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

Orthotopic liver transplantation (OLT) is a life-saving procedure for end-stage liver failure. We reviewed 39 children (24 girls, 15 boys) who received OLT for biliary atresia from 1987 to 1991. Twenty had unsuccessful portoenterostomy, 6 were referred too late for a drainage operation, and the remaining 13 achieved bile drainage but developed portal hypertension. At transplant 37 had decompensated liver disease with varices (28), ascites (24), encephalopathy (17), and gastrointestinal bleeding (12). The median weight and age at transplant were 8 kg and 12.6 months, respectively. The median waiting time was 65 days. Forty-eight grafts (30 reduced and 18 whole) were performed; graft loss was 33% and 27%, respectively. Of the 30 segmental grafts, 15 were reduced conserving the left lateral segment and hepatic vein (Brisbane technique)--13 were from the left lobe and 2 from the right lobe. The overall subject survival rate is 72%. Eleven deaths occurred: primary nonfunction (3), sepsis (3), perioperative bleed (3), and other causes (2). Early complications included: hepatic artery thrombosis (5), hepatic vein thrombosis (2), bowel perforation (3), biliary leak (3), and acute rejection (8). Later complications were chronic rejection (4) and biliary stricture requiring reconstruction (3). Follow-up at 12 months confirms good quality of life for both child and family with catch up growth and normal development. Technical advances in reduction hepatectomy have allowed us to treat small babies under 1 year with an urgent requirement for OLT, with comparable results to those obtained with whole grafts. In conclusion, in the future size and age need not be a contraindication to OLT in children with biliary atresia.
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PMID:Liver transplantation in babies and children with extrahepatic biliary atresia. 822 94

We studied retrospectively the clinical records of 291 hospital patients with liver cirrhosis, 95% of which was alcohol related. Within this group, 114 patients presented 155 episodes of infection in 144 separate hospital admissions. In a previous communication, we pointed out that although infection was the fourth cause of admission, it was the main cause of death in this group. The main incidence of infection was among the female group. The most common infections episodes were respiratory and bacterial spontaneous peritonitis (BSP). On admission, 57% of the patients were diagnosed as belonging to the C Child group; 38% presented sepsis and 22% were hospitalary infections. The most frequent infections were respiratory and BSP. We obtained bacteriologic documentation in 55% of the episodes with prevalence of Gram negative bacilli (E. coli), with high relative frequency of neumoccocus. The most frequent complications were related to hepatic insufficiency. Global death rate was 27.1%, while nosocomial death rates were 42.1% and 40.9% for patients with Child C. We observed the highest incidence of mortality in patients with SBP and non localized bacteriemia. Survival rates were 42% for 2 years and 18% for 5 years. In summary, we stress the relevancy of checking the presence of infection systematically in every cirrhotic patient with encephalopathy and/or renal insufficiency without justifiable cause.
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PMID:[Infections during the hospitalization of patients with liver cirrhosis]. 829 12

The case histories of two patients with sickle cell disease and gram negative sepsis complicated by encephalopathy and hypertension is presented. The first patient had 2 episodes of "hypertensive encephalopathy" before control of her blood pressure was achieved while the second patient had only one. The occurrence, though apparently rare, can have serious implications. Possible mechanisms are discussed and the need to monitor the blood pressure of children with sickle cell disease is stressed.
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PMID:Acute encephalopathy, hypertension and gram negative sepsis in sickle cell disease. 831 20

Indications for liver transplant in acute fulminating hepatitis (AFH) are predominantly affected by the high mortality of this spontaneous evolution (80-100%). At present patients with AFH have priority for transplant since they form part of the 0 emergency group according to the National Transplant Organisation. During the period between 1986 and the end of February 1992, a total of 254 liver transplants were performed in 202 patients (52 retransplants). In 26 patients (12.8%) (16 females and 10 males) the indication was fulminating acute hepatitis. Etiology was unknown in 20 patients, secondary to hepatitis B in 4 and to hepatitis A in 1, and was caused by isonazide ingestion in 1 case. The age limits were 3-60 years (X = 31.5 years). An isogroup graft was performed in 16 patients (61.5%), compatible in 3 (11.6%) and incompatible in 7 (26.9%). Due to anthropometric differences, a partial graft was used in 7 patients (26.9%); in 2 of the latter the graft was taken from the same donor ("split-liver"). Placement was always orthotopic with resection of the retrohepatic vena cava in 25 patients and its preservation in 1 (left lobe of split-liver). Peroperative (30 days) mortality was 23% (6/26); 2 due to cerebral death, 2 due to sepsis, 1 due to multisystemic insufficiency (MSI) and 1 due to acute pancreatitis. Four patients (15.3%) died some time after transplant; 1 after 5 months due to broncho-pulmonary complications, 1 after 7 months due to subacute hepatitis, 1 after 3 months due to respiratory failure and the last after 5 months due to anoxic encephalopathy and lung infection. Ten patients (39.4%) were re-transplanted; 4 following chronic rejection, 4 due to primary graft no function, 1 due to arterial thrombosis and 1 due to recurrent hepatitis (with cirrhosis). Two of the latter patients died intraoperatively due to coagulopathy and hemorrhage, and 3 following surgery (1 due to sepsis, 1 due to respiratory complications and 1 due to respiratory insufficiency). Two patients underwent a second re-transplant (1 due to chronic rejection and 1 due to recurrent hepatitis) and of these 1 died peroperatively due to sepsis and MSF. Overall mortality was therefore 61.5% (16/26) and the actuarial survival rate of 17 patients (10 living + 7 postoperative deaths) was 68% at 12 months and 52.9% at 36 months. Even if peroperative mortality is relatively high, liver transplant is currently the elective treatment for fulminating acute hepatitis.
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PMID:[The treatment of acute liver failure due to fulminating hepatitis by total or partial orthotopic liver transplantation. The clinical results]. 832 33

Encephalopathy and polyneuropathy occur in 70% of septic patients. The encephalopathy is diffuse, appears early, is often severe, but reverses quickly with successful treatment of the sepsis. The electroencephalogram is a sensitive indicator of the incidence and severity of the encephalopathy, but computed tomograms of the brain and cerebrospinal fluid findings are unremarkable. Critical-illness polyneuropathy develops later and in association with multiple-organ failure. Recovery is more gradual. Difficulty in weaning from the ventilator is an important early manifestation. Electromyography should be routinely performed to establish the diagnosis. The polyneuropathy is a primary axonal degeneration, predominantly of distal motor fibers. A persistent deficit may eventuate in severe cases. Whether muscle is affected as consistently as brain and peripheral nerve, and by the same process, has not been determined. Medications used in critical care units, notably sedatives and neuromuscular blocking agents, often confuse the clinical picture. The neurological pathophysiology is unknown but current evidence suggests that nervous system dysfunction arises through the same mechanisms as for systemic organs in the septic syndrome.
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PMID:The neurological complications of sepsis. 838 91

Three patients with stage 4 neuroblastoma were treated with a schedule comprising alternating modules of myelosuppressive (ifosfamide, etoposide, doxorubicin) and less myelosuppressive (vincristine, cisplatin) drugs given every 10 days regardless of the neutrophil count. A partial response was seen in two patients, and a very good partial response, in one patient. Extensive blood-component support was required. Non-haemopoietic toxicity was severe and led to treatment delays in two patients. Ifosfamide-related encephalopathy was seen in one patient and nephrotoxicity, in two patients. Mucositis was severe in two patients, may have contributed to the high rate of sepsis observed, and precluded the use of doxorubicin in one patient. As ifosfamide and doxorubicin were felt to be responsible for much of the toxicity, a subsequent schedule did not include these agents.
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PMID:Prohibitive toxicity of a dose-intense regime for metastatic neuroblastoma containing ifosfamide, doxorubicin and cisplatin. 843 77

Systemic inflammatory response syndrome (SIRS) is characterized by body temperature abnormalities, tachypnea or hyperventilation, tachycardia, and leukocytosis or leukopenia. Although it is typically associated with a serious infection and referred to as sepsis, SIRS can stem from noninfectious causes, as well. We report the cases of four patients with toxic serum levels of salicylate (33.5 to 67.6 mg/dL) and SIRS, and we discuss mechanisms responsible for SIRS. Our patients showed temperature disturbances (35.5 degrees C to 39.8 degrees C), noncardiogenic pulmonary edema, and mixed acid base disturbances. Other abnormalities included coagulopathy (disseminated intravascular coagulation), encephalopathy, and hypotension. All four patients recovered from SIRS, probably due to early recognition and treatment; only one patient did not survive the hospitalization. Chronic salicylate toxicity should be considered as a cause of SIRS in the absence of a source of infection, since survival appears to be dependent on prompt diagnosis and management.
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PMID:Systemic inflammatory response syndrome caused by chronic salicylate intoxication. 863 72

Over the last three years, 53 patients underwent transjugular portosystemic shunting (TIPS). 49 patients were treated successfully (92.5%). Procedure-related morbidity (intention to treat) was seen in 11 patients (20.8%): encephalopathy (n = 5), sepsis (n = 3), right heart failure (n = 2) and progressive liver failure (n = 1). 30-day mortality rate was 13.2% (7/53); five of these patients were in stage Child-Pugh C, one patient in stage B, and one patient had a known coronary heart disease. 30-day rebleeding rate was 6.1% (3/49), but all these patients could be retreated successfully by radiological methods (PTA, embolisation, thrombolysis). Angiographic follow-up (mean six months) of 35 patients detected 30 (85.7%) haemodynamic relevant obstructions (stenosis of stent: n = 4, stenosis of hepatic vein: n = 15, stenosis of stent and hepatic vein: n = 5, occlusion of TIPS-shunt: n = 6). Secondary patency rate following percutaneous reintervention was 91.3%. All rebleedings in the follow-up (n = 7) were treated successfully by TIPS-revision. Five out of 12 patients (41.7%) with refractory ascites were treated successfully by TIPS (complete resolution of ascites after three months: n = 4, significant reduction of ascites: n = 1). We conclude that transjugular portosystemic shunt is an effective way of treating portal hypertension, but there is a need to develop methods to prevent the high incidence of shunt stenosis.
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PMID:[Transjugular intrahepatic portasystemic shunt. A new therapeutic method in portal hypertension]. 865 Jun 59

Brain dysfunction is observed clinically in patients suffering from prolonged endotoxic shock. However, the etiology of brain dysfunction during sepsis is not clear. Certain researchers have reported that the decrease in brain catecholamines concentration during septic shock might be etiologically important in brain dysfunction. Therefore, we hypothesized that the beta-adrenergic receptor system undergoes a change during septic shock, and plays a role in the pathogenesis of septic encephalopathy. In this study, we examined two models of septic shock in rats, each of which has a different time course for the shock state. Male Wistar rats were divided into four groups: (1) Control--0.9% saline vehicle, (2) Lipopolysaccharide (LPS) i.v.-- Escherichia coli endotoxin 1.0 mg/ml i.v. bolus, (3) Sham-operated, and (4) Cecal ligation and puncture (CLP) model. The rats were killed by decapitation at 3, 12, or 24 hr after the treatments, and the brains were removed and subdivided into three areas: the forebrain, cerebellum, and brain stem. In the LPS i.v. group, the brain tissue norepinephrine (NE) concentration had decreased in the forebrain and brain stem and the tissue epinephrine (E) concentration had decreased in the brain stem by 3 hr after treatment. In the CLP group, the brain tissue NE concentration had decreased in the forebrain, cerebellum, and brain stem (P < 0.05), and the tissue E concentration had decreased in the forebrain and brain stem by 24 hr after treatment (P < 0.05). An alteration in beta-adrenergic receptor density in the forebrain was observed at 24 hr in the CLP group (control, 237.0 +/- 14.0 fmole/mg protein; LPS i.v., 233.2 +/- 3.0 fmole/mg protein; sham-operated, 236.0 +/- 3.0 fmole/mg protein; CLP, 177.0 +/- 4.2 fmole/mg protein). These alterations in transmitter concentrations and beta-adrenergic density in the forebrain may be an important factor in septic encephalopathy.
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PMID:Impairment of the brain beta-adrenergic system during experimental endotoxemia. 865 32

Eight cases of ecstasy related acute liver damage referred to a specialised liver unit are described. Two patients presented after collapse within six hours of ecstasy ingestion with hyperthermia, hypotension, fitting, and subsequently disseminated intravascular coagulation with rhabdomyolysis together with biochemical evidence of severe hepatic damage. One patient recovered and the other with evidence of hyperacute liver failure was transplanted but subsequently died, histological examination showing widespread microvesicular fatty change. Four patients presented with acute liver failure without hyperthermia. All four fulfilled criteria for transplantation, one died before a donor organ became available, and two died within one month post-transplantation of overwhelming sepsis. Histological examination showed submassive lobular collapse. Two patients presented with abdominal pain and jaundice and recovered over a period of three weeks; histological examination showed a lobular hepatitis with cholestasis. Patients developing jaundice or with evidence of hepatic failure particularly encephalopathy and prolongation of the international normalised ratio, or both, whether or not preceded by hyperthermia, should be referred to a specialised liver unit as liver transplantation probably provides the only chance of recovery.
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PMID:Acute liver damage and ecstasy ingestion. 867 2


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