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

One hundred consecutive patients treated by restorative proctocolectomy with construction of an ileo-anal anastomosis and a J-shaped (n = 90) or an S-shaped ileal reservoir were studied prospectively to evaluate postoperative complications and functional outcome and to search for factors that might influence results. There were no deaths. Postoperative complications requiring surgery were pelvic sepsis (3 patients), pouch-related fistula (2), peritonitis following ileostomy closure (3) and small bowel obstruction (6), with an overall relaparotomy rate of 14%. The cumulative risk of pouchitis was 30% at 2 years. The average stool frequency decreased gradually, stabilizing at about five evacuations/24 h after 1 year. At that time 9% of patients still had greater than or equal to 7 day-time evacuations and 40% had night evacuations (greater than 1/week). These parameters did not improve further with time. Mucous soiling, a frequent problem initially, also diminished with time, occurring in 30% of patients at 1 year. At 2 years, however, this mucous leak occurred in only 20%, suggesting that improvement of continence can be expected to occur even beyond one year. Despite defects in function patient satisfaction was generally excellent. So far only three patients have preferred conversion to an ileostomy. To establish which factors might influence the functional results a specially designed scoring system, combining all functional variables, was used. It was shown that results deteriorated with increasing age and that elderly women tended to have a poorer result than elderly men. Sex, previous parity or postoperative complications appeared not to affect the functional outcome. Male sexual disturbances occurred in 8%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The clinical and functional outcome after restorative proctocolectomy. A prospective study in 100 patients. 270 83

Postoperative course is reported in 52 children with malignant tumors (neuroblastoma, Wilms-tumor, non-Hodgkin-lymphoma, osteosarcoma etc.) who were operated on between 1979 and 1987. 26 children received chemotherapy prior to surgery, whereas 26 children were operated on without preceding chemotherapy (control group). Most children were under six years of age. 15 Children (57.7%) with preoperative chemotherapy developed early postoperative complications, such as sepsis, pneumonia, suture dehiscence, woundhealing disturbances and ileus, whereas this was the case in only 5 children (19.2%) without preoperative chemotherapy (P 0.0005). Four of the children with preoperative chemotherapy (15.4%) sustained late complications, such as local recurrence or mechanical bowel obstruction, whereas none of the control children did so. Lethality rate from underlying disease did not differ in both groups during follow-up (5 = 19.2% vs. 5 = 19.2%). This demonstrates that the surgeon must carefully be aware of an increased possibility of early and late complications in children who have to undergo surgery for malignant tumors following preoperative chemotherapy.
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PMID:[Postoperative course in children with malignant tumors following preoperative chemotherapy]. 273 47

Ninety-three patients who underwent surgery were studied retrospectively over a five-year period for complications of diverticular disease, including free perforation in 32 patients (with fecal peritonitis in 8), inflammation or peritonitis in 22 patients, an abscess in 11 patients, and intestinal obstruction in 14 patients. Sixty-eight patients (73 percent) had systemic symptoms and signs consistent with serious sepsis. There has been a growing popularity of the Hartmann procedure throughout the study period. The overall 30-day mortality rate was 10.8 percent. Because of a high proportion of poor-risk patients, the Hartmann group fared particularly badly compared with those who had other operations, with a 28 percent mortality rate, 69 percent incidence of major complications, and one third of the survivors having a permanent colostomy. Other operative procedures are discussed, but until prospective data become available, it is unlikely that the widespread popularity of the Hartmann procedure will decline. Therefore, the importance of meticulous attention to technical detail is stressed if results are to improve.
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PMID:Emergency surgery for complicated diverticular disease. A five-year experience. 279 71

Between January 1 1974 and October 31 1987, 98 patients with biopsy proven unresectable adenocarcinoma of the pancreas were treated with I-125 implants during laparotomy. Presenting symptoms were pain (57 patients), jaundice (45 patients), and weight loss (34 patients). All patients underwent laparotomy and surgical staging. Thirty patients had T1NoMo disease, 47 patients had T2-3NoMo disease, and 21 patients had significant regional lymph node involvement (T1-3N1Mo). The surgical procedure performed was biopsy only (16 patients), gastric bypass (36 patients), biliary bypass (49 patients), and partial or total pancreatectomy with incomplete resection (5 patients). The total activity and the number of seeds used were determined from the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram. Stereoshift localization X ray films were taken 3-6 days after operation. The mean activity, minimal peripheral dose (MPD), and volume of the implants were 35 mCi, 13,660 cGy, and 53 cm3, respectively. In addition, 27 patients received postoperative external irradiation and 27 patients received chemotherapy. Postoperative complications were observed in 19 patients. These included post-operative death (1 patient), biliary fistula (4), intraabdominal abscess (4), GI bleeding (3), gastric or small bowel obstruction (6), sepsis (5), and deep vein thrombophlebitis (4). Pain relief was obtained in 37/57 patients (65%) presenting with pain. A multivariate analysis showed that four factors significantly affected survival: T stage, N stage, administration of chemotherapy, and more than 30% reduction in the size of the implant on follow-up films. The median survival for the entire group was 7 months. A subgroup of patients with T1No stage disease who received chemotherapy survived 18.5 months. The indications for I-125 seed implantation in unresectable carcinoma of the pancreas are discussed.
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PMID:Treatment of primary unresectable carcinoma of the pancreas with I-125 implantation. 280 54

The physical inconvenience and adverse psychological impact of ileostomy on patients led surgeons to seek a more normal and acceptable alternative. This is a report of the Mayo Clinic experience with, and modifications of, the ileoanal reservoir procedure. The hospital charts of 188 patients who had a J-pouch construction were reviewed. The operative technique is described. There were no hospital deaths. In 10 patients the operation was a failure. Complications included pelvis sepsis (21 patients), anastomotic sinus (15), anastomotic stricture (22), small-bowel obstruction (43), peritonitis after ileostomy closure (10) and pouchitis (15). Careful patient selection for the procedure is important. Crohn's disease is a contraindication. Of the patients studied, 95% found life more acceptable with an ileoanal anastomosis than with a loop ileostomy.
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PMID:J pouch with ileoanal anastomosis. 282 16

Of 84 patients who underwent restorative proctocolectomy with an ileoanal reservoir in 21 Italian departments of surgery, 51 had ulcerative colitis, 32 familial polyposis and 1 intractable constipation. Follow-up information is available for all 58 patients who had their ileostomy closed, the length of follow-up ranging between 2 and 78 months. There were no operative deaths. A failure rate (i.e. excision of the pouch) of 3 per cent was observed. Sepsis was the most common postoperative complication, and was most often related to ileoanal anastomosis dehiscence (15 per cent), followed by small-bowel obstruction requiring laparotomy (10 per cent). Clinical 'pouchitis' occurred in 14 per cent of patients after ileostomy closure. The average frequency of defaecation was four motions per 24 h; evacuation was spontaneous in all patients and only 5 per cent complained of troublesome faecal soiling while 34 per cent had occasional incontinence to flatus and mucus. Patients with a short or absent rectal cuff had a lower rate of incontinence (30 versus 48 per cent, difference not statistically significant) without any increase in the frequency of genito-urinary disorders. None of the two most used reservoirs, the J (n = 40) and S pouch (n = 17) showed significant superiority in terms of bowel frequency and continence. Incontinence was more likely in patients whose ileostomy closure had been delayed for more than one year.
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PMID:Clinical and functional results after restorative proctocolectomy. 283 77

Prospectively collected information on 2524 patients who had undergone "curative" resection for colorectal cancer was analysed to establish the rank-order of importance of both clinical and pathological factors affecting outcome. The patients were divided into two groups. In the first, a statistical weighting was established for each prognostic factor and those that influenced long-term survival were, in order of importance, lymph node status, tumour mobility, number of lymph nodes positive for tumour, presence of bowel obstruction, and depth of primary tumour penetration. Factors that influenced in-hospital mortality were cardiopulmonary complications, intraabdominal sepsis (without anastomotic leak), presence of bowel obstruction, and age. In the second group these mathematical weightings were applied, and the predicted and observed outcomes were in close agreement. Statistical techniques of this kind will be of value in prognosis and in analysis of the results of new treatment regimens.
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PMID:Prediction of outcome after curative resection for large bowel cancer. 287 36

Intestinal stenosis or stricture occurs in approximately one third of medically treated infants surviving the acute phase of necrotizing enterocolitis (NEC). Identification of these lesions by the use of routine contrast enemas has been advocated as a means of decreasing potential morbidity from delayed diagnosis. However, the significant incidence of spontaneous resolution and reluctance to submit asymptomatic infants to contrast enema have led recent researchers to reserve these studies for patients developing symptoms of obstruction during a period of close observation. From July 1984 to July 1986, symptomatic strictures developed in five infants (15%) responding to medical management at our institution. Contrast enemas were not routinely performed and four (80%) of these patients presented with life-threatening sepsis or perforation associated with intestinal obstruction. Two infants developed complete colonic obstruction 4 and 6 weeks after discharge from the Intensive Care Nursery, having initially tolerated oral feedings. Both infants were critically ill due to perforation or sepsis and underwent emergency colostomy at community hospitals. Two other infants developed abdominal distension with sepsis and cardiopulmonary decompensation while remaining hospitalized for prematurity and pulmonary insufficiency. These patients became symptomatic 5 and 7 weeks after cautious refeeding while closely monitored in the Intensive Care Nursery. The occurrence of such life-threatening complications suggests that clinical observation alone is not adequate in the management of many of these infants. Contrast enemas should be performed to identify those patients at risk of such potential morbidity or mortality, especially those infants not residing near pediatric surgical facilities.
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PMID:Post-necrotizing enterocolitis strictures presenting with sepsis or perforation: risk of clinical observation. 304 59

Apple peel deformity of the small bowel is a variant of jejunal atresia with a high mortality. Forty five percent of these patients can be expected to die, most from anastomotic leaks with sepsis, or anastomotic failure with prolonged ileus and malnutrition. This report documents survival of three consecutive patients treated by an adaptation of the Santulli "chimney" anastomosis. This method accomplishes the goals of relief of intestinal obstruction, minimal resection, and preservation of tenuous intestinal blood vessels. All three patients had a benign postoperative course and made an uneventful recovery. Intestinal function is normal in each patient at 1 1/2 years. Based on this experience, it appears that a Santulli jejunojejunostomy combined with total parenteral nutrition offers the most promising operative strategy in the treatment of patients with apple peel bowel.
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PMID:Apple peel jejunal atresia. 310 85

A retrospective study is presented of 200 cases of diverticular disease admitted to Auckland Hospital over the 6-year period 1979-84. The epidemiology of the total group, the mode or type of presentation, pathology and investigative practice have been examined. Seventy-six patients required surgical intervention either electively or as an emergency and these cases have been considered in detail. The surgical group included 44 men and 32 women; 21 patients presented for elective resection, and 55 patients underwent surgery during their emergency admission. In the emergency group, 20 laparotomies were performed for pericolic/pelvic abscesses, five for small/large bowel obstruction, 30 for peritonitis and only one laparotomy was performed for haemorrhage. The mortality for the entire group was 4% with all deaths occurring in the acute diverticulitis group. Three deaths followed emergency surgery and a further five patients died without coming to surgery, the diagnosis of acute diverticulitis being made only at post-mortem. Overall, 44% of cases of acute diverticulitis underwent emergency surgery and a further 6% required surgery over the next 1-5 years. Resectional surgery was practised widely in the emergency group (the most common being Hartmann's operation). Less radical surgery is also preferred for localized sepsis in selected cases. The mortality was confined to patients who did not undergo resection of the septic focus. The elective group (24 patients) usually presented as a result of stricture, or chronic symptoms, and these patients generally did well with elective resection. The group of patients presenting with colonic bleeding behaved in a very benign manner. There was no mortality and only one patient required emergency surgery for bleeding.
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PMID:Diverticular disease in Auckland. 315 Jun 60


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