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

Critical conditions had been established in 21 (23.1%) of 91 patients with systemic connective tissue diseases for a 12 year period: renal failure (most often), sepsis, pericarditis with cardiac tamponade, hemorrhagic diathesis, terminal arteritis with gangrene, gastrointestinal perforations with peritonitis, etc. The corticosteroids applied in high doses and predominantly parenterally and the immunosuppressors are the main drugs used in the treatment of these conditions. Plasmapheresis when possible is a useful supplement. The prognosis of the acute critical conditions depends mainly on the affected organ (more favorable in pericarditis with tamponade and unfavorable in renal failure and gastrointestinal perforations with peritonitis (and on the basic disease) more optimistic in systemic lupus erythematodes and very pessimistic in nodal periarteritis and other allergic vasculitis).
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PMID:[The problems of treating acute critical states in diffuse connective tissue diseases]. 321 40

Injuries missed at initial operation have the potential to cause the most disastrous complications in trauma patients. Over the past 5 years, 12 patients have required re-operation for 14 injuries missed at initial laparotomy and/or thoracotomy. Six missed injuries were vascular, two each in the thorax, pelvis, and retroperitoneum. The other eight were visceral: three small bowel (one patient), two pancreatic, and one each of the heart, ureter, and diaphragm. Five patients (42%) died, three with missed vascular and two with missed visceral injuries. Three died due to complications directly related to their missed injuries, while the unrecognized injury did not play a significant role in the other two. Indications for re-operation in patients with vascular injuries were hypotension in two patients, persistent output from drains in three, and refractory acidosis in one. Re-exploration in visceral injuries was for clinical sepsis in three patients, DIC in one, cardiac tamponade in one, and persistent chest tube drainage in one. Eleven of the 12 patients presented to the E.D. in shock. All patients had multiple injuries with a mean of 3.25 organ systems injured. Hypotension, coagulopathy, and/or hypothermia (T less than 92 degrees) were felt to have contributed to missing the injury in five of the patients with vascular, and three of the patients with visceral injuries. In the four other patients, injuries were missed due to inadequate exploration or a low index of suspicion in the presence of multiple injuries.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Injuries missed at operation: nemesis of the trauma surgeon. 339 94

Our experience with the Bentall and DeBono procedure is reviewed. Between April, 1977 and April, 1985, seventeen patients underwent repair of annulo-aortic ectasia (9 cases), and dissecting aneurysm with aortic regurgitation (8 cases). Three patients had cardiac tamponade due to rupture of dissecting aneurysm. In regard to this procedure, we recently performed the continuous suture method on the prosthetic valve ring, coronary ostia, and distal anastomosis sites. In this study, there was one early death due to a sudden rupture of the dissecting aneurysm of the left thoracic cavity on the 10th postoperative day. In addition, there were two late deaths due to sepsis and suspected arrhythmia. The late follow-up period ranged from 6 months to 8 years (mean 35 months), and all patients were in NYHA Class I or II. We conclude that the composite valve graft method is an excellent technique for annuloaortic ectasia and ascending aortic dissections with aortic regurgitation because of its low operative mortality and fair survival rate.
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PMID:Surgical consideration of replacement of the ascending aorta and aortic valve with a composite valve graft--operative and long-term results of Bentall and DeBono procedure. 366 68

Twenty specimens of heart with mycotic aneurysms at the aortic root were studied. In ten cases, mycotic aneurysm followed infection of the aortic valve. In one case, it developed following infection of an aortic jet lesion, and in nine patients, the aneurysm was at the seat of a prosthetic aortic valve. In seven of the 11 cases with a natural aortic valve, the valve was either unicuspid or bicuspid. A retrospective evaluation of the data on the clinical records of the 20 patients revealed that infective endocarditis or noncardiac postoperative sepsis was present in 11. The most frequently isolated microorganism was Staphylococcus aureus. Conduction disturbances were found in six patients, all of them with involvement of the atrioventricular node by the aneurysm. Perforation into intracardiac cavities was found in four, two into the right ventricular infundibulum and one each into each atrium. Pericardial tamponade was caused by bleeding from the aneurysm in two cases, and myocardial infarction was a probable consequence of coronary arterial compression by the aneurysm in two cases. Mycotic aneurysms of the aortic root, in spite of their being partially or completely healed of active infection, carry a high risk of the complications enumerated. Among the 20 cases, cultures were positive in 11 and negative in nine. Staphylococcus aureus was cultured from five of the cases.
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PMID:Mycotic aneurysms of the aortic root. A pathologic study of 20 cases. 375 65

A 7-month-old infant presented with suspected sepsis. On the third day of illness signs of cardiac tamponade developed. Tamponade was relieved by pericardiocentesis, and countercurrent immunoelectrophoresis (CIE) analysis of the fluid was positive for meningococcus group B. Antibiotic treatment was changed to penicillin G. After echocardiography demonstrated reaccumulation of fluid, a modified #16 gauge angiocatheter was placed percutaneously in the pericardial space. When drainage slowed it was repositioned using two-dimensional echocardiography. After 24 h the catheter was removed and no further accumulation occurred. The antibiotics were continued an additional 10 days and the infant recovered uneventfully. Modification of the catheter and echographic repositioning may decrease the need for surgical drainage in such patients.
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PMID:Purulent meningococcal pericarditis: chronic percutaneous drainage with a modified catheter aided by echocardiography. 405 34

The oncology patient can experience medical or surgical emergencies as a result of effects of the primary tumor, metastases, or systemic effects of the disease. Emergencies unrelated to the primary oncologic diagnosis, such as acute myocardial infarction, drug overdose, or gastrointestinal hemorrhage, also may occur. For this reason routine emergency protocols and diagnostic procedures should be followed in the treatment of oncology patients. We review the major oncologic-related emergencies, including central nervous system and spinal cord compression, airway obstruction, cardiac tamponade, gastrointestinal obstruction, adrenal insufficiency and hypercalcemia, sepsis, and coagulopathies. Medical and surgical emergencies in the oncology patient should be treated aggressively in the emergency department because a determination about the quality of life of the patient, or the reversibility of the acute process, often cannot be answered quickly in the emergency setting.
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PMID:Emergency evaluation of the cancer patient. 646 53

A case of ruptured septic myocardial infarct with death from cardiac tamponade in an intravenous drug addict with left-sided infective endocarditis and septic coronary artery embolism is described. To the best of our knowledge, there is no previous report of such a case in the literature. Although uncommon, infective endocarditis with coronary embolisation is a well-documented cause of myocardial infarction, although not normally associated with ventricular free wall rupture, and should be considered in intravenous drug addicts who present with cardiac symptoms and signs of sepsis.
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PMID:Sudden death from ruptured septic myocardial infarct in an intravenous drug addict. 759 May 50

Pentoxifylline (PTX), a xanthine derivative used in the treatment of circulatory insufficiency, has been found to have protective effects in different models of sepsis. We hypothesized that this drug might improve the cellular oxygen availability following endotoxin challenge by increasing oxygen delivery (DO2) and/or tissue oxygen extraction. The oxygen extraction capabilities were studied during a reduction in blood flow induced by cardiac tamponade. Fourteen anesthetized, ventilated, and paralyzed dogs, received intravenous 2 mg/kg of Escherichia coli endotoxin followed by a continuous infusion of 20 ml/kg.h of saline. 30 min later tamponade was induced by repeated bolus injections of warm saline into the pericardial space. Seven dogs were pretreated with PTX as an intravenous bolus of 20 mg/kg, followed by a continuous infusion at 20 mg/kg.h, and the other seven dogs served as a control group. PTX largely attenuated the systemic and pulmonary vasoconstriction observed in the control group and resulted in significant increases in cardiac index, DO2 and oxygen consumption (VO2). PTX also improved ventilation/perfusion matching in the lungs as indicated by a higher PaO2 and PvO2 and a lower venous admixture than in the untreated group during cardiac tamponade (both p < .05). In addition, the critical DO2 (DO2 crit) was lower and the critical oxygen extraction ratio was higher in the PTX treated than in the control group (9.1 +/- 1.8 vs. 11.6 +/- 2.4 ml/kg.min, and 70.6 +/- 14.0 vs. 49.3 +/- 14.6%, both p < .05). The VO2/DO2 dependency slope was also steeper in the PTX-treated than in the control group (.80 +/- .28 vs. .43 +/- .19, p < .05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pentoxifylline improves the tissue oxygen extraction capabilities during endotoxic shock. 772 87

By its microvascular and anti-inflammatory actions, prostaglandin E1 (PGE1) has been suggested both in animal models and in humans to have a therapeutic value in sepsis. To investigate whether PGE1 could improve the oxygen extraction capabilities in severe sepsis, our study focused on the relationship between oxygen uptake (VO2) and oxygen delivery (DO2) during an acute reduction in blood flow induced by cardiac tamponade in endotoxic dogs. Thirty anesthetized, ventilated dogs were divided into three groups. A first group (N = 10) served as a control receiving 20 ml/kg/hr of saline intravenously. A second group (N = 10) received PGE1 at 100 ng/kg/min along with the same saline infusion. A third group (N = 10) received the same dose of PGE1 with only 1 ml/kg/hr of saline. Thirty minutes after the initiation of this therapy, Escherichia coli endotoxin (2 mg/kg) was injected in each dog. In each group, the administration of PGE1, fluids, or both was continued throughout the study. Tamponade was then induced by repeated bolus injections of warm saline into the pericardial space. Steady-state measurements of VO2 (derived from the expired gases) and DO2 (the product of cardiac index and oxygen content) were obtained sequentially after each saline injection. The administration of PGE1 + fluids resulted in significant increases in stroke volume, cardiac index, and DO2 and reductions in systemic and pulmonary vascular resistance. Stroke volume and cardiac index were lower in the PGE1 alone than in the PGE1 + fluids group. The VO2 levels at critical DO2 (DO2crit) were identical. However, DO2crit, which was 12.2 +/- 2.8 ml/kg/min in the control group, was significantly decreased to 9.8 +/- 2.0 ml/kg/min in the PGE1 + fluids and to 9.3 +/- 2.7 ml/kg/min in the PGE1 alone group (both P < 0.05). Critical oxygen extraction ratio (O2ERcrit) which was 47 +/- 14% in the control group, was increased to 63 +/- 16% in the PGE1 + fluids group and to 61 +/- 17% in the PGE1 alone group (both P < 0.05). To investigate whether PGE1 also improves oxygen extraction capabilities in the absence of endotoxin, a second series of experiments was performed in 14 dogs, receiving saline alone (Control, N = 7) or plus PGE1 at 100 ng/kg/min (PGE1, N = 7). DO2crit was 10.7 +/- 2.9 ml/kg/min in the PGE1 group vs 10.1 +/- 1.8 ml/kg/min in the control group (NS). O2ERcrit tended to be higher in the PGE1 group than that in the control group (68 +/- 13% vs 60 +/- 15%, P = 0.054).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Prostaglandin E1 increases oxygen extraction capabilities in experimental sepsis. 793 24

A 610 g infant born after 27 weeks of gestation required central venous infusion therapy by a 23 gauge silastic catheter with its tip located in the superior vena cava. During adequate antibiotic therapy for sepsis the infant developed cardiac tamponade with circulatory failure. Therapeutic pericardiocentesis revealed pericarditis and not hydropericardium. Central venous infusion could be continued relapse-free without a change in catheter position. After bacteriologic identification of Staphylococcus epidermidis in blood culture and pericardial aspirate, the central venous line was removed and identified as the source of infection by identical bacterial growth from the catheter tip. While cardiac perforation has been recognized as a rare complication of central venous infusion even by very soft and thin silastic catheters, this is to our knowledge the first report on cardiac tamponade from bacterial pericarditis following catheter sepsis in a neonate.
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PMID:[Pericardial tamponade caused by catheter infection in an extremely small premature infant]. 811 75


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