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)

Eleven models of total artificial hearts (TAHs) have been used for transient or permanent circulatory support in patients with failing hearts. From April 4, 1969 to July 1, 1991, 230 TAHs were used in 226 patients (four patients received a second TAH) at 39 centers worldwide. Five patients received a Symbion TAH as a permanent circulatory support device; the remaining 221 received TAHs as bridges to cardiac transplantation. The principal investigators received written requests for demographic and clinical information after each implant and annually thereafter to assess survival. The mean patient age (+/- SD) was 43 +/- 12 years (range, 13-69 years); 88% of patients were men. The primary indications for implantation were deterioration while on a transplant waiting list (34%) and acute cardiogenic shock (33%). The duration of implantation ranged from < 1 to 603 days; 65% received heart transplants. The incidence of infection and embolic events occurring during implantation times were 36% and 9%, respectively (stroke, 5%; transient ischemic attacks 4%). Most deaths were caused by sepsis (33%) and multiorgan failure (32%) during the implantation period; sepsis (36%) and rejection of the donor heart (19%) were responsible for most deaths in patients who died after transplantation. The 1 year survival rate was 37% for all patients receiving a device and 50% for those who received a transplanted organ. In the overall Symbion TAH population (187 patients), 40% survived 1 year and 56% of the transplanted group survived 1 year; 39 non-Symbion TAH implants resulted in one long-term survivor (3%).(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Registry report. Use of total artificial hearts: summary of world experience, 1969-1991. 145 8

We report on the successful repeated treatment of a patient with rapidly progressive severe brain-stem stroke by application of I.V. tissue plasminogen activator (tPA). This treatment twice led to a prompt remission of severe brain-stem symptoms, although a permanent therapeutic success could not be achieved. Unfortunately, the patient died a few days later from pneumonia and sepsis. Necropsy revealed bilateral partial brain-stem infarctions and a subtotal stenosis of the vertebrobasilar junction with superimposed fresh thrombus. The clinically dramatic response to tPA indicates that this type of treatment is potentially successful in high-grade subtotal basal cerebral artery stenosis with progressive stroke symptoms. In particular, application of tPA should be considered if stroke progression cannot stopped by therapeutic heprinization. A prospective randomized oligocentric study is advocated.
 ...
PMID:[Repeated treatment of subtotal vertebrobasilar stenosis with tissue plasminogen activator (tPA)]. 149 91

The reported clinical use of the Sarns centrifugal pump (Sarns, Inc./3M, Ann Arbor, Mich.) as a cardiac assist device for postcardiotomy ventricular failure is limited. During a 25-month period ending November 1988, we used 40 Sarns centrifugal pumps as univentricular or biventricular cardiac assist devices in 27 patients who could not be weaned from cardiopulmonary bypass despite maximal pharmacologic and intraaortic balloon support. Eighteen men and nine women with a mean age of 60.4 years (28 to 83) required assistance. Left ventricular assist alone was used in 12 patients, right ventricular assist in 2, and biventricular assist in 13. The duration of assist ranged from 2 to 434 hours (median 45). Centrifugal assist was successful in weaning 100% of the patients. Ten of 27 patients (37%) improved hemodynamically, allowing removal of the device(s), and 5 of 27 (18.5%) survived hospitalization. Survival of patients requiring left ventricular assist only was 33.3% (4/12). Complications were common and included renal failure, hemorrhage, coagulopathy, ventricular arrhythmias, sepsis, cerebrovascular accident, and wound infection. During 3560 centrifugal pump hours, no pump thrombosis was observed. The Sarns centrifugal pump is an effective assist device when used to salvage patients who otherwise cannot be weaned from cardiopulmonary bypass. Statistical analysis of preoperative patient characteristics, operative risk factors, and postoperative complications failed to predict which patients would be weaned from cardiac assist or which would survive.
 ...
PMID:Experience with the Sarns centrifugal pump in postcardiotomy ventricular failure. 151 45

The clinical outcome of 61 patients with renal amyloidosis treated with chronic dialysis was reviewed. Eighteen patients, 4 with primary or AL amyloidosis and 14 with reactive or AA amyloidosis, died within one month from starting treatment. The other 43 patients were treated with dialysis for 3 to 199 months and are the object of this study. Sixteen patients had AL amyloidosis and 27 had AA amyloidosis. Thirty-five patients were treated with hemodialysis (HD) for a mean period of 40 +/- 47 months and 8 were treated with continuous ambulatory peritoneal dialysis (CAPD) for 20 +/- 15 months. Patient survival rate at 1 and 5 years was 68% and 30% respectively. There was no difference in survival rate between patients treated with HD and those treated with CAPD, while patients younger than 45 had a better 5-year survival rate. Twenty four (60%) patients achieved a satisfactory rehabilitation with dialysis. At the last follow-up, 15 patients (14 on HD, 1 on CAPD) were alive 61 +/- 58 months after starting dialysis. Twenty-eight patients died after 30 +/- 20 months. The main causes of death were: cardiovascular accident (11), stroke (3), sepsis (5) and cachexia (5). The most important extra-renal complications of amyloidosis were related to cardiovascular involvement (heart failures, arrhythmias, hypotension) and gastrointestinal involvement (malabsorption). Intra-dialytic hypotension in patients on HD and peritonitis in patients on CAPD were the main problems related to dialytic procedure. his study confirms that life expectancy and the quality of life of dialysis patients with systemic amyloidosis are poorer than those of general dialysis population.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Chronic dialysis in patients with systemic amyloidosis: the experience in northern Italy. 151 84

We retrospectively reviewed the records of 88 patients who underwent a total of 95 in-situ bypass operations. Seventy-eight percent were diabetics, 56% hypertensives, 23% had a history of a myocardial infarction, 18% a previous stroke or transient ischemic attack, and 19% a renal transplant. Eighty-eight percent had general anesthesia. Eighty-four percent of the operations extended distal to the popliteal trifurcation, with an average operating time of 5.12 +/- 1.25 hours and blood loss of 354 +/- 239 ml. The overall mortality was 4.2%, with two deaths due to wound sepsis and two deaths due to congestive heart failure. The perioperative myocardial infarction rate was 6.3%. The average age of the patients who died was significantly greater than the age of those who survived (78.2 +/- 17.7 years vs. 59.9 +/- 14.8 years, p less than 0.05). The Goldman risk index was not helpful in predicting cardiac complications. The results show that patients undergoing in-situ bypass operations are at high risk for cardiovascular complications. Aggressive perioperative evaluation and management similar to that shown to reduce such complications in abdominal aortic aneurysm surgery should be helpful.
 ...
PMID:Complications and mortality of the in-situ saphenous vein bypass for lower extremity ischemia. 153 65

Several models of total artificial hearts have been used for transient or permanent circulatory support in patients with decompensation. The most successful and widely used device, however, has been the Symbion total artificial heart. From Dec. 12, 1982, to Jan. 1, 1991, 180 Symbion total artificial hearts were implanted in 176 patients in 28 centers. Five patients received a Symbion total artificial heart as a permanent circulatory support device, whereas 171 patients received the device as a bridge to heart transplantation. Of the 175 bridge devices (171 patients) 141 were Symbion J7-70 hearts and 34 were Symbion J7-100 hearts. Four patients received two total artificial hearts, the second one after the failure of a transplanted heart because of either rejection (two patients) or donor heart failure (2 patients). Most of the recipients were males (152). The age was 42 +/- 12 years (mean +/- SD) with a weight of 74 +/- 14 kg. The most common indications for implantation included deterioration while awaiting heart transplant (36%) and acute cardiogenic shock (32%). The cause of heart disease was primarily ischemic (52%) and idiopathic (35%) cardiomyopathy. Duration of implantation ranged from 0 to 603 days (mean 25 +/- 64 days). One hundred three (60%) patients had the device less than 2 weeks, 37 (22%) between 2 to 4 weeks and 31 (18%) more than 4 weeks. Complications during implantation included infection (37%), thromboembolic events (stroke 7%, transient ischemic attack 4%), kidney failure requiring dialysis (20%), bleeding requiring intervention (26%), and device malfunction (4%). Of the 171 patients, 118 (69%) underwent orthotopic heart transplantation. Actuarial survival for all patients with implants was 62% for 30 days and 42% for 1 year, and for patients with transplants was 72% for 30 days and 57% for 1 year. The main causes of death were sepsis (33%), multiorgan failure (21%), and posttransplant rejection (10%). The results indicate a relative success of this treatment for patients with an otherwise fatal prognosis. Moreover, as the demand for donor organs far exceeds availability, continued investigation of total artificial hearts is justified.
 ...
PMID:Summary of the clinical use of the Symbion total artificial heart: a registry report. 154 May 98

The right ventricular hemodynamic effects of incremental continuous positive airway pressure (CPAP) were assessed in 16 studies in nine unanesthetized, spontaneously breathing sheep. In seven sheep, studies were performed before and after the induction of sepsis. CPAP was applied in four increments of 4 mm Hg via a cuffed tracheostomy tube. Cardiac output, right ventricular ejection fraction (RVEF) and right ventricular end-diastolic volume (RVEDV) were assessed by thermodilution. In this model, incremental CPAP produced similar effects in septic and nonseptic studies. Cardiac output was preserved by a progressive increase in heart rate (106 +/- 25 to 126 +/- 29, p less than 0.05) in spite of a significant decline in stroke volume index (49 +/- 7 to 43 +/- 7, p less than 0.05). Transmural pulmonary artery pressure and pulmonary vascular resistance index increased with incremental CPAP whereas RVEF declined (0.38 +/- 0.05 to 0.31 +/- 0.05, p less than 0.05). Transmural right atrial pressure declined significantly (7.7 +/- 1.7 to 4.8 +/- 2.9, p less than 0.05) whereas RVEDV was unchanged. In this study incremental CPAP was associated with an enhancement of right ventricular compliance. Further, right ventricular preload was preserved in spite of the measured increase in intrathoracic pressure and cardiac output was maintained in the face of a CPAP-related increase in right ventricular afterload by compensatory increases in heart rate and right ventricular work.
 ...
PMID:Increased right ventricular compliance in response to continuous positive airway pressure. 155

Tumor necrosis factor-alpha (TNF alpha) has been implicated as an endogenous mediator of the cardiovascular manifestations of sepsis and septic shock. We studied the acute effects of a single dose (50 or 200 micrograms/kg) of intravenous recombinant human TNF alpha (rhTNF alpha) on myocardial function in halothane-anesthetized dogs. Regional cardiac dimensions were measured by using sonomicrometry. Intracavitary left ventricular, ascending aortic, and pulmonary artery pressures were measured by use of micromanometers. Cardiac index was determined by means of thermodilution. Myocardial performance was analyzed by assessing changes in the slope of the left ventricular end-diastolic length-stroke work relationship obtained by performing transient vena caval occlusions. Animals were resuscitated by means of normal saline solutions to maintain baseline regional end-diastolic length. Over a 3-hour period of observation, rhTNF alpha decreased systemic vascular resistance index, but the cytokine did not compromise intrinsic myocardial performance. The circulatory response to rhTNF alpha was a hyperdynamic state characterized by tachycardia, augmented cardiac index, and increased intrinsic myocardial contractility (leftward shift of the left ventricular end-diastolic length-stroke work relationship). In addition, rhTNF alpha caused systemic acidosis and increased plasma levels of prostacyclin metabolite (6-keto-prostaglandin F1 alpha). After the dose of rhTNF alpha large volumes of fluid were required to maintain baseline end-diastolic length. We conclude that in the acute setting, rhTNF alpha elicits abnormalities in peripheral vascular tone that are not accompanied by depression of myocardial function.
 ...
PMID:Load-insensitive assessment of myocardial performance after tumor necrosis factor-alpha in dogs. 159 65

A clinical case that occurred in a 42 years old female and which fulfils the diagnostic criteria for the entity described as Heat Stroke is presented. In this case, besides the usual manifestations of hyperpyrexia without sweating along with consciousness disorders, features of consumptive coagulopathy, rhabdomyolysis and well marked laboratory liver dysfunction have also been found. The severity of this situation and its less common occurrence in temperate climates, together with the uncertainty in establishing the diagnosis, namely when infection is suspected--in the present case the initial diagnosis was Sepsis, which led to patient's admission in an infectious diseases intensive care unit--motivate the authors to make this report. Furthermore, they consider this case to be a good example of the varied clinical and laboratory manifestations and possible severe complications that Heat Stroke may display.
 ...
PMID:[Febrile coma and disseminated intravascular coagulation following heat stroke]. 160 73

Melanoma frequently disseminates to the gastrointestinal tract, being found post-mortem in 60 per cent of patients with disseminated disease, while during life it is diagnosed in only 4 per cent. During the period 1981-87, 835 melanoma patients were referred and 30 developed complaints caused by gastrointestinal metastatic melanoma. Twenty-three patients were treated surgically. The interval between treatment of the primary melanoma and detection of intestinal involvement was a median of 34 months (range 2-87 months). In four patients recurrence in the gut was the first evidence of dissemination. Major complaints were nausea and vomiting, abdominal pain, signs of anaemia, and blood in the stools. Complications were bleeding (ten cases), ileus due to intussusception (five cases), bowel perforation (four cases) and cholecystitis (one case). The metastases, mainly localized in the small bowel, were removed by relatively simple procedures. Symptoms were reduced in 19 patients. Two patients died after operation: one from sepsis due to suture leakage, the other from pneumonia and a cerebrovascular accident. Of the remaining patients, 16 survived a median of 7.5 (range 0.7-32.0) months. Five patients are still alive 72, 72, 70, 7 and 2 months after the metastasectomy, three of whom are tumour-free. The actuarial 5-year survival of all patients is 19 per cent. These results support surgical intervention for patients with complaints and/or complications attributable to gastrointestinal metastatic melanoma.
 ...
PMID:Surgery for melanoma metastatic to the gastrointestinal tract. 168 96


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