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

Anticoagulation is the cornerstone in the treatment of deep vein thrombosis. However, the treatment of septic deep vein thrombosis is controversial. Unlike septic superficial vein thrombosis, venous excision is often associated with limb-threatening or even life-threatening complications. Some authors have suggested thrombectomy as the only means of resolving the sepsis. We reviewed our experience with seven patients who had septic deep vein thrombosis. Phlebography or noninvasive studies documented deep vein thrombosis and blood cultures were positive in all patients. The mean age was 31.5 years with a male/female ratio of 5:2. All patients were treated with anticoagulants and intravenous antibiotics. One patient required surgical exploration for associated abscess of the groin. The patients became afebrile with normal white blood cell counts from 3 to 18 days after therapy was begun. No cases of recurrent sepsis occurred. We conclude that antibiotic therapy and anticoagulation are adequate treatment and therefore consider venous thrombectomy unnecessary.
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PMID:Septic deep vein thrombosis. 378 32

Emergency hemipelvectomy (HP) is a rare procedure. Only three incidents have been previously reported. This paper describes six additional cases, analyzes our results, and sets forth criteria for patient selection. There were five men and one woman. The median age was 38.5 years. Primary underlying diseases were sarcoma (three cases), peripheral vascular disease (one), deep vein thrombosis (one), and drug abuse (one). Life-threatening peripelvic sepsis and hemorrhage were indications for emergency HP. All six patients had multiple procedures prior to definitive HP. Four classical and two modified HPs were performed. The mean operative time was 3.5 hours, the mean blood loss 2292 ml. There were no intraoperative complications. The median duration of hospitalization was 56 days. Five of six patients were saved. Life-threatening peripelvic sepsis or hemorrhage associated with tumor recurrence, radiation, or failed vascular reconstruction is an indication for emergency HP. Neither age nor physical condition should be a deterrent. The patient should not be allowed to advance to a premorbid state before HP is considered, although concomitant intra-abdominal disease is a contraindication. HP is recommended in lieu of hip disarticulation. We anticipate that the need for emergency HP will increase as limb salvage procedures for extremity sarcomas and dysvascular disease become more frequent.
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PMID:Emergency hemipelvectomy in the control of life-threatening complications. 685 96

In the presence of obstructive jaundice, surgical procedures are associated with high rates of mortality and morbidity. In an endeavour to identify risk factors associated with a poor outcome, a detailed prospective study of 28 jaundiced patients has been performed. Factors associated with a fatal outcome of operation were serum bilirubin level > 300 mumol/1, glomerular filtration rate < 50 ml/min, the presence of an abnormal level of fibrin degradation products (FDP) in serum, and the presence of endotoxaemia. Postoperative deep venous thrombosis was associated with low serum albumin, normal liver enzymes and rapid kaolin clotting time. Postoperative haemorrhage occurred in patients with FDP or endotoxaemia. Patients with normal renal function or elevated levels of liver enzymes were protected from sepsis. Based on the identification of these risk factors and of those patients with inoperable disease, a plan for management is proposed.
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PMID:The identification of risk factors and their application to the management of obstructive jaundice. 693 56

Deep venous thrombosis with pulmonary embolism is considered rare in pediatric population, but a literature review points out this disease more frequent than would be expected in children. The low incidence and the poor consideration of this occurrence in pediatric age group, cause the thromboembolic disease with pulmonary involvement an often missed diagnosis. The illness is usually related to intravenous catheters, surgery, trauma, sepsis, prolonged immobilization, neoplasia, drugs, some congenital or acquired diseases. The Authors report their experience with two pediatric cases of inferior vena cava thrombosis and pulmonary embolism treated with anticoagulant therapy, temporary vena cava filters and locoregional fibrinolysis.
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PMID:[Deep venous thrombosis and the prevention of a pulmonary embolism with temporary caval filters: the experience in 2 pediatric cases]. 756 52

Autoimmune thrombocytopenic purpura (AITP) is generally a chronic disorder in affected adults. Twenty-five percent of these patients will become refractory to routine therapy (corticosteroids and splenectomy), as well as most other available agents. Intravenous pulse cyclophosphamide therapy was used to treat 20 patients with severe refractory AITP who had previously failed to achieve a sustained remission with a mean of 4.8 agents (range 2 to 8). Patients received 1 to 4 doses (mean 2.0) of 1.0 to 1.5 g/m2 intravenous cyclophosphamide per course. Of the 20 patients treated with pulse cyclophosphamide therapy, 13 patients (65%) achieved a complete response (CR), four (20%) a partial response (PR), and three patients (15%) failed to respond. Of the 13 complete responders, eight have remained in remission with stable platelet counts during followup intervals of 7 months to 7 years (median 2.5 years). Five patients developed recurrent AITP 4 months to 3 years following a CR. Of these, two patients responded to subsequent courses of pulse cyclophosphamide therapy with current remissions of 1 and 4 years. Of the four patients who obtained a PR, two remain in partial remission after 10 months and 4 years; one relapsed after 18 months and, after retreatment, is still in remission at 6 months. Of the patient characteristics examined, duration of disease was most strongly associated with response to pulse cyclophosphamide. Side-effects of treatment included neutropenia (three patients, one of whom developed staphylococcal sepsis), acute deep venous thrombosis (two patients), and psoas abscess (one patient). Intravenous pulse cyclophosphamide should be strongly considered in the treatment of patients with refractory AITP. There is a relatively low incidence of side-effects, and it can be administered easily on an out-patient basis.
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PMID:Pulse cyclophosphamide therapy for refractory autoimmune thrombocytopenic purpura. 779 54

Total hip replacement is a frequently practised operation. Depending on age, circumstances and individual assessment, cemented, non-cemented and hybrid forms are used. Apart from general risks, such as vascular and/or neural injuries, thrombosis and infections, there are specific risks, depending on the surgical technique. If cemented systems are used, the anesthesiologist must be on the alert in respect of a possible multi-causal cardiopulmonary depression during the implantation of the prosthesis. Incidents may be reduced or moderated by measures such as reduction of pressure from the femoral cavity or anesthetic measures such as avoidance of N2O during or after cementation, use of anti-histamines, etc., but there is no absolute protection from severe reactions by the cardiopulmonary system. In these cases it is imperative to recognise and treat hypoxic conditions immediately, whatever the cause, such as cardiac or pulmonary depression. If a non-cemented hip replacement is used or a revision is necessary the main problem is usually a higher blood loss. Especially in such cases it is necessary to apply a well-organised sequence of blood-saving methods to protect patients from the general risks of homologous blood transfusion. Even though the main concern of the public is the possibility of contamination of donor blood with the AIDS virus, transmission of hepatitis C virus is a much more common problem. Depending on the diagnostic methods the occurrence of thrombosis after total hip replacement has been reported to be as much as 55%. To minimise this high incidence, sufficient prophylaxis, adequate fluid therapy, suitable anesthetic techniques and cutting down on the duration of the operation should be taken into account. The use of low molecular weight heparins has certain advantages. If deep vein thrombosis has occurred, therapy consists of anticoagulation with intravenous heparin and immobilisation. A rare but severe complication is a deep hip prosthetic infection. More than 50% of infections are caused by coagulase-negative staphylococci and anaerobic bacteria. To avoid sepsis it is imperative to employ adequate high-dosage antibiotics, revisional surgery and, if necessary, even excision arthroplasty. There is no "ideal" anesthesiological method for total hip replacement. Regional techniques as well as general anesthesia have their specific pros and cons which are controversially discussed in respect of their priority. To achieve early diagnosis of embolism, especially in the case of high risk patients, the exigency of extensive haemodynamic monitoring as well as Doppler-ultrasound is discussed.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Total hip endoprostheses--characteristic aspects from the anesthesiologic viewpoint]. 781 63

A single-centre experience of military vascular injuries in the recent conflict in Yugoslavia is reviewed. From 1 April to 13 December 1991, 1020 casualties were admitted to the Surgical Clinic at the Teaching Faculty of the University in Zagreb, Croatia. A total of 120 injured blood vessels in 76 patients were treated in the department of vascular surgery. Casualties were transported to the hospital after treatment by forward surgical facilities. The transportation time ranged from 3 to 18 (mean 7) h. The most common injuries were to the popliteal artery (12.5%) and brachial veins (10.0%). After segmental resection, arterial and venous revascularization with saphenous vein graft interposition was the preferred option. Twenty-six fasciotomies were performed because of compartment syndrome. Indications for six amputations included sepsis, deep vein thrombosis and extensive myonecrosis. Concomitant bone fractures were stabilized by an external fixator in 90.4% of cases. Vascular injuries were repaired before orthopaedic stabilization. Completion arteriography was used to delineate concomitant distal lesions.
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PMID:Military vascular injuries in Croatia. 807 91

Home parenteral nutrition (HPN) was used for the treatment of 18 patients with chronic intestinal failure (CIF): short bowel syndrome (9), extensive intestinal disease (4), motility disorder (4), entero-enteric fistulas (1). The underlying diseases were: chronic inflammatory (7), mesenteric vascular (4), scleroderma (2), pseudo-obstruction (2), malignancy (2), radiation enteritis (1). HPN was more effective on protein-calorie nutritional status than on fluid and electrolyte balances. About two-thirds of the patients achieved full or partial social rehabilitation. During the 6 months before HPN, there were 20 hospitalizations (mean stay: 55 days). During HPN (mean length of treatment: 22 months/patient) there were 16 hospitalizations (mean stay: 22 days), 8 of which were caused by HPN complications (sepsis and deep vein thrombosis; overall incidence of catheter-related complications: 0.411 per patient-year). Bone demineralization, liver abnormalities and biliary stones developed, respectively, in 57%, 28% and 11% of the cases. The underlying intestinal condition played a role in their pathogenesis. The annual cost of HPN ranged from 40 (Hospital Pharmacy Service) to 80 (commercial firm) million lire per patient. To sum up, HPN improves the nutritional status and the quality of life of patients with CIF, and the risk of complications is acceptable. The medical and social advantages are considered to offset the cost of the technique.
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PMID:Home parenteral nutrition for the management of chronic intestinal failure: a 34 patient-year experience. 828 74

The pattern of postoperative pyrexia in Khartoum was prospectively studied in 260 patients who underwent a variety of surgical operations. Ninety four patients (36.1%) developed postoperative pyrexia. The commonest causes of pyrexia encountered were wound sepsis (10%), malaria (9.6%) and respiratory tract infection (7.3%). Less frequent causes were urinary tract infection, thrombophlebitis, intra-abdominal sepsis and deep vein thrombosis. In 14.6% of the patients, the cause of pyrexia was undetermined. The risk factors for postoperative pyrexia were the patient's age, diabetes mellitus, obesity, preoperative chest infection, smoking, duration of surgery, operator's surgical experience and urethral catheterisation. The postoperative pyrexia was associated with 7.4% mortality rate which was due to intra-abdominal sepsis and pulmonary embolism. The incidence of postoperative pyrexia can be minimised by adequate preoperative preparation, meticulous surgical technique and good postoperative care.
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PMID:Pattern of postoperative pyrexia in Khartoum. 862 71

Vascular nursing presents constant challenges. The natural history of vascular disease coupled with the complexity of the patient population provides an environment for constant learning. Providing care to these unique individuals demands a thorough knowledge of vascular anatomy and physiology, diagnostic interventions, treatment modalities, multidisciplinary resources, and nursing interventions. This case study explores the multifaceted realm of vascular nursing by examining the hospital course and multidisciplinary plan of care of a 22-year-old man whose hospital course began with a lower extremity deep venous thrombosis and progressed to pulmonary embolus, phlegmasia cerulea dolens, compartment syndrome, sepsis, arterial thrombosis, severe coagulopathy, priapism, laryngeal bleeding/laryngospasm, and subsequent notification of having received a unit of blood from a donor whose human immunodeficiency virus status was later determined to be positive. The intent of this article is not to define a specific means of practice but to share with colleagues the wealth of knowledge that was gained from this experience.
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PMID:Undiagnosed hypercoagulable state: a case study. 870 92


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