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)

Pregnancy used to be considered a contraindication for endoscopic surgery of the digestive tract. We report a case of cholecystectomy carried out laparoscopically for complicated gall stones in a woman who was 14 weeks pregnant. There was no post-operative maternal or fetal morbidity. The mother carried on the pregnancy to term normally and gave birth to a normal infant. The same results have been reported in the literature for three other cases of cholecystectomy and six of appendicectomy. The sole technical precautions that had to be undertaken were in introducing and placing the trocars, taking into account the size of the uterus. There has been no scientific proof that CO2 is toxic for the fetus. Clinical practice shows that endoscopic surgery is possible without any obstetrical risk including thrombo-emboli, nor specific sepsis occurring in any of the three trimesters of pregnancy. The advantages of the endoscopic approach are that there is less post-operative pain and therefore less need to take analgesics. There are no complications because of an abdominal wound and the patient can both feed and walk about immediately after the operation with a reduction of the time spent in hospital. There is probably less risk of aborting when compared with classical laparotomy. The endoscopic route can be chosen when surgery is needed in the digestive tract during pregnancy.
 ...
PMID:[Endoscopic surgery during pregnancy. A case report of cholecystectomy]. 834 56

This randomised controlled trial of 357 patients who had had an incomplete abortion compared suction curettage with conventional curettage for evacuation of the uterus. The 179 patients undergoing suction curettage had a significantly lower intra-operative blood loss (P < 0.0001) and a significantly higher mean haemoglobin level at follow-up compared with the 178 patients who had conventional curettage. Suction curettage was a faster procedure and less painful. No difference was found between the two groups with regard to the incidence of post-abortal sepsis, or the re-evacuation rate. No problems were encountered with the use of suction curettage in the presence of uterine sepsis. In an era where blood transfusions should be kept to an absolute minimum, suction curettage will help to save blood in several ways.
 ...
PMID:Suction v. conventional curettage in incomplete abortion. A randomised controlled trial. 828 Feb 70

We report a rare case of non-menstrual toxic shock syndrome (TSS) in the course of Staphylococcus aureus sepsis in a 31-year-old primigravida who developed high fever and severe pulmonary and cardiovascular failure within a few hours at the end of the 29th week of a twin pregnancy. Mechanical ventilation was necessary due to signs of adult respiratory distress syndrome (ARDS) and catecholamines were needed to maintain a somewhat adequate blood pressure. A forceps delivery was performed immediately. Postoperatively, the patient was brought to the intensive care unit (ICU) due to the suspicion of severe septic shock. In addition to the extreme cardiovascular instability and massive disturbance of pulmonary gas exchange, the clinical picture was characterised by a disseminated intravascular coagulopathy (DIC) with marked petechial bleeding and ecchymoses on all extremities. Moreover, a confluent, spotty exanthem of the trunk and extremities could be seen. Despite all therapeutic efforts, the patient died within a few hours after admission to the ICU with signs of multiorgan failure. Post-mortem, multiple staphylococcal abscesses were found in the kidneys, liver, and uterus. Moreover, acute ulcerous endocarditis of the mitral valve and septic myocardial foci with myocarditis were seen. The Staph. aureus strain isolated from the blood cultures was shown to produce TSS toxin 1 (TSST-1) and enterotoxin B. In summary, the clinical picture can be interpreted as severe staphylococcal sepsis complicated by TSS. TSS is a specific type of infectious disease, occurring mainly in young women during the menstrual period (80%-90%), but it has also been reported in non-menstrual cases (10%-20%). It is characterised by sudden-onset high fever, hypotension, rash, mucosal hyperaemia, and various additional symptoms such as myalgia, vomiting, and diarrhoea. The clinical course depends on the extent of the organ failure due to decreased tissue perfusion during hypotension. Severe cases are accompanied by multiple organ-system failure including impaired renal function, which is reversible in nearly all cases. Respiratory failure ranges from interstitial and alveolar aedema to ARDS in 10% of cases; severe DIC is seen in 10%-15%. Another severe clinical complication is cardiac insufficiency. The etiology of TSS is based on a localized or, rarely, systemic infection with certain Staph. aureus strains that are capable of producing toxins, the most important one being TSST-1. Staph. aureus strains can also produce various other enterotoxins that may be involved in the pathogenesis of TSS. The pathogenetic importance of the toxins is supported by the antibody titers in TSS patients: more than 80% of healthy adults show high levels of antibody titers, whereas 90% of TSS patients exhibit low levels in the acute phase followed by a significant increase during convalescence. It is not clear whether the toxins cause TSS by a direct effect or by release of mediators due to their function as superantigens. The clinical characteristics of non-menstrual TSS are identical to those of menstrual TSS, but it can occur in many clinical settings in both sexes at any age. Severe clinical courses are more frequent in non-menstrual TSS: the mortality is about 8%-11% in non-menstrual TSS compared to 2%-5% in menstrual TSS. The diagnosis is based mainly on clinical signs and the isolation of toxin-producing Staph. aureus strains. Besides antibiotic therapy, treatment is primarily directed to the correction of hypotension and additional organ-system failure. Other therapeutic measures such as the elimination of toxins by plasma separation or the administration of antibodies or gamma-globulins are subjects of investigation with no general recommendations at this time.
 ...
PMID:[Lethal, non-menstrual toxic shock syndrome associated with Staphylococcus aureus sepsis]. 859 62

This is a Phase II groupwide study of the Gynecologic Oncology Group (GOG) to determine the toxicity and efficacy of a combination of ifosfamide and doxorubicin in patients with advanced or metastatic leiomyosarcomas of the uterus who had not received other chemotherapy. Thirty-five women were entered into this study; 1 patient was ineligible (primary not documented), leaving 34 patients treated with ifosfamide, 5.0 g/m2/24 hr, and mesna, 6.0 g/m2/36 hr, by continuous IV infusion preceded by doxorubicin, 50 mg/m2 iv over 15 min. Each course of therapy was repeated every 3 weeks if counts allowed. One patient was inevaluable for response, leaving 34 evaluable for toxicity and 33 evaluable for response of chemotherapy. GOG grade 3 or 4 granulocytopenia occurred in 17 patients (48.6%), 2 patients developed granulocytopenic fever (5.7%), and 1 died of sepsis. Two patients developed grade 3 thrombocytopenia, and 1 died of cardiotoxicity. There were nine partial and one complete responses for an overall response rate of 30.3%; the response duration averaged 4 months. The combination of ifosfamide and doxorubicin is toxic but has moderate activity in patients with advanced or metastatic leiomyosarcoma of the uterus.
 ...
PMID:Ifosfamide and doxorubicin in the treatment of advanced leiomyosarcomas of the uterus: a Gynecologic Oncology Group study. 875 54

Between the 1st July 1990 and the 30th June 1995, 34 caesarean hysterectomies and 2708 (22%) caesarean sections were performed from 12,227 births on the I. Department of Obstetrics and Gynaecology Semmelweis University Medical School in Budapest. From all 34 cases, hysterectomy were performed in 9 cases (26%) after complicated delivery, in other 9 cases (26%) during elective caesarean section and in 16 cases (47%) during urgent caesarean section. The incidence of caesarean hysterectomy is 2.7/1000 labour in our study. We listed the placenta increta, placenta accreta, placenta adherens, placenta praevia, uteroplacental apoplexia, scar disruption, uterus rupture, atony, sepsis puerperalis, abruptio placentae, haematoma paravaginale as urgent indications and so elective indications were myoma uteri, cervical carcinoma, ovarial tumour and in-situ cervical carcinoma. We collect the elective and urgent indications of caesarean hysterectomy and summarize the possible operative and postoperative complications in our study.
 ...
PMID:[Postpartum hysterectomy]. 875 6

A two and a half year review of 39 peripartum hysterectomies done at Ga-Rankuwa Hospital from 1 January 1993 to 30 June 1995 was conducted. There were a total of 21,108 deliveries, 4,894 (23.19 pc) of which were caesarean deliveries. The ages of the patients ranged from 17 to 46 years and parity from 0 to 9. A large number, 31 (79.5 pc) of the patients were unbooked. The commonest indications were ruptured uterus 14 (35.9 pc) puerperal sepsis 13 (33.3 pc) and post partum haemorrhage four (10.3 pc). The complications included wound dihescence, sepsis, bladder injury, ureteral injury and two deaths occurred.
 ...
PMID:Peripartum hysterectomy at Ga-Rankuwa Hospital: a two and a half year review. 886 82

The management of a pregnancy complicated by uterus myomatosus remains being controversially discussed. Myomectomy early in pregnancy is opposed by exspectative management with myomectomy subsequent to the post partum period. Therapeutic abortion and exstirpation of the gravid uterus represent only hypothetical but not reasonable alternatives. Complications like ureteral obstruction, sepsis, and torsion of the uterus with subperimetrial bleeding as a cause of fever of unknown origin may occur. Rapid growth of a fibromatous uterus in pregnancy may call for a biopsy. Two cases are presented to demonstrate that with intensive pregnancy surveillance exspectative management is justified and may lead to successful confinement of the pregnancy.
 ...
PMID:[Pregnancy and extreme myomatous uterus--conservative management]. 899 21

In the relatively long history of man, surgery has been a comparatively recent development; the abdomen was first deliberately opened to remove an ovarian cyst by Ephraim McDowell in Kentucky in 1809. The first abdominal hysterectomy was performed by Charles Clay in Manchester, England in 1843; unfortunately the diagnosis was wrong and the patient died in the immediate post-operative period. The following year, Charles Clay was almost the first to claim a surviving patient, however she died post-operatively and it was not until 1853 that Ellis Burnham from Lowell, Massachusetts achieved the first successful abdominal hysterectomy although again the diagnosis was wrong. Vaginal hysterectomy dates back to ancient times. The procedure was performed by Soranus of Ephesus 120 years after the birth of Christ, and the many reports of its use in the middle ages were nearly always for the extirpation of an inverted uterus and the patients rarely survived. The early hysterectomies were fraught with hazard and the patients usually died of haemorrhage, peritonitis, and exhaustion. Early procedures were performed without anaesthesia with a mortality of about 70%, mainly due to sepsis from leaving a long ligature to encourage the drainage of pus. Thomas Keith from Scotland realized the danger of this practice and merely cauterized the cervical stump and allowed it to fall internally, thereby bringing the mortality down to about 8%. Hysterectomy became safer with the introduction of anaesthesia, antibiotics and antisepsis, blood transfusions and intravenous therapy. During the 1930s, Richardson introduced the total abdominal hysterectomy to avoid serosanguineous discharge from the cervical remnant and the risk of cervical carcinoma developing in the stump. Apart from this innovation, and the transverse incision introduced by Johanns Pfannenstiel in the 1920s, there was little advance in hysterectomy techniques until the advent of endoscopic surgery and the performance of the first laparoscopic hysterectomy by Harry Reich in Kingston, Pennsylvania in 1988. The refinement and increasing safety of laparoscopic hysterectomy suggests that it will be used increasingly in the future, although developments in pharmacology and photodynamic therapy and interventional radiology may reduce the traditional indications for the operation.
 ...
PMID:Hysterectomy: a historical perspective. 915 33

Disseminated intravascular coagulation is the result of a severe underlying disorder that initiates massive activation of the coagulation system. It is always a symptom of the underlying disorder. These disorders may be as varied as meningococcemia and abdominal aortic aneurysm. Disseminated intravascular coagulation is a clinical diagnosis. Once the clinical impression has been considered, a small number of readily available tests will substantiate the diagnosis. Further testing is probably not necessary and certainly not cost-effective. Therapy for disseminated intravascular coagulation requires 1) the correction of the underlying problem, either by drainage of an abscess for sepsis, evacuation of the uterus in an obstetric catastrophe, or treatment of septicemia with antibiotics; and 2) the concomitant restoration of the circulatory system, perfusion, blood pressure, and electrolyte balance. Other forms of therapy are available but are quite secondary to these two. Success depends on the ability to recognize and correct the cause.
 ...
PMID:Disseminated intravascular coagulation. 937 26

This study assessed the nature and extent of maternal mortality (MM) among a cohort of pregnant women in urban Bamako, Mali. Data were obtained from a sample of 5782 pregnant women identified during March 1989 and September 1992. Interviews were conducted at 6 weeks and 1 year after delivery. Other clinical information was collected from households and medical records in 1993. By 1994, 4717 women had been traced. Over 95% of the sample were married and Muslim. About 16% were primiparous. Over 25% had 4 or more children. Most women had some contact with local health centers during pregnancy. Only 10% delivered at home. 24-55% delivered in maternity units that were different from their source of prenatal care. 4580 had live births; 198 had late abortions or stillbirths. The MM ratio was 327/100,000 (15 deaths). The lifetime risk of maternal death was 2.7%. Inclusion of the 5 late maternal deaths raised the MM ratio to 436/100,000. 13 deaths were due to direct causes. 7 deaths were due to hemorrhage, including 1 abortion and 2 cases of ruptured uterus. 4 were due to hypertensive disorders during pregnancy. 3 died from sepsis after cesarean section, including 2 cases of obstructed labor. 6 women delivered and died at a national teaching hospital. 5 were delivered at a district maternity hospital and died at the referred national teaching hospital. 3 died at home.
 ...
PMID:Assessment of maternal mortality and late maternal mortality among a cohort of pregnant women in Bamako, Mali. 1042 61


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