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

In a historical cohort study, acute renal failure developed in 16.5% of 157 patients with rhabdomyolysis over a two-year study period. Underlying clinical, laboratory, and causative factors associated with the development of acute renal failure were examined. Factors predictive of renal failure in this setting, determined by multiple logistic regression analysis, included the degree of serum creatine kinase, serum potassium, and serum phosphorus level elevation; the degree of depression of serum albumin level; and the presence of dehydration at presentation or sepsis as the underlying cause. The predictive model that was developed correctly classified 93% of subjects and was statistically validated.
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PMID:Factors predictive of acute renal failure in rhabdomyolysis. 338 1

During 1983 and 1984 12 patients suffering of acute renal failure aged 65 or more were treated in the Intensive Care Unit. All patients were oliguric at the moment of the acceptance. In six of them laboratory parameters: the renal failure index and the excretional fraction of filtered sodium indicated functional oliguria. In other six patients acute renal failure of the parenchymal type was present with a renal failure index from 3.8 to 34.7. Four patients were treated with the extracorporeal hemodialysis because of the lack of the adequate diuresis following the rational treatment. The patients suffered from: cardiogenic shock, sepsis, dehydration, acute pancreatitis, coma during medicamentous intoxication, osteomyelitis, urosepsis and thrombosis of the abdominal aorta. The urine osmolality was not specific enough for the differentiation of the type of acute renal failure, the urine: plasma osmolality ratio and the creatinine urine: plasma ratio were of greater values and the renal failure index and the excretional fraction of filtered sodium were referring parameters for the differentiation of the type of acute renal failure.
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PMID:The characteristics of acute renal failure in older persons. 371 62

We consider a proximal loop ileostomy to be an integral part of a pelvic pouch procedure with ileoanal anastomosis. In the absence of controlled studies and considering the reported poor results with high rates of pelvic sepsis when this operation is performed without a proximal defunctionalizing ileostomy, we will continue to routinely use proximal ileostomy in all patients undergoing this procedure. There is a high rate of complications related to loop ileostomy; however, they are not life threatening and do not preclude an excellent long-term result. Dehydration requiring readmission to the hospital occurred in 20 percent of the patients in this series. More sensitive clinical data, such as measurement of urinary electrolyte levels, should be used to identify patients at high risk for this complication. Septic complications were rare after closure of the loop ileostomy, but bowel obstruction was common. Bowel obstruction rarely required operative intervention, but it is possible that changing the method of closure may decrease the rate of obstruction. The use of loop ileostomy to bypass temporarily part of the terminal ileum may have significant metabolic effects that require further study.
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PMID:Complications of loop ileostomy. 379 85

The therapeutic goals for fluid replacement in 9 patients were studied. Five cases in sepsis, 2 in necrotizing pancreatitis and 2 in fat embolism were treated as dehydration or hypovolemia. Fluid replacement was performed with the view of obtaining the amelioration of circulation and urine output, even if CVP or PCWP had been elevated on admission. The values of CVP and PCWP, renal function and pulmonary function were assessed retrospectively. Out of 9 patients, one died of refractory shock, brain edema due to fat embolism and remaining one after recovery of shock. Out of 6 survivors, 2 showed oliguric renal failure, and 2 nonoliguric renal failure. The volume of administered fluid ranged from 5445 ml/10 hrs to 15820 ml/14 hrs and speeds of fluid administration were 545 ml/hr to 1248 ml/hr. CVP value on admission ranged from 4.0 to 22.0 cmH2O (3.0 to 16.3 mmHg), mean value 14.0 +/- 6.5 cmH2O. Through the course, the highest CVP and PCWP ranged from 12.5 to 26.5 (mean 19.8) mmHg and 14 to 36 (mean 20.9) mmHg, respectively. Out of 9 patients, 8 were suffering from respiratory distress, however, 7 recovered by PEEP except for one refractory shock. High values of CVP or PCWP could be recognized even if in hypovolemic shock and/or septic shock. Maintenance of higher values (18-20 mmHg) in CVP and/or PCWP during fluid resuscitation might be recommended because adequate fluid resuscitation could sustain the renal function, and result in good outcome.
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PMID:[Therapeutic goals for fluid management in profound shock]. 382 15

The recent published literature dealing with urinary tract calculi during pregnancy has been summarized. Our own experience with 17 patients, (0.08% of the deliveries) in a recent 12-year interval has been described. Emphasis must be placed on the safety and limitations of renal ultrasonography. Excretory urography should be performed in patients with urinary infection not responding after 48 hours of antibiotic therapy, with declining renal function, with massive hydronephrosis on renal echography, or with pain and dehydration from vomiting. The timing of postinjection films is critical; a 3-hour film and, if needed, a 6-hour film are recommended. Criteria for intervention (nonoperative or operative) include calculous pyelonephritis, persistent massive hydronephrosis with impairment of renal function, and protracted pain or sepsis.
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PMID:Renal calculi in pregnancy. 389 20

Uterine rupture in the developing world remains a significant problem. 45 cases treated in a rural hospital in Nigeria are discussed in this article. The predisposing factors included cephalopelvic disproportion (62%), grand multiparity (33%), previous cesarean section (24%), placental pathology (15%) and abnormal presentation (20%). The factors associated with maternal death included sepsis (71%), macerated stillborn infant (60%), vulvar edema (50%), prolonged labor (42%), hand presentation (50%) and hysterectomy (37.5%). Hemodynamic resuscitation and prompt surgical intervention remain the mainstays of therapy. Patients ranged from ages 16 to 46, and gravidity ranged from 1 to 11. 38 of the 45 patients had no prenatal care. 8 of the 9 maternal deaths that occurred were among these 38. It is common for patients with uterine rupture to be admitted after uterine contractions have ceased, with profound dehydration and early septic or hemorrhagic shock. In 39 (87%) of the 45 cases, no fetal heart tones were heard on admission. 29 (58%) of the 45 uterine ruptures involved the lower uterine segment exclusively. Surgical procedures performed were hysterectomy in 8 cases and tubal ligations in 4 cases. The distinction between early and obstructed labor, cephalopelvic disproportion in the US, and true obstructed labor, as seen in rural Nigeria, is an important one. There often is a double-hump sign from the ballooning lower uterine segment in cases of long-obstructed labor, for which the patient may have been given an herbal powder. Numerous types of herbal mixtures have shown oxytocic properties and may contribute to the high incidence of uterine rupture. Prenatal care is an important preventive factor. Placental pathology appeared to play an etiologic role in several cases. The decision as to whether surgical repair or hysterectomy is the appropriate treatment is greatly influenced by cultural realities. Among the rural tribes of the Bendel State in Nigeria, fertility and the ability to menstruate are considered essential to a woman's worth within the community and in her family. Repair of a ruptured uterus is associated with lower maternal mortality than is hysterectomy and is therefore the preferred procedure.
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PMID:Uterine rupture in Nigeria. 399 69

The prevalence, presentation, and outcome of bacteremia due to Shigella and other gram-negative bacteria were determined by review of records of 2,018 inpatients with shigellosis who had their blood cultured in a Bangladeshi hospital in 1976-1983. Shigella bacteremia occurred in 82 (4.1%) patients; other bacteremia occurred in 102 (5.1%) patients. Patients with shigella sepsis more frequently (P less than .02) manifested severe dehydration, abdominal tenderness or ileus, agitation or lethargy, and leukocytosis than did nonbacteremic controls; they developed more frequently (P less than .05) renal failure (26%), leukemoid reaction (22%), thrombocytopenia (20%), and hemolytic-uremic syndrome (6%). The prevalence of all bacteremia was highest in the first year of life. Protein-energy malnutrition was a strong risk factor for shigella sepsis (P less than .01). The fatality rate in shigella bacteremia (21%) was higher (P less than .005) than in nonbacteremic shigellosis (10%) but lower (P less than .001) than in other bacteremia (51%). At highest risk of death from shigella bacteremia (P less than .01) were patients less than one year old, non-breast-fed, malnourished, and afebrile.
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PMID:Shigella septicemia: prevalence, presentation, risk factors, and outcome. 404 31

Our experience in treating seven patients with severe crush injury of the lower limbs is described. They were brought to hospital 12 h after rescue and had no treatment until then. All seven developed acute renal failure due to myoglobinuria and dehydration. Five were anuric and three non-oliguric. All developed severe sepsis and two had also acute respiratory failure. No bleeding tendency was observed. They were treated along the following lines: early extensive fasciotomy and removal of dead tissues; early fluid challenge; early peritoneal dialysis and/or hemodialysis; high caloric, high protein nutrition; vigorous antibiotic therapy when infection was evident. There were no deaths in our patients. Our management and results are discussed and compared with those in the literature.
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PMID:Management of crush syndrome. 609 Dec 2

A male infant had severe muscular hypotonia from birth. Recurrent vomiting with dehydration and severe metabolic acidosis complicated the course. Elevated lactate (up to 12.3 mmol/l; n less than 2), pyruvate (0.4 mmol/l; n less than 0.05) and alanine levels were found in serum with an abnormal lactate/pyruvate ratio (greater than 30; n less than 15). In urine the concentrations of lactate, pyruvate, alanine and of several intermediates of the citric acid cycle were increased. In muscle, numerous disseminated "ragged red fibres" were found by light microscopy; muscle fibres were found to contain subsarcolemmal aggregates of mitochondria, lipid droplets and glycogen by electromicroscopical methods. Moreover, mitochondria with a typical circular arrangement of cristae were noticed. In liver homogenates normal activities of pyruvate carboxylase and pyruvate dehydrogenase complex were found; in liver mitochondria also succinate-cytochrome-c-oxidoreductase activity was normal. However, in muscle no succinate-cytochrome-c-oxidoreductase activity was detectable. The patient became increasingly lethargic and died because of sepsis at 5 months of age.
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PMID:Mitochondrial myopathy with lactic acidosis and deficient activity of muscle succinate cytochrome-c-oxidoreductase. 609 51

Renal venous thrombosis, a clotting process that originates in the venous radicles and progresses into the main renal vein and vena cava, predominantly affects newborn infants. It may be manifest in one or both kidneys and follow maternal diabetes, diarrhea and dehydration, congenital heart disease, acute blood loss, sepsis, asphyxia, and shock. The most common signs include gross hematuria, enlarged palpable kidneys, and thrombocytopenia. Evaluation should include ultrasonography of the kidneys (demonstrating renal enlargement with disruption of the normal echo pattern), computed tomography, and renal isotope scanning. The initial treatment is supportive. Surgical intervention is not indicated in the acute phase except in the rare instance of bilateral disease. Anticoagulant therapy is still controversial. Late sequelae include impairment of renal function, shrunken hypoplastic kidney, arterial hypertension, and tubular defects.
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PMID:Renal venous thrombosis in children: changes in management. 635 1


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