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

The authors report their experience with transhiatal esophageal resection accumulated during the period between January 1978 and March 1990. Indications for the procedure included cancer of the gastric cardia (26.3%), cancer of the hypopharynx (3.8%), cancer of the esophagus (59.2%), and benign esophageal disease (9.8%). Esophageal substitution was performed using a tubulized stomach (63.6%), ileo-ceco-coloplasty (28.5%), left colon (7.6%), and jejunum (0.3%). The majority of patients with neoplastic disease were found to be in an advanced stage (67.3% of esophageal cancer patients and 69.7% of cancer of the cardia patients with stage III disease). The mean intra-operative volume of blood transfused varied between 533 and 1,220 ml. Sixteen patients required hospitalization in the intensive care unit. The mean length of post-operative hospitalization varied between 16.8 and 20.6 days. Operative complications included hemorrhage (0.3%) and tracheal injury (0.6%). Operative (30 day) mortality was 5.8%. Causes of death included respiratory insufficiency (35.2%), pulmonary sepsis (23.5%), abdominal sepsis (17.8%), and others (undefined, 23.5%). The 5 year survival was 48.5% for cancer of the gastric cardia, 57.1% for cancer of the hypopharynx and 11.8% for esophageal cancer.
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PMID:Esophageal resection by cervico-abdominal approach without thoracotomy. 147 91

We present a retrospective study of 68 esophageal cancer patients treated with surgery between 1975 and 1991. Results showed a resectability of 73.5% with the most frequent surgical approach being a Lewis esophagectomy. The mean hospitalization time was 24.7 days with a postoperative mortality of 7.3%. Other complications included anastomotic leakage, wound infection, sepsis and pulmonary disorders. Over-all survival at 3 years was 17.3%, reaching 24% in resected patients. Survival according to lymph node involvement was 13.4% for lymph node positive patients and 34.5% for node negative patients. According to histopathologic stage, survival rates were 34.6% and 8.59% for early and advanced tumor respectively, the difference being statistically significant using the Mantel-Haenszel test.
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PMID:[Cancer of the esophagus (II): the results of surgery, anatomicopathological study and patient survival]. 149 56

MRSA strains were first isolated in 1981 and have increased markedly from 1985 in our surgical ward. One hundred and ninety four strains of MRSA were isolated and 81 cases developed critical infections which were associated with enterocolitis, pneumonia and sepsis. There were many cases in esophageal cancer patients. Bacteriological features of the MRSA strains clearly changed in 1985 from IV to II coagulase type, accompanied with high resistance for antibiotics. Our management against nosocomial infection for MRSA started from April 1988. The number of MRSA cases decreased in 1989, increased in 1990 and decreased again in 1991. We are confident that our management is effective and we will take further efforts to choose the most adequate antibiotics after surgery in our surgical ward.
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PMID:[Postoperative MRSA infections in digestive tract surgery]. 150 33

The authors present their experience obtained from January/78 to March/90 with transhiatal esophagectomy. Two hundred and eighty-nine patients were operated on using this procedure; 171 of them underwent the operation for cancer of the esophagus, 76 for cancer of the cardia, 11 for cancer of the hypopharynx, and 31 for benign conditions. The esophageal replacement was made with stomach in 63.6% of the cases, ileo-ceco-coloplasty in 28.5%, left colon in 7.6%, jejunum in 0.3%. Cancer patients were mainly in advanced stages (stage III in 67.3% of esophageal cancer, and in 69.7% of cardial cancer). Average blood requirements for the different diseases ranged between 500 and 1,100 cc. Only 16 patients required admission in the ICU. Mean hospital stay ranged from 16.7 to 20.6 days. Surgical complications were hemorrhage (0.3%), and tracheal injury (0.6%). Overall operative mortality (at 30 days) was 5.8%, as a result of respiratory insufficiency (35.2%), pulmonary sepsis (17.8%), and others (23.5%). Long term survival at five years was 11.8% for cancer of the esophagus, 48.5% for cancer of the cardia, and 57.1% for cancer of the hypopharynx.
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PMID:Esophageal resection through a translaparotomic-transcervical approach. 160 44

When esophageal disruption occurs in the presence of preexisting esophageal disease or is associated with sepsis or fluid and electrolyte imbalance, aggressive and definitive therapy often provides the only chance for patient salvage. Twenty-four adults (average age, 59 years) with intrathoracic esophageal perforations underwent esophagectomy: 15, transhiatal esophagectomy without thoracotomy; and 9, transthoracic esophagectomy. Restoration of alimentary continuity with an immediate cervical esophagogastric anastomosis was carried out in 13 patients. Eleven underwent a cervical or anterior thoracic esophagostomy, and 10 of them had a subsequent colonic (7) or gastric (3) interposition from 4 to 32 weeks (average time, 8.6 weeks) later. The perforations were due to esophageal instrumentation (9 patients), acute caustic ingestion (2), emesis (2), intrathoracic esophagogastric anastomotic disruption (2), and other causes (9). Preexisting esophageal disease in 20 patients included chronic strictures (10 patients), reflux esophagitis (3), esophageal cancer (3), achalasia (2), diffuse spasm (2), and monilial esophagitis (1 patient). Ten patients were operated on within 12 hours after the injury; 3, within 12 to 24 hours; and 11, within three to 45 days (average interval, 6.6 days). There were three hospital deaths (13%). Nineteen of the 21 survivors were able to swallow comfortably until the time of death or latest follow-up. Aggressive diagnosis and aggressive treatment of life-threatening esophageal perforations are advocated. Conservative procedures (repair, diversion, or drainage) for a perforation with preexisting esophageal disease often inflict more morbidity than esophageal resection, which eliminates the perforation, the source of sepsis, and the underlying esophageal disease. The decision to restore alimentary continuity in a single stage must be individualized.
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PMID:Esophagectomy for esophageal disruption. 229 75

In 35 consecutive patients who underwent esophagectomy for malignancy the nutritional status was evaluated. 15 patients were estimated to be malnourished and were therefore treated by total parental nutrition (TPN) for 7 days. In the control group (n = 20, no TPN) the nutritional status was normal. TPN corrected abnormal serum parameters with short half-life time. Therefore the nutritional status of both groups was equal at time of operation. The postoperative clinical outcome of both groups was as follows: In TPN-treated patients postoperative hospital stay for 26 days was shorter compared to 32 days in controls, no patients died (vs n = 4), no patient developed sepsis (vs n = 4), no patient developed acute renal failure (vs n = 3). These differences did not reach levels of significance due to the small patient groups. In conclusion our study shows that patients with esophageal cancer and regarded as well nourished seemed to suffer from nutritional deficits. Assessment of the nutritional status by commonly used nutritional parameters does not reveal these deficits.
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PMID:[The effect of preoperative parenteral nutrition on the perioperative course in patients with esophageal cancer]. 250 66

Imipenem/cilastatin sodium (IMP/CS) was administered to patients with severe infections complicated by hematological disorders and solid tumors to assess its efficacy and safety. Primary diseases in this series of 76 cases included 37 cases of hematological disorders (acute leukemia in 25 cases, malignant lymphoma in 7 cases, aplastic anemia in 3 cases and 2 other diseases) and 38 cases of solid tumors (lung cancer in 7 cases, gastric cancer in 11 cases, esophageal cancer in 6 cases, pancreatic cancer in 3 cases, bile duct cancer in 4 cases, hepatocellular cancer in 3 cases, and 4 other diseases). Following results were obtained. 1. Types of infection in hematological diseases were sepsis in 5 cases, suspected sepsis in 24 cases, pneumonia in 5 cases and 3 others. The efficacy rates were 100% in sepsis, 62.5% in suspected sepsis, 80% in pneumonia and 73% in all cases. 2. Types of infection in solid tumors were sepsis in 2 cases, suspected sepsis in 13 cases, pneumonia in 10 cases, cholecystitis in 2 cases, cholangitis in 5 cases, liver abscess in 2 cases, and 4 others. The efficacy rates were 50% in sepsis, 69.2% in suspected sepsis, 80% in pneumonia, and 71.1% in all cases. 3. IPM/CS was administered in single use in 66 cases and in combination with other antibiotics in 9 cases. The efficacy rate in the single use was 72.7% and that in the combination use was 66.7%. 4. The efficacy rate in 35 cases of first use was 71.4% and that in 40 cases of second use was 72.5%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical evaluation of imipenem/cilastatin sodium against severe infections complicated with hematological disorders and solid tumors]. 261 13

Thirty-two patients with advanced epidermoid carcinoma of the esophagus were treated with ifosfamide (1.50 gm/m2 daily x 5 days) with uroprotective mesna in a phase II study. Eighteen patients were previously untreated. Of 28 evaluable patients, two (7%) had partial remissions lasting 2+ and 6+ months. Toxicity was predominantly myelosuppression with a median WBC nadir of 1.8 cells/ul. Seven patients required hospitalization for nadir sepsis. Ifosfamide has minimal activity in esophageal cancer and causes severe myelosuppression.
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PMID:Phase II trial of ifosfamide in epidermoid carcinoma of the esophagus: unexpectant severe toxicity. 319 90

In order to find an effective and suitable chemotherapy regimen for preoperative treatment of esophageal cancer, patients with inoperable or metastatic disease were treated with a combination of etoposide and cisplatin. Of 27 evaluable patients, 13 had squamous cell carcinoma, 13 adenocarcinoma, and 1 muco-epidermoid carcinoma. No complete responses were noted. Nine of 13 patients with squamous cell carcinoma and only one of 13 with adenocarcinoma showed a partial response. Nine of 10 responders achieved a partial response after 2 courses, one after 4 courses. There was one toxic death, due to sepsis during leukopenia. Other toxicities were alopecia, nausea and vomiting, nephrotoxicity, thrombocytopenia and leukopenia.
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PMID:Etoposide and cisplatin in advanced esophageal cancer. A preliminary report. 323 66

Cisplatin plus 5-FU appears to have significant additive activity in various tumors, such as head and neck carcinoma and esophageal cancer. A partial explanation for this may be drug synergism, which has been noted in the L1210 leukemia model. Based on these data, a prospective trial of weekly bolus 5-FU (15 mg/kg) and cisplatin (60 mg/m2) given every 3 weeks was initiated at Indiana University. Forty-one patients, of whom 38 are fully evaluable for response, were treated with these two drugs. Ten partial and one complete response (complete + partial response rate = 29%) were observed in the 38 evaluable patients. Thirteen additional patients had stable disease for greater than or equal to 3 months. The median durations of remission and survival time were 6 and 10.3 months, respectively. Myelosuppression was unusually severe, with granulocyte counts less than 1000/mm3 in 65% of patients, including four patients with granulocyte count nadirs less than 100/mm3. Three patients developed granulocytopenic fever, with two drug-related deaths (sepsis, hyperosmolar coma). Nearly all patients had nausea and vomiting, but this was not a treatment-limiting toxic effect in any patient. Although this combination suggests a higher response rate than usually seen with bolus iv 5-FU in colon cancer, a trial comparing 5-FU alone or with cisplatin to determine whether true synergy exists is currently underway.
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PMID:Cisplatin plus 5-FU for the treatment of adenocarcinoma of the colon. 407 11


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