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

During August 1989-August 1994 at the referral-based obstetric practice of MacKay Memorial Hospital in Taipei, Taiwan, obstetricians saw 8 pregnant women with acute pancreatitis. All but 1 patient had gallstones and/or hyperlipidemia. None had ever been diagnosed with pancreatitis or gallstones in the past. None suffered from alcoholism. One woman was lost to follow-up at 33 weeks gestation. No pregnant woman died. Magnesium sulfate and nifedipine controlled preterm labor in 2 patients. Two women underwent cesarean section (fetal distress and elective). Pancreatitis struck all but 1 during the 3rd trimester of pregnancy. One woman presented at 23 weeks gestation with loss of consciousness, abnormally low volume of circulating plasma in the body, upper gastrointestinal bleeding, and a dead fetus. She also had diabetes mellitus which had gone untreated for 2 years. After spontaneous delivery of the dead fetus, she developed metabolic encephalopathy, sepsis, respiratory distress, and acute renal failure. She completely recovered and left the hospital 62 days after arriving. Physicians instituted conservative treatment for pancreatitis and a fat-restricted diet for hyperlipidemia. Labor was induced in 3 women after determining fetal lung maturity. Pancreatitis symptoms diminished after delivery. At 2 weeks postpartum, they underwent cholecystectomy. In fact, all but 3 women underwent cholecystectomy. Five patients had a fever greater than 38 degrees Celsius upon admission. Three patients were jaundiced. All 8 patients experienced nausea and/or vomiting and abdominal pain. Six women had low serum calcium levels. Only 1 had a serum lactic dehydrogenase level above 350 IU/L. Primiparous women were just as likely to develop pancreatitis during pregnancy as multiparous women. These findings suggest that early diagnosis and prompt treatment of acute pancreatitis are essential to a favorable outcome.
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PMID:Acute pancreatitis in pregnancy. 766 Jul 65

Septic encephalopathy is an early manifestation of sepsis. Changes in consciousness, focal or generalized seizures, multifocal myoclonus and/or varying hemiparesis are common clinical findings. All of these symptoms are reversible when sepsis has been successfully treated. Because there are no generally accepted criteria for the diagnosis of septic encephalopathy, it is a diagnosis of exclusion. We report the case of a 68-year-old patient who developed septic encephalopathy secondary to diarrhea and E. coli sepsis. In this case, symptoms of septic encephalopathy were fully reversed after the patient's E. coli sepsis had been adequately treated.
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PMID:[Diarrhea, coli infection, septic encephalopathy: escalation of a seemingly banal symptom]. 772 73

The TIPS (transjugular intrahepatic portosystemic shunt) procedure is a relatively new therapeutic treatment option for variceal bleeding secondary to portal hypertension. The TIPS procedure evolved in response to the need for a safe, nonoperative shunting procedure, and is becoming a practical alternative to surgically placed shunts. Possible complications of a TIPS include hemorrhage, postprocedure sepsis, shunt encephalopathy or decompensation. Development of shunt stenosis or occlusion is associated with re-bleeding. Three children (ages 10-13) with recurrent, significant variceal bleeding were referred for the TIPS procedure. Two had recurrent GI hemorrhage despite sclerotherapy. To date, all have maintained shunt patency for up to 1 year. None of these children have had significant re-bleeding episodes, and the only recurrence of varices was associated with an obstructed shunt. In this article, the author reviews both conventional treatment and the TIPS procedure for the child with bleeding varices. Nursing implications from a pediatric perspective are emphasized. Pediatric GI nurses must understand TIPS in order to prepare the child and family and to monitor for complications or shunt failure afterward.
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PMID:Transjugular intrahepatic portosystemic shunt (TIPS): a pediatric perspective. 785 7

With increasing survival rates from acute medical or surgical emergencies a new form of peripheral neuropathy, CIP, has been recognized. CIP can be seen only in patients who are considered to be critically ill; therefore, it invariably occurs in the ICU. Typically, initial symptoms begin with transient (hours to a few days) septic encephalopathy followed by generalized weakness, manifested in weaning failure, limb weakness and hyporeflexia. Diagnosis is confirmed by an EMG. CIP should be considered in any elderly patient with sepsis and prolonged respiratory muscle weakness. Prognosis is poor in severe cases, in which the EMG also shows severe axonal degeneration. In milder forms, fair to good recovery is expected within weeks. Management includes treatment of sepsis, normalization of failing organ function, physical therapy and proper nutrition.
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PMID:Acquired respiratory failure in critically ill patients. 786 Sep 77

We assessed the long-term efficacy of transjugular intrahepatic portasystemic stent-shunt (TIPSS) in 64 patients. Insertion was successful in 56 patients (87.5%). The reasons for its use were: variceal bleeding (49); ascites (6); portal hypertensive gastropathy (6); hypersplenism (2); and embolization of a spontaneous shunt (1). Fourteen patients were Childs A, 20 Childs B and 28 Childs C cirrhotics. Two patients were non-cirrhotic; one with amyloidosis and one with non-cirrhotic portal fibrosis. Patients were followed clinically and radiologically (Doppler ultrasonography and routine portography at 6 months). During 33 patient-years of follow-up, 22 died, 12 during index admission (two were procedure-related) and nine were transplanted. Twenty-five patients are alive, with a mean survival of 7.1 (SD 7) months. Variceal rebleeding occurred in 10 patients (22.7%), one of whom died, and was always associated with shunt insufficiency (shunt thrombosis 2, hepatic vein stenosis (HVS) 1, intimal hyperplasia (IH) 4, dislocated stent 1, inadequate stent 2). Clinical encephalopathy was induced in seven patients (17.1%) following TIPSS. All responded to medical therapy, but two required reduction in shunt size. Ascites improved after TIPSS in 36 patients (87.8%), but reaccumulated in seven (17.5%), associated with shunt dysfunction in five (SBP 2, IH 3, HVS 2). Fatal sepsis occurred in two patients, and 14 other episodes of infection required antibiotics. TIPSS is a useful treatment for variceal bleeding, resistant ascites and portal hypertensive gastropathy. Shunt dysfunction and sepsis occur frequently, and regular surveillance is necessary.
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PMID:Transjugular intrahepatic portosystemic stent-shunt (TIPSS): long-term follow-up. 795 6

We report a case of spontaneous peritonitis due to Candida albicans, in a diabetic patient with alcoholic liver cirrhosis, ascites, gastrointestinal bleeding from esophageal varices, sepsis, renal failure and encephalopathy. These factors, added to prolonged antibiotic therapy and instrumental manipulations, could have resulted in the colonization by Candida, usually described in secondary peritonitis, but perhaps underdiagnosed in cirrhotic patients with spontaneous peritonitis and severe multiorgan failure.
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PMID:[Ascitic peritonitis due to Candida albicans]. 798 5

Renal failure occurs commonly in children with shock, coagulopathy and multi-organ failure. Successful management of these patients requires not only management of the renal failure, but recognition and treatment of the underlying process. In addition to common and well-recognised causes of renal failure and shock, such as Gram-negative sepsis, there are a number of syndromes which are either less well recognised or confined to specific geographic locations. This article reviews the clinical and epidemiological features of the syndromes with shock and renal failure, focusing on the more recently recognised syndromes such as staphylococcal and streptococcal toxic shock syndrome, haemorrhagic shock and encephalopathy syndrome and viral haemorrhagic fevers.
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PMID:Syndromes with renal failure and shock. 801 5

While orthotopic liver transplantation (OLT) has become the treatment of choice for most irreversible end-stage liver diseases, its role in patients with hepatitis B (HBV) infection is controversial. A high risk of reinfection of the transplanted graft, associated with significant morbidity and mortality, has been reported. Although passive and active immunization can delay reappearance of the virus in the allograft, there is not yet an effective therapy for recurrent HBV infection in liver transplant recipients. Between October 1985 and March 25, 1991, 28 OLT in 25 patients with acute and chronic HBV infections were performed. Twelve of the patients were HBV DNA-negative, six were HBV DNA-positive, and seven were not tested prior to transplantation. Only the 19 patients surviving more than 100 days after transplantation were considered to have sufficient duration of follow-up (mean 734 days; range 500-1545) to include in analysis of recurrence. Five (26%) were free of recurrent disease at the time of last follow-up (mean 1031 days, range 526 to 1770 days. Recurrent HBV in the allograft, as defined by positive immunoperoxidase stains of biopsy sections for viral antigens, was detected in 74% (13 male, 1 female; 7 Asian, 7 white) at a mean of 134 days posttransplantation. Histological changes of viral hepatitis, first appearing an average of 157 days (range 95-326) posttransplantation, were evident in 13 of 14 with positive immunostaining. Twelve of the 14 patients were treated, on an open trial basis, with intravenous and oral prostaglandin E (PGE) because of deteriorating clinical condition. Eleven of the twelve responded to PGE with an initial drop in serum transaminases, improvement in coagulopathy and resolution of encephalopathy. One patient failed to respond and died of a myocardial infarction within 9 days of institution of therapy. Three of the eleven patients with an initial response relapsed and died in liver failure as a direct result of recurrent HBV after 13, 16, and 37 days of treatment in association with generalized sepsis. Eight of the 12 patients (67%) had a sustained favorable response to PGE therapy (mean follow-up 737 days, range 403-1545). All patients with a sustained response had accompanying improvement in histology and reduction in viral antigen staining in hepatocytes. Treatment with PGE appeared to be of benefit in recurrent HBV infection of the transplanted liver with an initial response rate of 92% and a sustained response rate of 67%.
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PMID:Prostaglandin E in the treatment of recurrent hepatitis B infection after orthotopic liver transplantation. 804 36

From 1977 till 1991, the diagnosis of systemic lupus erythematosus was made on 137 children aged 18 years or under in Chang Gung Memorial Hospital. The medical records were reviewed and the clinical data were analysed with emphasis on the morbidity and mortality of this disease. The clinical and laboratory characteristics were similar to the findings from most other reports. Renal failure accounted for 8% of the initial presentation. The non-infectious complications were, in the order of frequencies, hypertension, avascular necrosis of femoral head, cataract, encephalopathy, and venous thrombosis. Sepsis, cutaneous infection and urinary tract infection were the frequently encountered infectious complications. The major causes of death in childhood onset systemic lupus erythematosus were sepsis (42%) and renal failure (30.7%). Forty patients were lost to follow-up. The 5-year survival rate, calculated by life-table, was 76.3%.
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PMID:The morbidity and mortality associated with childhood onset systemic lupus erythematosus. 806 33

To study the molecular basis of ammonia toxicity, highly reproducible models of acute liver failure and acute hyperammonemia in the rabbit were developed. Acute liver failure was induced by two-stage liver devascularization, and acute hyperammonemia by prolonged ammonia infusion such that the plasma ammonia pattern found in acute liver failure was simulated. Clinical symptoms, spectral analysis of the EEG, biochemistry (blood gases, renal function, electrolytes and markers of hepatic injury) and the presence of cerebral edema were studied. During acute liver failure severe encephalopathy developed after 10.2 +/- 1.9 h (n = 6, mean +/- SEM). Other liver-failure-associated abnormalities were cerebral edema, lactic acidosis, renal dysfunction, hypothermia and septicemia. During acute hyperammonemia, severe encephalopathy developed after 18.2 +/- 0.4 h (n = 6, mean +/- SEM). Other abnormalities found were cerebral edema and lactic acidosis. In both animal models comparable EEG changes were observed (a decrease in mean dominant frequency and theta-activity, and an increase in delta activity). However, these changes were not statistically significant, and non-specific as they also occurred in control rabbits despite their clinical wellbeing. This study demonstrates in the rabbit the similarity between encephalopathy due to acute ischemic liver failure and that due to hyperammonemia. An observed difference in hyperammonemia-induced encephalopathy was pronounced ataxia, which did not occur during acute liver failure, whereas hypothermia, sepsis and renal failure occurred exclusively in acute liver failure. Our models appear satisfactory for the study of hepatic encephalopathy and ammonia toxicity.
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PMID:Encephalopathy from acute liver failure and from acute hyperammonemia in the rabbit. A clinical and biochemical study. 817 26


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