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

All patients greater than 50 years of age (N = 96) admitted with a pre- or postoperative diagnosis of acute appendicitis from 1971 to 1980 were reviewed. A comparative series of 91 patients aged 25 to 50 years was similarly reviewed. Noninflammatory diseases of the appendix and incidental appendectomies were excluded. Detailed study of symptoms, clinical presentation, laboratory evaluation, radiographic evaluation, concomitant diseases, hospital course, surgical findings, complications, and mortality were completed. Comparison of patients aged 25 to 50 to patients older than 50 years revealed a statistically significant increased incidence of perforation in the older group (p less than 0.0001). Sixty-five per cent of the older group showed greater incidence of perforation. Further analysis of this series yields the hypothesis that the increased incidence of perforation is related to a significant decrease in the frequency of classic presentation in the greater-than-50 age group, a significant decrease in frequency of correct admission diagnosis and a significant delay between admission and surgical procedure in the older group. A more rapid pathophysiologic progression of appendicitis with increasing age was noted. A much higher percentage of older patients was undiagnosed until the surgical procedure. In this group, there was a longer duration of symptoms, less frequent classic presentation, and decreased frequency of right lower quadrant guarding and tenderness as compared to patients with correct diagnosis prior to surgery. Complications were much more frequent in older patients and higher still in those with perforation. Analysis of findings by decade of life revealed an anticipated high incidence of perforated appendicitis in patients greater than 50, but also showed a continuation of the high incidence of perforation into the decade 40 to 50. There were three deaths in the entire study group (1.6%) all occurring in the older age group with postoperative sepsis.
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PMID:Appendicitis in mature patients. 400 82

We report a four-year-old girl, previously splenectomized because of thalassemia major, who was admitted with gastroenteritis, abdominal pain and high grade fever. At laparotomy she was found to have appendicitis and mesenteric adenitis. Blood and stool cultures grew yersinia enterocolitica. Clinical course was favourable under Ampicillin-Gentamycin treatment. The importance of iron metabolism in the pathogenesis of yersinia sepsis is stressed, being this topic reviewed.
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PMID:[Yersinia enterocolitica septicemia in a thalassemic girl]. 406 76

Appendicitis remains one of the commonest paediatric surgical emergencies in a busy paediatric surgical practice. In spite of improved diagnostic skills and surgical care, the incidence of severe appendicitis has remained unaltered in children over the past few decades and therefore remains a therapeutic challenge. A protocol for the treatment of severe appendicitis was instituted in the Division of Paediatric Surgery at the Royal Canberra Hospital by the author from 1981 to 1984 inclusive, and the results of treatment according to the protocol are presented. The results suggest that an aggressive approach to gangrenous and perforated appendicitis can result in very low morbidity from sepsis. The protocol is discussed.
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PMID:The management of severe appendicitis in children. 408 3

The relationships between resistant pathogens, serum levels of gentamicin, and the outcomes of gangrenous or perforated appendicitis were analyzed in 147 patients. Failure to cure the infection occurred significantly more frequently among patients treated with cefoperazone or cefamandole than among those treated with clindamycin and gentamicin in combination. The failures were associated with recovery of resistant Bacteroides fragilis from intraoperative cultures. Pseudomonas species were also associated with failures, their in vitro susceptibility not correlating with clinical cure. Patients with gentamicin peak serum levels of less than 6 micrograms/ml in the first three days were not more likely to be associated with failure than were patients with higher levels. These clinical observations indicate that antibiotic therapy of intra-abdominal sepsis should include antibiotics with in vitro activity against B fragilis and that precise adjustments of gentamicin levels may not improve outcome. In addition, Pseudomonas species may play a significant role in some of these infections.
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PMID:Perforated and gangrenous appendicitis: an analysis of antibiotic failures. 622 64

A study of antibiotic treatment of intra-abdominal sepsis was conducted between May 1978 and May 1981. In the first phase, clindamycin (C) was compared with metronidazole (M), each combined with tobramycin (T), in a prospective, double-blind, randomized study. Twenty-three patients received C + T and 34 patients received M + T. The two groups were similar with respect to age, gender, underlying disease, presence of abscess, clinical condition, severity of illness, duration of illness before treatment and bacteriology. Anaerobic organisms outnumbered facultative and aerobic organisms. Bacteroides fragilis and Escherichia coli predominated. In the C + T group of patients, 74% had a good response. In the M + T group, 83% had good results. Adverse effects were few and minor in the two treatment groups. Three patients on C + T and one who received M + T followed by C + T died of infections; two patients died of underlying disease. In the second, open phase of the study, M + T was used to treat 45 patients with 46 courses. Twenty patients had intra-abdominal abscesses, which represented all grades of severity of illness. Five patients received long-term corticosteroid therapy. Almost half the patients had peritonitis complicating appendicitis. Good results were obtained in 81%. One patient died of the underlying disease and one died of infection complicating severe trauma and hypovolemic shock.
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PMID:Metronidazole in the treatment of intra-abdominal sepsis. 633 65

Intraabdominal sepsis most frequently follows penetrating or blunt abdominal trauma or perforated appendicitis or diverticulitis. The initial escape of the endogenous gastrointestinal microflora into the peritoneal cavity results in peritonitis and secondary septicemia, which is frequently followed by localized intraabdominal abscesses. These infections are most frequently polymicrobial and relate directly to the unique endogenous microflora at the various levels of the gastrointestinal tract. The treatment of intraabdominal sepsis is primarily centered around prompt, appropriate surgical intervention. parenterally administered antibiotics are also required to decrease the chance of local bacterial invasion or septicemia. The choice of the appropriate agent(s) to be used initially, before culture and sensitivity reports are available, depends primarily on the clinical presentation. Clinical and experimental studies of intraabdominal sepsis have largely stressed the use of antibiotic agents that have a spectrum of activity effective against both the aerobic coliforms and anaerobic Bacteroides fragilis.
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PMID:Empiric antibiotic therapy for intraabdominal infections. 634 4

A total of 133 children, aged 16 months to 15 years (mean 6.7 years), with presumptive acute appendicitis, was included in a double-blind, placebo-controlled trial of the short-term (72 hour) use of metronidazole suppositories as prophylaxis against post-operative infection. There was no significant difference in the incidence or severity of wound infection or post-operative intra-abdominal sepsis between the metronidazole-treated and placebo groups. It is suggested that intra-rectal metronidazole, when used exclusively, is not sufficient for effective prophylaxis for appendicitis in childhood.
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PMID:A double-blind controlled trial of metronidazole suppositories in children undergoing appendicectomy. 634 59

Single doses of clindamycin hydrochloride and gentamicin sulfate given preoperatively, combined with intraoperative topical application of povidone-iodine were given to patients with perforated or gangrenous appendicitis. The incidence of wound sepsis was reduced from 36% to 5%; severe infections were reduced from 25% to 0% when compared with a control untreated group of patients. When used alone, povidone-iodine had little effect in these patients. No toxic effects of the antibiotics or antiseptic were recorded nor were any resistant strains of pathogenic organisms grown from cultures.
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PMID:Combined preoperative antibiotic therapy and intraoperative topical povidone-iodine. Reduction of wound sepsis following emergency appendectomy. 637 44

Laparotomy was performed on 579 children at the University Clinic of Paediatric Surgery in Mainz from 1.1.1975 to 31.12.1982. The children were up to 15 years of age; appendicitis or inguinal and umbilical hernia cases were not included. Postoperative sepsis occurred in 74 patients (12.8% of all children with laparotomy); in 51 cases positive bacteriological findings were seen besides the clinical and clinicochemical ones. Sepsis morbidity was particularly high in children who had not yet completed their first year of life (postoperative sepsis occurring in approximately every fourth infant); among the disease patterns, the following were particularly prominent: Defects of the abdominal wall (23 out of 50 children developed postoperative sepsis); intestinal atresia (18 out of 59 children); intestinal perforation (11 out of 39 children). In addition, sepsis morbidity was enhanced after relaparotomies. Gram-negative bacteria were most frequent among the 51 patients with bacteriologically positive findings; these bacteria consisted mostly of representatives of the group of enterogenous pathogens. These groups of bacteria were also the most frequently occurring pathogens in mixed and secondary infections. 33 out of 74 children with postoperative sepsis died. The mortality rate was 68% in prematurely born infants compared with mature newborns. Lethality was highest among children with congenital defects of the abdominal wall and intestinal perforations. Among the patients with bacteriologically positive findings the lethality was particularly high with multiple attacks of sepsis, in case of septitides caused by multiple pathogens, by Candida albicans and after relaparotomy.
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PMID:[Importance of infection following laparotomy in childhood]. 639 38

Forty-four patients with enterocutaneous fistulas treated at the University of Nigeria Teaching Hospital (UNTH) Enugu in five years (1977-81) are reviewed. Most fistulas resulted from complications of surgery (29 per cent) and appendicitis (55 per cent). The commonest locations were in the cecum (48 per cent), ileum (30 per cent), and colon (20 per cent). The outstanding complication was sepsis. Spontaneous closure occurred in 15 patients (34 per cent). Twenty-two patients were treated surgically. There was a high mortality of 18 per cent from septic complications and malnutrition.
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PMID:Enterocutaneous fistulas in Enugu, Nigeria. 646 92


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