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

Indications for hemodynamic assessment by right heart catheterization include shock, pulmonary edema, severe trauma and sepsis. The introduction of the catheter and the location of the tip in the pulmonary artery, however, can cause severe complications. In the present study the incidence of complications was observed in 93 consecutive right heart catheterizations in critically ill patients with no evidence of recent myocardial infarction. The low incidence of complications during introduction and with the catheter tip located in the pulmonary artery justifies right heart catheterization in patients with hemodynamic and/or respiratory instability treated in an intensive care unit.
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PMID:Prospective study on the incidence of complications of right heart catheterization. 650 83

We retrospectively examined the outcome of anesthesia and surgery in 59 hypothyroid patients and in 59 paired euthyroid matched controls. Hypothyroid patients had more preoperative risk factors but did not differ as a group from controls with regard to duration of surgery or anesthesia, lowest temperature and BP recorded during surgery, need for vasopressors, time to extubation, fluid and electrolyte imbalances, incidence of arrhythmias, pulmonary and myocardial infarction, sepsis, need for postoperative respiratory assistance, bleeding complications, or time to hospital dismissal. Analysis of subsets of hypothyroidism (thyroxine level, less than 1.0, less than 3.0, and greater than or equal to 3.0 micrograms/dL) also failed to disclose any significant differences compared with matched controls. Among patients with mild or moderate hypothyroidism, we found no evidence to justify deferring needed surgery until the hypothyroidism has been corrected.
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PMID:Outcome of anesthesia and surgery in hypothyroid patients. 667 33

Twenty synthetic vascular graft infections are reviewed. Diagnosis of aortic shaft infections has been improved by combined CAT and Gallium scanning, with a 100 per cent sensitivity and specificity. An increasing incidence (70%) of gram-negative or resistant infections is noted, with a correspondingly high mortality. Delay in diagnosis resulted in an 100 per cent mortality versus 20 per cent when diagnosis was made rapidly. Mortality was usually from sepsis, but nearly half of the deaths occurred due to stroke or myocardial infarction.
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PMID:Synthetic vascular graft infection. The continuing headache. 669 35

There is increasing emphasis on carrying femoro-popliteal bypass grafts below the knee and most vascular surgeons agree that reversed saphenous vein makes the best graft. However, some other considerations have become important and deserve consideration. P.T.F.E. grafts in this location have almost as good a long term patency rate as autologous vein grafts. Some very experienced vascular surgeons have indicated their preference for this type of graft, citing some of these pertinent reasons: Peripheral vascular disease usually is associated with lesions in other vessels. Since coronary artery bypass has become so commonly used to stave off myocardial infarction some thought should be given to preservation of suitable saphenous veins for this purpose. Harvesting the saphenous vein adds additional surgical trauma, time, exposure to sepsis, lymphatic interruption and extra incisions. Once we opt for preferential P.T.F.E. grafts, then we start to search for a simpler technique.
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PMID:Femoro-popliteal bypass simplified. 670 2

Purulent pericarditis is a serious but uncommon disorder which rarely complicates acute myocardial infarction. We have described a patient who had fatal purulent pericarditis subsequent to Swan-Ganz catheterization, which was done to facilitate the management of left ventricular failure complicating acute myocardial infarction. Although rare, purulent pericarditis should be considered in the differential diagnosis of otherwise unexplained sepsis associated with myocardial infarction. The presence of a pericardial effusion may rapidly be confirmed by echocardiography, and diagnostic pericardiocentesis undertaken.
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PMID:Infections of the heart complicating acute myocardial infarction. 674 Mar 67

Three patients with Boerhaave syndrome were successfully managed with nonoperative treatment. The diagnosis was delayed 5 days in one patient and 10 days in the other two. None of the patients appeared septic. Their conditions had been misdiagnosed as myocardial infarction, pneumonia and pulmonary embolism. Treatment consisted of intravenous hyperalimentation and administration of antacids and antibiotics. Cimetidine was also used in one patient. Two patients were discharged 14 days after diagnosis and the third on the 20th hospital day. Follow-up barium swallows showed complete healing in 2 months in all three patients. Conservative management of spontaneous esophageal perforation is feasible when (1) the perforation is already 5 days old, (2) there are no signs of severe sepsis, (3) esophageal barium study shows a wide-mouthed cavity draining freely back into the esophagus, and (4) the pleural space is not contaminated. When the diagnosis is made promptly, surgical therapy remains the treatment of choice, and patients managed conservatively who show signs of sepsis should be operated on without hesitation. Follow-up esophageal evaluation should be performed to confirm complete healing and to evaluate underlying disease.
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PMID:Boerhaave syndrome. Successful conservative management in three patients with late presentation. 678 84

29 tubal sterilization deaths occurring in the US between 1977-1981 were identified. 11 followed complications of general anesthesia, 7 were due to sepsis, 4 to hemorrhage, 3 to myocardial infarction, and 4 to other causes. Sterilization was performed by laparoscopy in 17 cases, laparotomy in 11, of which 8 were pregnancy-related, and colpotomy in 1. The mean age was 31, ranging from 19-43. 10 women had underlying medical conditions that may have contributed to their deaths. 6 of the deaths due to complications of anesthesia were probably due to hyperventilation in women who were not intubated, 4 to intraoperative cardiorespiratory arrests with unknown precipitating events, and 1 to hyperkalemia probably caused by an idiosyncratic reaction to succinylcholine. 3 deaths attributed to sepsis followed apparent bowel injury during unipolar coagulation. 3 deaths from hemorrhage followed major vessel lacerations during laparoscopic sterilization. 2 women dying of myocardial infarction were heavy smokers and 1 was also 35 and used oral contraceptives (OCs) to the day of the operation. The 3rd woman was obese and had a strong family history of cardiac disease. 1 other death may have been associated with use of OCs. The 29 deaths may not include all sterilization-attributable deaths from 1977-81, resulting in possible biases in distribution of causes. Use of endotracheal intubation when general anesthesia is used, particularly for laparoscopic sterilization; safer use of unipolar coagulation or use of alternative techniques; careful insertion of the needle and trocar for laparoscopy; and discontinuation of OC use prior to sterilization may help prevent steriliztaion-attributable deaths.
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PMID:Deaths attributable to tubal sterilization in the United States, 1977 to 1981. 684 28

Shock is a clinical syndrome caused by a variety of primary insults, such as myocardial infarction, sepsis, and hypovolemia, which terminate in a failure of cellular perfusion. Management requires identification of the initial insult and the patient's hemodynamic pattern. The therapeutic approach in a patient may include resuscitation, fluid replacement, pH adjustment, and drug therapy. The specific treatment, however, must be tailored to fit the patient's individual problems and hemodynamic responses.
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PMID:Managing shock. 687 35

In a retrospective study of 50 patients with infective endocarditis (IE), we found an overall mortality of 44%: among the 26 patients with natural valves (NV) the mortality was 19%; among the 24 with prosthetic valves (PV) it was 71%. Congenital heart disease was recognized in 17 of our cases, with a significant clustering in the NV group (50% vs 17%, p = 0.029); the most frequently encountered malformation was the bicuspid aortic valve. The incidence of rheumatic heart disease was 46% in the NV group and 83% in the PV group (p = 0.015). Manifestations of IE were protean and multisystemic. We calculated an average of 4.6 symptoms and 4.7 signs for each patient. Although sepsis was abated with appropriate antibiotics, death often ensued from multiple complications: congestive heart failure, arrhythmia, stroke, embolic myocardial infarction, valvular destruction or dehiscence, coagulopathy. New features of natural valve infective endocarditis are a rising incidence in the elderly and a survival rate seemingly at its peak. Features of prosthetic valve infective endocarditis include overwhelmingly frequent embolization to the central nervous system (p = 0.004), spleen (p = 0.009) and kidney (p = 0.010). Advances in therapy for this disease may come from early surgery in late prosthetic valve endocarditis and from future prospective studies to define how the host response influences the outcome.
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PMID:Infective endocarditis update experience from a heart hospital. 697 38

During a five-year period, 280 patients underwent myocardial revascularization within 60 days of having suffered an acute myocardial infarction. Eighty-six percent of them had angina. Twelve patients had calculated ejection fractions of less than 20%; 79, 21% to 40%; and 105, from 41% to 60%. Ten patients had one graft; 33, two; 74, three; and 163, four or more. Twenty-four patients had concomitant ventricular aneurysm repair. The intra-aortic balloon pump was used in only seven patients. There was one postoperative death secondary to respiratory insufficiency and sepsis, resulting in a hospital mortality of 0.4%. Myocardial revascularization is a safe procedure following recent myocardial infarction, with results comparable to elective revascularization. Our long-term results suggest that revascularization may decrease the incidence of recurrent myocardial infarction.
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PMID:Coronary artery bypass after recent myocardial infarction. 698 98


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