Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prospective study of a new stent for bridging choledochal stenoses was performed in seven patients (5 females, 2 males, age range 49-80 years) with benign bile duct stenosis or bilioduodenal fistula in whom conventional bougienage (3 patients) and/or month-long implantation of plastic prostheses (7 patients) failed because of reocclusion. The self-expanding mesh stents (Wallstent) were implanted by duodenoscopy in six patients. In one patient with a B-II stomach, the stent could only be inserted by the percutaneous transhepatic route. All prostheses were inserted endoscopically without complications. At follow-up after an average of eight months prosthesis-related complications were found in only one patient; there was no case of prosthesis occlusion. One patient with a bilioduodenal fistula of unknown origin developed fever and sepsis three days after implantation and subsequently a liver abscess which resolved on repeated drainage and antibiotic therapy. Although definitive interpretation of the results requires a longer follow-up period, on the basis of the present data endoscopic reconstructive splinting of benign choledochal stenosis would appear to be a promising technique.
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PMID:Bridging of benign choledochal stenoses by endoscopic retrograde implantation of mesh stents. 186 Apr 40

Disturbances of the arterial perfusion of the graft following liver transplantation (LTx) are mainly of technical origin and contribute considerably to the postoperative morbidity and lethality. Aim of this retrospective survey was to determine the incidence and the consequences of hepatic artery thrombosis (HAT) and stenosis (HAS) in 203 patients (pts.) who underwent 246 liver transplantations. HAT was identified in 22 pts. by clinical, laboratory and sonographic and/or angiographic means. In 4 pts. HAT was asymptomatic and was detected during routine examination. Two pts. underwent immediate retransplantation, of which only one survived. Primary revascularization was performed in 16 pts., but was successfully only in 5 pts. Six pts. eventually underwent retransplantation with only one survivor. Biliary complications after HAT were observed in 10 pts. (45%), presenting in 8 pts. as biliary leak, in 2 pts. as bile duct stenosis. In the 12 patients with HAT who died the leading causes of death were sepsis (n = 3) and multiple organ failure (n = 3). HAS was observed in 11 pts., of which one was asymptomatic. Ten pts. underwent surgical revision. Redo of the arterial anastomosis was the most common procedure. Four pts. survived long term. Biliary tract complications were seen in 3 pts. (leak 1, stenosis 2). Three pts. died secondary to HAS from sepsis. These results confirm the life threatening character of any arterial complication after LTx. Because other reasons are rarely detected, the majority is attributable to technical faults. In order to avoid arterial complications extraordinary care has to be taken in the surgical handling of the arterial supply of the graft during harvesting, back table work and transplantation.
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PMID:[Arterial complications after liver transplantation]. 763 31

Eleven children, 4 males and 7 females, with biliary atresia receiving living related liver graft were studied. The mean age was 1.8 years and the mean body weight was 10.3 kg. The donors were 4 fathers and 7 mothers. The graft was the lateral segment or left lobe. ABO blood group matching was compatible in 9 and incompatible in 2. All patients except one were crossmatch negative. Immunosuppression at induction was triple therapy (cyclosporine, azathioprine and steroid) or FK506 plus steroid. Acute rejection episodes were treated with pulse steroids. When the signs of rejection persisted despite steroid pulse therapy, 15-deoxyspergualin (DSG) was added. The survival rate of the patients was 73%. Three patients died of portal vein thrombosis, hepatic artery thrombosis and sepsis respectively. Other major complications included hyperbilirubinemia, bile duct stenosis, bile leakage and portal vein anastomosis narrowing. Complications of the donor were sepsis in one, and liver dysfunction in two. Although there are some complications related to graft size mismatch and operative procedure, living related partial liver transplantation is an effective therapy in countries where donor source is restricted.
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PMID:Living related partial liver transplantation in biliary atresia: 11 cases of experience. 914 48

A hepatic portocholecystostomy (HPC) has been recommended to avoid postoperative cholangitis in the case of a patent distal extrahepatic bile duct (PDEBD) for the treatment of biliary atresia (BA). We investigated the efficacy and clinical problems of HPC in BA. The clinical records of eight patients with BA and PDEBD were reviewed. The diameter of the common bile duct was compared between the patients with BA and PDEBD and age-matched patients with neonatal hepatitis (NH). Five of 8 patients with PDEBD underwent HPC. One patient had to be converted to a cholecystojejunostomy because of common bile duct stenosis at 19 years of age. The other two patients underwent a reoperation by a hepatic portojejunostomy due to poor bile drainage after HPC. Another patient became jaundice-free one month after HPC, but died of sepsis due to bile leakage 3 months thereafter. The mean diameter of the common bile duct in BA with PDEBD was significantly smaller than that of NH (0.76 +/- 0.16 mm (n = 8) in BA vs. 1.90 +/- 0.39 mm (n = 11) in NH, p<0.01). HPC was thus found to be an excellent operative method for preventing postoperative cholangitis in BA, however, many clinical problems still need to be overcome for such a narrow distal duct.
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PMID:Hazards of hepatic portocholecystostomy in biliary atresia. 1137 Sep 77

Hepatic artery thrombosis (HAT), a serious complication after orthotopic liver transplantation (OLT), can lead to patient death in the absence of revascularization or retransplantation. Herein we have presented clinical characteristics, imaging findings, and long-term outcomes of 3 OLT patients with HAT who were treated conservatively and developed hepatic arterial collaterals. These patients underwent transplantation due to hepatitis B cirrhosis, cryptogenic cirrhosis, or hepatitis C infection and alcoholic disease. They presented with bile duct stenosis and/or a bile leak at 1, 3, and 36 months after transplantation, respectively, and were treated with percutaneous drainage and stent placement, endoscopic retrograde cholangio-pancreatography (ERCP), or reanastomosis of the bile duct over a T tube. HAT was confirmed using multidetector computed tomography (MDCT) 3-dimensional (3D) angiography and Doppler sonography. They survive in good condition with normal liver function at 30, 50, and 42 months after OLT, respectively. Development of collateral arterial circulation to the liver graft was detected with MDCT 3D angiography and Doppler sonography. From our experience with 3 patients and a literature review, we believe that there are a number of patients who experience long-term survival after the diagnosis of irreversible HAT and the development of collaterals. Although this group is at high risk for sepsis and biliary complications, these are usually self-limiting complications due to improved treatment regimens. The development of collateral arterial flow may also be beneficial.
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PMID:Hepatic artery thrombosis after orthotopic liver transplantation: 3 patients with collateral formation and conservative treatment. 2314 10