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

To determine the incidence and types of infections in Hodgkin's disease, particularly those related to the overwhelming pneumococcal sepsis syndrome, 210 consecutive patients with previously untreated Hodgkin's disease who underwent staging laparotomy with splenectomy from March 1968 to October 1979 were reviewed. For 178 patients (85 percent) alive at the end of the study, the mean follow-up time was 68.1 months. Eighty-two serious infections occurred among 59 (28 percent) of the patients; 47 (57 percent) serious infections were microbiologically documented and 35 (43 percent) were clinically documented. Forty-seven microbiologically documented serious infections occurred in 34 patients and consisted of 23 episodes of pneumonia, 10 cases of bacteremia, seven wound infections, two cases of disseminated herpes zoster, one subphrenic abscess, and four miscellaneous infections. Microbiologically documented serious infections occurring during initial treatment or remission had lower incidences of leukopenia (29 versus 58 percent) (p = 0.09) and death (11 versus 53 percent) (p = 0.005) than those occurring after relapse of Hodgkin's disease. Of the microbiologically documented serious infections, 76 percent were associated with a predisposing factor(s) (leukopenia, postoperative state, steroids, peripheral neuropathy, leukemia), of which 34 percent were fatal. Microbiologically documented serious infections unassociated with a predisposing factor were never fatal, including the only episode of pneumococcal sepsis in the series. In contrast to microbiologically documented serious infections, only 14 percent of clinically documented serious infections (versus 38 percent) were fatal. The overwhelming pneumococcal sepsis syndrome and other infections thought to be associated with the asplenic state are uncommon problems in patients with Hodgkin's disease after splenectomy.
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PMID:Infection among 210 patients with surgically staged Hodgkin's disease. 685 90

Increased concern over the potential immunologic consequences of splenectomy has prompted surgeons to attempt salvage of traumatized spleens. We report a retrospective study of 172 consecutive patients with documented splenic injury treated over a 2-year period: 107 patients underwent splenectomy; 65 were managed without total splenectomy; 32 were not explored. The overall mortality rate was 27%; the overall complications were 30%, including a 13% incidence of post-splenectomy subphrenic abscess. The incidence of infectious complications after splenectomy was 36%, while the incidence in nonsplenectomized patients was 9%. The Injury Severity Scores (ISS) in the two groups were significantly different (p less than or equal to 0.05). When the group whose spleens were salvaged was compared to an equivalent group matched for ISS, age, and sex, there was no significant difference in sepsis rates (23% vs. 10.7%; 0.10 greater than or equal to p greater than or equal to 0.05). Survival in those with postinjury infectious complications was significantly improved in patients with a remaining spleen (p less than or equal to 0.01). Abdominal computerized tomography was used successfully as a method of following injured and repaired spleens in order to predict return to full activity.
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PMID:The management of splenic injury. 708 16

This report describes the mortality in 100 liver resections performed in 96 patients for seven benign and 93 malignant liver tumours. Repeat hepatectomy was performed in four patients who developed recurrences after the first liver resection. Two patients died within 30 days. The first was a 67-year-old man who died on the 2nd postoperative day from cardiac failure. The second was a 69-year-old man who died on the 4th postoperative day with liver failure caused by hepatic vascular ischaemia. There were four other hospital deaths at days 33, 40, 45 and 50. A 65-year-old lady died on day 40 from sepsis caused by small bowel infarction. A 30-year-old man died on the 33rd postoperative day owing to liver failure from accelerated hepatic lymphoma spread. A 71-year-old diabetic lady died on the 45th postoperative day from sepsis caused by an untreated subphrenic abscess. A 65-year-old lady died on day 50 from systemic candidiasis after adult respiratory distress syndrome (ARDS). Further reduction in operative mortality could be achieved by better patient selection. Liver resection still remains a major operation, but has become a safe surgical procedure.
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PMID:Early mortality in 100 consecutive liver resections in 96 patients with benign and malignant liver tumours. 779

We report the case of 61-year-old woman with cryptogenic liver abscesses who had been profoundly ill with severe upper abdominal pain, impaired consciousness, prostration, continuous high fever secondary to sepsis, and thrombocytopenia (platelets, 1-5 x 10(4)/mm3) since admission. Ultrasonograms and computed tomograms revealed two separate multiloculated lesions in the right lobe of the liver, consistent with the liver abscesses. Immediately after diagnosis, percutaneous abscess drainage was performed under ultrasonographic guidance; however, only a small amount of pus was drained, prompting continuous irrigation of the abscess cavity. Four days later, transcatheter hepatic arterial infusion of antibiotics was attempted. However, the abscesses had enlarged and her general condition had worsened. On hospital day 8, she underwent right hepatectomy because the multiloculated lesions were refractory to drainage. The operation was successful in terms of hepatectomy, although she continued to suffer from sepsis, secondary right subphrenic abscess formation, and prolonged thrombocytopenia with associated coagulation disorders for two months. Examination of multiple cross sections of the resected specimen disclosed that the lesions consisted of aggregations of multiple small locules. There was no communication between the locules and there were true septations, rather than multiloculated lesions with pseudoseptations. The patient has been well for 2 years without recurrent abscess of the liver or any infectious disease.
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PMID:Right hepatectomy for pyogenic liver abscesses with true multiloculation. 905 4

Splenectomy (SE) is one of the surgical interventions requiring an increased internal care. The removal of the spleen which is an organ with an exceptional function can lead to complications even in people who are healthy in all other respects. The complications in coincidence with SE can arise early (up to 30 days after surgery) or later. Early complications can involve infections of the respiratory tract (especially bronchopneumonia), or subphrenic abscess. Thromboembolic complications occur not only in peri-operational period, but also in several weeks or months after SE. A severe complication resides in disseminated intravascular blood coagulation. Late complications represent a lifelong danger for asplenic patients. They include the fulminant sepsis, known as so-called OPSI syndrome (overwhelming postsplenectomy infection). The mortality rate in coincidence with the latter is very high despite intensive antibiotic therapy. The risk is especially high in children, in immuno-deficient states and immunosuppressive therapy. 60% of patients develop OPSI during the first two years, out of whom one third is afflicted in the first half of the year following SE. In more than 30% of patients OPSI manifests itself minimally 5 years later. The prevention of infection in coincidence with SE is performed by means of immunization, antibiotic prophylaxis and via education of patients. Immunization includes the administration of a polyvalent pneumococcus vaccine, in children it includes also the vaccine against Haemophilus inluenzae and Neisseria meningitidis. The appropriate antibiotic prophylaxis is represented especially by penicillin, amoxicillin, or amoxicillin with clavulanic acid. The children or other patients with disturbed immunity functions are administered with antibiotics in low doses per os for a long period. Antibiotics in the therapy of OPSI are administered in full doses together with immunoglobulin, both are applied intravenously. A specific approach is required in patients with autoimmune thrombocytopenia, in whom the increase in the number of thrombocytes prior to operation can be achieved by high intravenous doses of corticoids or immunoglobulin G. In this case, unless explicitly necessary, the transfusion of thrombocytes should not be performed prior to SE. The antithrombotic therapy is appropriate in patients at high risk of post-surgical thrombosis (e.g. hereditary haemolytic anaemias, myeloproliferative diseases, SE in coincidence with polytraumatism.
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PMID:[Perioperative care by internists in splenectomy]. 972 63

Blood glucose levels in the high normal range or even moderate hyperglycemia is the expected profile in septic postoperative patients receiving high-calorie enteral alimentation. The addition of growth hormone as an anabolic agent should additionally reinforce this tendency. In a cancer patient undergoing partial gastrectomy with lymphadenectomy and suffering from postoperative subphrenic abscess and prolonged sepsis, tube feeding (38.3 kcal/kg/day) and growth hormone (0.17 IU/kg/day) were simultaneously administered for 25 days. Blood glucose levels were in the lower limits of the normal range before growth hormone introduction, and continued with a similar tendency during most of the therapeutic period. Two additional complications, namely heart arrest and peripheral edema, were documented during the same period. It is concluded that sepsis was the most likely mechanism for low glucose values, and that high-calorie enteral diet and growth hormone supplementation did not prevent that result. It is uncertain whether heart arrest was due to the drug, but its association with peripheral edema is well documented in clinical series.
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PMID:Low blood glucose levels and other complications during growth hormone supplementation in sepsis. 1077 22

Fistulous communications between the abdominal and the pleural cavity are rare; they implicate intra-abdominal sepsis. We present a rare case of subphrenic abscess following gastric perforation, which resulted in thoracic empyema. This report emphasises that gastropleural fistulas, although uncommon, should be considered in differential diagnoses of thoracic empyema, especially when there is a longstanding history of peptic ulceration.
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PMID:Gastropleural fistula originating from the lesser curve: a recognised complication, an uncommon pathway of communication. 1160 44

The authors made in a young 48-year-old patient a subtotal gastric resection with atypical resection of the liver on account of a metastasis, the basic diagnosis being: gastric tumour, histologically diffuse carcinoma with mucus formation. On the 6th postoperative day the condition was complicated by sepsis and dehiscence of the oesophagoantroanastomosis. With regard to the complication with a relapse of a subphrenic abscess the patient was repeatedly checked. He was for a prolonged period (repeatedly) on artificial pulmonary ventilation on account of ARDS and lobar bronchopneumonia; complete parenteral and subsequently parenteral and enteral nutrition was administered. After stabilization of the condition (after 5 months from the first operation) the patient was discharged into domiciliary treatment with enteral nutrition which was administered by jejunostomy by means of a pump for enteral nutrition. Four months after discharge the oesophagus and stomach were replaced by the colon. The patient is at present in a good clinical condition, does not suffer from malnutrition. No signs of relapse of the disease. The importance of intensive, long-term although costly postoperative care reflected on the satisfactory health status of the patient is beyond doubt.
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PMID:[Complications of treatment of stomach cancer--case report]. 1168 47

After surgical therapy the survival outcome of gastric cancer is still poor. Early diagnosis and radical surgery are the two most important means to improve the prognosis. Radical surgery must include all lymph nodes embryologically related to stomach. The aim of this study was to verify whether an aggressive surgical strategy can increase postoperative survival rate. In the period 1990-1994 eighty two patients with gastric cancer were operated on. The M:F ratio was 1.6:1 and the mean age was 65.3 years (range 23-89). Palliative operations (6 gastroenterostomy) were performed in 7.3% of cases. In the other patients, 36 total gastrectomies (43.9%), 8 total gastrectomies extended to spleen, pancreas and colon (9.7%), 32 distal subtotal gastrectomies (39.1%) were performed. Gastric exeresis was always associated with lymph node dissection extended to level I and II (R2). In some cases level III and IV lymphadenectomy (R3) was performed according to Maruyama-Mishima technique. There were no intraoperative deaths. The operative mortality was 13.6% for total gastrectomies and 3.1% for subtotal gastrectomies. Postoperative complications occurred in 15.9% of total gastrectomies (3 anastomotic fistula, 2 wound infection, 1 subphrenic abscess, 1 melena) and in 3.1% of subtotal gastrectomies (1 sepsis). Stage III and IV cancers represented 74.4% of all cases (stage IIIA 19.6%, IIIB 21.9%, IV 32.9%). Metastatic lymph node involvement (N2+) affected 53.1% of T3 and 88.2% of T4 cancers. The mean survival rate of patients subjected to gastroenterostomy was 6 months. The 2-year survival for total gastrectomies was 42%, for subtotal gastrectomies 28.1%. In our experience, wide removal of lymph nodes and total or extended gastrectomies were performed without any increase of mortality and morbidity. In advanced stages, a wider exeresis increased survival and prevented local recurrence.
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PMID:[Radical surgical treatment of gastric cancer. Personal experience]. 1261 Dec 56

Spleen abscess is not frequent in children. It may be caused by haematogenous seeding of the spleen with bacteria from primary septic focus; by direct spread of infection from adjacent structures, or by secondary infection in an area of the spleen damaged by infarction, trauma or parasitic infestation. A 13-year-old girl with spleen abscess following appendectomy is presented. Uneventful appendectomy was followed by prolonged unexplained sepsis that could not be controlled with high intravenous doses of different antibiotics. One month after appendectomy, exploration of the postoperative wound, pericecal and Douglas region was done, but neither pus or intra-abdominal foreign body were found. Abdominal ultrasonography and Nuclear Magnetic Resonance (NMR) revealed multiple spleen abscesses in the upper pole and the hilus region 44 days after appendectomy. Splenectomy with left subphrenic space drainage was performed, and an accessory spleen, 29 x 12 mm, was left intact. Left subphrenic abscess was revealed by echosonography 10 days later (5 days after abdominal drain has been removed), and image-guided percutaneous abscess drainage was therefore performed. Continous irrigation of the abscess cavity with adequate antibiotic solution, through pigtail drain left in position, was installed for next 12 days until the wash out was clear and sterile. Drain was removed and the patient discharged. Four months after discharge the patient was asymptomatic.
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PMID:[An unusual spleen abscess in a 13-year-old girl after appendectomy]. 1797


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