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

The study of 1527 autopsies showed that in 2% of cases the cause of death was Infective Endocarditis (IE) (acute in the absolute majority), mostly not diagnosed due to fulminant disease or to the short hospital stay and in some cases not correctly treated. Sepsis was correctly diagnosed in 12 patients (9 of whom were i.v. drug addicts) and was not identified in 14 patients (12 of whom had acute disease) who were diagnosed as suffering from CNS disease or pneumonia. Systematic autoptic study of patients with or without IE appears to be a very useful method to determine correctly IE mortality.
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PMID:[Infective endocarditis in a series of 1527 autopsies: clinical-pathology correlations]. 1275 29

The early events of severe sepsis set in motion a cascade of events that significantly contributes to the morbidity and mortality observed during the first few days of this syndrome. Although sepsis is a deadly, acute disease, survivors also suffer long-term consequences. Clinical data underscore subsequent high mortality rates associated with patients who are long-term survivors of the acute septic episode. Within 1 year of surviving severe sepsis, there is a 26% predicted mortality rate, and many patients succumb to lung complications. In this review, we focus on the cellular and molecular mechanisms that dictate the longer-term sequela of sepsis and related lung injury. We have established a murine model of experimental sepsis [cecal ligation and puncture (CLP)], which results in an approximate 60% survival rate. Our studies have demonstrated that these survivors are susceptible to a fungal infection with 100% mortality when challenged 3 days or 15 days post-recovery from the initial CLP. This increased mortality correlates with changes in cytokines and Toll-like receptor expression and alterations in lung leukocyte populations. We hypothesize that the lung becomes predisposed to nosocomial infections for extended periods of time after severe sepsis via mechanisms that include alterations in inflammatory cytokines and an increase in immunomodulatory chemokines, such as monocyte chemoattractant protein-1 and C10. These mediators may alter the innate-immune response by affecting dendritic cells and macrophages, which could provide a mechanism for the immunosuppression observed following sepsis.
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PMID:The chronic consequences of severe sepsis. 1455 84

Targeting apoptotic cell death pathways provides wide-ranging opportunities for the discovery and development of novel drugs. Some targeted therapies that selectively induce apoptosis in cancer cells are already marketed, and numerous pro-apoptotic drugs for treating cancer are currently being developed. The anti-apoptotic drugs that are most advanced in development are targeting acute disease indications such as stroke, myocardial infarction and sepsis, in which the role of apoptosis has been best defined and inhibitors of the apoptotic pathway have shown activity in various animal models. In the future, novel drugs might also result from an understanding of apoptotic pathways in chronic disorders.
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PMID:Apoptosis: target for novel drugs. 1457 60

Homeopathy has been used for more than two hundred years to treat chronic disease using various approaches in a wide range of diseases. However, for acute disease and critical illness, application has been limited by inadequate training of homeopathic physicians and the small number of pertinent clinical studies. In view of the difficulty of practising homeopathy in Intensive Care Units (ICU), a protocol was developed to facilitate description of objective homeopathic symptoms with a ranking of symptoms appropriate for these situations (Protocol for Objective Homeopathic Semiology). Examples of favorable results with individualized homeopathic treatments for a series of cases of Systemic Inflammatory Response Syndrome (sepsis) are described.
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PMID:Homeopathic practice in Intensive Care Units: objective semiology, symptom selection and a series of sepsis cases. 1937 70

Mortality is one of the most important quality markers in critical care, and there have been many epidemiological studies trying to identify risk factors to better understand the mechanisms leading to death in this complex disease. One of the major problems is that there are multiple factors contributing to fatal outcome of septic patients, and it is difficult to distinguish between those that are independent from the acute disease (comorbidities and 'risk factors') and those that are directly involved in the pathomechanisms of sepsis, thus leading to the 'sepsis-attributable' mortality. In this short commentary, some examples of different approaches of how to analyze data on mortality are presented.
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PMID:'Relation, association, attribution ...' - the multiple faces of death in critical care medicine. 1925 May 47

Severe sepsis is associated with early release of inflammatory mediators that contribute to the morbidity and mortality observed during the first stages of this syndrome. Although sepsis is a deadly, acute disease, high mortality rates have been observed in patients displaying evidence of sepsis-induced immune deactivation. Although the contribution of experimental models to the knowledge of pathophysiological and therapeutic aspects of human sepsis is undeniable, most of the current studies using animal models have focused on the acute, proinflammatory phase. We developed a murine model that reproduces the early acute phases but also the long-term consequences of human sepsis. We induced polymicrobial acute peritonitis (AP) by establishing a surgical connection between the cecum and the peritoneum, allowing the exit of intestinal bacteria. Using this model, we observed an acute phase with high mortality, leukopenia, increased interleukin-6 levels, bacteremia, and neutrophil activation. A peak of leukocytosis on day 9 or 10 revealed the persistence of the infection within the lung and liver, with inflammatory hepatic damage being shown by histological examination. Long-term (20 days) derangements in both innate and adaptive immune responses were found, as demonstrated by impaired systemic tumor necrosis factor alpha production in response to an inflammatory stimulus; a decreased primary humoral immune response and T cell proliferation, associated with an increased number of myeloid suppressor cells (Gr-1(+) CD11b(+)) in the spleen; and a low clearance capacity. This model provides a good approach to attempt novel therapeutic interventions directed to augmenting host immunity during late sepsis.
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PMID:Model of polymicrobial peritonitis that induces the proinflammatory and immunosuppressive phases of sepsis. 2117 7

Perineoscrotal gangrene is an acute disease, a rare and severe affection of the perineum, whose evolution is unpredictable and rapidly extensive. The diagnosis is clinical. The paraclinical examinations allow early diagnosis and assessment of anatomical and biological repercussions. We conducted a retrospective study of 45 patients spread over six years, involving a multidisciplinary team consisting of three specialists (urologists, visceral, plastic surgeons). The average age was 52 years. The largely male dominated our series. Fournier gangrene was the most common etiology. We noted five cases of death (11%) in the acute phase, secondary to septic shock (four patients) or multiple organ failure (one patient). The evolution was favorable in 40 other patients in the series, requiring an initial management in intensive care unit, and surgical treatment. The average hospital stay was 17 days. After the acute phase, all patients underwent a surgery for skin coverage, ranging from guided healing (two patients) to musculocutaneous flap of the gracilis (six patients) via the secondary suture (four patients), the burying the testes (18 patients) and half thick skin graft, with a functional and aesthetic result was acceptable, and minimal sequelae. In our series, the most predictive prognostic factors would be the delay of care, sepsis on admission and associated diseases.
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PMID:[Perineal-scrotal gangrene: epidemiological and therapeutic aspects. About 45 cases]. 2145 Mar 84

Sepsis is a frequent emergency and an acute disease which is still highly lethal. Due to an early involvement of the brain in terms of a sepsis-associated delirium the neurologist plays an important role in the early diagnosis of the interdisciplinary disease. The following review details the main diagnostic aspects of a sepsis-associated delirium.
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PMID:[Clinical neurological diagnosis of sepsis-associated delirium]. 2185 75

The potential of nitric oxide (NO) as a rapid assay biomarker, one that could provide a quantum leap in acute care, remains largely untapped. NO plays a crucial role as bronchodilator, vasodilator and inflammatory mediator. The main objective of this review is to demonstrate how NO is a molecule of heavy interest in various acute disease states along the emergency department and critical care spectrum: respiratory infections, central nervous system infections, asthma, acute kidney injury, sepsis, septic shock, and myocardial ischemia, to name just a few. We discuss how NO and its oxidative metabolites, nitrite and nitrate, are readily detectable in several body compartments and fluids, and as such they are associated with many of the pathophysiological processes mentioned above. With methods such as high performance liquid chromatography and chemiluminescence these entities are relatively easy and inexpensive to analyze. Emphasis is placed on diagnostic rapidity, as this relates directly to quality of care in acute care situations. Further, a rationale is provided for more bench, translational and clinical research in the field of NO biomarkers for such settings. Developing standard protocols for the aforementioned disease states, centered on concentrations of NO and its metabolites, can prove to revolutionize diagnostics and prognostication along a spectrum of clinical care. We present a strong case for developing these biomarkers more as point-of-care assays with potential of color gradient test strips for rapid screening of disease entities in acute care and beyond. This will be relevant to global health.
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PMID:Nitric oxide and its metabolites in the critical phase of illness: rapid biomarkers in the making. 2353 1

Acute respiratory distress syndrome (ARDS) is one of the devastating sequelae of sepsis, and so far no specific promising pharmacotherapies have been proven to decrease mortality from it. Stem cell therapy is a novel therapy that can promote earlier and more effective remodeling and repair of damaged lung tissue. Bone marrow-derived mononuclear cells are an alternative stem cell therapy that is safely and easily administered on the day of harvesting and yields benefits in acute disease processes like ARDS. In a recent issue of Stem Cell Research and Therapy, Maron-Gutierrez and colleagues demonstrated that the effects of transfused bone marrow-derived mononuclear cells on lung mechanics, inflammation and mortality might be different in different septic ARDS models due to different insults.
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PMID:Bone marrow-derived mononuclear cell therapy in sepsis-induced acute respiratory distress syndrome: different insults, different effects! 2440 30


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