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

Nine cases of acute acalculous cholecystitis were diagnosed in the surgical intensive care unit at Hartford Hospital during a 2 year period after abdominal, cardiovascular, and traumatic surgery. A tender mass in the right upper quadrant was suggestive but not diagnostic of the condition. Hyperamylasemia was seen in all patients. Ultrasonography is the most useful diagnostic tool; serial studies reveal progressive gallbladder dilatation and edema. Tube cholecystostomy was used in five patients and cholecystectomy in four. Cholecystostomy led to resolution of the inflammatory process in all five patients. Cholecystectomy should be reserved for those patients with extensive gallbladder necrosis. Six of the nine patients in the series died, all from multiple systems failure with concomitant sepsis. Hypotension is probably central to the development of acute acalculous cholecystitis. In the face of elevated intraluminal gallbladder pressure caused by ampullary edema and increased bile viscosity, hypotension may result in mucosal ischemia and necrosis with subsequent bacterial colonization. Acute acalculous cholecystitis represents another organ failure in critically ill patients who are experiencing progressive failure of multiple organ systems. An aggressive approach to the manifestations of organ failure, including acalculous cholecystitis, must be employed.
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PMID:Acute acalculous cholecystitis in the critically ill patient. 618 83

Sisomicin sulfate (SISO) was used for the treatment of infections complicated by malignant diseases in 10 cases; 4 cases with suspicious sepsis, 2 with pneumonia, 2 with urinary tract infection, 1 with renal abscess and 1 with cholecystitis. SISO was administered by intravenous drip infusion at daily dose from 100 to 150 mg for 6 to 12 days, concomitantly with other antibiotics. Clinical results were as follows; Good in 2, fair in 5, poor in 3 cases. As to the side effects of SISO, cylindruria with aggravation of microscopic hematuria and elevations of GOT, GPT and A1-P were observed each one of them, respectively. The relationship to the SISO, however, was not clear. In view of the above results, the drip infusion of SISO may be useful for the treatment of serious infection complicated by malignant diseases.
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PMID:[Clinical experience of sisomicin sulfate by intravenous drip infusion for the treatment of infection complicated by malignant disease]. 659 72

Diseases of the biliary tract are common problems, frequently encountered in clinical practice. Infection is a major cause of mortality in patients with extrahepatic obstruction, especially in the elderly patient. Survival in patients with biliary tract stones, complicating cholecystitis and ascending cholangitis or abscess formation depends on timing of surgery with decompression of the biliary tract, attention to fluid and electrolyte management and on prompt institution of antibiotics. The initial choice of antibiotics should be based on the organisms most frequently encountered in biliary tract sepsis, especially E. coli, enterococci, klebsiella, pseudomonas, clostridia and ps. aeruginosa. Serum levels as well as the concentration of the antibiotic in the bile are important factors determining efficacy. Cefoperazon (Cefobis), a new cephalosporin with a spectrum of antimicrobial activity that differs from some previously marketed cephalosporins, in that it is effective also against ps. aeruginosa, achieves high biliary concentrations. A clinical study is presented which proves this new antibiotic to be a safe drug and the cephalosporin of choice to treat biliary tract infections.
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PMID:[Acute and chronic biliary tract infections. Studies of the therapeutic effect of a new broad-spectrum cephalosporin]. 661 4

Thirty two patients with empyema of the gall bladder were identified among 1327 cases of gall-bladder disease presenting to one hospital over a six year period. Abdominal pain had been present for a median of eight days and, in eight cases, for between one and four months. In a few cases, the disease was painless and was discovered unexpectedly at postmortem or at operation for unrelated disease. The serious nature of the complaint was belied by the often scanty physical signs. Less than half the patients had a pyrexia of more than 37.5 degrees C and the presence of sepsis was rarely suspected clinically. Eight patients (25%) died, usually from unsuspected septicaemia. This considerable mortality might be reduced by the wider use of blood culture in cases of apparent 'cholecystitis' and by greater awareness that empyema of the gall bladder is sometimes chronic, painless, and afebrile.
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PMID:Empyema of the gall bladder - reappraisal of a neglected disease. 664 80

In a 2-year period (1981-1983), 87 abdominal re-explorations (1.6% of total laparotomies) were performed on 77 patients for sepsis in five Downstate hospitals. Fifty-one patients were re-explored solely on clinical grounds, 21 on clinical plus radiographic criteria, four solely on radiographic grounds, and 11 for multiple organ failure. The overall mortality rate was 43%. As expected, the most common laparotomy finding was intra-abdominal abscess (47); other findings included anastomotic leak (14), necrotic bowel (10), evidence of technical error (five), and acalculous cholecystitis (two). The most common clinical findings were localized tenderness, fever, and absent bowel sounds (85%). Fifty-four special studies were performed with an overall accuracy rate of 76%. CAT scans and contrast radiographs were most accurate (92% and 81%) while sonography and gallium scans were less useful (59% and 60%). Seven patients had negative laparotomies. While all were distended and six were febrile, only one patient had focal tenderness. In the 11 patients explored solely for multiple organ failure, six patients had drainable pus despite negative radiographic studies, and two survived. The other five patients had negative laparotomies, and all died. Factors correlated with mortality were age over 50, peritonitis at the primary operation, and multiple organ failure. The approach to these seriously ill patients should be governed by a high index of suspicion. Clinical findings are at least as reliable as sophisticated radiographic modalities of which CAT scan appears to be the most accurate. Re-exploration for multiple organ failure alone will yield a significant group of patients with drainable septic foci and some survivors; thus, exploration for this indication appears to be defensible.
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PMID:Re-operation for intra-abdominal sepsis. Indications and results in modern critical care setting. 669 29

Acute, acalculous cholecystitis is seen among patients suffering with bacterial sepsis, burns, trauma, or cancer; clinical conditions that could lead to activation of factor XII-dependent pathways and result in inflammation of the gall bladder. To test this hypothesis, dogs were injected intravenously with ellagic acid or rutin, known polyphenol activators of factor XII, or with Escherichia coli endotoxin, also known to activate factor XII, and monkeys were injected intravenously with ellagic acid. In both species, in vivo activation of factor XII-dependent pathways with polyphenol activator resulted in rapid and selective development of acute vasculitis in the serosa and muscularis of the gallbladder and margination of polymorphonuclear neutrophils in pulmonary blood vessels. Intravenous injection of E. coli endotoxin in dogs resulted in necrosis and thrombosis of vessels that were especially severe in the serosa and muscularis of the gallbladder but also present in vessels of many other organs. These observations indicate that blood vessels of the gall bladder and, to a lesser degree, the lung are especially sensitive to injury consequent to in vivo activation of factor XII-dependent pathways and, in view of the common ingestion of plant polyphenols, may provide important insight into the pathogenesis of cholecystitis in man.
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PMID:Induction of acute cholecystitis by activation of factor XII. 676 72

Post-traumatic acalculous cholecystitis is a potentially lethal complication that may develop in patients during hospitalization for trauma. Three case reports illustrate that obscuration of many early diagnostic symptoms and signs may make this complication particularly treacherous in the neurosurgical patient. Suspicion should be aroused by unexplained fever, leukocytosis, elevated serum bilirubin and alkaline phosphatase values, and developing intolerance to oral or tube feedings. There may be a rapid progression to signs of an acute abdominal condition. Symptoms are most likely to occur 1 week to 1 month after the episode of trauma. Patients of all ages are susceptible. Diagnosis is best confirmed by noninvasive iminodiacetic acid hepatobiliary scanning accompanied by ultrasound or abdominal computed tomographic scanning. The treatment of choice is emergency cholecystectomy. The cause is most likely multifactorial and is probably related to hypotension, sepsis, or biliary stasis with subsequent cystic duct obstruction. Although this disease is rare, its incidence is apparently increasing, and a high index of suspicion is warranted in the neurosurgeon involved in the care of the biliary tract disorder.
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PMID:Post-traumatic acalculous cholecystitis on a neurosurgical service. 682 28

Acute acalculous cholecystitis was observed to increase in frequency between 1950 and 1979, an increase that was statistically significant. The greatest part of this increase occurred between 1965 and 1979. Acute acalculous cholecystitis was also found to be associated with a higher mortality rate, more than twice that of acute calculous cholecystitis. Acute acalculous cholecystitis occurred in a variety of clinical settings including bacterial sepsis, severe trauma including surgical trauma and burns, multiple transfusions, and severe debilitation. The lesion in the gallbladder consists of intense injury of blood vessels in the muscularis and serosa similar to those induced experimentally by in vivo activation of factor XII dependent pathways. Possibly because of the intensity of vascular injury, acute acalculous cholecystitis with minimal clinical manifestations may rapidly progress to gangrene with perforation. Undelayed surgical treatment, which has become more widely accepted over the past 50 years, is essential. It may have also contributed to the increased recognition of this clinical entity.
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PMID:Acute acalculous cholecystitis. An increasing entity. 705 88

Acute alithiasic cholecystitis developed in 25 patients during the course of surgical, traumatic, or infective aggressions. Diagnosis was usually by ultrasonography, which proved to be the best means for exploration of the accessory biliary pathways during the postoperative period. If not, in the absence of a diagnosis, the lesion was usually discovered during a repeat operation because of sepsis. Findings during operation are frequently difficult to interpret. When confronted with a large but only slightly oedematous gallbladder, and when the rest of the abdomen appears normal, this should be sufficient to establish the diagnosis and to perform a cholecystectomy. Prevention of such accidents requires ultrasonographic surveillance of the gallbladder in high risk patients. The value of cholecystokinin is discussed.
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PMID:[Postoperative and stress-induced alithiasic cholecystitis. Report on 25 cases seen between 1960 and 1980 (author's transl)]. 706 8

Gallbladder and extrahepatic bile duct operations merit special consideration in cirrhotic patients. During the past 15 years at Strong Memorial Hospital, 33 cirrhotic patients have undergone cholecystectomy or an operation for bile duct obstruction. Of the 21 patients with cirrhosis subjected to cholecystectomy for cholecystitis and cholelithiasis, nine had uncomplicated courses. Included in this group was one patient in whom the intrahepatic portion of the gallbladder was deliberately not resected. The other 12 patients (57%) had excessive intraoperative bleeding and required transfusion of three or more units of blood. One patient required additional exploratory surgery and antifibrinolytic therapy to control bleeding. In an additional group, only one of seven patients whose gallbladder was removed during a portal decompressive procedure bled excessively from the liver bed. A third group of five patients, including four with secondary biliary cirrhosis who underwent operations on the bile duct for obstruction, had massive intraoperative bleeding (greater than 5 U). Four of the five exsanguinated, and the remaining patient died of sepsis. A more conservative approach toward elective cholecystectomy in the cirrhotic patient is indicated. If an operation is performed, increased bleeding should be anticipated; extensive intrahepatic dissection should be avoided. Intraoperative infusion of vasopressin and an antifibrinolytic agent should be considered.
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PMID:Biliary tract surgery and cirrhosis: a critical combination. 728 Sep 97


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