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

The effect of preoperative total parenteral nutrition (TPN) on morbidity and mortality was studied in medical records of discharged surgical patients. Patients were classified into two groups on the basis of their ability to meet established criteria for malnutrition and the use of preoperative or postoperative TPN. The control group consisted of 44 patients who received TPN only after surgery or for less than 5 days preoperatively. The experimental group consisted of 26 patients who received treatment for at least 5 days before surgery and/or after surgery. Nutrition parameters measured included serum albumin, total lymphocyte count, hemoglobin, weight, and percent weight loss. Major septic complications (MSC) considered were intra-abdominal sepsis, wound dehiscence, septicemia, and pneumonia. Other complications included respiratory failure, congestive heart failure, fistulas, urinary tract infection, shock, and death. The experimental group showed improvements after surgery in the nutritional parameters listed and had a lower incidence of morbidity and mortality. Deficits in serum albumin, total lymphocyte count, and weight losses greater than or equal to 10% have been significantly (p less than .01) linked to the incidence of MSC. MSC also has been more frequently noted among patients who did not have TPN prior to surgery and who died following surgery. Therefore, preoperative TPN does appear to make a difference in the outcome of surgery.
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PMID:The effect of preoperative total parenteral nutrition on surgery outcomes. 311 53

In order to assess the significance of malnutrition in determining surgical complications and the possibility of their reduction by preoperative nutritional support (PNS), a randomized controlled trial is being performed at our institution. The results relative to 100 patients who underwent major surgery for gastrointestinal disease, are presented here. In the treatment group 49 patients received 30 kcal/kg/day and 200 mg/kg/day of nitrogen for at least 7 days in the immediate preoperative period (nine patients were excluded from this group due to early surgery--seven cases; or refusal to accept PNS--two cases. Data analysis with their inclusion or exclusion showed similar results.) Fifty-one patients constituted the control group. The observed septic complication rate was, respectively, 30 and 35.3% (p:NS). When the analysis was restricted to the patients with abnormal instant nutritional assessment (INA), as defined by Seltzer et al (serum albumin less than 3.5 g/dl and/or total lymphocyte count less than 1500 cells/mm3), a statistically significant difference was observed in the incidence of sepsis between the two subgroups (21% vs 53.3%, p less than 0.05). Analogous results were obtained from the patients who underwent gastrectomy for gastric cancer: 16.7% of septic complications in the malnourished treated patients and 100% in the malnourished control ones (p less than 0.05). The occurrence of serious sepsis (sepsis score greater than or equal to 10, according to the scoring system developed by Elebute and Stoner) in the malnourished subgroups was 5.2% and 26.7%, respectively, (p = 0.09). The postoperative mortality rate was not significantly changed by the PNS (reduction from 3.9% to 2.5%, p:NS).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Preoperative parenteral nutrition in the high risk surgical patient. 312 96

Malnutrition is associated with increased incidence of surgical complications and mortality. The efficacy of preoperative parenteral nutrition in preventing septic states and mortality was evaluated in malnourished patients undergoing gastrointestinal surgery. The patients were allocated to three groups according to criteria of malnourishment. In all groups parenteral nutrition decreased the incidence of septic complications and serious sepsis as compared with control patients.
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PMID:Preoperative parenteral nutrition of malnourished surgical patients. 313 10

Sepsis is associated with severe metabolic disturbances and progressive failure of utilization of carbohydrates, lipids and proteins to meet the energy requirements of peripheral tissue. The causes of this condition are analysed. The interrelation between malnutrition and sepsis is discussed. Current concepts regarding the meeting of water and ion requirements, indications for administration of colloid solutions and infusion of glucose, lipid emulsions and amino acid solutions in each stage of sepsis are presented. Various views on the amount and quality of necessary nutrients are discussed providing evidence that a number of problems have to be solved yet.
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PMID:Meeting the energy requirements in sepsis. 313 82

A patient with acquired immunodeficiency syndrome (AIDS) who required aggressive nutritional intervention via home parenteral nutrition therapy is described, and nutritional status, etiology and therapeutic management of AIDS-associated malnutrition, role of nutrition support, and factors for consideration in using parenteral nutrition in AIDS patients are discussed. Parenteral nutrition therapy was initiated in a 30-year-old AIDS patient with Kaposi's sarcoma lesions of the gastrointestinal tract because of rapid weight loss, low serum protein levels, and malnutrition. He had previously undergone a small-bowel resection and a jejunojejunostomy, and radiation and antineoplastic-drug therapy was planned. During parenteral nutrition therapy, the patient demonstrated increased physical strength and was able to care for himself during most of the time spent at home or in a long-term-care facility. Aggressive measures, including parenteral nutrition therapy, were discontinued 11 days before the patient's death. Complications of therapy included one episode of sepsis and a tear in the external catheter tubing. Malabsorption and diarrhea mainly caused by gastrointestinal disease, reduced food intake because of oral and esophageal infections, adverse effects from medication, and depression are factors that can contribute to AIDS-associated malnutrition. Also, hypermetabolism resulting from infections and fevers may contribute to malnutrition in AIDS. The extent to which this malnutrition affects the underlying immune dysfunction occurring in the syndrome and the response to other more direct drug therapies in AIDS is not known. Available methods for nutritional intervention are based on clinical experience and anecdotal reports. Because of gastrointestinal disease, an oral diet, supplements, and enteral tube feedings may not meet nutritional goals for an AIDS patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Parenteral nutrition in the management of gastrointestinal Kaposi's sarcoma in a patient with AIDS. 313 64

Gut malnutrition in patients with persistent hypermetabolism is hypothesized to be an important factor in postseptic multiple organ failure syndrome (MOFS). The hypothesis was made that enteral nutrition (EN) started at the onset of hypermetabolism could reduce the incidence of MOFS. Sixty-six patients with persistent hypermetabolism 4 to 6 days after onset of sepsis were prospectively randomized to receive either parenteral nutrition (PN) or enteral nutrition (EN) at 1.5 gm protein/kg/day and 30 nonprotein calories/kg/day; the EN and TPN were of the same composition. There was no reduction in either the incidence of MOFS or mortality attributable to the route of nutrition administration. The PN group tended to have better visceral protein support; the EN group had more gut complications. When analyzed, the type of formula given did have an effect on the nutritional outcome but not on the mortality rate. A formula with a nonprotein-calorie-to-nitrogen ratio of 100:1 was associated with more nitrogen retention, higher levels of visceral proteins, and better gut tolerance. The route of nutrition administration does not seem to affect the incidence of postseptic MOFS or mortality when hypermetabolism is already present and when commercially available nutritional formulas are used. The relationships among the route of nutrition, the type of enteral formula, and the disease process of hypermetabolism and MOFS appear to be complex and require much more investigation before the role of the gut and enteral nutrition can be defined.
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PMID:Enteral nutrition does not prevent multiple organ failure syndrome (MOFS) after sepsis. 314 Apr 3

Two hundred patients assessed for nutritional deficiencies were analyzed for reaction to skin testing with common antigens and the incidence of sepsis and death. Only 39% of all skin tests were positive, though 50% of the patients had at least one positive test. Associated diagnoses revealed a high incidence of malnutrition, cancer, radiation therapy, and chemotherapy. Analysis using Chi-square and Gamma shows good statistical correlation between skin tests and sepsis and death. Those with negative tests (anergic) using PPD, Candida, and mumps had a threefold higher mortality. Major sepsis also increased in the skin negative group (+80%), but here the incidence varied directly with the number of positive skin tests. Mortality, unlike sepsis, was influenced only by the presence of delayed hypersensitivity and was not related to the number of positive reactions. The basic rate of infection or mortality was not influenced by major surgery.
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PMID:Delayed hypersensitivity on a surgical service. 318 56

This retrospective study of the main causes of child mortality was conducted within the Department of Child Health, Dr. Pirngadi General Hospital, between January-December 1986. The main causes were: bronchopneumonia, encephalitis, purulent meningitis, serous meningitis, sepsis, tetanus, and several malnutrition. Case fatality rates were: 29%, 44%, 41%, 31%, 47%, 12%, and 18%, respectively.
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PMID:Seven diseases as main causes of death in Department of Child Health, Dr. Pirngadi General Hospital. 324 52

The group B streptococcus has been shown to be a major cause of meningitis in the newborn and an occasional cause of endocarditis and sepsis in postpartum women. Little attention has been devoted to this organism as a cause of bacterial endocarditis. Twelve patients with group B streptococcal endocarditis were seen at The Presbyterian Hospital, New York, NY, between 1974 and 1985. There were seven women, five men. Ages ranged from 32 to 81 years. Serious underlying disease was present in all - diabetes mellitus in seven, carcinoma in three (bladder in two, and breast in one), alcoholism in three, malnutrition in two, heroin addiction in one, tuberculosis in one, serious prior valvular heart disease in two. The aortic valve was affected in four patients - mitral in two, mitral and aortic in one, tricuspid in four, unknown in one. The presentation was acute in seven patients. Metastatic infection occurred in seven, heart failure in six, major emboli in four, septic pericarditis in one, myocardial abscess in one. The group B streptococcus should be considered as a pathogen capable of causing acute endocarditis in certain patients with defects of host defense, particularly patients with diabetes mellitus, carcinoma or alcoholism. Cardiac surgery may be necessary in these patients due to the rapid destruction of the valves which occurs, in spite of the fact that the organisms are usually highly susceptible to penicillin.
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PMID:Streptococcus agalactiae (group B) endocarditis--a description of twelve cases and review of the literature. 330 82

Orthotopic liver transplantation began in Brisbane in January 1985. During the first two years of the programme an assessment committee evaluated 55 patients (38 adults, 17 children). Patients were either accepted for transplantation, rejected as unsuitable or deferred for elective reassessment. All of the 10 adults who were rejected for transplantation because they had "too advanced" disease died within four months of assessment. Six children who were accepted for transplantation died before a suitable donor liver could be found. In the first two years, 21 orthotopic liver transplantations were performed on 18 patients (adults, 13 patients; children, five patients). Fifteen of 21 grafts were procured from within Queensland. Twelve (67%) patients are alive at three to 23 months and all have been discharged from hospital. Deaths in adults were due to sepsis (three patients), aspiration pneumonitis (one patient), rejection and hepatic artery thrombosis (one patient) and the recurrence of a hepatocellular carcinoma five months after discharge from hospital (one patient). Two patients underwent a second transplantation procedure because of chronic rejection at four months and at 11 months, respectively, after the initial operation. One patient received a second transplant for primary graft failure at four days after the operation. A scoring system which considered the presence of pre-operative patient factors, such as coma, ascites, malnutrition and previous abdominal surgery, partly predicted the operative blood loss and patient survival. In conclusion, orthotopic liver transplantation is being performed in Australia with survival rates that are comparable with those of established overseas units.
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PMID:The Queensland Liver Transplant Programme: the first two years. 330 93


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