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

For many years knee arthrodesis has been recommended for patients with severe degenerative disease complicated by obesity, venous insufficiency or old sepsis. Recently, failed total knee arthroplasties are being treated by arthrodesis, but these new indications entail new and difficult circumstances. A biplane fixation frame, more rigid than the Charnley clamp, and the instrumentation for producing absolutely flat opposing surfaces are important. The frame provides the advantages of good access to the wound and permits early ambulation. Pin tract loosening and infection are potential disadvantages, but in this small series were not significant.
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PMID:The biplane frame: modified compression arthrodesis of the knee. 728 20

Jejuno-ileal shunting was performed in 67 patients with massive obesity, last ten with a side-to-side jejuno-ileal anastomose. The technique is simple and rapid and carries little risk of sepsis. No complications were observed. This particular operation is one of several surgical treatments proposed for massive obesity and appears to be most satisfactory.
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PMID:[Latero-lateral jejuno-ileal shunt in the treatment of massive obesity (author's transl)]. 730 71

Between October 1967 and November 1977, the jejunoileal bypass was performed on 177 patients for morbid exogenous obesity. The female--male ratio was 9:1. The mean follow-up period was 3.4 years and their ages ranged from 15 to 58 years. Eighty-five per cent of this patient population base were between the ages of 21 and 49 years, and in 83% the onset of obesity was in childhood. Four parameters were used to assess the effectiveness of this procedure: 1) the ponderal index, 2) the per cent of ideal weight, 3) complications, and 4) diarrhea. Using the ponderal index, 38% of the results were excellent, 20% satisfactory, and 25% poor. When the per cent of ideal weight was used, the results were 24, 27 and 32% respectively. For complications, the results were 55, 23 and 5% and with diarrhea, 53, 22 and 8%. A summary of these mean values was 42.5, 23 and 17.5% for excellent, satisfactory and poor results. There were four deaths in this series, occurring 2--16 months postoperatively, due to sepsis, pulmonary embolism, drug overdose, and liver failure. Of the 28 patients (17%) requiring revision, eight were revised for inadequate weight loss, four for excessive weight loss, 15 for uncontrollable diarrhea, and 11 for metabolic electrolyte problems. In 14% the revision was required for multiple indications. A review of 100 of these patients to determine their response to the procedure revealed that 91% were able to recommend the procedure to other patients and intrepreted their results as being excellent in 51%, good in 36% and fair in 11%. Continued use of this procedure should be deferred pending much needed investigation of the associated complications.
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PMID:Jejunoileal bypass. Long-term results. 740 62

A retrospective study of 116 cases of fatal pulmonary thromboembolism, drawn from a total of 11,044 Coroner's autopsies, conducted over a 5-year period, yielded a necropsy prevalence of 1.05%, with an annual incidence varying between 0.78%-1.32%. There was a statistically significant peak monthly incidence of 1.89% in September (P < 0.03), as well as significantly higher rates between April to September as a whole, compared to the rest of the year (P < 0.03). There was a marked preponderance of females (male:female ratio = 0.59) and 48.3% of the subjects were > or = 60 years of age, with a distinct peak (23.3%) in the 8th decade. The prevalence of the common predisposing factors were as follows: surgery 41.4%, trauma 30.2%, sepsis 22.4%, obesity 18.1%, malignancy 10.3% and pregnancy 4.3%. The peak time of death following trauma and/or immobilization was one week. Apparently, a total of 54 subjects (46.6%) were ambulant prior to death, while 29 (25%) did not have any of the common risk factors studied. The prevalence of cigarette smoking and oral contraception could not be ascertained due to inadequate clinical documentation, even among medical inpatients. The majority of deaths (85.3%) occurred in hospitals, of which 44.8% were surgical patients. Pulmonary thromboembolism was apparently not suspected in 77.1% of the 105 patients who died whilst under the care of qualified medical practitioners, there being no significant difference between medical and surgical inpatients. In these cases, death was most often attributed to acute myocardial infarction or ischaemic heart disease. The study also showed a high prevalence of underlying chronic obstructive airways disease (37.1%) and of moderate to severe coronary atheroma (37.9%). The clinico-pathological and medico-legal implications of these findings are discussed.
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PMID:Pulmonary thromboembolism is not uncommon--results and implications of a five-year study of 116 necropsies. 757 14

Patients with diabetes mellitus are at a higher risk to undergo surgical intervention compared with the non-diabetic population, and additionally, they have an increased perioperative morbidity and mortality. Insulin deficiency and insulin resistance are aggravated by surgery and anaesthesia. The consequences of hyperglycemia are glycosuria, volume depletion from osmotic diuresis, impairment of wound healing and leucocyte function and exacerbation of ischemic brain damage. Depending on the extent of hypoinsulinemia, lipolysis and ketogenesis are enhanced which may result in metabolic acidosis with subsequent electrolyte disturbances. Protein catabolism is increased because of increased breakdown and decreased synthesis. Insulin administration reverts or overcomes most of these disturbances. The preoperative assessment includes the diagnoses of the long-term complications to judge the intraoperative risks. Long-acting insulins, such as ultralente of animal origin should be stopped preoperatively and substituted by protamine and lente insulins. In type-2-diabetic patients, long-acting sulfonylurea drugs such as chlorpropamide should be stopped and substituted by short-acting agents. Metformin must always be stopped. Type-2-diabetic patients with marked hyperglycemia under oral treatment should be switched to insulin before operation. The insulin requirements in diabetic patients during surgery vary from 0.25-0.40 U per gram glucose in normal weight patients, 0.4-0.8 U per gram glucose in case of obesity, liver disease, steroid therapy or sepsis, to 0.8-1.2 U per gram glucose in patients undergoing cardiopulmonary bypass surgery. Therefore, the appropriate dose has to be determined individually. The regimen nowadays preferred by most authors is based on variable rate insulin infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Perioperative management of the diabetic patient. 758 26

Total proctocolectomy and ileal pouch-anal anastomosis (IPAA) is the best option in the surgical treatment of ulcerative colitis, and for some patients with familial polyposis. Contraindications to the procedure include old age, obesity, weak sphincters, perianal sepsis and previous enterectomy. In this study the results of IPAA in five patients with one or more of these contraindications are presented and ways of dealing with them are discussed. All patients had a favourable outcome showing that such contraindications are relative, and IPAA may be attempted as long as patients are fully informed and understand the risks to which they are subject.
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PMID:The ileal pouch-anal anastomosis in challenging patients: stretching the limits. 785 20

Mediastinitis-related right ventricular rupture is an unusual but potentially life-threatening complication of cardiac operations. Between January 1981 and December 1990, a total of 10,182 patients underwent heart operations for ischemic, valvular, and congenital heart disease at the Montreal Heart Institute. Forty-eight patients (0.5%) had postoperative mediastinitis necessitating surgical exploration and sternal debridement. The mediastinum was left open for daily irrigation with povidone-iodine and chest reconstruction was postponed. During treatment, seven patients (0.07%) had right ventricular rupture necessitating immediate surgical repair. All had ischemic heart disease before the operation. There were five women and two men, ages ranging from 52 to 65 years (mean 58 +/- 5 years). Surgical repair consisted of autologous patch covered with omentoplasty assisted with cardiopulmonary bypass. Two patients died, one during the operation of massive hemorrhage and the other 10 days after the operation of uncontrolled sepsis. Five patients survived 2 to 29 months (mean 23 +/- 10 months) after right ventricular rupture, with an overall survival of 71%. Obesity was more frequent in the patients with right ventricular rupture and was found to be a significant risk factor (multivariate analysis, p < 0.05, relative risk 3.22). Histologic examination of the right ventricle in the patient who died after a successful repair revealed fatty infiltration of the right ventricular wall. This may have predisposed the patient toward ventricular rupture. In conclusion, right ventricular rupture, an unusual event in heart surgery, is related to open sternal debridement. Favorable outcome of this complication depends on immediate surgical management, autologous repair, and the use of omentoplasty.
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PMID:Right ventricular rupture. A complication of postoperative mediastinitis. 787 26

Intraamniotic infection is a common (2-4%) event in labor. The predictors of IAI include preterm labor or rupture of membranes, abnormal vaginal flora (e.g., GBS, sexually transmitted disease, bacterial vaginosis), obstetric manipulations (e.g., vaginal exams, internal fetal monitoring) in the presence of ruptured membranes, and diminished host response (due to smoking, drug abuse, obesity, immunodeficiency states, etc.). Group B Streptococcus and Enterobacteriaceae are the most important organisms associated with the polymicrobial infection. Anaerobes predict post-cesarean section complications. Neonatal pneumonia (2-5%) and early neonatal sepsis (1-4%) are the outcomes of the greatest concern and are caused by group B streptococcal or aerobic gram-negative rod infections. These outcomes are kept to a minimum if maternal antibiotic chemotherapy is started interpartum with agents that are safe, cross the placenta, and are active against GBS and Escherichia coli (e.g., ampicillin plus gentamicin). Anaerobic coverage should be added (clindamycin) if a cesarean section is performed. Antipyretics such as acetaminophen will reduce the hyperthermic stress on the fetus, and persistent fetal tachycardia after antipyretics may indicate fetal infection. Continuous electronic fetal monitoring is appropriate in cases of IAI, and providers should be prepared for neonatal resuscitation, early neonatal intravenous antibiotics, and respiratory support at delivery.
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PMID:Chorioamnionitis and intraamniotic infection. 829 82

Today Fournier's gangrene ranks among necrotizing fasciitis. Most of the cases reveal the origin of the disease (proctogenic, urologic, gynecologic). Untreated, the polybacterial synergistic infection will overwhelmingly spread along anatomically defined fascias of the pelvic floor. Thus the lethality rate is high, especially in patients with risk factors i.e. diabetes, alcoholism, arterial occlusive disease, chronic consumptive disorders and obesity. Only by instant and radical surgical excision of the total gangrenous tissue the spreading of the disease and the developing of sepsis can be stopped together with calculated antibiotic therapy and intensive care. Mutilating operations (i.e. penectomy, orchiectomy) are seldom necessary; thus plastic reconstructions will show good results both in function and cosmetic. Based on the experience with 6 patients, a pathogenic concept, concerning both diagnosis and therapy, is presented: after radical emergency surgery in the first risky stage, an elective approach can safely be performed in a second stage for the repair of functional lesions.
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PMID:[Fournier's gangrene]. 843 51

The elderly are more liable to problems from drugs used systemically. An accurate diagnosis may reveal conditions in which drug treatment is not required, especially those due to faulty habits and environmental problems, and local conditions susceptible to injections or surgery. Obesity, sepsis, hypothyroidism, osteomalacia, unsuspected fractures and drug side-effects may give correctable rheumatological problems. Use of analgesic anti-inflammatory drugs needs great care in the elderly; use analgesics instead when possible. Rheumatoid arthritis in the elderly demands maximum use of nonpharmacological treatment and local treatment. Analgesic anti-inflammatory drugs should be used carefully and sparingly. Use slow-acting drugs as in younger patients.
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PMID:Anti-rheumatic treatment in the elderly. 846 80


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