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

This brief review of abdominal emergencies is by no means encyclopedic. Indeed, it simply reflects the multiplicity of problems that can occur and suggests the need for a high index of suspicion and an optimistic attitude toward their solution. In addition, the surgeon must keep in mind the fact that cancer patients may also suffer acute abdominal distress from extra-abdominal causes such as pneumonia, myocardial infarction, diabetes mellitus, and hematologic abnormalities such as porphyria or sickle cell anemia. Inflammatory bowel disease, pelvic inflammatory disease, acute hepatitis or other similar problems more commonly seen in general hospital populations may also develop. Consultations for an acute condition of the abdomen in patients receiving marrow-suppressing chemotherapy are challenging problems and repeated examination every few hours is required to detect subtle changes. Hypovolemia, sepsis, confusion and unexplained metabolic acidosis may be the only criteria for surgical exploration. An unnecessary operation in a leukopenic and thrombocytopenic patient is indeed risky, but failure to drain an occult abscess or resect a perforated segment of bowel is always lethal. An additional consideration is the likelihood of response to further treatment of the underlying disease. Unless further effective therapy is unavailable, pessimism is unwarranted.
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PMID:Abdominal emergencies. 31 58

Complications after heart valve replacement remain a substantial source of morbidity and mortality despite continuing advances in surgical care and prosthetic design. Infectious endocarditis occurs in about 4 percent of patients and may appear early (within 60 days) or late after operation. Endocarditis of early onset is commonly due to staphylococcal, fungal or gram-negative organisms and is fatal in 70 percent or more of cases. Infection of late onset is more often of streptococcal origin and the mortality rate is lower, about 35 percent. With either type, prompt recognition, vigorous and appropriate antimicrobial therapy and early consideration of surgical intervention are crucial. The postperfusion and postpericardiotomy syndromes are relatively common and relatively benign syndromes associated with postoperative fever. Their recognition is important to prevent confusion with endocarditis or sepsis and thus to reassure the patient and physician. Treatment is primarily symptomatic. Intravascular hemolysis occurs with most prosthetic heart valves but is more common with certain prostheses and with paraprosthetic valve regurgitation, with significant hemolytic anemia in 5 to 15 percent. Oral iron replacement therapy is effective in the majority of patients, but occasionally blood transfusion or reoperation for leak around the prosthesis is necessary. Prosthesis dysfunction due to thrombus may be recognized clinically by recurrence of heart failure, syncope, cardiomegaly and altered prosthetic valve sounds or new murmurs. Hemodynamic studies verify the diagnosis, and prompt reoperation is indicated for this potentially lethal problem. Systemic embolization has decreased markedly with the introduction of cloth-covered prostheses and is frequently related to erratic or ineffective anticoagulant therapy. We continue to recommend anticoagulant therapy for all patients with prosthetic heart valves unless there is a major contraindication.
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PMID:Diagnosis and management of complications of prosthetic heart valves. 109 75

Advanced age is frequently considered a contraindication to radical exenterative surgery. We reviewed the outcomes of 63 patients age 65 years or older who underwent pelvic exenteration between 1960-1991 at The University of Texas M. D. Anderson Cancer Center. Sixty-three percent had preexisting medical illnesses. Major or potentially life-threatening complications were noted in 38% of the patients. An additional 38% experienced minor complications. Sixty percent experienced one or more infectious complications, including pyelonephritis, wound infection, sepsis, and flap necrosis. When both major and minor complications were considered, infectious morbidity was the single largest category. Although they are not life-threatening, nonspecific infectious morbidity and transient confusion were the most frequent individual complications, occurring in 26 and 24% of patients, respectively. Twenty-four percent of the patients experienced no complications. Thirty-four percent of the postoperative survivors suffered late major morbidity. Operative mortality was 11%; multisystem failure was the most frequent cause of death. After a mean follow-up of 4 years, 22 patients were alive with no clinical evidence of disease. Twenty-one patients died of recurrent disease, with a median time to recurrence of 9.6 months. The 5-year survival rate for the group was 46%. In comparison, 363 patients younger than age 65 who underwent exenteration during the same period experienced an operative mortality rate of 8.5% and a 5-year survival rate of 45%, neither of which were significantly different from the rates found for the older group (P = .51 and .52, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pelvic exenteration in the elderly patient. 156 64

Recent developments in the pathophysiology and treatment of sepsis have clearly shown the confusion produced by the imprecise terminology used to define the various facets of the sepsis process. The criteria required to diagnose bacteremia, sepsis, sepsis syndrome or septic shock vary from one author to the other. This inaccuracy accounts for the inability to compare the results of therapeutic investigation from different groups. The aim of this article is to point out the necessity of standardized terminology and to propose definitions which might be appropriate.
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PMID:[Sepsis: confusion of terms]. 160 81

Sternal sepsis following median sternotomy is an infrequent yet devastating complication of cardiac surgery, leading to prolonged hospitalization, increased hospital expense, and a high associated morbidity and mortality. The development of sternotomy infection is multifactorial. Numerous prospective and retrospective studies have pointed to a multitude of clinical and perioperative variables as being causative, with as many other studies presenting evidence of the contrary. This has led to confusion about which clinical variables should be modified so as to minimize the individual patient's risk for developing this severe complication. Other less obvious factors also come into play. Malnutrition, whether overt or subclinical, is not uncommon in cardiac patients. Immune competency is affected by operative trauma, as well as a variety of perioperative factors including underlying nutritional status, transfusion, cardiopulmonary bypass, and anesthesia. This creates a complex milieu for the development of postoperative infection. In this review, the multiple risk factors of median sternotomy infection are studied and treatment options briefly discussed.
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PMID:The risk factors of median sternotomy infection: a current review. 180 73

Multicenter noncomparative trials of intramuscular administration of imipenem/cilastatin for the treatment of a variety of infections requiring multiple-dose therapy are reviewed. Fourteen centers in the United States and 18 centers elsewhere participated in these studies. A total of 686 patients (461 evaluable) were treated worldwide. The severity of the infection was rated as moderate in 58.9%, mild in 37.2% and severe in 0.6%. The most common sites of infection were the skin and soft tissue (36.2%) and intra-abdominal (17.6%). Polymicrobial infections were relatively common (27%). Dosing regimens in evaluable patients were 500 mg every 12 h (45.1%), 750 mg every 12 h (36.2%) and 500 mg every 8 h (18.6%). The overall clinical outcome was favorable (clinical cure or improvement) for 95% or more of the evaluable patients with the various body system infections, except in gynecologic infections where 89% of the evaluable patients had a favorable outcome and for sepsis where the favorable outcome was 76%. Where data were available for analysis (skin and soft tissue infections) there was no difference in favorable clinical outcome among patients with moderate infection treated with 1.0 g/day (95% favorable) compared with 1.5 g/day (94% favorable). The overall bacteriologic eradication rate was 91%. Clinical adverse effects were similar in type but less common in frequency than those noted in other studies with the intravenous formulation, with nausea, vomiting and diarrhea being most common; no instances of seizures or confusion were observed. The laboratory adverse effects were similar to those seen in other studies with the intravenous formulation, with increased liver enzyme values the most common. The intramuscular injection was well tolerated in 87% of the patients and moderately well tolerated in 6.6%. The efficacy and low incidence of side effects of the intramuscular formulation of imipenem/cilastatin are significant advantages in the cost-effective treatment of infections.
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PMID:Intramuscular imipenem/cilastatin in multiple-dose treatment regimens: review of the worldwide clinical experience. 187 87

Physicians and surgeons have long recognized that septic illness may be accompanied by abnormal brain functions; however, no systematic, comprehensive study has been done to define the clinical and laboratory features of the syndrome of sepsis-associated encephalopathy. We undertook such a prospective study in a tertiary care hospital and found that of 69 patients with fever and microbial cultures, 32 had marked brain dysfunction, 17 showed mild encephalopathy, and 20 were clinically nonencephalopathic. Severe cases showed obtundation and paratonic rigidity while milder cases showed confusion, inappropriate behavior, inattention, disorientation, and writing errors. There were no focal neurological deficits. The following factors correlated with the severity of brain dysfunction: adult respiratory distress syndrome; fatal outcome; certain types of EEG abnormality; axonal peripheral neuropathy; elevated peripheral white blood cell count; elevated serum levels of alkaline phosphatase, bilirubin, creatinine, phosphate, potassium, and urea; reduced blood pressure and reduced serum albumin level. Our data suggest that brain functions fail with dysfunction of other organs in septic illness. Pathogenetic mechanisms are discussed. The brain dysfunction should be regarded as potentially reversible, even in severely encephalopathic cases. Prompt control of the infection is the most important measure in controlling the encephalopathy and in preventing the increased mortality found with severely encephalopathic patients.
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PMID:The encephalopathy associated with septic illness. 207 9

General practitioners and accident and emergency departments are often involved in the management of hand or finger sepsis. Such cases are usually easily diagnosed and treated. We report a more serious disorder which may mimic the condition and cause diagnostic confusion.
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PMID:A case of tumour simulating pulp space infection. 210 20

Septicaemia frequently presents without "classic" signs of infection--tachypnoea, hypotension and confusion are the commonest features. The mortality rate is 40 to 80% and in intensive care units, septicaemia accounts for 70% of all deaths. Despite the use of antimicrobial drugs to which the offending organism is sensitive, patients are still dying. Effects on distant organ systems are due to "Mediators". "Microvascular Failure" resulting in tissue hypoxia is the unifying hypothesis of multiple organ failure in septicaemia. Mortality is correlated with the number of organ system failures. Supportive management is aimed at prevention of organ failure--manipulation of the circulation being the central key. Intravascular volume expansion, vasoactive drugs, mechanical ventilation and invasive monitoring are the means. Antimicrobial therapy must be guided by 'best guess' approach with multiple agents until isolation of the offending organism can recommend specific therapy. Aggressive surgical drainage or excision, is particularly applicable in abdominal sepsis. Several adjunctive therapies aimed at mediators of sepsis, are as yet experimental.
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PMID:Septicaemia and the prevention of multiorgan failure--the intensive care perspective. 222 36

The sick cell syndrome is a disorder of the cellular Na+/K+ pump with several causes which include hypoxia, sepsis, hypovolaemia and malnourishment. We report an example of the sick cell syndrome which occurred twice to a patient admitted to our Burn Centre, the first time due to hyponutrition and the second time septicaemia. The striking features of this syndrome were hyponatraemia (less than 130 mmol) despite an increasing sodium intake, a reduced natriuria (less than 20 mmol), a trend to hyperkalaemia and unchanged haematological parameters. Clinically the syndrome was characterized by confusion and hallucinations, and the problem was solved by appropriate treatment of the cause.
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PMID:Sick cell syndrome in a burned patient. 225 76


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