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

Local debridement, drainage, and diverting colostomy, with or without primary repair of the rectum, have been considered to be the standard treatment for most rectal injuries, but they are not sufficient for those patients sustaining uncontrollable bleeding or extensive rectal devascularization. This report assessed the indications and results of abdominoperineal resection of the rectum in these patients. Ten patients who were victims of explosive trauma presented with massive perineal injuries and extensive rectal devascularization. Six of these were treated with local debridement of necrotic tissue, pararectal drainage, antibiotics, and colostomy. Five of the six patients initially treated by colostomy died after operation from hemorrhage or sepsis. The sixth patients, who survived, had an abdominal resection of the rectum performed 5 days after the colostomy for removal of a gangrenous rectum. All five of those who underwent abdominoperineal resection survived (p less than 0.01). Increasing violence in the life patterns of modern society enhances the possibility of occurrence of this type of lesion, previously limited to military practice. The need for careful investigation of rectal viability is emphasized. Primary abdominoperineal resection of the rectum is advised when extensive devascularization has occurred.
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PMID:Abdominoperineal resection in the treatment of devascularizing rectal injuries. 88 96

Of a total of 1037 women of reproductive age who died during the period 1976-85 in the Matlab area that was under demographic surveillance, 387 (37%) were maternal deaths. The mean maternal mortality over the 10-year period was 5.5 per 1000 live births (101 per 100 000 women of reproductive age). Major causes of maternal death, which were assessed using a combination of record review and field interviews, included postpartum haemorrhage (20%), complications of abortion (18%), eclampsia (12%), violence and injuries (9%), concomitant medical causes (9%), postpartum sepsis (7%), and obstructed labour (6.5%). Deaths caused by postpartum haemorrhage were positively associated with both maternal age and parity, whereas those caused by eclampsia and injuries were more common among young and low-parity women. If maternal deaths arising from complications of abortion are disregarded, 20% of all maternal deaths occurred during pregnancy, 44% during labour and the two days following delivery, and 36% during the remaining postpartum period.These findings support the need to develop a service strategy to address the risks of childbearing and childbirth in areas such as rural Bangladesh, where almost all deliveries take place at home. This strategy must be based not only on preventive and educational interventions, including family planning and antenatal care, but also on systematic attendance at home deliveries by trained professional midwives, backed up by an effective chain of referral.
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PMID:Causes of maternal mortality in rural Bangladesh, 1976-85. 326 66

More than 300 head injuries per year are evaluated by the neurotrauma team at the Maryland Institute of Emergency Medicine. Although most of the injuries follow motor vehicle accidents, a significant number also follow industrial accidents or acts of personal violence. Approximately 25% of patients with serious head injuries have associated episodes of sepsis--commonly because of other bodily injuries. We have identified a syndrome characterized by encephalopathy and/or accentuation of focal neurological dysfunction in head injury patients that presents during episodes of sepsis and that occurs in the absence of meningitis. Aggressive fever management alone does not reverse the encephalopathy. Neurodiagnostic studies reveal no focal changes. The intracranial pressure often remains normal or unchanged, and no improvement is evident after the empirical administration of standard doses f steroid or osmotic agents. The patient's neurological condition returns to base line once the sepsis has been eradicated. Ongoing investigations suggest an immunological basis for this abnormality.
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PMID:Alterations in neurological function in head-injured patients experiencing major episodes of sepsis. 709 94

Predicting the future can be interesting but difficult, particularly because of the exciting developments in the science of injury, inflammation, sepsis, and shock. Considering what has happened between 1895-1995, it is difficult to contemplate what will happen in the next 100 years. Will change accelerate in the 21st century? So far, our scientific knowledge and capability have exceeded the ability to care for injured and operated patients. Much of the future will depend upon society's ability to control violence and prevent injury. Most of the factors resulting in death after injury are beyond the control of those caring for patients or those studying patient problems. Thus the major risk factors for death after trauma are injury severity, the age of the patient, the problems of shock, and end-stage organ injury. If we are to decrease mortality from injury, we must work to prevent injury and decrease the severity of injury while improving our capabilities to care for the injured. New rapid diagnostic procedures, immediate therapy at the scene of the injury, portable or flying resuscitative and therapeutic units, and better understanding of the need for the inflammatory response in contrast to the disaster produced by an overwhelming inflammatory response will help. The major hazard for predicting the future in the management of injured patients could be predicting that something cannot be done. We recognize now that almost anything can be done if we learn enough and understand the problems sufficiently well. The Shock Society is dedicated to that purpose.
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PMID:Trauma management in the 21st century. 859 28

This is a report of a retrospective study of 24 children managed for penetrating abdominal injury over 10 years, and it represents 34% of all abdominal injuries in children in that period. Falls onto sharp objects within and around the home were responsible for ten of the injuries, seven were injured by animal horns and four were sporting injuries. Violence and road traffic accidents were uncommon. Most patients (67%) had evisceration of omentum or intestine, and one of these was found at laparotomy to have a jejuno-jejunal intussusception. Seven children had injury to hollow viscera. There were three deaths, one each from overwhelming sepsis, tetanus and haemorrhage.
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PMID:Penetrating abdominal injuries in children in Nigeria. 1071 17

Some of the serious side effects of childbirth are described for women in the critical postpartum period in developing countries. These side effects include hemorrhage, anemia, nutrition deficits, infection, family violence, and emotional problems. The postpartum period applies to 42 days after delivery, and it is a time when the healing and return of the reproductive organs to their nonpregnant state occurs. During this time, women should receive extra rest, food, and supplementation. In developing countries, maternal mortality primarily occurs during the puerperium. A study in Bangladesh found that 60% of women die during the postpartum period compared to 20% during pregnancy. Women tend to ignore their health problems in general, and, after the birth of a child, there is a tendency to focus on the newborn. A study in the UK revealed that 50% of women with children have longterm maternal health problems related to childbirth. Most postpartum complications are due to hemorrhage and infection. Normal blood loss after delivery is about 150 ml with a range of 300 ml for heavy loss and 500 ml for postpartum hemorrhage. An Australian study showed that 17% lose 500 ml of blood during delivery, and 4% lose more than 1000 ml. Excessive blood loss is directly related to a risk of anemia, and anemic women are at the highest risk of maternal mortality. The physical condition of women is the most significant feature in determining the seriousness of blood loss. A moderate level of blood loss with anemia is dangerous. Anemia leads to chronic fatigue and increased susceptibility to infection. Assuring high nutritional intake (iron and calcium fortified diets) during the postpartum period counteracts anemia and provides calories for adequate milk production. Adequate nutrition during the pregnancy means storage of nutrients for the postpartum period. Some cultures prescribe food restrictions which can impact deleteriously on women's health. Complications or prolonged delivery often lead to sepsis or infection. Infections may occur with improperly healing of tears. Violence against women can occur due to a stillbirth or failure to produce a male heir. Little is known about maternal stress and depression among postpartum women in developing countries.
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PMID:Postpartum care is crucial for health and survival. 1234 57

Tanzania's health policy is to improve the health of all Tanzanians with a focus on those most at risk. One of the major objectives is to reduce infant and maternal morbidity and mortality and increase life expectancy. The life expectancy in Tanzania is 49 years for males and 53 years for females. Maternal mortality is recorded at 300-400 deaths per 100,000 women. The main causes are haemorrhage, sepsis, rupture of the uterus, anaemia, and others. The risk factors associated with the above causes include maternal height, age, child spacing, and number of births per woman; malaria and anaemia; imbalance of energy and food intake; HIV/AIDS; women's workload; and female genital mutilation (FGM). To address issues of women's health, the government has put in place many strategies, for example, a ministry to look after women's issues, the safe motherhood initiatives, improvement of the knowledge and skill of health care providers, as well as collaboration with nongovernmental organizations (NGOs) and private agencies. The health sector reform is important because it has negatively affected women's access to health care. To improve the health of women in Tanzania, health and health-related sectors should cooperate and collaborate in order to empower women in the areas of education, social status, and technology. Policies must also address poverty, nutrition, adolescent health, and violence and sexual abuse.
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PMID:Major factors that impact on women's health in Tanzania: the way forward. 1295 70

Alcohol abuse and dependence, referred to as alcohol-use disorders (AUDs), affect 76.3 million people worldwide and account for 1.8 million deaths per year. AUDs affect 18.3 million Americans (7.3% of the population), and up to 40% of hospitalized patients have AUDs. This review discusses the development and progression of critical illness in patients with AUDs. In contrast to acute intoxication, AUDs have been linked to increased severity of illness in a number of studies. In particular, surgical patients with AUDs experience higher rates of postoperative hemorrhage, cardiac complications, sepsis, and need for repeat surgery. Outcomes from trauma are worse for patients with chronic alcohol abuse, whereas burn patients who are acutely intoxicated may not have worse outcomes. AUDs are linked to not only a higher likelihood of community-acquired pneumonia and sepsis but also a higher severity of illness and higher rates of nosocomial pneumonia and sepsis. The management of sedation in patients with AUDs may be particularly challenging because of the increased need for sedatives and opioids and the difficulty in diagnosing withdrawal syndrome. The health-care provider also must be watchful for the development of dangerous agitation and violence, as these problems are not uncommonly seen in hospital ICUs. Despite studies showing that up to 40% of hospitalized patients have AUDs, relatively few guidelines exist on the specific management of the critically ill patient with AUDs. AUDs are underdiagnosed, and a first step to improving patient outcomes may lie in systematically and accurately identifying AUDs.
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PMID:Alcohol-use disorders in the critically ill patient. 2092 4

Accidents or violence can result in penetrating trauma in the adult population. Contaminated penetrating foreign bodies introduced at the time of wounding cause infection, especially high velocity projectiles, which result in cavitation. Surgical debridement reduces potential infection; however, perioperative antibiotics are usually indicated owing to studies demonstrating high rates of sepsis in the pre-antibiotic era. Trauma-associated pathogens include Gram-positive, Gram-negative and anaerobic pathogens. Antibiotic resistance is increasing, and several recent panels have sought to develop guidelines for perioperative prevention and empiric treatment of infection to limit usage and reduce selective pressure for resistance. We review infections of the CNS, thorax, abdomen and extremities following penetrating trauma injury, as well as the data supporting a reasonable antimicrobial approach.
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PMID:Prophylaxis and treatment of infections associated with penetrating traumatic injury. 2117 80

In this diverse issue, we have a report on the high cost of diabetes quality improvement programs. Two studies using health information technology, including one that embedded a questionnaire and tool for bipolar disorder into an electronic health record to improve diagnosis, and another that collected information about anxiety and depression for adolescents with a personal digital assistant. Other articles considered sources of disparities in screening for colorectal cancer in rural Georgia, and the characteristics of sepsis in HIV patients. Clinicians will likely find interesting how patients interpret and report provider reactions to interpersonal violence situations. We also have a review of the symptoms patients report in a community practice sample; breast cancer survivors' perspectives on acupuncture for treating hot flashes; clinical reviews about Alzheimer disease and prasugrel; and several interesting brief case reports.
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PMID:Focus on clinical practice: improving the quality of care. 2257 Mar 85


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