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

The authors studied 333 acute cholecystitis out of 2,200 operated on for lithiasis of the gall-bladder, 186 bacteriological tests were carried out on the vesicular liquid and wall. They insist on the main anatomo-pathological characteristic: early, partial or total destruction of the mucous together with acute inflammatory lesions of the wall and even sometimes necrosis. This irreversible lesion is due to the acute obstruction of the gall-bladder by blockage of a calculus. Acute cholecystitis are practically always aseptic at the beginning. Sepsis is a secondary complication. These anatomo-pathological and bacteriological elements have two therapeutic corollaries: 1. The patient has to be operated very early at the aseptic stage. 2. Preliminary antibiotherapy becomes useless. Under these conditions there is practically no death before the age of 65. Mortality concern old people, operated late and suffering from other disease.
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PMID:[Acute calculous cholecystitis (author's transl)]. 48 81

Consecutive patients undergoing emergency appendectomy (283) or urgent cholecystectomy (51) were prospectively studied for the development of post-operative incisional or peritoneal sepsis. Severity of the original peritoneal infection was carefully recorded, while use of a Penrose dam to drain the peritoneum was randomized according to pre-assigned hospital number. Both aerobic and anaerobic cultures were taken from the abdomen at the time of operation as well as from all postoperative infectious foci. Results demonstrated no essential differences in incidence of wound and peritoneal infection following appendectomy for simple or suppurative appendicitis (187) or following cholecystectomy for acute cholecystitis (51). However, with gangrenous or perforative appendicitis (94), incisional and intra-abdominal infection rates were 43% and 45%, respectively, when a drain was used; yet only 29 and 13%, respectively, without a drain. These latter differences were significant (p < 0.001). In addition, intra-abdominal abscesses were three times as likely to drain through the incision than along any tract provided by the rubber conduit. Cultures revealed that hospital pathogens accounted for a greater proportion of wound and peritoneal sepsis after cholecystectomy and appendectomy for simple or suppurative appendicitis if a drain had been inserted than if managed otherwise. By contrast, a mixed bacterial flora was responsible for most infections following appendectomy for gangrenous or perforated appendicitis, irrespective as to use of a drain.
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PMID:Abdominal drainage following appendectomy and cholecystectomy. 64 99

Liver biopsy was done at the time of operation in 125 consecutive upper abdominal procedures to assess the incidence of unsuspected or undiagnosed hepatic abnormalities. Specifically excluded were hepatic lesions unexpectedly identified at laparotomy. Sixty-seven percent of the liver biopsy specimens were abnormal, the most frequent findings being fatty metamorphosis, cholestasis, triaditis, fibrosis, inflammatory infiltrate, cholangitis, cirrhosis, and hepatitis. The most frequent operation performed was cholecystectomy. In 63 patients with chronic cholecystitis, there was a 51% incidence of abnormal liver histology, while in nine patients with acute cholecystitis, the incidence was 78%. In 83% of all other operations, abnormal liver biopsy specimens were identified. Bile leakage, hemorrhage, and infection did not occur in this series, despite inclusion of patients with severe biliary obstruction, abnormal clotting factors, and intra-abdominal sepsis. New techniques of histochemical enzyme analysis and electron microscopy are expected to enhance the clinical correlation of occult hepatic lesions. We conclude that liver biopsy in a safe, informative adjunct to all upper abdominal procedures.
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PMID:'Routine' liver biopsy in upper abdominal surgery. 88 45

An open-label prospective study was performed employing intramuscularly administered imipenem as an adjunct to surgery in 20 patients with acute cholecystitis and 24 patients with perforated or gangrenous appendicitis. Three (12.5%) septic failures occurred in appendicitis patients and 2 (10%) failures in cholecystitis patients. There were no deaths. Adverse effects were minor, and there was no toxicity. Although failures were not associated with in vitro resistance, Pseudomonas spp. were recovered from 2 of 3 appendicitis failures. Intramuscular imipenem appeared to be an effective single-drug antimicrobial when used as an adjunct to surgery in patients with acute cholecystitis or perforated appendicitis. It should be a more cost-effective alternative to the current multiple-drug therapy frequently employed in patients with intra-abdominal sepsis.
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PMID:Intramuscular imipenem as adjuvant therapy for acute cholecystitis and perforated or gangrenous appendicitis. 187 86

Because of the difficulty in diagnosing acute cholecystitis in critically ill patients with severe intercurrent illness by clinical and imaging methods or percutaneous aspiration of the gallbladder, a trial of percutaneous cholecystostomy was performed in 24 patients in the intensive-care unit with persistent, unexplained sepsis after a complete clinical, laboratory, and radiologic search showed no alternative source of infection. Persistent high fevers, despite antibiotic therapy, were present in all patients, with elevated WBC count in 18 patients, vague abdominal tenderness in 11, and septic shock requiring vasopressors in 15. Sonographically, all patients had distended, spherical gallbladders, six had gallstones, eight had wall thickening, three had pericholecystic fluid, and four had Murphy's sign. All patients were seen by a senior abdominal surgeon, who agreed to a trial of percutaneous cholecystostomy. Fourteen patients (58%) responded to percutaneous cholecystostomy, as evidenced by a decrease in WBC count, defervescence, and the ability to be weaned off vasopressors. Bile cultures were positive in four patients. Ten patients (42%) did not respond to percutaneous cholecystostomy; five eventually died of unrelated causes. A respiratory source of infection was eventually found in three of these 10 patients, with no proved source of infection in the remainder. No complications related to catheter insertion occurred in this group of patients. Bile leaks occurred in two patients when the percutaneous cholecystostomy catheter was removed, but without serious consequence. Our experience suggests that a lower threshold for performing percutaneous cholecystostomy in this difficult clinical subset of patients is worthwhile.
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PMID:Treatment of critically ill patients with sepsis of unknown cause: value of percutaneous cholecystostomy. 202 59

In a previous study of patients with acute cholecystitis, we demonstrated equal efficacy with a broad spectrum penicillin (piperacillin) and a penicillin plus amino-glycoside combination. Whether a single agent broad spectrum penicillin is adequate treatment for more severe infections, such as acute cholangitis, however, is still unclear. We, therefore, conducted a three center, prospective, randomized trial to determine whether or not a broad spectrum penicillin alone is adequate therapy for patients with acute cholangitis. During a 36 month period, 96 patients with sepsis and biliary obstruction were randomly assigned to receive either piperacillin (n = 49) or ampicillin plus tobramycin (n = 47). The two groups receiving antibiotics were similar with respect to all clinical and laboratory parameters. The incidence of blood cultures with positive results (20 versus 21 per cent) and underlying malignant lesions (51 versus 62 per cent) was also similar between the two groups. The percentage of patients with a clinical cure or significant improvement was the same in the two groups (69 versus 70 per cent). However, there was a significant difference in the cure rate between patients with benign and malignant biliary obstructions (83 versus 59 per cent, p less than 0.01). No significant differences were noted between the two antibiotic groups with respect to drug toxicity, but patients with malignant conditions were more prone to antibiotic related toxicities (2 versus 19 per cent, p less than 0.05). These data suggest that outcome of treatment in patients with acute cholangitis is similar with either a broad spectrum penicillin or a penicillin plus aminoglycoside combination and is dependent upon the nature of the biliary obstruction.
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PMID:Broad spectrum penicillin as an adequate therapy for acute cholangitis. 221 31

Posttraumatic acute cholecystitis is a serious complication which can occur in multitrauma patients. Predisposing factors may include fasting, hypotension, transfusions, sepsis, and narcotics. Common signs and symptoms include right upper-quadrant pain or tenderness, nausea and vomiting, and fever. Symptoms began 26 days and 108 days posttrauma in the two patients studied while they were on the rehabilitation service. The recommended treatment is immediate cholecystectomy. Conservative management results in much higher mortality.
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PMID:Posttraumatic acute cholecystitis on the rehabilitation service. 236 1

Radionuclide cholescintigraphy (RC) is a useful adjunctive diagnostic tool for the identification of acute cholecystitis. False-positive rates, that is, nonvisualization, of 10 to 38 per cent have been reported in patients with factors associated with nonfilling of the gallbladder, such as prolonged fasting and the administration of total parenteral nutrition, pancreatitis, alcoholism or other critical illnesses. The administration of morphine sulfate increases resting pressure of the common bile duct because of constriction of the sphincter of Oddi, and increases the likelihood of gallbladder visualization. We administered morphine sulfate (0.05 to 0.1 milligram per kilogram given intravenously) to 68 patients (including 25 critically ill patients) suspected of having biliary sepsis and who demonstrated nonvisualization of the gallbladder by RC at 30 to 60 minutes. Visualization of the gallbladder occurred within 60 minutes after the administration of morphine sulfate in 38 patients and within 30 minutes in 36 of the 38, aiding in exclusion of the diagnosis of acute cholecystitis in 37 patients. Acute cholecystitis was confirmed by laparotomy in 28 of the remaining 31 patients. There were two false-positive and one false-negative scans, yielding a sensitivity rate of 97 per cent, a specificity rate of 95 per cent, positive and negative predictive values of 0.93 and 0.97, and an accuracy of 96 per cent for this investigative procedure. We conclude that administration of morphine sulfate in conjunction with RC in seriously ill patients enhances the reliability of this test.
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PMID:Morphine cholescintigraphy. 238 16

Prophylactic antibiotics are given routinely to patients undergoing surgical treatment of the biliary tract to prevent postoperative infection if risk factors for postoperative sepsis are present. Cefmetazole (CM) is a new broad spectrum parenteral cephamycin antibiotic. This drug possesses a spectrum of activity against a wide range of gram-negative and gram-positive bacteria that is similar to cefoxitin (CX), an antibiotic widely used for prophylaxis with operations upon the abdomen. In this study, there was a random selection of two patients to receive CM to every one patient to receive CX. The dose of CM was 1 gram given intravenously every eight hours for three doses beginning 30 minutes before the operation; three doses of CX were given intravenously, 2 grams every six hours. Fifty-two evaluable patients comprised the CM group and 26, the CX group. The risk factors for postoperative infection were acute cholecystitis (CM, seven patients; CX, one patient), evidence from imaging procedure suggesting need for exploration of the common duct (CM, six; CX, one), hyperbilirubinemia (CM, eight; CX, four), hyperamylasemia (CM, 17; CX, seven); age of 60 years or more (CM, six; CX, one), obesity (CM, 36; CX, 14) and diabetes mellitus (CM, four; CX, five). Operative bactibilia and the organisms were comparable in both groups. Postoperative days of fever greater than or equal to 38 degrees C. (oral) (CM, 0.83 +/- 1.20; CX, 0.58 +/- 0.96) and hospitalization (CM, 6.59 +/- 2.20; CX, 5.04 +/- 1.26) were similar. Postoperative septic complications at the operative site occurred in two patients in the CM group (4 per cent) and in none of the patients in the CX group (p = 0.4; N.S., Fischer exact test). These two antibiotics had similar efficiency in preventing postoperative infections.
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PMID:Controlled comparison of cefmetazole with cefoxitin for prophylaxis in elective cholecystectomy. 240 23

Acute cholecystitis continues to be a life-threatening complication in patients after trauma. In an 18-month period we have recognized and treated five patients with burn injuries who had acute cholecystitis. They ranged in age from 13 to 40 years. Four of the five patients had positive blood cultures and all five patients had positive bile cultures. The diagnosis was made on the basis of unexplained sepsis and an abnormal sonogram or hepatobiliary scan. Four patients underwent cholecystectomy and one patient underwent a cholecystostomy. Four patients survived and were discharged from the hospital. All five patients were receiving nutritional support. Factors such as prolonged fasting, dehydration, narcotic administration, and sepsis have been suggested as contributing factors in the development of acute cholecystitis. Acute cholecystitis is a serious complication in such patients and must be considered and treated promptly. Serial ultrasound studies have been helpful in managing patients suspected of having acute septic cholecystitis.
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PMID:Acute septic cholecystitis in patients with burn injuries. 267 16


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