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

Ecchymosis of the scrotum and lower abdominal wall occurred in four newborn boys. All were anemic. Three had coagulation abnormalities and evidence of sepsis. In two, group B streptococcal septicemia was documented. Intraperitoneal hemorrhage from a ruptured subcapsular hematoma of the liver was the source of blood in the scrotum in three, and most probably in the fourth as well. Two infants died in spite of antibiotics, vigorous blood replacement, including exchange transfusion, and desperation laparotomies for continued intraperitoneal hemorrhage. Newborns with scrotal ecchymosis should be examined for intraperitoneal hemorrhage, ruptured subcapsular hematoma of the liver being the most probable source. Their coagulation status should also be evaluated, and sepsis should be suspected, especially in those with a demonstrated coagulopathy. Group B Streptococcus is a likely primary etiologic agent in these critically ill neonates. Nonoperative treatment, as given the two survivors in this experience, is preferred.
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PMID:Scrotal ecchymosis: sign of intraperitoneal hemorrhage in the newborn. 675 34

The clinical spectrum of neonatal endocarditis, including bacterial and nonbacterial types, is examined in five case reports that were drawn from nursery experiences over a recent 2-year period. In contrast to previous reports of 100% mortality from neonatal endocarditis, one patient survived. Changing heart murmur and hematuria were most frequently associated with bacterial and nonbacterial endocarditis in four of the five cases. Pulmonary hypertension, thrombocytopenia, and coagulopathy were also associated with nonbacterial endocarditis. Echocardiograms were performed on four of the patients; only one was suggestive of endocarditis. Staphylococcus aureus was isolated from both cases of bacterial endocarditis, including the single survivor. Thus, it is suggested that the initial antibiotic coverage of any neonate with the clinical syndrome of sepsis, hematuria, and a heart murmur include antistaphylococcal coverage for the possibility of bacterial endocarditis.
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PMID:Endocarditis in high-risk neonates. 682 46

In a retrospective study of 50 patients with infective endocarditis (IE), we found an overall mortality of 44%: among the 26 patients with natural valves (NV) the mortality was 19%; among the 24 with prosthetic valves (PV) it was 71%. Congenital heart disease was recognized in 17 of our cases, with a significant clustering in the NV group (50% vs 17%, p = 0.029); the most frequently encountered malformation was the bicuspid aortic valve. The incidence of rheumatic heart disease was 46% in the NV group and 83% in the PV group (p = 0.015). Manifestations of IE were protean and multisystemic. We calculated an average of 4.6 symptoms and 4.7 signs for each patient. Although sepsis was abated with appropriate antibiotics, death often ensued from multiple complications: congestive heart failure, arrhythmia, stroke, embolic myocardial infarction, valvular destruction or dehiscence, coagulopathy. New features of natural valve infective endocarditis are a rising incidence in the elderly and a survival rate seemingly at its peak. Features of prosthetic valve infective endocarditis include overwhelmingly frequent embolization to the central nervous system (p = 0.004), spleen (p = 0.009) and kidney (p = 0.010). Advances in therapy for this disease may come from early surgery in late prosthetic valve endocarditis and from future prospective studies to define how the host response influences the outcome.
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PMID:Infective endocarditis update experience from a heart hospital. 697 38

Fifty-five infants participated in a double-blind study of indomethacin therapy for the closure of patent ductus arteriosus. Seventeen infants died. There was no significant difference in autopsy findings between the groups with respect to pneumonia, disseminated intravascular coagulopathy, necrotizing enterocolitis, sepsis, intraventricular hemorrhage, hydrocephalus, kernicterus, brain softening, and renal damage. For those infants who survived and returned for follow-up at approximately 1 year of age, there was no significant difference between the control (n = 17) and indomethacin (n = 13) groups with respect to physical growth, Bayley scores, respiratory infection, abnormal eye ground, neurological defects, and abnormal EEG. Four in the control group (24%) and three in the indomethacin group (23%) had moderate to severe neurological defects and/or scored less than 80 on the Bayley Mental Development Index or Psychomotor Development Index. It appeared that indomethacin therapy did not have a long-term adverse effect on premature infants.
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PMID:Intravenous indomethacin therapy in premature infants with patent ductus arteriosus. Causes of death and one-year follow-up. 711 4

Trauma surgeons must be familiar with the different alternatives that are available in managing hepatic injuries. Although most injuries of the liver can be managed by straightforward operative techniques, the severe injury requires immediate recognition and expedient application of surgical skills for a successful outcome. These guidelines are intended to counter the two major causes of death associated with liver trauma: operative hemorrhage and postoperative sepsis. Operative technique must be impeccable. Operative judgment must be based on the specific entities involved. The correct operative maneuvers must be made before hypovolemic and ischemic insults have irreversibly affected organ function or before a profound coagulopathy has developed. It is imperative that the surgeon and anesthesiologist work as a team when confronted with a patient who has a major liver injury.
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PMID:Surgical management of liver trauma. 712 74

Le Veen's peritoneal-jugular shunt was employed in the treatment of irreducible ascites in 16 patients with cirrhosis of the liver. Intraoperative mortality was 18%. It was due to disseminated intravascular coagulopathy in 2/3 cases. Regression of ascites and renal failure was noted in all survivors. Follow-up over 6-28 months (mean 10 months) showed that 2 patients had died from sepsis and two from liver failure. Recurrence of ascites (3 cases) had been brought about by malposition or thrombosis of the venous catheter; in one subject, thrombosis extending to the vena cava superior necessitated a portal shunt. There were no instances of digestive haemorrhage attributable to rupture of oesophageal varices. Good results free from complications were noted in 7 patients (43%) and easily treatable complications in 9 (56%). There was an evident improvement over the results obtainable with conventional management. The fact that mortality is generally confined to patients in Child's group C with marked hypoprothrombinaemia suggests that such candidates should be carefully selected. This, together with technical improvements designed to reduce the incidence of intravascular coagulopathy and haemodynamic overload following the operation, would seem capable of permitting better results in the future.
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PMID:[Treatment of irreducible ascites of cirrhotic patients with peritoneo-jugular shunt]. 715 96

Reported are 27 autopsies with significant increases in the numbers of megakaryocytes within the renal glomerular capillary network (P less than 0.001). These were selected from 118 cases in which peripheral vascular megakaryocytosis could be expected preterminally. Generally, the histologically observed increases in numbers of renal megakaryocytes corresponded to increases in the pulmonary microcirculation and in the bone marrow. An exception to the latter was noted in patients who had morphologic evidence of coagulopathy without sepsis.
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PMID:Megakaryocytes in renal glomeruli. 719 93

Platelet concentrates from HLA-compatible donors frequently provide satisfactory posttransfusion platelet responses in patients who, for immunologic reasons, are refractory to pooled random-donor platelet transfusions. The use of donors who have HLA antigens "crossreactive" with those of the recipient has increased the number of donors available for individual patients. Occasionally, successful transfusions occur with donors mismatched for HLA. Immunologic explanations include a restricted pattern of HLA antibody production and a variable expression of HLA antigens on the platelet surface. Immunologic reasons for poor response to HLA-matched transfusions include ABO incompatibility, antibodies directed against platelet-specific antigens. HLA-Bw4/Bw6 incompatibility, and as yet undefined incompatibilites. The one-hour posttransfusion platelet count may be useful in identifying patients who are alloimmunized and have non-immunologic reasons for shortened platelet survival such as fever, sepsis, or a coagulopathy. Caution must be used in evaluating results of currently available platelet crossmatch tests.
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PMID:Transfusion strategy: use of HLA-matched platelet transfusions for alloimmunized patients. 722 58

Multiple extremity gangrene developed in five patients as a complication of dopamine therapy. The clinical conditions were (1) penetrating chest trauma requiring pneumonectomy with postoperative sepsis, (2) cardiac arrest with aspiration pneumonia, (3) lymphoma with sepsis, (4) Klebsiella pneumonia, and (5) myocardial infarction. The development of acrocyanosis leading to gangrene occurred at dopamine dosages of 5.1 to 10.2 micrograms/kg/min. The alpha-adrenergic vasoconstriction effects of dopamine would not be expected from the doses employed in these patients. Thus, other factors beside pure alpha vasoconstriction are responsible for tissue necrosis after the use of dopamine. We believe that the embolic complications of disseminated intravascular coagulation and hypovolemia are serious risk factors in the development of dopamine gangrene. Peripheral vasoconstriction from dopamine, even at low doses, may set the stage for thrombotic complications of disseminated intravascular coagulation and lead to tissue damage. In laboratory models of disseminated intravascular coagulation, an alpha-adrenergic drug is required to produce peripheral ischemic tissue damage. Treatment of tissue ischemia related to dopamine depends on early recognition of acrocyanosis. Phentolamine, an alpha blocker, has been recommended for treating dopamine ischemia, either through local instillation into ischemic tissues or intravenous infusion. We recommend a high index of suspicion for, and early treatment of, underlying consumptive coagulopathy in all patients requiring dopamine.
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PMID:Dopamine gangrene. Association with disseminated intravascular coagulation. 730 16

The clinical and laboratory findings in seven children with Kawasaki disease are reviewed. Four of the patients had the more complicated course that has characterized the cases diagnosed in North America. This suggests that the benign forms are often mistaken for other febrile illnesses. The patients were two girls and five boys ranging in age from 4 months to 7 years; six were Caucasian and one was a North American Indian. Fever, redness of the oral mucosa, an erythematous or scarlatiniform rash and cervical adenopathy were seen in all; six patients had the characteristic fingertip desquamation and nonexudative conjunctivitis. Cardiac involvement occurred in four patients, two of whom had coronary artery aneurysm or thrombosis. Arthritis or arthralgia was seen in six patients, and aseptic meningitis occurred in four. Of the three patients with jaundice two underwent laparotomy and excision of a hydropic gallbladder; one of them died from Klebsiella pneumoniae sepsis and disseminated intravascular coagulopathy.
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PMID:Kawasaki disease, or mucocutaneous lymph node syndrome: report of seven cases in North America. 737 Aug 80


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