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

Cyclophosphamide (CTX) 600 mg/m2, carboplatin 280 mg/m2, and cisplatin 50 mg/m2 were administered on day 1 every 4 weeks to 41 previously untreated ovarian cancer patients with residual disease greater than 2.0 cm after primary laparotomy. Of 22 patients with measurable disease treated with up to eight cycles of therapy, the overall clinical response rate was 73% (exact 95% confidence interval [CI], 50% to 89%), with 50% complete response (CR). Six of 11 clinical CR (cCR) patients underwent surgical restaging; three pathologic CRs (pCRs) and three pathologic partial responses (pPRs) with residual disease less than 2.0 cm were documented. Fourteen patients had nonmeasurable but assessable disease; the clinical response rate was 57% (Cl, 29% to 82%) with two (14%) CRs. Second-look surgery was performed in one of the two cCR patients; a pPR was documented. Five patients with nonassessable disease were stable during chemotherapy; two underwent surgery and had pCRs. The median time to treatment failure (TTF) was 14.8 months, and median survival for the 41 patients is 26.7 months. Overall, 37% of the patients had progression-free intervals of at least 2 years, and 27% have survival times in excess of 3 years. Hematologic toxicity was substantial but manageable, with 58% and 66% experiencing a granulocyte nadir less than 500/microL and a platelet nadir less than 50,000/microL, respectively. One treatment-associated fatality occurred as a result of leukopenic sepsis and renal failure in the setting of progressive disease and ureteral obstruction. Mild to moderate nausea and vomiting occurred in most patients, but none experienced severe ototoxicity or peripheral neuropathy. Over all courses, 73% of the projected dose intensity of CTX and carboplatin and 86% of cisplatin were delivered. Since granulocytopenia and thrombocytopenia were dose-limiting, the addition of colony-stimulating factors that support both myeloid and megakaryocyte precursors may permit further dose intensification.
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PMID:Cisplatin, carboplatin, and cyclophosphamide combination chemotherapy in advanced-stage ovarian carcinoma: an Eastern Cooperative Oncology Group pilot study. 191 29

Skeletal muscle wasting is commonly observed in critically-ill patients and has been attributed to catabolic fibre atrophy and to neuropathy. This study describes the occurrence of a necrotizing myopathy in 15 out of 31 critically-ill patients who had percutaneous biopsies taken from the tibialis anterior muscles. While most cases showed necrosis of isolated fibres, 5 of the 12 patients who had serial biopsies showed progressive necrosis of up to 95 per cent of the fibres. One other case showed infarction and one case had staphylococcal vasculitis. Atrophy of type 1 and/or type 2 fibres was documented by morphometry in 12 cases. Myoglobin-containing casts were demonstrated immunohistochemically in renal tubules on either biopsy or necropsy material in 5 out of 7 cases. The presence of muscle necrosis was a clinically unexpected finding which may contribute to weakness, complicate the interpretation of tissue biochemistry and energy balance studies, and potentiate renal failure. The necrosis is probably multifactorial in origin, with ischaemia and sepsis contributing factors.
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PMID:Necrotizing myopathy in critically-ill patients. 191 68

At Stanford University, a Novacor left ventricular assist system (Baxter Healthcare Corporation, Novacor Division, Oakland, Calif.) was placed as a bridge to heart transplantation in 13 patients. During the hospitalization preceding device implantation, all patients were receiving inotropic support for biventricular failure, 11 had pulmonary edema, 6 had life-threatening ventricular arrhythmias, 5 had liver dysfunction with coagulopathy, and 2 had renal failure necessitating artificial support. The mean cardiac index before implantation of the Novacor system was 1.5. All survivors with the Novacor device had a dramatic increase in cardiac output (mean cardiac index = 3.1). One patient with cardiac allograft rejection died during implantation of the left ventricular assist system. Two patients died of pulmonary sepsis and multiorgan failure after the device was implanted. All patients who had the Novacor device implanted for more than 7 days were able to walk and ride stationary bicycles while awaiting transplantation. Ten patients (77%) underwent successful heart transplantation after a mean of 18 days' support with the Novacor device. One patient died of presumed sepsis 2 days after transplantation. Nine patients (90%) are alive 4 months to 6 years after transplantation. In the overall United States experience, 68 patients (as of May 1990) have had a Novacor left ventricular assist device implanted. Five were still being supported, 39 had received a transplant (62%), and 35 patients (90%) survived the transplant hospitalization (1 died later). No instances of device failure have occurred. Overall, the Novacor assist system provided effective bridging to transplantation, with posttransplant survival similar to results after routine transplantation. Modifications and improvements based on this clinical experience have been made in the areas of patient selection, techniques of operative placement, postoperative management, and design of the assist system. Isolated left heart support with a fully implantable left ventricular assist system will be offered as an alternative to heart transplantation for selected patients by 1992.
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PMID:Clinical experience with the Novacor ventricular assist system. Bridge to transplantation and the transition to permanent application. 192 34

The collected data on extracorporeal membrane oxygenation (ECMO), now referred to as extracorporeal life support (ECLS), for pediatric cardiac support has not been analyzed. The purpose of this study was to review the Extracorporeal Life Support (ELSO) Registry data to evaluate the results, identify possible predictors of outcome, and attempt to establish criteria. From 1981 to June of 1990, 189 patients were placed on ECLS for cardiac assist. The age range was 0-204 months (median, 7 months). Mean time on ECLS was 115 +/- 75 hours. Fourteen patients were placed on ECLS as a bridge to transplant or for management of transplant rejection. All of the remaining 175 patients were treated in the postoperative period. The causes of mortality included lack of improvement in cardiovascular function in 69 (37%) of the patients, major central nervous system damage in 28 (15%), uncontrollable hemorrhage in three (2%), sepsis in three (2%), and pulmonary interstitial disease in two (1%). The Registry data were examined for predictors of outcome. There was no significant difference between survivors and nonsurvivors when compared for duration of ECLS, mechanical complications, arterial or venous blood gases, ventilation settings, or hemodynamics. Forty-three percent of 189 pediatric patients treated with ECLS for cardiac failure survived. The highest survival, 61%, occurred in right-sided lesions and the lowest, 18%, in post-Fontan. Mediastinal bleeding, cardiac arrest, renal failure, and prolonged intubation were all associated with a poor outcome. Most deaths were attributed to irreversible cardiac or brain injury, suggesting that results could be improved by earlier identification of high-risk patients and earlier institution of ECLS.
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PMID:Extracorporeal life support for cardiac assist in pediatric patients. Review of ELSO Registry data. 193 7

Malaria is diagnosed in 50-70 patients each year in Norway. Severe malarial infection with cerebral involvement as well as hypoglycaemia, circulatory collapse and renal failure is often difficult to diagnose since the condition is only rarely seen in Scandinavia. This report describes a 49 year old seaman, who was admitted to hospital with a clinical picture of sepsis with multiorgan involvement including cerebral affection. Subsequently, it turned out that the patient had a severe infection with Plasmodium falciparum, involving more than 50 per cent of the red blood cells. Despite being comatose for one week with repeated attacks of grand mal type, and requiring 11 days mechanical ventilation plus dialysis for 4 weeks, he recovered uneventfully and was dismissed from hospital with only minor neurological sequelae. Even severe malaria with cerebral involvement can result in full restitution if the diagnosis is made early and exchange transfusion plus treatment with relevant drugs are instituted promptly.
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PMID:[Exchange transfusion in cases of falciparum malaria]. 194 97

The Wisconsin Division of Health (DOH) began surveillance for severe illnesses associated with group A beta-hemolytic streptococcus (GABS) infections in late 1989 to describe the current epidemiologic features and clinical spectrum of these infections in the state. Severe illness was defined by the isolation of GABS from the blood or by the development of one or more of the following in a patient infected with GABS: shock, extensive tissue injury, desquamating rash, disseminated intravascular coagulation, renal failure, adult respiratory distress syndrome, or death. Case reports involving 28 patients with severe GABS-related illnesses with onset from November 1989 through October 1990 were received by the DOH. The majority of the case-patients had sepsis (57%), cellulitis (50%) or both. Nine (32%) cases were fatal. Those who died were older than those who survived (median age 74 years v 43 years, p = 0.002) and were more likely to have clinical diagnoses that included pneumonia (relative risk [RR] 3.0, 95% confidence interval [CI] 1.2, 7.3) or necrotizing fasciitis/myositis (RR 3.7, 95% CI 1.5, 9.0). The median interval from illness onset to hospitalization was similar for fatal cases (1 day) and non-fatal cases (2 days), suggesting that early intervention after the appearance of clinical illness may not improve the outcome.
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PMID:Severe illness associated with group A-hemolytic streptococcal infections. 194 73

Eighteen consecutive patients with sepsis due to surgically confirmed peripancreatic necrosis extending diffusely into the retroperitoneal fat were treated in our hospital from 1980 to 1987. Management consisted of early retroperitoneal debridement of necrotic tissue and drainage through lumbar incisions. Enteral nutrition was implemented in all patients 3-8 days after their first surgery. A total of 40 reoperations were required--an average of 2.6 per patient. Complications included respiratory failure (17), renal failure (4), gastrointestinal bleeding (4), retroperitoneal bleeding (1), and gastrointestinal fistulas (6). Four (22%) of the 18 patients died; the major cause of death was multiple organ failure secondary to sepsis. Before 1980, all patients with severe pancreatitis treated in our hospital died, despite the use of different management techniques. The use of the extraperitoneal route for early debridement of necrotic tissue and to avoid contamination of the peritoneal cavity has substantially reduced the mortality associated with peripancreatic necrosis in our hospital. The mortality in this series of patients (22%) compares very favorably with that reported in studies of similar patients.
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PMID:Retroperitoneal drainage in the management of the septic phase of severe acute pancreatitis. 199 93

We study the renal function in meningococcal sepsis in other to get prognostic data in disease evolution. We include 116 patients of whom we take data of anamnesis; physical examination; blood, urine and cerebrospinal fluid biochemical and microbiologic studies and TISS and APS score. We analyze qualitative and quantitative data of renal function statistical and we compare with another prognostic data of disease. We find that renal failure in meningococcal sepsis gets worse the prognostic of the disease.
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PMID:[Renal function in meningococcal infection. Analysis of 116 cases]. 201 59

Sepsis syndrome frequently results in endothelial injury in many organ systems. To evaluate neutrophil-pulmonary endothelial cell interaction in the sepsis syndrome, we studied 39 critically ill patients prospectively and 20 normal volunteers. Thirteen patients with sepsis (mean age, 71.4 years), 14 patients in an intensive care unit control group (mean age 65.4 years), and 12 patients admitted with acute myocardial infarction (mean age, 66.8 years) were evaluated. Blood samples were drawn from septic patients within 24 hours and from ICU and MI patients within 72 hours of admission. All sepsis patients were culture positive, 6 of 13 from the blood. Both renal failure and ARDS developed in 54 percent of septic patients. 51Cr-labelled neutrophils were prepared and added to bovine pulmonary endothelial cell monolayers with and without added phorbol myristate acetate. Endothelial cells with adherent PMA and nonadherent PMN's, were harvested and radioactivity in each fraction measured with a gamma scintillation counter. Baseline and maximally stimulated (PMA, 3.0 ng/ml) neutrophil adherence to endothelial cells were similar in all patients groups. However, in septic patients, PMA-stimulated PMN adherence was reduced at lower doses, most significantly in those who developed ARDS within 24 to 48 hours of admission (p less than 0.05). Seventy-one percent of patients who developed ARDS had reduced stimulated adherence (PMA 1.0 ng/ml) compared to 22 percent of critically ill patients who did not. We conclude that diminished adherence of neutrophils to endothelium in response to low-level PMA stimulation is significantly more common in patients with sepsis who develop ARDS. Our findings suggest that PMN-endothelial cell interaction is altered by the time sepsis is clinically recognized but before the development of ARDS. We speculate that the observed reduction in adherence of the PMN to endothelial cells may be a consequence of down-regulation by mediators generated in the inflammatory response to sepsis and/or the need for active participation of septic endothelium in this interaction.
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PMID:Neutrophil-endothelial cell interaction in critical illness. 203 31

The present study documents the occurrence of renal failure in 4 nephrotic patients including 3 with minor glomerular lesions and one with membranoproliferative glomerulonephritis. One patient died of sepsis at 3 months after onset of the acute renal failure. In the remaining 3, forced diuresis employing albumin plus furosemide in increasing doses to 600 mg/day reversed the renal failure independent of corticosteroid therapy. All of the 4 patients showed characteristic findings consisting of a remarkably low fractional excretion of sodium and an unexpectedly low urine osmolality at the onset of acute renal failure, although they were rather hypervolemic. Our findings suggest that the occurrence of a low fractional excretion of sodium and low osmolality may provide a good index of an absolute indication for intensive weight reduction therapy such as high-dose furosemide in nephrotic patients with acute renal failure in order to reverse the acute renal failure.
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PMID:Renal failure with nephrotic syndrome: reversal with large doses of furosemide. 203 33


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