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

In a 5 year period, eight patients in whom acute acalculous cholecystitis developed during intravenous hyperalimentation are reviewed with emphasis on factors contributing to pathogenesis. Gallbladder distention, biliary stasis, and bile inspissation, thought to be important in the pathogenesis of this disease, are enhanced with the use of hyperalimentation, and this potential complication is being seen with increasing frequency in seriously ill or injured patients who are being fed parenterally. In addition to hyperalimentation, sepsis, hypotension, multiple transfusions (more than 10 units), prolonged fasting, and ventilatory support were frequent common denominators. Typical findings of pain, tenderness, and a mass in the right upper abdominal quadrant are infrequent, and the diagnosis rests on a high index of suspicion and ultrasonography. This syndrome may be preventable by the stimulation of gallbladder emptying with intermittent fat ingestion or parenteral infusion of cholecystokinin.
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PMID:Acute acalculous cholecystitis: a complication of hyperalimentation. 11 61

A patient operated upon for acalculous cholecystitis was later found to have Caroli's disease, congenital ectasis of intrahepatic bile ducts. Cholangitis, calculi and abscesses occurred in both lobes of the liver. Sepsis was not controlled despite open drainage, hepatic segmentectomy and ductal lavage with antibiotics and saline. At autopsy the liver contained a dozen unsuspected cavities filled with calculi, bile and pus. Diagnosis of Caroli's disease is best made by operative cholangiography in patients with atypical biliary disease. Management with antibiotics alone is seldom successful. Hepatic resection is better than drainage procedures for unilateral lesions. In patients with bilateral abscesses and no extrahepatic ductal obstruction or dilation, surgical treatment is often ineffective.
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PMID:Caroli's: a surgical challenge. 42 75

Cholecystitis is uncommon in individuals under 21 years of age and, when present, usually is associated with pregnancy, sepsis, metabolic defects, hemolytic anemia, or hereditary disorders. Over the past 4 1/2 years, 92 patients 20 years of age and younger have been admitted to our institution with gallbadder disease. Of these patients, 88 were female and 76 were of Mexican-American origin. Only two of these individuals had associated hemolytic anemia. Seventy-six of these females had been pregnant at least once, and 57 were more than 10 pound overweight. Cholecystectomy was done on 88 of these patients, and cholelithiasis was found in 86. There were 28 explorations of the common bile duct, 18 of which were positive. This series represents an earlier onset of cholelithiasis in this population.
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PMID:Gallbladder disease in patients 20 years of age and under. 98 5

The diagnosis of intraabdominal sepsis in critically ill intensive-care-unit patients remains a challenge. Diagnostic laparoscopy has been performed in seven such patients following admission for coronary artery bypass surgery, gram-negative sepsis, major burns, pneumonia, myocardial infarction, and post-pneumonectomy. Laparoscopy revealed acalculous cholecystitis in two patients (one removed laparoscopically), gangrenous colon in two, cirrhosis with liver infarction in one, and, in two patients, no pathology. Although five patients died postoperatively, none was related to the laparoscopy. There were no intraoperative complications and no known pathology was missed. Because of its ease and accuracy, diagnostic laparoscopy should be considered in all critically ill patients suspected of harboring intraabdominal pathology. Further studies are needed to fully establish its efficacy and safety.
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PMID:Diagnostic laparoscopy in critically ill intensive-care-unit patients. 144 51

Fifty-nine E. coli strains isolated from clinical cases of peritonitis, appendicitis, cholecystitis, wounds and respiratory infections as well as from other miscellaneous sources were investigated. A control group constituted by 475 E. coli strains isolated from the faeces of healthy individuals were also studied. E. coli O-grouped and investigated for production of cytotoxic necrotizing factor CNF1 and alpha-haemolysin (Hly), expression of P fimbriae and mannose-resistant (MRHA) and mannose-sensitive (MSHA) haemagglutination. Virulence factors significantly associated with extraintestinal strains were: production of CNF1 (19% versus 5%, p < 0.001), Hly (27% versus 9%; p < 0.001) and expression of MRHA (44% versus 16%; p < 0.001). The majority of extraintestinal strains (68% versus 36%; p < 0.001), in contrast with faecal E. coli, belonged to O serogroups frequently detected in uropathogenic and bacteraemic E. coli. These results suggest that E. coli causing different types of extraintestinal infections show similar virulence factors and belong to the same serogroups. However, between E. coli isolated from intraabdominal, wound and respiratory infections the number of strains with virulence factors was lower than in E. coli causing urinary tract infections and sepsis.
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PMID:[Escherichia coli virulence factors causing peritonitis, appendicitis and other extraintestinal infections]. 145 Feb 57

Melanoma frequently disseminates to the gastrointestinal tract, being found post-mortem in 60 per cent of patients with disseminated disease, while during life it is diagnosed in only 4 per cent. During the period 1981-87, 835 melanoma patients were referred and 30 developed complaints caused by gastrointestinal metastatic melanoma. Twenty-three patients were treated surgically. The interval between treatment of the primary melanoma and detection of intestinal involvement was a median of 34 months (range 2-87 months). In four patients recurrence in the gut was the first evidence of dissemination. Major complaints were nausea and vomiting, abdominal pain, signs of anaemia, and blood in the stools. Complications were bleeding (ten cases), ileus due to intussusception (five cases), bowel perforation (four cases) and cholecystitis (one case). The metastases, mainly localized in the small bowel, were removed by relatively simple procedures. Symptoms were reduced in 19 patients. Two patients died after operation: one from sepsis due to suture leakage, the other from pneumonia and a cerebrovascular accident. Of the remaining patients, 16 survived a median of 7.5 (range 0.7-32.0) months. Five patients are still alive 72, 72, 70, 7 and 2 months after the metastasectomy, three of whom are tumour-free. The actuarial 5-year survival of all patients is 19 per cent. These results support surgical intervention for patients with complaints and/or complications attributable to gastrointestinal metastatic melanoma.
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PMID:Surgery for melanoma metastatic to the gastrointestinal tract. 168 96

Four patients with underlying diseases including multiple trauma, aortic graft infection, and complex fistulae developed acute acalculous cholecystitis with bile cultures positive only for Candida albicans. The primary site of the candida infection included urinary tract, gastrointestinal tract, and an aortic graft in one patient each and was undetermined in the trauma victim. All had received broad-spectrum antibiotics; three of the four were in the intensive care unit (ICU) with organ failure. Ultrasonography showed a thickened gallbladder wall in three patients and sludge in one. Hepato-iminodiacetic acid scans were nonvisualizing in these three patients. Operative findings included gangrenous cholecystitis in two patients and edematous cholecystitis in one. The fourth patient was treated with percutaneous cholecystostomy and interval cholecystectomy. The interval from the onset of symptoms to recognition of the need for operation was an average of 7 days. Two of the four patients died of ongoing sepsis. Candida cholecystitis is a life-threatening complication of critical surgical illness. Risk factors are similar to those for candida infection elsewhere and include antibacterial therapy, complex fistulae, disseminated malignancy, immunosuppression, and prolonged ICU stay. A high index of suspicion for this fungal pathogen and aggressive surgical therapy offer the only chance for a favorable outcome.
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PMID:Acalculous candida cholecystitis: a complication of critical surgical illness. 174 3

Laparoscopic cholecystectomy is a minimally invasive procedure whereby the gallbladder is removed using laparoscopic techniques. The indications are similar to those for elective traditional cholecystectomy, but selection of patients is important for success. Contraindications are currently evolving. Patients with advanced cholecystitis, abdominal sepsis, ileus, bleeding disorders, pregnancy, and morbid obesity should not undergo this procedure. The procedure requires good traditional surgical skills, as well as additional laparoscopic (and laser) skills. Operative time is slightly longer than for traditional cholecystectomy, but decreases with experience. Morbidity is low, but there is a concern about bile duct injuries. Mortality is very low (0%) and is comparable to traditional cholecystectomy (0.4%). The major advantages of laparoscopic cholecystectomy are the short hospital stay (average: 2 days) and early return to normal activity (7 days). This results in a reduction in hospital costs. Adequate training and credentialing are important processes to foster good patient outcomes.
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PMID:Traditional versus laparoscopic cholecystectomy. 182 53

The variable clinical presentation and natural history of acute pancreatitis are illustrated by case reports, namely a case with a falsely positive diagnosis of biliary pancreatitis, a case with acute interstitial pancreatitis of biliary origin, a patient with early and severe late systemic complications and with sterile necrotizing pancreatitis necessitating operative debridements twice, a patient with acute pancreatogenic ascites and ARDS requiring drainage and respiratory supportive care, a patient with biliary pancreatitis and operation for necrotizing cholecystitis, with a further, late intervention for pancreatic abscess, and a patient with internal drainage for a pseudocyst, complicated by acute biliary pancreatitis due to cholesterolosis of the gallbladder. Modern clinico-pathological classification of acute pancreatitis and modern definitions of pancreatic sepsis are important for determining prognosis and adequate treatment.
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PMID:[Variable course in acute pancreatitis exemplified by case reports]. 186 65

An open-label prospective study was performed employing intramuscularly administered imipenem as an adjunct to surgery in 20 patients with acute cholecystitis and 24 patients with perforated or gangrenous appendicitis. Three (12.5%) septic failures occurred in appendicitis patients and 2 (10%) failures in cholecystitis patients. There were no deaths. Adverse effects were minor, and there was no toxicity. Although failures were not associated with in vitro resistance, Pseudomonas spp. were recovered from 2 of 3 appendicitis failures. Intramuscular imipenem appeared to be an effective single-drug antimicrobial when used as an adjunct to surgery in patients with acute cholecystitis or perforated appendicitis. It should be a more cost-effective alternative to the current multiple-drug therapy frequently employed in patients with intra-abdominal sepsis.
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PMID:Intramuscular imipenem as adjuvant therapy for acute cholecystitis and perforated or gangrenous appendicitis. 187 86


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