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

Colouterine fistula complicating diverticulitis is rare. Our experience with two patients, one with chronic vaginal discharge and the other with acute overwhelming sepsis, emphasizes the wide spectrum of clinical presentations that may accompany this entity. In patients with chronic symptoms, surgery is indicated to forestall further local infectious complications, and a single-stage sigmoid resection without hysterectomy may be adequate. If malignancy cannot be excluded, a single-stage en bloc resection of the uterus and colon is the procedure of choice. Hysterectomy may also be mandatory to extirpate a nidus of acute infection. When severe local inflammation or obstruction mandate urgent operation, a two-stage procedure involving resection and end colostomy, followed by reanastomosis at a later time, is safest and most effective.
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PMID:Colouterine fistula secondary to diverticulitis. 399 53

Uterine rupture in the developing world remains a significant problem. 45 cases treated in a rural hospital in Nigeria are discussed in this article. The predisposing factors included cephalopelvic disproportion (62%), grand multiparity (33%), previous cesarean section (24%), placental pathology (15%) and abnormal presentation (20%). The factors associated with maternal death included sepsis (71%), macerated stillborn infant (60%), vulvar edema (50%), prolonged labor (42%), hand presentation (50%) and hysterectomy (37.5%). Hemodynamic resuscitation and prompt surgical intervention remain the mainstays of therapy. Patients ranged from ages 16 to 46, and gravidity ranged from 1 to 11. 38 of the 45 patients had no prenatal care. 8 of the 9 maternal deaths that occurred were among these 38. It is common for patients with uterine rupture to be admitted after uterine contractions have ceased, with profound dehydration and early septic or hemorrhagic shock. In 39 (87%) of the 45 cases, no fetal heart tones were heard on admission. 29 (58%) of the 45 uterine ruptures involved the lower uterine segment exclusively. Surgical procedures performed were hysterectomy in 8 cases and tubal ligations in 4 cases. The distinction between early and obstructed labor, cephalopelvic disproportion in the US, and true obstructed labor, as seen in rural Nigeria, is an important one. There often is a double-hump sign from the ballooning lower uterine segment in cases of long-obstructed labor, for which the patient may have been given an herbal powder. Numerous types of herbal mixtures have shown oxytocic properties and may contribute to the high incidence of uterine rupture. Prenatal care is an important preventive factor. Placental pathology appeared to play an etiologic role in several cases. The decision as to whether surgical repair or hysterectomy is the appropriate treatment is greatly influenced by cultural realities. Among the rural tribes of the Bendel State in Nigeria, fertility and the ability to menstruate are considered essential to a woman's worth within the community and in her family. Repair of a ruptured uterus is associated with lower maternal mortality than is hysterectomy and is therefore the preferred procedure.
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PMID:Uterine rupture in Nigeria. 399 69

A review of the prelegal abortion scene in the US precedes discussion of the effect of injected soap, phenol, cresol, and their compounds. The latter is based on a review of 4 toxicology books. There is little difference in the symptoms after the instillation of phenols, cresols, or soaps. Any one of those agents can cause vaginal bleeding, abdominal pain and distension, nausea, vomiting, and cramps. The damage produced by the use of Lysol thus is due to both the phenol and soap components of the compound. Following instillation into the uterus, there is coagulation necrosis of the decidua and placental site. The toxin will invariable cause thrombosis of the intrauterine and parametrial veins. The thrombosis may spread to the entire pelvic vein plexus and paravaginal, paracervical, and ovarian veins. The liver and kidney are affected by the toxin. Icterus and bile pigments in the urine and clinical evidence of liver damage are seen often. Pulmonary edema has been described as have microscopic to massive pulmonary oil emboli and thrombosis. Depression of all bone marrow elements due to toxin has been reported. The red blood cells are further depressed in number because of hemolysis. Cerebral changes include oil emboli, cerebral coagulation, necrosis, and petechial hemorrhages. Until Studdiford and Douglas described gram-negative sepsis causing shock, patients admitted with hypotension accompanying septic abortion were thought to have concealed blood loss. Studdiford and Douglas showed that gram-negative septicemia could produce hypotension. With the advent of massive antibiotic therapy for septic abortion and septic shock, most of these patients could be saved. The kidneys, after exposure to phenolic-soap comounds, show mainly lower nephron changes. As long as the toxin is in the system those changes continue until irreversible renal damage occurs. It is essential to remove the source of the poison (the affected uterus) and then remove the circulating toxins. the main problem is removal of the circulating toxin. In addition to the problems produced by fixed and circulating toxin, it has been shown that most phenol-soap induced abortions are infected. Thus it is necessary to employ the optimal antibiotic therapy for septic incomplete abortion. The initial management phase moves along classic lines. First is monitoring the vital state and supporting the systems. This includes maintaining an intravenous solution with a large-bore needle, monitoring central venous pressure, measuring urinary output, monitoring the vital signs, maintaining adequate oxygenation, and supporting the blood pressure with blood vasopressors or other agents, as needed. Second is diagnosing the extent of the illness. Third is the initial treatment, which includes reestablishment of the blood volume with blood transfusions; aggressive coverage with double or triple antibiotic therapy; correction of hypofibrinogenemia with cryoprecipitate, fresh whole blood or fresh frozen plasma, as indicated; and avoidance of overhydration in the presence of actual or suspected renal failure. After antibiotic coverage has been established, removal of retained products of conception is indicated.
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PMID:Treatment of women who have undergone chemically induced abortions. 404 35

The causes of the high maternal mortality rate (21.6/1000) at the Goroka Base Hospital in Papua New Guinea are reviewed for the 1964-1973 period. This study covers deaths directly due to pregnancy and childbirth and deaths due to other causes occurring in association with pregnancy and childbirth (referred to as associated deaths). The definition of parity in this study is the number of previous pregnancies that have lasted 28 weeks or more. During the 10-year period, 6031 public patients were admitted for confinement and 542 public patients were admitted following delivery elsewhere. For the purpose of deriving the maternal mortality rate (MMR), only direct maternal deaths are considered. The MMR was much higher (97.8) for patients admitted after delivery than for those admitted before delivery. The parity of 74 of the patients who died from direct obstetric causes was recorded: para 0, 52.7%; para 1-4, 40.5%; and para 5 or more, 6.8%. Autopsy confirmed the cause of death in 33 (23.2%) of the 142 maternal deaths. In most patients, sufficient clinical data was available to establish the diagnosis. Sepsis was the predominant cause of death, accounting directly for 44 (38.3%) of the deaths. Obstructed labor accounted for 29 deaths (25.2%) with the uterus intact. Of patients whose parity was recorded, 15 (60%) were primigravida, 8 (32%) were multigravida, and 2 (8%) were multigravida. Of 45 patients admitted to Goroka Base Hospital with the diagnosis of ruptured uterus, the mortality was 28.9%. The incidence of ruptured uterus declined from 1.4% to 0.4% over the 10-year review period. Abortion was the cause of 14 deaths. Criminal interference was admitted in 9 patients and may have occurred in the others. The cause of death of 4 women was toxemia of pregnancy; 2 of these patients were referred from other hospitals, each after treatment for pre-eclampsia. Pulmonary embolism was responsible for 1 death as was extrauterine pregnancy. There were 29 deaths in patients delivered by caesarean section. Additionally, 3 women died after referral following caesarean section at other hospitals. The average duration of hospitalization for patients with peritonitis at or developing after caesarean section was 17.7 days. 27 deaths were associated with pregnancy, and the conditions responsible are listed in a table. Continuing education is necessary to reduce maternal morbidity and mortality. Simple proposals for health education purposes are identified.
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PMID:Maternal mortality at Goroka Base Hospital. 453 53

A woman who had a copper 7 coil inserted without difficulty, in 1978 decided to have another baby, and in February 1980, she asked for the device to be removed. Her (GP) general practitioner could not find the threads so she was referred to me. She did mention to her GP that she had noticed the threads appearing at her anus after defecation. The GP did a rectal examination and reassured her, suggesting that she had a vivid imagination. I saw her later that month and found no abnormality apart from a retroverted uterus and could not feel the coil with the uterine sound or hook within the uterine cavity. An X-ray of the abdomen showed that the IUD was identifiable in the midline front of the sacrum, and would appear to be in the uterus. In May 1980, she was admitted to hospital for removal of the coil. She told my senior house officer that she had felt the strings rectally: this observation was dismissed and not recorded in the notes. At operation I found a normal pelvis with retroverted uterus but no coil. Laparoscopy revealed no adhesions and no evidence of pelvic infection, but something seemed to be distorting the cavity of the sigmoid colon. It was then that my senior house officer mentioned that it was this patient who had thought she had felt the strings coming out of the rectum. She was asked to return as an outpatient 2 weeks later for sigmoidoscopy, after full bowel preparation. On sigmoidoscopy, the coil threads were readily visible and the copper 7 was found embedded 1/2 under the mucosa of the sigmoid colon at 17 cm. I grasped the free end with biopsy forceps and withdrew the coil, considerable force being needed. I prescribed ampicillin and metronidazole for 4 days and warned her about possible complications. However, the procedure caused no discomfort and there were no complications. Assuming the coil had been inserted into the uterine cavity, it it suprising that it had perforated the uterus and the sigmoid colon without causing pelvic sepsis and withoutt leaving adhesions. Edelman et al., in their review found 10 cases of bowel perforation with IUDs (4 Dalkon shields, 3 Lippes loops, and 3 copper T's or copper 7's). All cases presented with pelvic sepsis apart from 1 case of small bowel perforation with a Dalkon shield, but even then at laparotomy extensive adhesions were found between the fundus of the uterus and the small bowel in which the coil was embedded.
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PMID:Unusual presentation of translocated intrauterine contraceptive device. 611 99

Since 1972 the authors performed 1865 caesarean sections and used only a transisthmic suture of the uterine wound in one layer. No maternal mortality and no severe complications (rupture and dehiscence of the uterus, sepsis) were observed. An analysis of 1062 operations of the years 1978-1982 resulted in a course without complications (no fever, no transfusion) in 81.9 per cent. --These favourable results are likely to be attributed to the modification used.
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PMID:[Cesarean section using single-layer transisthmic uterine sutures]. 636 47

The periodicity of morbidity rate in heifers and dairy cows kept on pasture (278 animals) and in stables (187 animals) was studied in relation to macroclimatic conditions under the assumption of two peaks per annum. The following conditions were used as the parameters of morbidity: purulent inflammations of uterus, sterility, lesions of the female tract and sepsis, dystocia, retention of placenta, mastitis, foot diseases and lying down after parturition. No significant differences were found between the studied groups of animals. A statistically significant up to highly significant dependence was found between the health of the heifers and cows and macroclimatic conditions both in stables and on pasture; an increase in morbidity rate was recorded in spring and autumn.
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PMID:[Health status of cattle in relation to the time of year]. 641 43

Hydrocolpos is the result of vaginal obstruction and can become an emergency in the newborn period. The treatment of imperforate hymen is well defined, but the treatment of vaginal atresia is more complex. We encountered two cases of hydrocolpos secondary to distal vaginal atresia, that were operated on in the first days of life. One baby had distal atresia without persistance of urogenital sinus. Surgery combining abdominal perineal approaches and a posterior vaginoplasty was carried out. The second baby had hydrocolpos with persistance of urogenital sinus. Drainage through the sinus was unsuccessful because the baby developed sepsis by trapping urine in the uterus. Finally an abdominoperineal vaginal pull-through was successfully done. The embryology and literature are reviewed. The classification, indications and surgical technique are discussed.
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PMID:Hydrometrocolpos in neonate due to distal vaginal atresia. 650 18

Information from 2 recent books on the most common abortion techniques is presented. Menstrual aspiration can be performed up to 14 days after a missed period. A flexible plastic cannula 4-5 mm in diameter is passed through the cervix to the uterus, and the contents are evacuated using a syringe. Little dilatation is required and the procedure is done under local anesthesia. Aspiration through the 12th week is usually done under general anesthesia using a cannula and mechanical aspiration. A curette is used to assure that the abortion is complete. Local anesthesia is used in some places. From 12-16 weeks a combination of scraping and aspiration is used with general anesthesia and sometimes forceps. The uterine cervix requires greater dilatation. After 16 weeks the amniotic fluid is removed and a solution of salt and water is injected into the woman under local anesthesia. Contractions begin about 24 hours later. Labor may also be induced by oxytocin or prostaglandins which result in 8-15 hours of labor. This method of abortion probably causes the greatest amount of anxiety in the patient. Uterine scraping is described in the 2nd book as a procedure in which the cervix is progressively dilated with metal instruments of different sizes until it is sufficiently dilated to permit passage of the curette. Laminaria tents were previously placed in the cervix 24 hours prior to the abortion to achieve slow and progressive dilatation. General anesthesia is required because cervical dilatation is painful. In uterine aspiration the contents of the uterus are removed using tubes called Karmen cannulas. It is sometimes possible to avoid cervical dilatation by using thin cannulas, in which case general anesthesia may be avoided. After the aspiration the uterus may be scraped to assure the complete removal of the uterine contents. Prostaglandins may be used to initiate uterine contractions leading to expulsion of the uterine contents during the 2nd trimester of pregnancy. The procedure may cause significant side effects. Other procedures consist of injecting various substances into the uterine cavity during the 2nd trimester of pregnancy. Hysterotomy involves surgical opening of the abdomen and is analogous to cesarean section. Possible complications of an induced abortion include uterine perforation, bleeding, infection, and in extreme cases maternal death through sepsis. Medical attention should be sought in cases of hemorrhage, abdominal pain, fever, or general malaise after an induced abortion.
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PMID:[Literary but technical abortion]. 655 11

This paper presents data on perinatal and maternal deaths occurring in the Black Lion Hospital, Addis Ababa, in 1980. The data were collected by a research midwife. A total of 3936 infants were delivered to 3868 women during this period. The stillbirth rate was 52.6/1000; the perinatal mortality rate was 8.6/1000; and the maternal mortality rate was 7.8/1000. Of the 207 stillbirths 92 (44.5%) were unexplained, 66 (31.9%) were due to mechanical causes (e.g., ruptured uterus, cord prolapse, obstructed labor), 34 (26.4%) resulted from pregnancy complications (e.g., hemorrhage,hypertensive disease, congenital abnormalities), and 15 (7.3%) were due to intrapartum death. There was no obvious pathology in 38 of the 84 neonatal deaths. The remaining cases were due to conditions such as intrapartum asphyxia, antepartum hemorrhage, septicemia, and congenital abnormalities. 10 of these death involved preventable factors. Of the 30 maternal deaths, 13 were due to sepsis, 9 to hemorrhage, 4 to surgical conditions, 3 to medical conditions, and 1 to eclampsia. Inadequate monitoring of shocked patients and the nonavailability of blood tranfusions contributed to some of these deaths. Although socioeconomic and cultural factors play a role in perinatal and maternal mortality, coordinated maternity services could produce short-term improvements. Such maternity services should embrace both primary care, with an emphasis on the training of traditional birth attendants and health assistants, and high-risk hospital care. Good prenatal care and monitoring can identify women at high risk and ensure that they receive adequate medical supervision.
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PMID:Maternal and perinatal deaths in an Addis Ababa Hospital, 1980. 674 50


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