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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It is established by electron microscopical radioautography that sepsis results in the lowering of neutrophils bacterial capacity while their absorptive capacity is retained. Living bacteria may be released from neutrophils undergoing degradation into the environment. The same is observed when phagocytized but still living bacteria are located in phagosomes which are fused with one another and with neutrophil plasma membrane; after the destruction of the latter bacteria are released into the extracellular space. This is a negative issue for the host of the incomplete phagocytosis. Neutrophils participate more actively in the lysis of the necrotic tissues and wound cleaning than in the bacteria phagocytosis.
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PMID:[New data on the leukocyte functional morphology in pyo-septic processes]. 137 25

A number of human monoclonal antibodies (HmAb) recognizing type-specific determinants expressed by the lipopolysaccharide (LPS) of Pseudomonas aeruginosa and by the capsular polysaccharide (CPS) of Klebsiella were generated for potential treatment of nosocomial infections. The goal is to administer these type-specific HmAb prophylactically as a "cocktail" providing broad coverage. Lymphoblastoid cell lines (LCL) secreting HmAb recognizing P. aeruginosa LPS, toxin A or Klebsiella CPS were obtained by Epstein Barr Virus (EBV) transformation of peripheral blood lymphocytes (PBL) from donors immunized with either a polyvalent Klebsiella CPS or P. aeruginosa O-polysaccharide-toxin A conjugate vaccine. LCL secreting antibodies of the desired specificities were fused to a heteromyeloma cell line. Stable clones were selected by limiting dilution. Hybridomas secreting IgM HmAb which recognized P. aeruginosa Habs serotype 3 and 4 and all 7 Fisher immunotypes were isolated. All were able to prevent fatal experimental P. aeruginosa sepsis in mice when passively transferred. In addition, 4 lines secreting IgG HmAb which neutralize the cytotoxic activity of toxin A were characterized. IgM and IgA secreting hybridoma cells with specificity for Klebsiella CPS of 22 different serotypes were also isolated. Preliminary studies indicate that these HmAb are opsonic.
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PMID:Human monoclonal antibodies to Pseudomonas aeruginosa type-specific lipopolysaccharides, toxin A and Klebsiella capsular polysaccharides. 169 65

Between November 1984 and December 1989, 318 non-cemented Porous Coated Anatomic (PCA; How-medica, Rutherford, New Jersey) total hip replacements were performed by the authors. A follow-up of 1 to 6 years was allowed. The average age was 53.1 years (from 17 to 71 years). The distribution of right-to-left was approximately equal. There were 192 hip replacements for primary and post-traumatic osteo-arthritis, 42 for rheumatoid arthritis, 40 for avascular necrosis, 29 for congenital dislocation or hip dysplasia with secondary osteo-arthritis, 6 for Perthes disease, 5 for previous sepsis, 2 of whom had had a Girdlestone procedure, 2 for revision of a painful cup arthroplasty, and 1 for conversion of a previously fused hip. All patients were evaluated on a one hundred point Harrington Arthritis Research Centre Scale. Points were awarded for pain (0-35), function (0-35), motion (0-10), deformity (0-10) and gait (0-10). Pre-operative total scores averaged 45.5 (9-71) and postoperative scores averaged 83.9 (55-98). The overall results were excellent 20.5% (90-100), good 59.8% (80-90), fair 16.4% (70-80), and poor 3.3%. Postoperative radiographs were evaluated using zonal analysis. There was no deterioration on the radiographs after two years.
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PMID:Porous coated anatomic non-cemented total hip arthroplasty. 173 38

Forty-one fused hips in thirty-eight patients were converted to total hip replacement. The average length of follow-up was seven years. The predominant indications for conversion were progressively disabling pain in the low back or the hip, or both; loss of function due to immobility or malposition of the hip; and progressive pain and instability of the knee (usually ipsilateral). The postoperative arc of flexion averaged 87 degrees. Limb-length discrepancies improved an average of 2.5 centimeters. Postoperative function of the abductor muscles depended on the preoperative quality of those muscles and on the accuracy of the biomechanical restoration. Postoperative strength of the muscles of the hip improved for two years or more in most patients. There was complete or major relief of pain, improved mobility of the hip, and decreased dependence on supports for walking. There were nine failures: four because of sepsis, four because of loosening of the femoral component, and one because of malposition of the acetabular component. The failures were predominantly in patients who were fifty years old or less at the time of arthroplasty, patients who had had two or more previous operations, and patients who had had an injury to the hip. The quality of the results approached that after primary hip arthroplasty in older patients who have not had multiple previous operations on the hip. Survivorship analysis of the spontaneously fused hips that were treated with conventional hip replacement predicted a probability of survival of the implant of 96 per cent at thirteen years postoperatively (p = 0.048).
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PMID:Joint replacement for ankylosed hips. 229 72

Twenty-five hematogenously infected knee arthroplasties in 20 patients (17 with rheumatoid arthritis and 3 with arthrosis) were followed for 3 years. Staphylococcus aureus was the major infecting organism. Three patients with four arthroplasties died of sepsis. Two patients had removal of the arthroplasty, one of which resulted in an above-the-knee amputation. Four out of five arthrodeses fused. Two knees healed after early debridement and two healed without surgery. Ten knees had successful revision arthroplasty. Rheumatoid arthritis and constrained prostheses increase the risk of hematogenous infection. Any infection and especially cutaneous lesions in a patient with a knee arthroplasty should be treated vigorously.
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PMID:Hematogenous infection after knee arthroplasty. 342 83

Twenty-eight patients were treated for a failed total knee arthroplasty by arthrodesis with a new type of biplane external fixator. The reasons for failure of the total knee arthroplasty were sepsis in twenty-five patients, loosening in one, pain of unknown etiology in one, and fibrous ankylosis in one. The mean duration of fixation with pins was 112 days. In twenty knees, arthrodesis occurred without further treatment. One knee fused after the application of dual plates, and one united after treatment with electrical stimulation. Of the remaining six patients, one had an above-the-knee amputation for persistent non-union and five had a persistent pseudarthrosis. The extent of loss of bone appeared to be the most important factor influencing union of the primary arthrodesis. One patient who had a solid union of the arthrodesis had a persistent non-union after a fracture at the site of a femoral pin. The rate of success of 68 per cent that was achieved with the device that we used is similar to the rates obtained with the use of older external fixators.
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PMID:Failed total knee arthroplasty treated by arthrodesis of the knee using the Ace-Fischer apparatus. 354 19

Twenty-seven knees in 23 patients, all with seropositive rheumatoid arthritis and failed total knee arthroplasty, were treated by arthrodesis. Twenty of the 27 knees were solidly fused. A fusion aligned in 7 degrees +/- 5 degrees of valgus and knee flexion from zero to 30 degrees was associated with the highest rate of arthrodesis, the lowest rate of progression of disease in other joints, and the highest functional scores. Stable fixation using either internal or external fixation gave the most predictable rate of arthrodesis. Persistent sepsis and bone stock losses were associated with failure of arthrodesis, even under the best circumstances. All of the 20 successfully arthrodesed knees were completely functional.
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PMID:Knee arthrodesis following total knee arthroplasty in rheumatoid arthritis. 366 46

Follow-up studies were carried out in 1962, 1977, and 1981 on 35% or 943 or our 2690 patients operated upon from 1950 through 1981 for lumbar disc herniation. Seven hundred and twenty-four were done with and 1848 without spinal fusion. There were 11.2% operative, 8.3% postoperative and 18.9% late complications. Sepsis occurred in 2 patients (0.2%). Thrombosis decreased from 10% in the 1950s to 4% in the 1960s and to zero in the late 1970s. Reoperations were performed in 10.8% of the fused and in 23.6% of the nonfused patients. There were no serious vascular injuries and no postoperative deaths. Serious complications from lumbar disc surgery with the patient in the knee--elbow position occur rarely and ought to be avoided. Posterior spinal fusion seems to give better protection against recurrence of pain than simple removal of the herniated disc material.
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PMID:The knee--elbow position in lumbar disc surgery: a review of complications. 667 24

The penicillins are a large group of bicyclic ring compounds which contain a 4-membered beta-lactam ring (penams) fused to a 5-membered thiazolidine ring. Benzylpenicillin (penicillin G) was the first natural penicillin with potent activity against all Gram-positive pathogens, Gram-negative cocci and some spirochaetes and actinomycetes. For the last 50 years benzylpenicillin has been the mainstay of therapy for serious pneumococcal, streptococcal, meningococcal and gonococcal infections. However, the past decade has seen the emergence of resistance in certain parts of the world, initially among the gonococci, and more recently among the pneumococci and meningococci. Discovery of the 6-aminopenicillinamic acid nucleus has led to considerable manipulation of the basic ring structure, resulting initially in the synthesis of ampicillin, and subsequently the other aminopenicillins, analogues, esters and prodrugs. These drugs have the advantages of improved oral bioavailability and superior activity against Haemophilus influenzae, certain Gram-negative bacilli, salmonellae, enterococci and Listeria monocytogenes, making these agents popular in the treatment of upper and lower respiratory tract infections and urinary tract infections. The increasing spread of bacterial resistance, particularly among Enterobacteriaceae and H. influenzae, has curtailed the usefulness of these drugs in these clinical settings. To counteract this problem, a number of agents combining a penicillin and a beta-lactamase inhibitor (e.g. clavulanic acid, tazobactam and sulbactam) have been developed. These inhibitors have no intrinsic antibacterial activity, but combining them with a penicillin (e.g. amoxicillin/clavulanic acid) confers greater stability to beta-lactamases and hence a broader spectrum of activity. The emergence of penicillinase-producing staphylococci that rendered benzylpenicillin ineffective also stimulated the search for penicillinase-resistant penicillins--methicillin and nafcillin, followed by the acid-stable isoxazolyl penicillins. These agents are now the principle antistaphylococcal treatment. Methicillin-resistant coagulase-negative staphylococci are currently a major cause of hospital sepsis, and are resistant to these latter agents. Enteric Gram-negative bacilli have been the predominant cause of serious hospital infections during the last 30 years. Further manipulation of the penicillin structure has resulted in compounds with broader activity against Gram-negative bacilli, particularly Pseudomonas aeruginosa, while retaining activity against Gram-positive pathogens. The carboxypenicillins were the first step in this direction, but have been largely superseded by the ureidopenicillins. These agents have better activity against P. aeruginosa, and are still effective against Gram-negative and Gram-positive bacteria, including enterococci and anaerobic organisms.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Penicillins. A current review of their clinical pharmacology and therapeutic use. 769 96

Hip arthroplasty with an ipsilateral knee arthrodesis occurs infrequently but does raise concern regarding surgical technical difficulties, dislocation, sepsis, and long-term loosening. Sixteen patients were evaluated 7.5 years (average period) after surgery. Technical difficulties were not prohibitive. No dislocation or revision was necessary in any of the cases. Two patients died as a result of unrelated sepsis from an infected knee. Loosening and protrusio of the acetabulum occurred in two patients. Hip arthroplasty in patients with a fused knee does not incur undue risk of loosening or instability and can provide long-term good function and pain relief. Patients with multiple joint arthroplasties, in whom concurrent sepsis occurs, can have devastating results.
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PMID:Long-term evaluation of hip arthroplasty in patients with an ipsilateral knee arthrodesis. 847 9


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