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

Acute oral problems that frequently occur during oncologic therapy include mucositis, infection, and hemorrhage. Certain chemotherapeutic agents consistently produce significant mucositis. Herpes simplex virus infection is a frequent cause of oral ulceration. Gram-negative oral bacilli can cause severe local necrosis of oral tissues and lethal bacteremia and sepsis. Sepsis with oral streptococci is common in the early postengraftment period following bone marrow transplant. A case report describes the successful use of a new hemostatic agent to control hemorrhage in a patient with severe thrombocytopenia in leukemic relapse. Long-term dental complications of oncologic therapy include abnormal dental and craniofacial development. Dental abnormalities in children treated for acute lymphoblastic leukemia are more severe if oncologic therapy begins before 5 years of age and if cranial irradiation is used. The combination of high-dose cranial irradiation (2400 cGy) and chemotherapy before 5 years of age results in deficient mandibular growth. In children with reduced growth hormone production and deficient mandibular growth due to treatment with bone marrow transplantation, stimulation of mandibular condylar growth is reported following the use of growth hormone.
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PMID:Dental management of the pediatric oncology patient. 183 63

Elaborating on the use of the terms sepsis, septicemia, bacteremia and septicopyemia, the author stresses the importance of precise concepts and correct terminology to describe clinico-pathological entities with different pathogenesis. The significance of this attitude for medical teaching is discussed.
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PMID:[Septicemia?, Bacteremia?, Sepsis?, Septicopyemia?: the importance of conceptual unity and language in teaching]. 130 17

The incidence and prognostic importance of positive blood cultures were evaluated over a two-year period (1986/87) in 1371 admissions to a multi-disciplinary neonatal and pediatric intensive care unit (ICU). Blood cultures were performed in 439 patients of which 80 cultures were positive. Septicemia was confirmed in 70 cases, the 10 remaining cases being classified as contamination or bacteremia. The incidence of nosocomial, ICU-acquired septicemia was low (7/70). The major causative organisms of sepsis were those commonly encountered in neonatal and pediatric infections, including Haemophilus influenzae (37), Escherichia coli (11, Neisseria meningitidis (9) and group B streptococci (3). Typically nosocomial organisms were rare. In the group of 70 septicemic cases, multiple organ system failure was diagnosed in 23 patients. Nine died, most often due to irreversible septic shock (13% mortality). In order to avoid a selection bias, all admissions were examined for the presence of sepsis syndrome (clinical signs of sepsis with negative blood cultures). Out of 21 such patients, three died. The results suggest that in comparison to intensive care in adults the following conclusions may be drawn: (1) sepsis with positive blood cultures plays a minor role at our unit; (2) the rate of ICU-acquired septicemia is low (10% of all cases of sepsis with positive blood culture); and (3) the prognostic bearing of a positive blood culture in patients with septic signs is not too unfavourable (87% survival rate).
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PMID:[Incidence and prognostic significance of positive blood cultures in neonatal and pediatric intensive care]. 185 44

The authors describe a sixty-seven-year-old hypertensive, diabetic man with a mycotic abdominal aortic aneurysm infected with Clostridium septicum. The patient had colonic polyps but no malignant disease. They could find only one other report of a mycotic aneurysm infected with C. septicum. In that case, as in most other cases of C. septicum bacteremia, the patient had gastrointestinal cancer. Their case suggests that treatment for a clostridial infection should be considered in patients with known gastrointestinal disease, signs and symptoms of sepsis, and abdominal pain. Conversely, patients known to have a C. septicum infection should be evaluated for gastrointestinal lesions.
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PMID:Mycotic aortic aneurysm infected by Clostridium septicum--a case history. 186 18

Intra-abdominal sepsis may be caused by intestinal bacteria or by skin bacteria. In the largest series of patients studied in trials of quinolones, anti-anaerobic drugs were included in the therapeutic regimen. Several small series have reported success without the concomitant use of anti-anaerobic drugs. The balance of evidence at present suggests that the quinolones referred to in this report should be supplemented with anti-anaerobic drugs in the treatment of peritonitis related to bowel disease. Quinolones alone have been highly effective in the treatment of peritonitis associated with chronic ambulatory peritoneal dialysis, spontaneous bacterial peritonitis and biliary sepsis. Notwithstanding this success, the potential for an anaerobic aetiology in biliary sepsis and bacteremia must be borne in mind. Lack of clinical efficacy may be associated with resistant bacteria including streptococci. Quinolones offer a relatively non-toxic alternative in the management of intra-abdominal sepsis as well as being cost-saving since early discharge from hospital on oral medication is possible.
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PMID:Treatment of intra-abdominal infections with quinolones. 186 93

Five patients with AIDS and Listeria monocytogenes infection (three cases of bacteremia and two of meningitis) are reviewed. Four patients had prior or concurrent gastrointestinal illness. Two patients received corticosteroids. A 7- to 21-day course of ampicillin was administered with or without a 7- to 14-day course of gentamicin. This regimen was effective, with no evidence of relapse 7-8 months after therapy was discontinued. The relative infrequency of infection with L. monocytogenes in AIDS patients is unexpected. Tumor necrosis factor (TNF) appears to be essential in the inhibition of Listeria in vivo. Elevated levels of TNF in AIDS patients may be protective against listeriosis and thus help explain the low prevalence of listerial infection in this population. Nonetheless, although L. monocytogenes is an uncommon cause of illness in patients infected with the human immunodeficiency virus, it cannot be dismissed as a cause of undefined meningitis or sepsis.
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PMID:Listeria monocytogenes infections in patients with AIDS: report of five cases and review. 186 44

OBJECTIVE - To evaluate new treatments directed against endotoxin, tumor necrosis factor alpha, and interleukin 1 for use in sepsis and related disorders (sepsis syndrome and septic shock). DATA SOURCES - Investigations of these treatments in animal models, healthy human volunteers, and patients with sepsis and related disorders. STUDY SELECTION - Particular attention was paid to studies of patients with sepsis and related disorders, especially randomized, double-blind, controlled trials. DATA EXTRACTION - Animal studies and investigations with human volunteers were judged by how closely the experimental model replicated the clinical disorder (sepsis). Patient trials were assessed by sample size and design. Results of all studies were used to evaluate the likelihood that a given treatment would reduce mortality. DATA SYNTHESIS - Direct comparison of E5 and HA-1A antibody studies is difficult because of differences in their design, definitions of shock, and methods of subgroup analysis. However, both antibodies improve outcome in some subgroups: E5 benefits patients with gram-negative infection (bacteremic or focal) who do not have refractory shock, and HA-1A benefits those with gram-negative bacteremia (regardless of whether shock is present) but not those with focal gram-negative infection. Two agents that may be beneficial in gram-positive and gram-negative infection are monoclonal antibodies to tumor necrosis factor alpha and receptor antagonists to interleukin 1. Preliminary results with both are reviewed. CONCLUSIONS - All three types of treatment may improve outcome in sepsis. The best results will probably be obtained with combination therapy that interrupts multiple points of the inflammatory cascade underlying sepsis.
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PMID:A critical evaluation of new agents for the treatment of sepsis. 188 93

The barium enema is a safe and accurate diagnostic study of the colon but, in rare cases, complications may result. Many of these can be prevented by proper equipment and careful attention to technique. When a complication does occur, prompt recognition and management is vital in decreasing morbidity and mortality. Perforation of the bowel is the most frequent serious complication, occurring in approximately 0.02% to 0.04% of patients. Rarely the colon may burst due to excessive transmural pressure alone. However, a colon weakened by iatrogenic trauma or disease is more likely to perforate during an enema than is a normal healthy bowel. Injury to the rectal mucosa or anal canal due to the enema tip or retention balloon is probably the most common traumatic cause of barium enema perforation. Inflation of a retention balloon within a stricture, neoplasm, inflamed rectum, or colostomy stoma is particularly hazardous. Recent deep biopsy or polypectomy with electrocautery makes the bowel more vulnerable to rupture. The tensile strength of the bowel wall is impaired in elderly patients, patients receiving long-term steroid therapy, and in disease states including neoplasm, diverticulitis, inflammatory bowel disease, and ischemia. Intraperitoneal perforation leads to a severe, acute peritonitis with intravascular volume depletion. The ensuing shock may be rapidly fatal. Prompt fluid replacement and laparotomy are essential. If the patient survives the initial shock and sepsis, later complications caused by dense intraperitoneal adhesions may develop. Extraperitoneal perforation is usually less catastrophic but may result in pain, sepsis, cellulitis, abscess, rectal stricture, or fistula. Intramural extravasation often forms a persistent submucosal barium granuloma which may ulcerate or be mistaken for a neoplasm. The most dramatic complication of barium enema is venous intravasation of barium. Fortunately, this is quite rare as it may be immediately lethal. Most cases have been attributed to trauma from the enema tip or retention balloon, mucosal inflammation, or misplacement of the tip in the vagina. Bacteremia has been found in as many as 23% of patients following barium enema and, in rare cases, may cause symptomatic septicemia. Other less common complications include barium impaction, water intoxication, allergic reactions, and cardiac arrhythmias. Preparatory laxatives and cleansing enemas have been implicated in some instances of dehydration, rectal trauma, water intoxication, and perforation. Careful review of the indications for examination, previous radiographs, and clinical history will identify many of the patients at greater risk for complications so that appropriate precautions may be observed.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Recognition and prevention of barium enema complications. 188 35

Since an omega 3 fatty acid (FA) diet may have beneficial effects in inflammatory processes, we tested the hypothesis that the physiologic response to sepsis could be modified by altering the eicosanoid precursor pool via an omega 3 FA diet. Two groups (n = 8) of pigs were prefed for 8 days either an omega 3 FA or an omega 6 FA diet (Weaner Pig Feed with either menhaden or corn oil to produce a eucaloric feed with 15% fat) and then injected with live Escherichia coli. The omega 3 FA diet increased the concentration of eicosapentainoic acid (EPA, 20:5 omega 3) in plasma lipids, and increased the ratio of EPA to arachidonic acid (AA, 20:4 omega 6) in platelets from 1:20 to 1:1 over the 8 days. Following the injection of bacteria, there was a fall in PaO2 and blood pressure that was attenuated (p less than 0.05) by the omega 3 FA diet. The omega 3 FA diet, compared to the omega 6 FA diet, also attenuated the rise in thromboxane B2 (3.0 +/- 1.1 vs 12.9 +/- 5.7 ng/mL) and 6 keto-PGF1 alpha (0.8 +/- 0.5 vs 1.7 +/- 1.1 ng/mL) associated with bacteremia. We conclude that dietary omega 3 FA attenuated the physiologic response to sepsis, possibly by modifying arachidonic acid metabolism.
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PMID:Effects of a fish oil diet on pigs' cardiopulmonary response to bacteremia. 190 49

A hyperdynamic sepsis model was set up in seven adult baboons to evaluate neutrophil-activating peptide-1/interleukin (IL)-8 (NAP-1/IL-8), IL-1 beta, IL-6, tumor necrosis factor-alpha (TNF alpha), and IFN-gamma in plasma. By continuous intravenous administration of 10(10) cfu/kg live Escherichia coli over 8 h with additional infusion therapy (less than or equal to 50 ml/kg/h), endotoxin plasma levels of 2.7-22.3 ng/ml were observed. In plasma the kinetics of NAP-1/IL-8 and IL-6 were similar to those of IL-1 at the end of the experiment (8 h) (peak median values, 34, 4197, and 230 ng/ml, respectively). Differences were greatest for IL-6. Monocyte activation during sepsis was confirmed by elevated plasma neopterin levels (91-139 mumol/mmol of creatine). Granulocyte activation was evident from both incipient neutropenia and the massive release of neutrophil elastase into the plasma as measured by a new immunoassay (peak level, 374 ng/ml). Thus, in primate bacteremia, early TNF release is followed by a concomitant increase of NAP-1/IL-8 with plasma kinetics similar to those of IL-6 and IL-1 and accompanied by massive activation of neutrophils.
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PMID:Plasma neutrophil-activating peptide-1/interleukin-8 and neutrophil elastase in a primate bacteremia model. 190 12


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