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

The authors analyse the first 25 patients with spinal cord injuries treated by G. Brindley's technique based on section of the posterior sacral nerve roots to control detrusor hyperexcitability and electrostimulation of the anterior sacral nerve roots to ensure bladder emptying and to facilitate erection and defecation. The indications for this technique are essentially unstable bladders with incontinence and certain hypoactive bladders. The following results were obtained: Acquisition of continence in 90% of cases. Bladder capacity was always greatly increased. Almost complete bladder emptying in the majority of cases. Very marked reduction in urinary tract infection. Regularization of intestinal transit. The complications of this surgery were uncommon but serious: C.S.F. leaks, Postoperative denervations. Sepsis. Material or cable failure.
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PMID:[Electrostimulation of anterior sacral nerve roots in spinal cord injury patients (evaluation of the 1st 25 cases)]. 129 15

Bladder augmentation has evolved into a common method of management in children with a low capacity and/or poorly compliant bladder secondary to a neuropathic condition. We report on a 4-year-old girl with myelodysplasia who presented with sepsis and who had a perforation of the augmented bladder, which was surgically repaired. She returned for evaluation 1 month after she was discharged from the hospital when the distal component of the ventriculoperitoneal shunt was noted to protrude per urethram after clean catheterization. Distal shunt replacement with prolonged bladder drainage successfully resolved this perforation of the augmented bladder. The patient has had no further difficulties. We discuss the diagnosis and management of this case with reference to the current literature regarding complications of augmentation cystoplasty.
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PMID:Perforation and intravesical erosion of a ventriculoperitoneal shunt in a child with an augmentation cystoplasty. 173 10

Medium-term results are reported in 100 patients who had a Stamey operation for genuine stress incontinence. The results were good in 72, improved in 8 and 20 were failures when assessed clinically and with pad tests. Most of the failures occurred in the first post-operative year. A repeat Stamey operation was easy and the results have been good in 7 of the 8 cases. Bladder outflow obstruction, urinary infection and wound sepsis were not a problem.
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PMID:Follow-up results with the Stamey operation for stress incontinence of urine. 231 50

Increased intraabdominal pressure (IAP) has been demonstrated to cause intestinal and renal ischemia in both animals and humans. Neonates undergoing closure of anterior abdominal wall defects are at risk for these complications from markedly increased IAP, which are putatively responsible for a 13% to 20% mortality. In an effort to decrease morbidity and mortality we performed a 4-year prospective clinical study to determine if monitoring IAP using bladder pressure (BdP) measurements would significantly improve perioperative care in infants with abdominal wall defects. Forty-two consecutive infants with gastroschisis (28) and omphalocele (14) were prospectively studied. Intraoperative and serial postoperative measurements of BdP were obtained from an indwelling bladder catheter using a standard pressure transducer. Methods of initial closure, as well as manipulations in sedation, paralysis, and silo reduction, were selected to keep BdP < 20 mm Hg. Bladder pressure monitoring significantly altered the management of 64% of our patients, particularly those with gastroschisis (74%). Thirteen patients with gastroschisis underwent staged closure; in 7 (54%) this decision was based on high BdP even though bowel reduction was mechanically possible. Elevated BdP influenced the closure method and timing of silo reductions in 5 of 14 (42%) infants with omphalocele. There were no episodes of renal failure or refractory oliguria. There were three patients in a single cluster who developed uncomplicated, nonsurgical necrotizing enterocolitis late in their respective courses. One patient whose bowel was placed in a silo had severe hypotension associated with group B streptococcal sepsis and subsequently developed necrotic bowel despite low BdP.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Bladder pressure monitoring significantly enhances care of infants with abdominal wall defects: a prospective clinical study. 826 3

Bladder reconstruction using bowel segments was advanced when intermittent catheterization proved so acceptable. Access to the reservoir by way of the urethra is often not possible in children, especially boys. Implantation of the isolated appendix into the bladder remnant or colon segment similar to a ureteral reimplant provides a continence mechanism with ready catheter access (the Mitrofanoff principle). Since 1982 we have applied this principle in 41 pediatric cases of bladder reconstruction (64% boys). Primary diagnoses included bladder exstrophy (46%) and myelomeningocele (34%). Extending the concept of a flap valve continence channel with a narrow tube into the reservoir, segments of tapered ileum and ureters were also used (appendix 61%, ileum 12%, ureter 27%). Results of continence (100%) and uncomplicated catheterization (93%) have been satisfactory. Unfortunately, the longer the experience (average 3.2 years of followup), the more stone formation we experienced (32%), which is due to mucus production and bacteriuria as the stone nidus. There were 2 deaths, including 1 from a renal stone obstructing the ureter with sepsis and 1 a likely suicide. Reoperation was required for 3 stomal revisions, 2 bowel obstructions and 7 stone removals in 3 of the 6 cases in which the bladder neck was closed. Unique aspects of these reconstructions are presented, such as our current preference to bury the stoma in the umbilicus (7 cases), placement of the ureteral segment into the perineum as a neourethra and an unusual conjoined twin reconstruction.
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PMID:Appendicovesicostomy (and variations) in bladder reconstruction. 843 67

Bladder drainage of exocrine secretions during pancreas transplantation can be associated with significant complications. We present a proactive approach to these complications consisting of early cystoenteric conversion (CEC). Although 81 patients underwent pancreas transplant between March 1985 and May 1995; 26 (32%) required CEC. Complications presented as urine leaks, other complications, and refractory metabolic acidosis. There were 13 patients who presented with a urine leak: 12 with acute abdominal pain, and 1 asymptomatic. Serum amylase and creatinine rose a mean of 823 IU and 0.61 mg/dl, respectively. The interval to CEC ranged from 2 to 45 months. One patient died of fungal sepsis. Postoperative complications included duodenojejunal anastomotic bleed (n = 1), negative relaparotomy (n = 1), myocardial infarction (n = 1), graft pancreatitis (n = 1), and wound infection (n = 1). Twelve patients presented with other complications: three women with cystitis (n = 2) or hematuria (n = 1), and nine men with urethritis (n = 6), scrotal edema (n = 2), or dysuria (n = 1), The interval to conversion ranged from 1 to 108 months. There were no deaths. One patient required relaparotomy for anastomotic bleed. One patient was converted because of refractory metabolic acidosis. Admissions and inpatient days were significantly reduced. Overall mortality was 3.8%, morbidity 23.1%, and graft salvage rate 96.1%. Leak-associated mortality was 7.7%, morbidity 38.5%, and graft salvage rate 92.3%. For other complications the mortality was 0, morbidity 7.7%, and graft salvage rate 100%. CEC is a safe, effective treatment for urologic complications of pancreas transplantation. Morbidity and mortality were acceptable; admissions and hospital days were decreased. Early CEC results in superior outcomes and improved quality of life. It is preferable to nondefinitive measures for management of urologic complications of pancreatic transplantation.
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PMID:Early operative intervention for urologic complications of kidney-pancreas transplantation. 967 65

Chronic intestinal pseudo-obstruction (CIPO) in children may be life-threatening due to the complications of parenteral nutrition (PN) or catheter-related sepsis. Multivisceral transplantation (MVTx) is a lifesaving option but limited experience is available. We report our experience with MVTx in pediatric CIPO patients. Sixteen children with CIPO underwent MVTx at median age of 4 years. Indications for MVTx were liver failure (n = 10), loss of venous access (n = 3), or sepsis (n = 3). Modified MVTx without the liver was performed in six patients. Induction immunosuppression included tacrolimus, steroid with adjunctive agent in period I (April 1996 to December 2000), namely, OKT3 (n = 1), mycophenolate mofetil (n = 4), or daclizumab (n = 2); and in period II (January 2001 to present), Campath 1H (n = 4) or daclizumab (n = 5). The grade of rejection was severe in 12.5% and mild to moderate in 87.5% of cases. Isolated rejection of the transplanted stomach or pancreas was not diagnosed during clinical course or on autopsy. Actuarial patient survival for 1 year/2 years for period, I and II were 57.1%/42.9% and 88.9%/77.8%. None of the long-term survivors is on PN and all tolerate enteral feedings. Pancreatic enzyme supplementation or insulin therapy is not needed in survivors. Gastric emptying was substantially affected in one case. Bladder function did not improve in those with urinary retention problems. MVTx for CIPO offers a lifesaving option with excellent function of the transplanted pancreas and stomach among survivors.
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PMID:Multivisceral transplantation for pediatric intestinal pseudo-obstruction: single center's experience of 16 cases. 1505 Jan 42

We report a case of intravesical fat entrapment leading to failure of extraperitoneal bladder perforation to heal spontaneously. A 68-year-old woman underwent trans-abdominal hysterectomy complicated by an extraperitoneal bladder perforation. Despite prolonged catheterization, cystographic leakage persisted after 3 months. Bladder imaging and cystoscopy demonstrated a mass of perivesical pelvic fat protruding into the bladder cavity. The patient was symptomatic with pain and persistent urinary tract infection with episodes of sepsis. A transurethral resection of the mass was performed which led to bladder healing and resolution of symptoms.
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PMID:Intravesical fat entrapment as a cause of failure of extraperitoneal bladder perforation to heal spontaneously. 1745 6

Internal and external urinary catheters are used to manage urinary incontinence and incomplete bladder emptying. Bladder dysfunction cause determines whether short- or long-term catheter use is required which, in turn, determines whether an indwelling, intermittent, or external catheter should be used. The method of catheterization is based on the underlying bladder condition, the goals of treatment, and gender appropriateness. Complications such as infection (eg, catheter-associated urinary tract infection, sepsis) and its related sequelae have been found to be directly related to length of time of catheter use (eg, women are at greater risk for catheter-associated urinary tract infection when an indwelling catheter is in place >2 weeks); thus, catheter use must be medically justified and in the case of an indwelling catheter, involve the shortest period possible to ensure patient safety and regulatory compliance. Some newer catheter systems include coatings to prevent complications; complications specific to indwelling catheter use include obstruction from encrustations, urethral trauma and erosion, bladder stones and bladder cancer, and, in men, epididymitis. Complications from external catheters may occur when skin condition is compromised. Overuse of catheters has reimbursement ramifications. Numerous guidelines reflect the need for the judicious use of urinary catheters, particularly in long-term care patients. Because evidence-based research on long-term use of these devices is lacking, clinicians should use clinical experience when caring for patients with catheters.
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PMID:Internal and external urinary catheters: a primer for clinical practice. 1910 21

The urinary tract is an often forgotten and under-appreciated source of infection in anuric hemodialysis patients. Bladder abscess, also called pyocystis, is a severe complication of low urinary flow that can be difficult to detect, leading to delays in treatment and increased morbidity. The emergency physician should maintain a high suspicion for pyocystis, which can be quickly diagnosed by bedside ultrasound. We report a case of a hemodialysis patient with an initially minor presentation who developed sepsis secondary to pyocystis and prostate abscess.
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PMID:Pyocystis and prostate abscess in a hemodialysis patient in the emergency department. 2524 36


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