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

Prospective and retrospetive analyses were made of 34 patients with small bowel fistulae treated with and without total parenteral nutrition (TPN) between 1970--1981. The administration of TPN in the management of small bowel fistulae increased their rate of closing and decreased the number of permanent fistulae. No improvement was observed in mortality (44%). More than 90% of the deaths occurred in patients with uncontrolled sepsis. In patients older than 65 years a decreased healing tendency and a rise in mortality rate up to 80% was found despite TPN. In patients with high-output fistulae, inflammatory bowel disease and malignancy, good results could be reached with TPN. The suggested plan for management of small bowel fistulae is based upon initial nonoperative therapy, nutritional support, vigorous control of sepsis. These facilitate spontaneous healing or allow surgical closure in the optimal time.
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PMID:Total parenteral nutrition in management of external small bowel fistulae. 641 16

We report the results of a prospective audit of the rates of postoperative infection in patients having operations for inflammatory bowel disease. Apart from a single prospective controlled trial, all other groups have been studied sequentially using the original placebo control group for comparison. The rate of abdominal wound sepsis when no antibiotic was used was 37 per cent. This was reduced to 23.3 per cent with 24-hour cover using metronidazole and gentamicin. However, only after prolonged use of metronidazole and gentamicin for five days was there a significant reduction in abdominal wound infections to 13.3 per cent. Prophylaxis, using 24-hour cover with metronidazole combined with five-day therapy with mezlocillin, achieved an abdominal wound infection rate of 15.6 per cent. The most recent group of patients studied have received 24-hour cover with metronidazole and five-day exposure to latamoxef. In the last group the rate of abdominal wound infections was only 13.5 per cent and serious postoperative bleeding was recorded in eight patients (15 per cent) compared with serious bleeding is only three of the remaining 129 patients (2.3 per cent). The only patients in whom streptococcal isolates were eliminated were those receiving metronidazole and mezlocillin. The majority of infections was due to antibiotic-sensitive strains of Escherichia coli, Proteus, and Staphylococcus species.
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PMID:Audit of sepsis in operations for inflammatory bowel disease. 646 1

Seventy patients undergoing elective colorectal surgery for malignant and inflammatory bowel disease were allocated randomly to one of two groups. Patients in group 1 were given, after induction of anaesthesia, a single dose of metronidazole 500 mg i.v. Patients in group 2 were given in addition a single dose of cefuroxime 1.5 g i.v. Of 34 patients in group 1, 4 (11.8 per cent) developed postoperative infection. Of 36 patients in group 2, 5 (13.6 per cent) developed postoperative infection. No significant difference was noted in the incidence of postoperative sepsis between the two treatment groups.
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PMID:Single dose metronidazole with and without cefuroxime in elective colorectal surgery. 664 Feb 41

One hundred and twenty seven patients undergoing elective surgery for inflammatory bowel disease were divided into three groups according to their preoperative ideal body weight (less than 80%, 80-90%, and greater than 90%). The groups were well matched in respect of age, sex, corticosteroid therapy, pre-existing sepsis, peroperative antimicrobial chemotherapy, and resection site. None received peroperative nutritional support. The postoperative outcome was similar in each of the three nutritional groups including the incidence of postoperative sepsis, duration of hospital stay, and mortality. Serial peroperative changes in weight, fat, and muscle bulk were assessed by anthropometric measurements in 21 of these patients. The deficits in weight, fat, and muscle bulk were similar at 10 and 21 days postoperatively in the three groups. At 84 days those malnourished preoperatively had recovered their nutritional status faster than the well nourished patients. We conclude that in these patients undergoing elective resection for inflammatory bowel disease preoperative weight loss did not adversely affect the postoperative outcome.
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PMID:Impact of preoperative weight loss and body composition changes on postoperative outcome in surgery for inflammatory bowel disease. 673 54

Management of the perineal wound following rectal excision was assessed in 57 patients at the Toronto General Hospital; 40 had ulcerative colitis, 4 had Crohn's disease, 10 had carcinoma of the rectum, 2 had carcinoma of the anus and 1 had anal incontinence. The preferred technique was careful anatomical dissection with meticulous hemostasis, and primary skin closure with a laterally placed closed Hemovac suction system. Alternatively, wounds were packed and allowed to heal secondarily. Overall, the perineal wound healed primarily in 41 patients (72%). Primary closure was possible in 50 patients (88%); in 41 (82%) the wound healed without complication but in 9 (18%) the wound had to be opened because of hematoma and abscess (8 patients) or bleeding (1 patient). In 41 (91%) of the 44 patients with inflammatory bowel disease the perineal wound was closed primarily; 34 wounds (83%) healed without complication. In seven patients the perineal wound was packed at surgery because of bleeding (four), fecal spillage (two) or sepsis (one). Healing time averaged 6 months. These results indicate that primary closure is the optimal management of perineal wounds. Primary healing is achieved in a high proportion of patients and postoperative morbidity is decreased. Results are excellent in patients with inflammatory bowel disease as well as in those with carcinoma.
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PMID:Primary perineal wound closure following excision of the rectum. 682 98

Protein-energy malnutrition is common in patients with inflammatory bowel disease requiring surgery. Increased morbidity from sepsis may be associated with pre-operative weight loss due to associated diminished cellular immune defence mechanisms. Eighteen patients with Crohn's disease requiring elective abdominal surgery were divided into three nutritional groups before and after surgery, defined by their weight loss. The groups were well matched for other clinical variables. Delayed hypersensitivity skin reactivity to multiple antigens was measured before operation and during convalescence. The delayed hypersensitivity skin reactivity was depressed in the malnourished patients both pre-and post-operatively, although clinical outcome from surgery was not affected by nutritional status.
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PMID:Delayed hypersensitivity skin reactivity of patients with Crohn's disease: relationship with percentage ideal body weight and change after surgery. 686 27

A prospective double-blind placebo controlled trial was performed to test the values of 24-h cover with metronidazole and gentamicin in 57 patients requiring elective resections for inflammatory bowel disease (phase 1). The short term antimicrobial cover was not associated with a reduction in the incidence of postoperative sepsis. A further group of 30 patients who received metronidazole and gentamicin cover for 5 days (phase 2) was therefore studied and the results were compared with phase 1. There was a significant reduction in the incidence of sepsis in the patients receiving 5-day postoperative antibiotic cover compared with the placebo group.
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PMID:Clinical trials of the efficacy and duration of antibacterial cover for elective resection in inflammatory bowel disease. 704 28

The incidence and pathogenesis of sepsis following 107 elective operations in 87 patients with inflammatory bowel disease has been studied. Eighteen per cent developed wound sepsis and 13 per cent developed intra-abdominal abscess postoperatively. The prophylactic antimicrobial regimens used did not reduce the overall postoperative sepsis rates. The risk of developing postoperative sepsis was increased in patients with preoperative enterocutaneous or entero-enteric fistulas, pre-existing abscess and those with evidence of active disease (serum albumin less than 3.0 g/dl and serum seromucoids greater than 400 mg/gl). The incidence of postoperative sepsis was not affected by corticosteroid therapy at the time of surgery.
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PMID:Sepsis following operation for inflammatory intestinal disease. 737 54

The clinical course of 37 patients who underwent 46 liver transplantations for primary (n = 33) and secondary (n = 4) sclerosing cholangitis was reviewed. The median follow-up was 37 months. The patient and graft survivals for patients with primary sclerosing cholangitis at 1, 2, and 5 years were 96.9%, 91.6%, 87.9%, and 83.1%, 74.2%, 65.2%, respectively. In the patients with primary sclerosing cholangitis (PSC), prior surgery except for simple cholecystectomy was associated with significantly greater operative time and blood loss. No cholangiocarcinoma was identified at the time of transplantation. Human leukocyte antigen typing for PSC patients was heavily weighed toward B8 (58.8%) compared with control (11.8%). Sixty-two percent of patients with PSC also had inflammatory bowel disease. Moderate or severe rejection requiring OKT3, "rescue therapy" with FK506, or retransplantation was relatively higher in patients with inflammatory bowel disease (70%) versus patients without inflammatory bowel disease (36.4%) and a matched control group (37.5%). Progressive inflammatory bowel disease was seen in 6 of 19 patients, with 3 developing cancer and a dysplasia. Two patients in the entire group died of sepsis and 3 of colon cancer (2 recurrent and 1 primary). These data demonstrate that excellent survival results can be achieved in this group of patients. Rejection is frequent and often severe and steroid refractory. Colon cancer represents the most frequent cause of death in PSC patients after liver transplantation and demands constant attention.
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PMID:Liver transplantation for sclerosing cholangitis. 763 12

The diagnosis of abdominal infections and inflammations often presents considerable difficulty, and various imaging techniques may be required to localize them accurately. At present, radiolabelled leucocytes offer the most widely accepted radionuclide method for imaging inflammation. Because of the many advantages of technetium-99m (99mTc) over indium-111 (111In), 99mTc-HMPAO-leucocyte scintigraphy is preferred for the investigation of acute abdominal sepsis and inflammatory bowel disease, and 111In-leucocyte scintigraphy for more chronic infections and renal sepsis. The 99mTc-HMPAO-labelled leucocytes technique is highly accurate within the first few hours postinjection, and is therefore useful also in acutely ill patients. It is sensitive in detecting abdominal abscesses in all locations except the liver and spleen. By whole body imaging, unsuspected sites and types of infection can be found. 99mTc-HMPAO-leucocyte scan is valuable also in the investigation of acute cholecystitis in problematic situations in which ultrasound is known to give misleading results, especially in acute acalculous cholecystitis. In inflammatory bowel disease it can reliably assess disease activity, but a normal scintigraphy does not exclude mild inflammation. Leucocyte scan is useful also in suspected acute appendicitis, acute diverticulitis, pelvic inflammatory disease, aortic graft infection, etc. But infection and inflammation cannot reliably be differentiated, which may cause misinterpretations in the early postoperative period. Radionuclide techniques have an important role to play in the investigation of abdominal sepsis if the nuclear medicine department can offer instant investigations when the clinical problem is acute.
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PMID:Investigation of suspected intra-abdominal sepsis: the contribution of nuclear medicine. 797 41


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