Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This article presents an analysis of acute gastroduodenal mucosal lesions (AGML) based on a review of current literature and the personal experience of the authors. The pathology of AGML involes two distinct types of lesions, namely, superficial erosions confined to the acid-secreting gastric mucosa and presenting as erosive hemorrhagic gastritis, and acute ulcers that occur in the alkaline gastric mucosa and duodenum. The etiology of these two lesions is very likely different. Acut gastroduodenal ulcers, best known as stress ulcers, are probably "peptic" lesions, whereas erosive hemorrhagic gastritis appears to be due to pathologic back diffusion of hydrogen ions caused by a breakdown of the gastric mucosal barrier as a result of endogenous factors, such as gastric mucosal ischemia, and sometimes exogenous factors, such as alcohol, urea, and acetylsalicylic acid. Catecholamine hypersecretion resulting from severe stress, such as occurs in hypovolemia, sepsis, and hypercapnea, contributes to ischemia of the gastric mucosa by producing splanchnic vasoconstriction. The key to the diagnosis of AGML is early endoscopy in all cases of upper gastrointestinal bleeding. Therapy for AGML should begin with a trial of medical measures directed at restoring effective perfusion of tissues and removing hydrogen ions from the stomach by gastric washing. Medical therapy is effective in 80% of patients with erosive hemorrhagic gastritis, but surgical treatment is usually required in acute gastroduodenal ulcer. When surgery is necessary for either type of lesion, vagotomy with hemigastrectomy appears to be the most effective operation. The personal experience of the authors has involved 36 patients with AGML who were treated in three periods between 1968 and 1976. The mortality rate of patients with AGML has been reduced from 50% in the first 2 years to zero in the last 2 years by the use of emergency endoscopy for diagnosis, appropriate medical therapy, properly timed and executed surgery, and, most recently, selective angiography.
 ...
PMID:Progress in the treatment of acute gastroduodenal mucosal lesions (AGML). 1 30

This review will begin by giving the highlights of the history and explain development of the basic science knowledge of hemoglobin chemistry, function, and physiology. The necessary involvement of red cell metabolism, as it pertains to the maintenance of 2,3-diphosphoglycerate (2,3-DPG) levels, both normally and under the perturbed and experimental conditions of blood storage, will be given as part of the basic science data. The clinical science and transfusion data will comprise the main critical aspects of the paper. Analysis and comment of over 20 studies will be given on the effects of animal and human transfusions with altered 2,3-DPG levels. Decreased survival and organ function have been demonstrated with transfusion of low 2,3-DPG red cells, with or without anemia, in the conditions of exercise, shock, hypotension, ischemia, cardiac surgery, hypoxia, sepsis, and acidosis. By critical analysis of these studies, recommendations on general and specific patient needs for red cell transfusions with normal or high 2,3-DPG levels are given.
 ...
PMID:The significance of 2,3-DPG in red blood cell transfusions. 4 84

Due to poor results with conventional operative therapy for diffuse hemorrhagic gastritis (DHG), a prospective evaluation of gastric devascularization was performed on 21 patients. Sepsis, alcoholism, and steroid abuse were the common etiologic factors. In spite of the fact that these were all critically ill patients, all stopped bleeding with this operation and only two rebled (9%). The average operating time was 84 minutes. There were two operative complications and gastric necrosis did not occur. The mortality was high (38%) due to the primary disease. Gastric devascularization is a useful salvage procedure for the patient with DHG because it can be accomplished rapidly, with few complications, has a low rebleed rate, and causes no permanent sequelae. Since this procedure causes severe gastric mucosal ischemia, it casts doubt only on the importance of this mechanism alone as the cause of "stress ulceration."
 ...
PMID:Gastric devascularization: a useful salvage procedure for massive hemorrhagic gastritis. 30 Oct 14

In the years 1963--1977, the pathology department of the University of Colorado Medical School did 93 autopsies of patients with liver transplants. Fifteen of these patients had received a second graft. Sepsis was the greatest single cause of death or failure, and fungi and other organisms often considered opportunistic were frequent pathogens. Problems relating to removal of the liver from the donor, emplacement of the graft in the new host, and maintenance of the graft during the prolonged procedures together offer a monstrous challenge to the transplantation surgeon. All of these problems, classed as technical, include as complications infarction of the graft as the result of prolonged ischemia and blood loss or shock due to various causes, and all may produce alteration in structure of the liver; such changes may be misinterpreted as rejection. Rejection was a major cause of failure in only 5 patients, although the immunosuppression employed to control it contributed to the sepsis that so often was lethal. Hyperacute rejection was not observed in any of these transplanted livers, although 15 of these patients received a second transplant. Two of the patients whose grafts failed due to rejection had changes that indicated progression to an early stage of cirrhosis. We conclude that despite the persistent problems the liver is an organ peculiarly favorable for transplantation.
 ...
PMID:Liver transplantation: the pathologist's perspective. 39 27

Mycotic aneurysms occurred in five narcotics addicts treated between 1969 and 1975. Fever, localized tenderness, swelling, loss of distal pulses, and leukocytosis were common findings. The aneurysms were located in the femoral (two patients), brachial (two), and superior mesenteric arteries (one). They occurred at the site of arterial injection in three patients. In one patient with subacute bacterial endocarditis, an aneurysm of the superior mesenteric artery developed. In one patient, the pathogenesis was uncertain. All patients had rupture of the arterial wall, with hemorrhage contained by adjacent muscle or soft tissue. Four patients were treated by ligation and debridement. One, with preexisting ischemia, required amputation below the knee. One patient underwent repair with autogenous artery. Recurrent hemorrhage necessitated ligation of the artery. In all patients, extensive sepsis and tissue necrosis precluded repair with prosthetic material. All patients survived, without evident of ischemia.
 ...
PMID:Ruptured mycotic aneurysm: a complication of parenteral drug abuse. 57 79

During the forty-month period ending July, 1976, intraaortic balloon counterpulsation was used as an adjunct to medical or surgical therapy in 273 patients. Thirty-seven developed complications. Limb ischemia occurred in 16; it resolved in 12, resulted in gangrene of the toes in 1 and leg gangrene in 2, and was the casue of death in 1 patient. Aortic dissection was confirmed in 7 patients and strongly suspected in another 4. Eight of the 11 patients with dissection underwent cardiac procedures with heparinization at two days to three months after balloon insertion with no untoward effects. Septicemia developed in 2 patients, 1 of whom died of cardiogenic shock. Localized groin sepsis occurred in 8 patients, 2 of whom required removal of infected Dacron graft material. Awareness of the complications of balloon insertion, proper attention to details of balloon management at the time of insertion and removal, and continuous monitoring through a central-lumen balloon should decrease the incidence of complications.
 ...
PMID:Results and complications of intraaortic balloon counterpulsation. 59 68

One percent methylprednisolone acetate was evaluated as a pharmacologic agent in the prevention of dermal ischemia following burning. Standardized partial thickness burns were inflicted on guinea pigs. Burned guinea pigs were separated into five groups; one was treated with topical steroid, one with systemic steroid, one with both, one with emollient base without steroid, and one served as an untreated control. Histology and depth of dermal ischemia were evaluated by india ink perfusion technique. Untreated controls showed progressive dermal ischemia with complete absence of india ink-filled vessels in the dermis by 24 hours. Topical steroid alone improved dermal perfusion as suggested by relative levels of india ink filling. Topical steroid in the dosage used does not potentiate infection in standard burn wound sepsis models. Preservation of dermal appendages was seen secondary to improved dermal microcirculation with a ninefold increase in hair follicles in treated guinea pigs compared with controls.
 ...
PMID:Prevention of dermal ischemia after thermal injury. 64 24

Between January 1974 and March 1977, arm bovine carotid heterograft arteriovenous fistulas were constructed in 75 patients. Twenty-six fistulas were established between the distal radial artery and an antecubital vein, and 49 fistulas used the brachial artery and the axillary vein. Thirty-eight heterografts have functioned without complication over a maximun interval of 29 months, including 15 of 26 radiobasilic fistulas and 23 of 49 brachioaxillary fistulas. Of the 37 heterograft failures, 28 were caused by thrombosis, six by infection, two by false aneurysm formation, and one by distal arm ischemia. Early postoperative thrombosis was associated with a higher subsequent failure rate after thrombectomy than was late thrombosis and it often required insertion of a new heterograft. Infected heterografts must be ligated and eventually replaced with another fistula at a distant site to avoid the potentially lethal complications of systemic sepsis and local hemorrhage.
 ...
PMID:Venous access using the bovine carotid heterograft: techniques, results, and complications in 75 patients. 65 43

Patients requiring a major amputation for ischemia are frequently gravely ill. Physiologic amputation obtained by freezing the leg, usually with a tourniquet, will permit delay and intensive preoperative therapy. In an efficient, safe, and convenient method which we have developed and used in 46 patients, a pump circulates antifreeze solution through a specially constructed boot. The last 32 patients so treated have been analyzed as to indications and results. Advantages obtained control of sepsis, correction of diabetic coma, dialysis for chronic renal failure, improvement in congestive heart failure, and improvement in pulmonary function. Four patients had successful below-knee amputations after control of infection that had previously seemed to dictate above-knee amputation. The control of pain and odor, the resultant appreciation of the family, and the lessened demand on nursing staff offer worthwhile benefits in many of the patients, even in some in whom advanced systemic disease prevented survival.
 ...
PMID:Freezing an extremity in preparation for amputation. 68 74

Stress ulcers are multiple, superficial erosions which occur mainly in the fundus and body of the stomach. They develop after shock, sepsis, and trauma and are ofter found in patients with peritonitis and other chronic medical illness. Stress ulcers should be differentiated from reactivation of chronic duodenal or gastric ulcers. Cushing's ulcer following head injury, or drug-induced gastritis. Digestive symptoms are usually absent, hemorrhage is the most common manifestation, and perforation and obstruction are rare. The presence of luminal acid and ischemia are necessary for the production of stress ulcer, while disruption of the gastric mucosal barrier by refluxed duodenal content may contribute to the pathogenesis. Endoscopy is the mainstay of the diagnostic procedure, and angiography should be used if endoscopy fails to identify the bleeding lesions. Medical management should include volume replacement, nasogastric aspiration, and the use of antacid. Selective intraarterial infusion of pitressin has shown encouraging preliminary results. Surgical treatment is reserved only for those patients who continue to bleed despite all medical management. The operation of choice is open to question. We prefer vagotomy, pyloroplasty, and oversewing the ulcers as an initial operation. Since the result of all forms of therapy has been poor, it seems resonable to try to prevent ulcer development. The use of vitamin A, hyperalimentation, and growth hormones is still in an experimental stage. Large clinical studies with case control are necessary before recommendations can be made. The use of potent and frequent antacid to buffer the gastric content has shown promising results; however, these observations need to be confirmed in a properly controlled and randomized study.
 ...
PMID:Stress ulcers: their pathogenesis, diagnosis, and treatment. 79 64


1 2 3 4 5 6 7 8 9 10 Next >>