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

A comprehensive study of the course of the early neonatal period in 120 newborns infected with Chlamydia, analysis of somatic and obstetrical and gynecological anamnesis and the course of gestation, labor, and postpartum period in their mothers, and prospective clinical and microbiological examinations of these infants up to the age of 1 year revealed that the fetus is infected not only during delivery, but antenatally as well. The disease runs an extremely grave course in the neonates, often with generalization of the process. Chlamydial infection in the early neonatal period depends on the time and massiveness of infection of a child, the degree of morphofunctional maturity of the baby and presence of concomitant diseases related to unfavorable conditions of intrauterine development; it may take the following clinical forms: intrauterine sepsis, meningoencephalitis, intrauterine pneumonia, respiratory distress syndrome, gastroenteropathy, conjunctivitis. Problems in the diagnosis and treatment of the disease are discussed.
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PMID:[Current problems in the clinical course, diagnosis and treatment of Chlamydia infection in newborns]. 776 42

Yersinia enterocolitica has been described with increasing frequency in the United States. Commonly, Y enterocolitica is a self-limiting gastrointestinal disorder, but occasionally it can lead to fulminant infection. This case report describes a 3-week-old male who succumbed to Y enterocolitica sepsis and reviews the literature.
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PMID:Yersinia enterocolitica sepsis in a 3-week-old child. 780 64

Vibrio hollisae, one of the more recently described halophilic Vibrio species, is infrequently associated with gastrointestinal disease and only rarely recovered from individuals presenting with gram-negative sepsis. In this report we describe two cases of severe gastrointestinal disease associated with V. hollisae in otherwise healthy individuals. In one of these individuals, severe epigastric pain was apparently associated with signs of pseudoappendicitis, necessitating exploratory surgery. In both individuals, infection was associated with the ingestion of raw shellfish. These cases are discussed in light of previous reports on the epidemiology, pathogenesis, and spectrum of disease caused by this unusual pathogen.
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PMID:Severe gastroenteritis associated with Vibrio hollisae infection: report of two cases and review. 801 9

Cholestatic jaundice is the major complication of total parenteral nutrition (TPN) in infants and children. The pathogenesis of this syndrome is poorly understood. The aims of this study were: (1) to define the histologic liver injury in relation to the clinical course of infants on TPN and (2) to determine whether enteral feeding will reverse or halt these changes. We identified 31 infants treated for severe gastrointestinal disease for whom liver histology was available from 1987 to 1991. Clinical records and liver biopsy (23) or autopsy specimens (13) were reviewed. Five patients had biopsies at two subsequent operations. The clinical diagnosis was necrotizing enterocolitis (24), atresia or stenosis (3), midgut volvulus (2), Hirschsprung's disease (1), and sepsis (1). Twenty-one of 31 infants were premature and had a mean birth weight of 1,868 g. Twenty-five of 31 were on TPN and 28 of 31 had received some enteral feeding by the time of the biopsy. Enteral feeding was begun as early as possible in all infants even if continued TPN was necessary for full support. Cholestasis occurred in 71% of premature infants versus 22% of full-term babies. Infants with cholestasis had been on TPN for a longer time (37 days v 18) with a correspondingly shorter period of enteral feeding (17 days v 27). Mean total bilirubin level was 14 in patients with cholestasis and 5 in those without, but the bilirubin level did not correlate with the extent of histological injury and was frequently normal despite marked histological damage.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Total parenteral nutrition-associated cholestasis: clinical and histopathologic correlation. 826 85

Metformin is a biguanide that can used alone or in combination with sulfonylureas or insulin in the treatment of non-insulin-dependent diabetes mellitus (NIDDM). Since biguanides do not increase pancreatic insulin secretion, they are referred to as antihyperglycemic agents, as opposed to hypoglycemic agents. Biguanides reduce hyperglycemia by increasing, insulin sensitivity, decreasing glucose absorption, and inhibiting hepatic gluconeogenesis. Advantages of metformin include achieving glycemic control without exacerbating weight gain or hyperinsulinemia and beneficially affecting serum cholesterol concentrations. Although metformin has the potential to cause lactic acidosis, the incidence is significantly lower compared with phenformin. Risk factors for lactic acidosis include renal serum creatinine > 1.5 mg/dL and cardiovascular, pulmonary, and hepatic disease. Metformin should be temporarily discontinued prior to surgery and before administration of radiologic intravenous contrast, and in patients with sepsis, severe gastrointestinal disease, trauma, and acute cardiovascular events.
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PMID:Metformin: a new treatment option for non-insulin-dependent diabetes mellitus. 865 73

NEC represents the most common gastrointestinal disorder in newborn. Its range varies from 1% to 7.7% and is frequently associated with factors such as intestinal ischaemia, prematurity, gastrointestinal infection and early and rapid enteral feeding. Between 15/1/1990 and 15/6/1995, 129 critically ill newborns were admitted in NICU of Policlinico S. Orsola-Bologna. We examined only 93 patients, hospitalized for over 48 hours, presenting one or more risk factors for the development of NEC, such as birthweight < 2000 gm, respiratory distress, gastrointestinal bacterial colonization, sepsis, PDA and use of umbilical catheters. The aim of the study was to evaluate NEC incidence in newborns exposed to this complication and the analysis of risk factors associated with the elements of prevention and protection. No cases of NEC were observed despite the high incidence of risk factors. The newborns studied were divided in six different groups with increasing risk factors. Among the prevention elements of NEC, every patient was treated by nutrition, at first exclusively by TPN followed by careful enteral feeding (< 20 ml/kg/die) and the improvement of mesenteric blood flow by dopamine (2-3 mcg/kg/min); other preventive treatments were given according to clinical condition: dobutamine (5-10 mcg/kg/min in 51 ps.) to improve the cardiovascular function, gastrointestinal decontamination (8 ps.), antibiotic therapy (81 ps.), in cases of diagnosed infection and intravenous immunoglobulin (25 ps.) after discovering low ematic values. Analyzing the treatments and their day numbers in the 6 groups of patients no statistically significant differences were evident. On the contrary, dividing the patients into 3 groups according to GA (< 30 w, 30-35 w, > 35 w) an extension in treatment time is more evident in the group of GA < 30 weeks. Our therapeutic behaviour, based on respect of gastrointestinal blood flow, careful and gradual enteral feeding and prevention, constant monitoring and infection treatment, has been useful to stop the NEC incidence.
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PMID:[Risk factors and protective factors in a population a risk for newborn necrotizing enterocolitis]. 905 88

Clostridium difficile is a spore-forming anaerobe that resides in the colon and is capable of producing gastrointestinal disease in humans. Factors such as previous exposure to antibacterials and some antineoplastic agents have been reported to promote the overgrowth of C. difficile, with subsequent liberation of potent exotoxins that induce inflammation in the colonic mucosa. Colonisation rates vary, and are higher during infancy and hospitalisation, compared with healthy adults. Although many antibacterials have been reported to induce disease, those agents that achieve high concentrations in the intestinal lumen and are active against bowel flora are more likely to promote overgrowth of C. difficile. Agents with a high potential to induce C. difficile-associated disease (CDAD) include aminopenicillins, cephalosporins and clindamycin. These antibacterials are capable of reducing normal colonisation resistance within the colon. The exact incidence of CDAD is unknown. Some reports suggest an incidence of 1 to 3 infections per 100,000 courses of outpatient oral therapy. The spectrum of illness of CDAD can range from mild diarrhoeal disease to severe colitis, toxic megacolon and sepsis. Fatalities have occurred in some cases. Discontinuation of the offending antibacterial in patients with mild disease is often sufficient to alleviate symptoms. For those with moderate to severe illness, metronidazole and vancomycin are reported to be equally efficacious. Increasing resistance of enterococci to vancomycin limits its use to patients with severe life-threatening infections. Patients with recurrent disease usually respond well to the same course of therapy as was used to treat the initial infection. CDAD is potentially preventable when appropriate antibacterial selection and infection control measures are implemented.
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PMID:Drug-induced Clostridium difficile-associated disease. 925 29

We performed a retrospective review of patient case records to identify risk factors for candidaemia and to assess incidence, management and outcome of candidaemia in an Australian teaching hospital. Between January 1994 and June 1996, 38 cases of candidaemia were identified. The incidence was 0.74 per 1000 admissions of 24 h duration, and 1.54 per 1000 admissions of 5 days or more. The mortality rate was 34%, with eight of 13 (62%) of these deaths attributable to candidaemia. Risk factors included underlying gastrointestinal disease (66%) and recent abdominal surgery (61%), while recent broad spectrum antibiotic use was a contributing factor in 95%. Twenty-nine patients (76%) had a vascular access device in situ at time of detection. This was the apparent source of candidaemia in 28 (97%). Twenty-six (90%) were being used for TPN administration. Of patients receiving TPN, 5.2% developed candidaemia. Standard central venous catheters (CVC) were present in 21 patients (55%), having been in situ for an average of 12.7 days. Eighteen (86%) had been in situ for 7 days or more. Management involved removal of any implicated intravascular device. Thirty of 33 early survivors received antifungal chemotherapy. Therapy with amphotericin B, fluconazole alone or amphotericin B followed by fluconazole was equally effective. Concurrent corticosteroid use and neutropaenia contributed to increased mortality. Candidaemia is not benign. Policies regarding regular changing of central lines, especially in the setting of TPN administration and control of broad spectrum antibiotic use are appropriate measures aimed to reduce incidence. Management involves removal of implicated lines and antifungal chemotherapy. Pre-emptive therapy for candida infection should be considered in selected patients with the likelihood of TPN-related central line sepsis. Fluconazole is an effective alternative to amphotericin B in non-neutropenic patients.
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PMID:Candidaemia in an Australian teaching hospital: relationship to central line and TPN use. 957 Jun 55

A descriptive analysis and comparison of critically ill transported patients with non-transported patients will assist in selecting the appropriate referral and transportation process and subsequent incorporation into the critical care services of receiving hospitals. A retrospective review of transported and non-transported patients admitted to the same Intensive Care Unit was conducted. Patient demographics, disease categories, source of admission to ICU, APACHE II scores, predicted and actual hospital mortality, hospital and ICU length of stay were examined. Of all ICU admissions, 16% were transported. Transported patients had a different case mix, significantly higher severity of illness measures, mortality and length of ICU stay. Observed mortality of transported patients with sepsis, gastrointestinal disease or bleeding, intracranial haemorrhage and post respiratory arrest was less than predicted whilst those with neurological disease, post cardiac arrest and overdose had a higher than predicted mortality.
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PMID:Patient referral and transportation to a regional tertiary ICU: patient demographics, severity of illness and outcome comparison with non-transported patients. 1047 Mar 94

We report a now three year old male patient with ectodermal dysplasia and a polysaccharide specific humoral immunodeficiency. Immunological investigations showed compromised production of IgA, IgM, and IgG2. Isohaemagglutinins still were not detectable at the age of three years. Repeated vaccination with polyvalent pneumococcal polysaccharide vaccine did not result in production of specific antibodies. Two brothers showed clinical signs of ectodermal dysplasia. The elder brother died from pneumococcal sepsis at the age of 3 years. The younger brother suffers from chronic inflammatory gastrointestinal disease with ulcerations in all parts of the gastrointestinal system. Thus, a possible association between polysaccharide specific humoral immunodeficiency and ectodermal dysplasia may be considered.
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PMID:[Polysaccharide specific humoral immunodeficiency in ectodermal dysplasia. Case report of a boy with two affected brothers]. 1059 27


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