4

Phospholipase A2 (PLA2) activity was purified 12,544-fold with a 13% yield from the plasma of patients diagnosed of septic shock by the sequential use of heparin-agarose affinity chromatography, gel filtration, and reverse-phase f.p.l.c. Gel-filtration chromatography of plasma omitting high-ionic-strength buffer revealed a molecular mass different from that of purified PLA2 and co-elution with apolipoprotein A-I peaks, which suggests its association with high-density lipoproteins (HDL). N-terminal analysis of the enzyme activity protein band, electroblotted from a SDS-acrylamide gel and with an assessed molecular mass of 19 kDa, showed an identical sequence to that of alpha-chain of human C3 complement component, suggesting the presence in this band of a complex formed by a complement C3-derived anaphylatoxin (C3a)-related fragment and the PLA2 linked side-by-side. Because the preparation of plasma enzyme showed lower activity than the enzyme obtained from fibroblasts transfected with the coding sequence of human group-II PLA2, and because the addition of C3-derived anaphylatoxins from human serum inhibited the activity of this recombinant PLA2, it was considered that C3a-related peptides behave as inhibitors of group-II PLA2. The enzyme showed optimal activity on [14C]oleate-labelled autoclaved E. coli, on synthetic phosphatidylethanolamine, and on [3H]arachidonate-labelled membranes of the monoblast cell line U937, but it did not show any activity on the release of [3H]arachidonate from pre-labelled human polymorphonuclear leukocytes (PMNs). In short, PLA2 from plasma of sepsis patients shows unique associations with other plasma proteins which may influence its functional properties. The association with C3-related peptides shows an inhibitory effect on the enzyme activity, whereas the association with HDL might influence its environment and/or its interaction with cells. The study of the catalytic properties shows a prominent effect on bacterial phospholipids, synthetic phosphatidylethanolamine, and membranes from U937 monoblasts, but not on synthetic phosphatidylcholine or on PMNs, even when these cells were maintained in culture to allow spontaneous apoptosis and became a good substrate for pancreatic type PLA2.
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PMID:Phospholipase A2 from plasma of patients with septic shock is associated with high-density lipoproteins and C3 anaphylatoxin: some implications for its functional role. 786 6

Patients who are critically ill with sepsis, shock, respiratory failure, trauma, or major surgical procedures may have reduced morbidity and mortality when hemodynamic and oxygen transport variables are augmented to values higher than those traditionally considered normal. Lactate production and suboptimum oxygen transport values are associated with anaerobic metabolism and insufficient tissue oxygenation. Since lactate can be a marker of inadequate tissue oxygenation, serial lactate measurements may be useful in individualizing therapy to reverse tissue hypoxia. Optimum hemodynamic and oxygen transport values are highly individual, and no accepted method has been established for guiding therapy. These values, together with plasma lactate concentrations, may assist in individualizing therapy in critically ill patients. No consensus can be reached at this time as to which specific therapeutic end points are optimal, how to achieve these end points, and which subset of patients will benefit from this therapy.
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PMID:Defining and achieving optimum therapeutic goals in critically ill patients. 788 71

Optimum perinatal outcome is only achieved by the prevention of premature birth. When preterm delivery is unavoidable, antenatal pharmacologic therapy will result in a reduction in the leading causes of neonatal morbidity and mortality, mainly respiratory distress syndrome (RDS), BPD, intraventricular haemorrhage (IVH) and sepsis. These treatments combined with meticulous intrapartum management will result in significant improvements in the neonatal and long-term outcome in the premature baby.
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PMID:Preparing the fetus for preterm birth. 825 19

The effect of supernatant from phorbol myristate acetate (PMA) stimulated human polymorphonuclear granulocytes (PMN) on human factor VII was studied in vitro. The supernatant caused a rapid loss in factor VII coagulant activity by the action of human leukocyte elastase (HLE) and cathepsin G in the supernatant, as demonstrated by the use of specific inhibitors of the two serine proteases, respectively. Preincubation of the supernatant with the elastase inhibitor and the cathepsin G inhibitor preserved 80% and 25% of the clotting activity, respectively. Calcium protected factor VII completely from the supernatant mediated inactivation. Cathepsin G and HLE purified from PMN each destroyed the coagulant activity of factor VII when added to a non-plasma system. There were, however, no effect on factor VII activity when cathepsin G was added to plasma. Polyacrylamide gel electrophoresis in the presence of SDS indicated that HLE and cathepsin G cleaved the zymogen in the same manner, producing (a) peptide(s) of low molecular mass and a single large product of 48 kDa. Preincubation of factor VII with calcium ions inhibited the proteolytic action of HLE and cathepsin G. It is suggested that HLE and cathepsin G from activated granulocytes may be partly responsible for the loss in factor VII activity that is observed during sepsis.
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PMID:Human leukocyte elastase and cathepsin G inactivate factor VII by limited proteolysis. 805 78

Spinal injuries are caused by strong traumatic impacts, followed not only by a local spinal reaction but also systemic involvement. The main problems in the early posttraumatic period are haemodynamic instability, pulmonary insufficiency and SIRS. In this period multiple risks of secondary injuries to the spinal cord or other organs exist and may develop towards life-threatening sepsis, ARDS and multi-organ failure. Optimum therapy for spinal injury patients is demanding and requires an experienced team for diagnosis as well as primary and secondary care. Close cooperation between intensive care and surgery is also important.
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PMID:[Intensive care treatment concepts after traumatic spinal cord injury]. 1089 52

Vibrio vulnificus is a gram-negative bacterium that contaminates filter-feeding shellfish such as oysters. After ingestion of contaminated oysters, predisposed people may experience highly lethal septicemia. Contamination of wounds with the bacteria can result in devastating necrotizing fasciitis, which can progress to septicemia. The extremely rapid progression of these diseases can render antibiotic treatment ineffective, and death is a frequent outcome. In this study, we examined the potential use of bacteriophages as therapeutic agents against V. vulnificus in an iron-dextran-treated mouse model of V. vulnificus infection. Mice were injected subcutaneously with 10 times the lethal dose of V. vulnificus and injected intravenously, either simultaneously or at various times after infection, with phages. Treatment of mice with phages could prevent death; systemic disease, as measured by CFU per gram of liver and body temperature; and local disease, as measured by CFU per gram of lesion material and histopathologic analysis. Two different phages were effective against three different V. vulnificus strains with various degrees of virulence, while a third phage that required the presence of seawater to lyse bacteria in vitro was ineffective at treating mice. Optimum protection required that the phages be administered within 3 h of bacterial inoculation at doses as high as 10(8) PFU. One of the protective phages had a half-life in blood of over 2 h. These results demonstrate that bacteriophages have therapeutic potential for both localized and systemic infections caused by V. vulnificus in animals. This model should be useful in answering basic questions regarding phage therapy.
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PMID:Phage therapy of local and systemic disease caused by Vibrio vulnificus in iron-dextran-treated mice. 1237 4


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