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

490 living donor nephrectomies were performed during a 25-year period, all through a retroperitoneal approach. In this report, short-term complications and donor renal function are analysed. There was no mortality. The major complication rate was 1.4%. There were 5 cases of postoperative haemorrhage requiring reoperation, one of which developed non-A-non-B hepatitis. There was one case each of septicemia and pulmonary embolism. All these patients recovered. Minor complications were noted in 13.6% of the cases, mostly bacteriuria or minor pulmonary infiltrates. There were 5 cases of reversible heart disorders and 6 cases of mental disorders. After 6-12 months, all donors had satisfactory function of the remaining kidney, which had increased its GFR by 32-38%. We conclude that the short-term consequences of donor nephrectomy are acceptable. From previous reports, from this unit and from others, it is evident that the procedure does not carry any definite long-term health risks. With a permanent shortage of cadaveric organs and with continued superiority in the outcome of living donor transplantations, this important resource should not be disregarded.
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PMID:Living donor nephrectomy. Complication rates in 490 consecutive cases. 162 4

Low levels of thyroid hormone in the absence of clinical hypothyroidism often happen to patients with critical non-thyroidal illnesses (NTI). Low thyroid hormone concentrations in serum do not necessarily mean hypofunction of the thyroid gland; rather it is a helpful adaptation of the human body to the underlying diseases. We collected 133 hospitalized cases of critical NTI and analyzed the incidence of this phenomenon. Fifty-three per cent of the patients had T3 level lower than 60 ng/dl (normal:85-165 ng/dl) and 60% had T4 level lower than 6 ug/dl (normal:6-12 ug/dl). The lowest levels were observed in patients who had sepsis, were aged over 70 or died in this admission. Free T4 and TSH levels were within normal range in most cases. There is a strong negative correlation between the prognosis and the level of T4 in these patients. Those patients with markedly low levels of T3 and T4 should be treated more sophisticatedly.
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PMID:Abnormal thyroid hormone levels in critical nonthyroidal illness. 164 73

Tumor necrosis factor (TNF) may be involved in the disturbance of the procoagulant-fibrinolytic balance in septicemia, leading to microvascular thrombosis. To assess the dynamics of the fibrinolytic response to TNF in humans, we performed a crossover saline-controlled study in six healthy men, investigating the effects of a bolus intravenous injection of recombinant human TNF (50 micrograms/m2) on the stimulation and inhibition of plasminogen activation as well as on plasmin activity and inhibition. TNF induced a brief fourfold increase in the overall plasma plasminogen activator (PA) activity peaking after 1 h (p less than 0.0001), which was associated with rises in the antigenic levels of urokinase-type plasminogen activator (p less than 0.0001) and tissue-type plasminogen activator (p less than 0.0001). Plasminogen activator inhibitor type I antigen remained unchanged in the first hour, but showed a rapid eightfold increase thereafter (p less than 0.0001), which coincided with the decrease in PA activity. Generation of plasmin activity in the first hour was signified by an 11-fold rise in D-dimer levels (p less than 0.0001); inhibition of plasmin was reflected by a 36-fold rise in plasmin-alpha 2 antiplasmin complexes (p less than 0.0001), as well as by a transient 16% decrease in alpha 2-antiplasmin activity (p less than 0.01). In conclusion, TNF induced an early activation of the fibrinolytic system becoming maximal in 1 h, with a rapid inhibition thereafter. Earlier observations in the same subjects showed sustained coagulation activation for 6-12 h. The observed disbalance between the procoagulant and fibrinolytic mechanisms after TNF injection confirms the in vivo relevance of the effects of TNF on vascular endothelium in vitro and may explain the tendency towards microvascular thrombosis in septicemia.
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PMID:Fibrinolytic response to tumor necrosis factor in healthy subjects. 171 36

While the production of tumor necrosis factor (TNF) and interleukin-6 (IL-6) in septic shock and other inflammatory states is well established, the role of interleukin-8 (IL-8), a recently described neutrophil chemoattractant and activator, has yet to be fully elucidated. Using lipopolysaccharide (LPS)-stimulated human whole blood as an ex vivo model of sepsis, the kinetics of messenger RNA (mRNA) up-regulation and protein release of these cytokines were examined. Two waves of cytokine gene activation were documented. TNF and IL-6 were induced in the first wave with mRNA levels peaking between 2-4 hours and then rapidly declining. TNF and IL-6 protein peaked at 4-6 hours and then stabilized. IL-8 mRNA and protein were induced in the first wave, reached a plateau between 6-12 hours, and rose again in a second wave which continued to escalate until the end of the 24 hour study. These data demonstrate the complex patterns of cytokine gene expression and suggest that production of early mediators may augment continued expression of IL-8 to recruit and retain neutrophils at a site of inflammation.
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PMID:Kinetics of TNF, IL-6, and IL-8 gene expression in LPS-stimulated human whole blood. 198 98

Haematological examinations may contribute, especially by repeated investigations of parameters changing dynamically, to a greater safety of decisions concerning the beginning or termination of chemotherapy in neonates with suspected infections. We recommend to check the blood count every 6-12 h in such cases. A normal blood count does not exclude a sepsis but haematological changes may precede clinical symptoms for hours. We can confirm the good experiences of some authors with "screening-scores" to detect early infants with sepsis. Such a score should include I/T-Quotient, thrombocyte count, CRP and micro-ESR. This contributes to a greater predictive probability of an infection.
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PMID:[The significance of various hematological parameters for the early diagnosis of bacterial infections in premature and full-term neonates. 3. Discussion of the study results]. 228 7

15 VLBW-infants, who were classified to suffer from congenital pneumonia, were treated with a bovine surfactant. Mean gestational age was 25.5 weeks (range 23-27 weeks), mean birth weight was 700 g (range 530-930 g). Surfactant was instilled intratracheally at a mean dose of 41 mg/kg body weight (b.w.) (range 30-50 mg) 8 h after birth (range 6-12 h), if the fraction of inspired oxygen (FiO2) was greater than 0.5 or the peak inspiratory pressure (PIP) was greater than 22 cm H2O (b.w. less than 750 g) or greater than 25 cm H2O (b.w. 751-1000 g). Retreatment up to a total maximum of 4 doses of surfactant was permitted. Surfactant treatment reduced FiO2 from a pretreatment value of 0.79 to 0.50 one hour after application, however, 12 h later FiO2 had increased again to 0.75. Ventilation pressures showed a slight decrease during 12 h after surfactant treatment. 6 infants received 1 dose, multiple doses were given to 9 infants. 5 infants survived, 4 infants died from respiratory failure, 4 from sepsis and 2 from severe intracranial haemorrhage.
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PMID:[Effect of a bovine surfactant in very low birth weight premature infants with congenital pneumonia]. 237 70

We investigated the effect of large volume replacement with balanced electrolyte solutions on extravascular lung water (EVLW) in 16 adult surgical patients with sepsis syndrome. Patients entered the study within the 24 h period following surgical interventions for acute necrotizing pancreatitis, intra-abdominal abscesses, and/or peritonitis. Sequential measurements (n = 108) were made at intervals of 6-12 h over a 48 h period. There were no significant differences between initial and final values of thermal-dye EVLW (5.0 +/- 1.1 vs. 5.7 +/- 1.1 ml/kg), plasma colloid osmotic pressure (COP, 13.3 +/- 2.5 vs. 13.2 +/- 2.9 mmHg), pulmonary artery wedge pressure (PAWP, 9.2 +/- 3.0 vs. 10.8 +/- 3.0 mmHg), and COP-PAWP gradient (4.0 +/- 3.5 vs. 2.4 +/- 3.9 mmHg). All results expressed as (mean +/- SD). The EVLW did not correlate with plasma COP, PAWP, or COP-PAWP gradient. We conclude that large volume replacement with balanced electrolyte solutions with the secondary decrease in plasma COP and COP-PAWP gradient do not necessarily contribute to a substantial increase in EVLW. This study fails to show any causal relationship between decrease in plasma COP or COP-PAWP gradient and oedema formation in the lung.
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PMID:Effect of large volume replacement with balanced electrolyte solutions on extravascular lung water in surgical patients with sepsis syndrome. 260 37

Severe infections and particularly infectious shock are frequently accompanied by a varying degrees of disseminated intra-vascular coagulation (DIC). The mechanism at work is complex, involving endotoxin or bacterial lipopolysaccharide constituents that damage vascular endothelium and activate intrinsic coagulation, platelet function and the release of leucocyte coagulation-promoting compounds. The activation of coagulation in turn activates prekallikrein and complement and plays a part in shock. The laboratory plays an essential role in diagnosing DIC, determining its repercussions on the parameters of haemostasis and in monitoring its course under antibiotics, which in some cases may be combined with carefully controlled heparin treatment. Sensitive and specific tests are the assays for fibrinogen-fibrin degradation products (FDP) and soluble complexes (SC) using the haemagglutination test or the ethanol test. The platelet count should be combined with measurement of the bleeding time. A varying degree of thrombopenia is frequent but non specific. In cases of septicemia, it is an early warning sign. A selective fall in proaccelerin is an indirect early sign. A fall in antithrombin III (AT III) is considered a good sign of DIC but it does not occur in every case, and is most liable to be present in liver failure. From the FDP and fibrinogen results, it should be clear whether one is dealing with compensated, decompensated or even over-compensated DIC. Diagnosis should be complemented by a careful search for the clinical signs of coagulation and haemorrhage. It is indispensable for investigations to be repeated every 6-12 hours, for the sake both of treatment strategy, which can be extremely difficult, and DIC monitoring.
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PMID:[Diagnosis of defibrination syndromes in infectious pathology]. 673 53

Childhood hyperpyrexia is associated with serious infections particularly bronchopneumonia, infective diarrhoea, meningitis, measles, urinary tract infections, otitis media, septicemia and sickle cell crisis Hyperpyrexia was found most in children aged 6-12 months followed by children aged 12-18 months. Hyperpyrexia occurred least in children aged 2-6 months. Febrile convulsion was associated with 38% of the cases. Malaria was a cause of convulsion in 27% of children with fever. This appears to contrast earlier reports by Lennox (1953) and Familusi (1971). The study confirms the rarity of hyperpyrexia in children aged 3 months and under. Deaths recorded were in children brought at the late stages of their ill health. Intensive health education is recommended to obviate unnecessary death of children through ignorance and poor knowledge of simple first aid measures.
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PMID:Childhood hyperpyrexia in Benin City, Nigeria. 709 25

Attempts were made to evaluate the separate effect on kidney function of immunosuppressive treatment (IS) and plasma exchange (PE) in 27 patients with rapidly progressive glomerulonephritis (RPGN). Twenty-four of the patients were treated with PE. Initial IS was supplemented with PE within 6-12 days in 5 patients, and after at least 14 days in 13. Because of suspected septicemia, 2 patients were first treated with PE, and IS was not initiated until the possibility of septicemia had been excluded. In 4 severely ill patients wih rapid clinical deterioration, both treatments were started simultaneously. Twenty patients improved during one or both treatments, 4 with IS alone, 2 with IS and doubtfully with PE, 3 with IS and probably also with PE, 5 both with IS and PE and one with PE alone. In 5 patients the individual effects of IS and PE could not be evaluated. In another 2 patients the combined treatment seemed to influence the course favourably. In the remaining 7 patients the effect of the treatment was doubtful or nil. Two further patients with Goodpasture's syndrome were treated. They were admitted late, and both kinds of treatment were instituted simultaneously. One of them died in respiratory insufficiency, the other remained oliguric while the pulmonary changes faded. Thus, PE added a positive effect to IS in several patients with RPGN. The treatment had few and mostly mild side-effects.
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PMID:Immunosuppression and the additive effect of plasma exchange in treatment of rapidly progressive glomerulonephritis. 714 2


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