Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report two cases of Epstein-Barr virus (EBV)-associated lymphoproliferative disorders (LPD) after allogenic bone marrow transplantation which were conditioned with regimens including antithymocyte globulin (ATG). The first case was a 31 year-old man which severe aplastic anemia who was transplanted from HLA-matched unrelated donor conditioned with total lymphoid irradiation (TLI)/ cyclophosphamide/ATG and prophylactic administration of ganciclovir Grade I acute GVHD improved in response to cyclosporine (CsA). LPD as a polyclonal epipharyngeal mass developed at day +53 and spontaneously regressed along with the withdrawal of CsA. Second case was a 11 year-old boy with acute myelomonocytic leukemia (FAB:M4E). He was transplanted from HLA B locus mismatched mother conditioned with total body irradiation (TBI)/busulfan/L-PAM/ATG. He showed grade IV acute GVHD, which was controlled by steroids and FK-506. LPD as a monoclonal intestinal lymphoma was diagnosed at day +82, and he was unsuccessfully treated with ganciclovir, acyclovir, chemotherapy and transfusions of EBV-specific cytotoxic lymphocytes in addition to discontinuation of immunosuppressants, and died at day +18 due to sepsis and multiple cerebral infarction. Early detection and introduction of appropriate treatment for post bone marrow transplantation LPD is necessary.
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PMID:[Post-transplant EBV-associated lymphoproliferative disorders--report of two cases]. 957 43

To determine the clinical usefulness of the autopsy in elderly patients, we studied a total of 231 autopsies performed during 1986 and 1995 at Jikeikai hospital. Autopsies were done after 231 of 609 deaths (38%). The autopsy rate in our hospital fell from 63% in 1986 to 17% in 1995. Most primary causes of deaths as established by clinicians before autopsy were pulmonary, neoplastic, and cardiovascular diseases. The probability of a major unexpected finding at autopsy was higher in acute pneumonia, acute myocardial infarction, and cerebrovascular disease. No primary pathological cause of death was established by pathologists at autopsy in 13 cases (The clinical diagnoses in those patients were acute pneumonia in 5 patients, acute myocardial infarction in 2 patients, sepsis in 2 patients, bronchiale asthma, cerebral infarction, uremia, gastrointestinal bleeding each in 1 patient.) The mean age of these 13 patients was higher by 5 years than the age of the group as a whole. This indicate that elderly patients have many complications and that these deaths were caused by many small changes that were not be detected at autopsy. Latent cancer was found in 23 cases (12%): thyroid and colon cancer in 6 patients each, gastric cancer in 4, prostate cancer in 3, ovarian cancer in 2, and other cancers (renal, uterine, lung, urethral, pancreatis and liver) each 1 in patient.
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PMID:[Clinical usefulness of the autopsy in elderly patients]. 1021 66

A 58-year-old man with a history of cerebral infarction and bleeding due to duodenal ulcer was admitted with fever and arthralgia. Methicillin-sensitive Staphylococcus aureus (MSSA) was isolated from his peripheral blood. Bacteremia with MSSA was diagnosed, and antibiotic therapy was started. However, chest X-ray films and computed tomographic scans disclosed mass shadows in both lungs accompanied by dilated vascular markings. Pulmonary arteriography and magnetic resonance angiography revealed the existence of arteriovenous fistulas in both lungs. Ga scintigraphy disclosed a hot spot in the left lower lobe, consistent with the location of one fistula. This indicated that the fistula might be the focus of MSSA sepsis. Because the patient also had telangiectasia in his gastric mucosa, oral cavity, and nasal cavity, he was given a diagnosis of Rendu-Osler-Weber syndrome.
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PMID:[Arteriovenous fistula associated with Staphylococcus aureus sepsis in a patient with Rendu-Osler-Weber syndrome]. 1077 75

A case of cardiac myxoma with multiple brain hemorrhage is reported. A 57-year-old male had complained of lower abdominal pain, diarrhea and fever for 3 days. On admission, he was in a condition of disseminated intravascular coagulation and sepsis. An abdominal CT scan showed infarction in the right kidney and spleen and an echocardiogram also showed myxoma in the left atrium. Although he presented no neurological symptoms, the brain CT showed multiple brain hemorrhage in the bilateral brain hemispheres. Total resection of the tumor was carried out for the improvement of the patient's general condition. Vimentin, S-100 protein and neuron specific enolase was positive in immunological staining and the pathological diagnosis was myxoma. Postoperative recovery of consciousness was poor and left hemiparesis developed. CT showed the increase of hematoma but angiography showed no cerebral aneurysm. The symptoms improved with conservative therapy. However the enhanced lesion remained in the right parietal lobe and an operation was performed 5 months later. The myxoma cell could not be found in the pathological examination, so tumor embolism, cerebral infarction, hemorrhagic infarction due to DIC, hematoma enlargement caused by heparinization during operation were suspected to have occurred in this order without tumor growth.
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PMID:[A case of cardiac myxoma with multiple brain hemorrhage]. 1145 99

The surgical outcome of infectious abdominal aortic aneurysms was evaluated based on the preoperative presence or absence of systemic inflammatory response syndrome (SIRS). Nine patients were divided into two groups according to the criteria for SIRS such as body temperature, heart rate, respiratory rate, and white blood cell count. In the group with SIRS, rupture and impending rupture of aneurysms occurred in three of the four patients (75%). All aneurysms were resected with a small part as a remnant; two in situ and two extraanatomic reconstructions were performed. Three patients died after surgery: one after in situ (cerebral infarction) and two after extraanatomic reconstruction (sepsis and multiple organ failure). In the group without SIRS, closed en bloc resection in two patients and resection of the aneurysm with a small part as a remnant in three patients were performed. In situ reconstruction in all patients and omentum wrapping in two patients were performed. One of the five patients died of massive hematemesis 70 days after surgery. The overall mortality rate was 75% in the group with SIRS versus 20% in the group without SIRS. The surgical outcome of infectious abdominal aortic aneurysm depends upon the severity of underlying infection. A possibility exists that SIRS is a useful indicator for predicting the surgical outcome of patients.
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PMID:Surgical outcome of infectious aneurysm of the abdominal aorta with or without SIRS. 1148 45

Between January 1990 and October 2001, arch replacement was performed in 99 patients with aortic arch aneurysm at Omiya Medical Center. For brain protection during surgery, antegrade selective cerebral perfusion was performed. There were 11 (11.1%) hospital death, and causes were heart failure (3), pneumonia (2), respiratory failure (1), mediastinitis (1), cerebral infarction (1), sepsis (1), myocardial infarction (1), and bleeding (1). During follow-up, 24 patients died, and causes were pneumonia (4), malignancy (3), heart failure (2), cerebral infarction (2), rupture of residual aneurysm (2), asthma (1), myocardial infarction (1), sepsis (1), multiple organ failure (1), traffic accident (1), and unknown (6). Postoperative survival was 75.2% at 3 years, 61.5% at 5 years, and 35.3% at 8 years. Event free ratio was 71.8% at 3 years, 58.6% at 5 years, and 30.8% at 8 years. Surgery of the aortic arch using selective cerebral perfusion is a safe and demonstrated acceptable short- and long-term outcomes.
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PMID:[Long-term surgical outcomes of aortic arch aneurysm]. 1196 8

To prevent cerebral infarction during perioperative period, we have used an axillary artery for systemic perfusion and selective cerebral perfusion for aortic arch operation. Since 1996, 34 aortic arch operations were performed in our institution. Simultaneous 5 CABGs, 4 AVRs, 2 aortic root replacements and 1 MVR were performed. There were 2 hospital deaths (5.9%, sepsis and acute heart failure) and only 1 (2.9%) cerebral infarction. There were no deaths in patients over 75 years of age and in patients with extensive aneurysm which were replaced by 2-staged operation. Overall 3 years survival was 94.1% with no further death. We conclude that aortic arch operation through an axillary artery perfusion and with hypothermic selective cerebral perfusion can be performed with very low mortality and morbidity.
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PMID:[Mid-term outcome of aortic arch operation for true aneurysms; using an axillary artery perfusion]. 1196 14

The development of renal failure after open heart surgery is associated with a high mortality. Thirteen patients were treated with continuous hemodiafiltration (CHDF) for renal failure following open heart surgery since April 1999 to December 2001. The indication of CHDF was blood purification in 8 patients and water balance control in 5 patients. Two patients with hemodialysis (HD) before operation returned to usual HD early after operation, and discharged. One patient died of severe heart failure, and another patient died of sepsis and multi organ failure. In these 2 patients, CHDF could not withdrawn. Seven patients weaned from CHDF 1 to 19 days after operation. Five of 7 patients discharged, but 2 patients died of cerebral infarction 4 month after operation. The remaining 2 patients could not wean from CHDF, and were introduced HD. Only 1 of 13 patients had bleeding tendency (cardiac tamponade). CHDF did not influence the hemodynamic state and was very effective for the treatment of renal failure in many patients.
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PMID:[Analysis of continuous hemodiafiltration after open heart surgery]. 1263 20

The prognosis of the ruptured thoracic aortic aneurysm is poor. Even if the surgical treatment was performed, the clinical outcome does not sufficiently satisfy us. Between January 1978 to July 1999, 171 cases of thoracic aortic surgery were operated in our department, in which 12 patients were with the ruptured thoracic aortic aneurysm without acute dissection. The aneurysm was located in ascending aorta (2), aortic arch (6), descending aorta (3), and thoracoabdominal aorta (1). The aneurysm was ruptured into thorax (4), pericardium (2), mediastinum (3), lung (2), and esophagus (1). The operative procedure was artificial vascular graft replacement (9), patch closure (2), and aneurysmal interposition (1) [bypass with ascending aorta to abdominal aorta)]. The operations were performed during hypothermic circulatory arrest with antegrade selective cerebral perfusion (6), under total (1) or partial complete extracorporeal circulation (5). The hospital death was 33% (4/12). The causes of death were cerebral complication (2), sepsis (1), and multiple organ failure (1). The 12 patients were divided into 2 groups: group A; 8 cases with alive; group D; 4 cases with hospital death. We compared and analyzed the perioperative factors of these 2 groups. On intraoperative factors, operation time (minute) demonstrated a significant difference (498 +/- 129 in group A v.s. 851 +/- 227 in group D, p < 0.05). No significant difference was observed between the groups on extracorporeal circulation time, aortic clumping time, selective cerebral perfusion time, systemic circulatory arrest time, intraoperative blood loss, and blood transfusion. The postoperative major complication was revealed in 6 cases (50%, 6/12), cerebral infarction (3), sepsis (2), and hoarsness (1). In conclusions, to make an effort to shorten an operative time as possible, and to prevent the postoperative neurological dysfunction under selective cerebral perfusion, those efforts should contribute to a good postoperative outcome for the ruptured thoracic aortic aneurysm.
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PMID:[Clinical study on the surgical cases of the ruptured thoracic aortic aneurysm]. 1285 63

Cerebral infarcts are an important cause of neonatal convulsions. We report the etiologic factors, and clinical and neuroradiologic findings of four full term neonates who presented with neonatal convulsions and had cerebral infarct. In our patients the risk factors for the cerebral infarct were perinatal asphyxia, sepsis, dehydration and catheter application. All had convulsions as the initial sign of infarct and had cranial imaging which revealed the definitive diagnosis. The patients underwent an extensive evaluation for hereditary causes of cerebral infarct that included anticoagulant factors (Proteins C and S, antithrombin III, antiphospholipid antibodies), factor V Leiden and prothrombin gene mutations, blood and urine amino acid and urine organic acid levels. The results were found to be within normal limits. In conclusion, neonatal convulsions can be the first sign of cerebral infarct. For this reason it seems preferable to include cranial imaging by computed tomography or magnetic resonance imaging (MRI) in the work-up of cases with unexplained neonatal convulsions.
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PMID:Cerebral infarcts in full term neonates. 1292 2


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