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

Skin tests (ST) in 1332 patients are associated with increased morbidity from sepsis. Patients with normal skin tests had a 7% major sepsis rate and 2% mortality rate. Thirty-six per cent of anergic (A) patients and 21% of relatively anergic (RA) patients died; 52% of A patients and 34% of RA patients had sepsis. These data include all patients studied and represent their worst skin test. Two studies were done. The first was a retrospective evaluation of effect of surgery upon 49 anergic patients with biliary tract disease, colon cancer, bowel obstruction, hypovolemia and visceral abscesses. The patients did not receive total parenteral nutrition (TPN). The data show that surgery without TPN can reverse the anergic state and did so in 84% of patients reported. The second study was a prospective, double-blind, randomized trial of the effect of levamisole on skin tests, neutrophil chemotaxis (CTX), sepsis and mortality iin 39 preoperative anergic patients. Major sepsis was significantly increased in placebo group (p less than 0.05). Mortality, minor sepsis, restoration of skin tests and chemotaxis were somewhat better in levamisole patients but not statistically so. These studies show that in addition to TPN, surgery and immunorestorative drugs are viable approaches to the management of selected anergic patients.
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PMID:Therapeutic approaches to anergy in surgical patients. Surgery and levamisole. 11 27

In a kindred with a familial visceral myopathy, seven patients had operations seeking relief of chronic abdominal pain and other symptoms of intestinal obstruction; one patient had an 80% cystectomy and a Y-V-plasty of the bladder neck for urinary retention. Five patients with megaduodenum had bypass operations; a side-to-side duodenojejunostomy was done in four and a retrocolic gastrojejunostomy in one. Two of these died of postoperative complications, and one developed symptomatic adhesions. Two other patients who had duodenojejunostomy have done well for 6 years and 1 1/2 years respectively. One patient with dilation of the distal jejunum and proximal ileum had relief of intestinal obstructive symptoms from jejunostomy to decompress the destal jejunum. One patient who had a resection of the descending and sigmoid colon for sigmoid volvulus has done well for four years. Three of these seven patients developed peritonitis postoperatively, and two had symptomatic adhesions after operations. Duodenal aspiration from a patient who developed postoperative peritonitis grew E. coli, 10(13) colonies per ml. After review of the results of operations in other families and in our kindred, we favor side-to-side duodenojejunostomy in megaduodenum. Duodenal aspirate must be cultured before operation. Evidence of bacterial overgrowth in the aspirate should prompt appropriate antibiotic treatment to reduce the likelihood of sepsis.
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PMID:Surgical treatment in familial visceral myopathy. 42 61

Ten patients with heterozygous familial hypercholesterolaemia (Fredrickson type II) were treated by the operation of partial ileal bypass. Postoperatively, serum cholesterol levels fell by an average of 34% (P less than 0.005), and the decrease was satisfactorily sustained over a period of 12-30 months. Angina and xanthomas also improved in some patients. Postoperatively all patients experienced considerable diarrhoea, which lessened with time. Other complications of surgery included abdominal distension and cramps, colonic dilatation, sepsis and intestinal obstruction. It is concluded that partial ileal bypass significantly lowers serum cholesterol levels, but that in view of the complications the operation should be offered only to carefully selected patients who are intolerant of or unresponsive to conservative measures.
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PMID:Treatment of familial hypercholesterolaemia by partial ileal bypass. 44 62

The roentgenographic finding hepatic--portal venous gas (HPVG) has been reported extensively in the pediatric and radiology literature. The surgical implications and clinical significance have yet to be fully defined. This study reviews the 60 reported cases in the literature and adds four new cases. HPVG appears as a branching radiolucency extending to within 2 cm of the liver capsule. HPVG is associated with necrotic bowel (72%), ulcerative colitis (8%), intra abdominal abscess (6%), small bowel obstruction (3%), and gastric ulcer (3%). Mucosal damage, bowel distention and sepsis predispose to HPVG. The current mortality rate of 75% represents an improvement from previous experience. Analysis of survivors indicates that the finding of HPVG requires urgent surgical exploration except when it is observed in patients with stable ulcerative colitis.
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PMID:Hepatic--portal venous gas in adults: etiology, pathophysiology and clinical significance. 63 84

A five year experience with 782 patients requiring laparotomy for trauma is reviewed. Specifically, the 70 patients requiring unplanned reexploration have been studied to delineate the indications for and implications of such repeat laparotomies. The major indications for such reoperation were intraabdominal abscess (45.7 per cent), bleeding (15.5 per cent), peritonitis (12.1 per cent), and small bowel obstruction (8.6 per cent). There were 16 negative reexplorations (13.8 per cent). Overall mortality in the reexplored patients was 21.4 per cent, all victims of gunshot or blunt trauma. Mortality correlated with the number of required reexplorations, being 67 per cent in those requiring four operations. Of the 31 laparotomies performed initially for diffuse or localized intraabdominal sepsis, only 15 were highly suspected, and 13 of these by simple chest x-ray findings. If after laparotomy for repair of intraabdominal trauma a patient fails to meet the anticipated norm of convalescence, a high index of suspicion for early postoperative hemorrhage, or later sepsis, should be maintained. Such patients have far more to gain than lose by reexploration.
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PMID:Reoperation after abdominal trauma. 66 94

Performance of gastrointestinal anastomosis by means of surgical stapling devices has achieved popularity in the last decade even though no detailed study has been reported comparing complications following the stapled anastomosis with those following hand sutured procedures performed by the same surgeons. We have reviewed 812 operative procedures on the gastrointestinal tract performed in one hospital over a four year period. Stapled anastomoses were performed in 472 with 13 (2.8%) complications related to the anastomosis; in 296 sutured anastomoses there were nine (3.0%) related complications. Comparison did not disclose any significant difference in the number of complications in these two groups. In 44 instances wherein the anastomosis contained both staples and sutures, there were no related complications. Further analysis of the patients in each group disclosed that stapling procedures were utilized in a much higher percentage of those operations which were performed under emergency conditions or in the presence of intra-abdominal sepsis, intestinal obstruction, and carcinomatosis. If the technical details of surgical stapling are mastered, this technique appears to be as safe as suturing in the performance of anastomoses in the gastrointestinal tract.
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PMID:The stapled gastrointestinal tract anastomosis: incidence of postoperative complications compared with the sutured anastomosis. 71 96

An unexpectedly high morbidity (28 per cent) followed colostomy closure in 100 patients. One patient died postoperatively because of sepsis resulting from disruption of the colon anastomosis. Wound infection (10 per cent), intraperitoneal abscess (1 per cent), bowel obstruction (7 per cent), and fecal fistula (4 per cent) were other significant complications. Wound sepsis was greater after primary than after delayed wound closure. Obstruction did not correlate with the use of either an open or closed technic of anastomosis. Three patients required reoperation for complications. Temporary colostomy was constructed for colon injury in 85 per cent of patients. In view of the considerable morbidity of colostomy closure, alternate technics of managing colon trauma should be considered. Such technics include primary closure and exteriorization of repaired colon. When temporary colostomy is unavoidable, closure is best done by open, two layer anastomosis with delayed wound closure. Colostomy should be recognized as an important procedure associated with significant morbidity.
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PMID:Morbidity of colostomy closure. 78 53

We have reviewed the records of 48 patients who had colonic volvulus. Volvulus occurred in the sigmoid colon in 27 (56%) and in the right colon in 19 (40%). Volvulus elsewhere in the colon is rare, requiring unusual anatomic circumstances of a long mesentery and a mobile colon. The clinical history is characterized by a long history of bowel dysfunction followed by an episode of acute intestinal obstruction. The patient is often aged and is plagued by mental disorders and a number of degenerative diseases. Distention of the abdomen is the most significant finding, and tenderness may indicate peritonitis due to ischemic changes in the bowel. Three-positional films of the abdomen are most valuable, showing great distention of the colon and air-fluid levels in the bowel with regularity. Barium-enema studies will more accurately reveal the site and nature of obstruction. The barium-enema examination must be done carefully. It is omitted when peritonitis is present. Operative treatment is necessary for volvulus of the right colon. Non-operative reduction is effective for nonstrangulating volvulus of the sigmoid colon as an emergency procedure. Sigmoidoscopic examination and insertion of a long rubber tube will give dramatic relief to a substantial number of patients. Operative intervention is necessary when conservative measures fail. When gangrene is found at operation, exteriorization resection of the colon may be life-saving. Elective resections are recommended for patients who are in otherwise good health in order to prevent recurrences. The mortality rate in this series of 48 cases was 12.5 per cent. Cecal volvulus was present in each of the six patients who died. Sepsis and cardiopulmonary diseases were common in patients who died.
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PMID:Volvulus of the colon. 86 92

Between 1965 and 1975, 27 patients underwent surgical treatment for ileosigmoidal fistulas complicating Crohn's disease at the Cleveland Clinic. There was no death and no anastomotic leak. The preferred procedure is resection of the ileocecal area involved by Crohn's disease with ileocolic anastomosis and a separate segmental resection of the sigmoid colon with colocolic anastomosis. A covering temporary loop ileostomy is used when there is associated pelvic sepsis or small-bowel obstruction.
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PMID:The dilemma of Crohn's disease: ileosigmoidal fistula complicating Crohn's disease. 87 7

The pre- and intra-operative care of patients with acute intestinal obstruction is reviewed. The most important pre-operative problems are hypovolaemia, sepsis, electrolyte and acid-base imbalances. The evaulation and treatment of these disorders are discussed. The importance of preventing regurgitation and inhalation of stomach contents is emphasised and the methods which are used are described. The safest techniques of induction and maintenance of anaesthesia as well as muscle relaxation and intra-operative fluid therapy are indicated.
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PMID:[Anesthesia for patients with intestinal obstruction]. 115 44


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