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

Deep venous thrombosis and its complication pulmonary embolism are responsible for more than 50,000 deaths annually in the US, 2/3 of which occur postoperatively. Nearly 75% of such deaths could be avoided by adequate prophylaxis. All forms of surgery entail some risk of deep venous thrombosis, ranging from 10% after endoscopic prostate resection to over 50% for total hip replacement. 1.6 of thromboses will embolize and 1/4 of pulmonary emboli are fatal. The goal of prevention is to decrease the incidence of fatal pulmonary emboli while limiting the risks related to prevention. A secondary goal is to reduce the frequency of postthrombotic syndrome, a late complication of deep venous thrombosis which frequently causes invalidism. A preoperative evaluation of risks of deep venous thrombosis and of the likelihood of bleeding problems should be followed by selection of appropriate preventive measures. The evaluation should be repeated postoperatively, taking into account such factors as the duration of the intervention, the diagnosis, and the predicted duration of bed rest. Evaluation of the risk of deep venous thrombosis requires knowledge of its etiopathogenesis. Deep venous thrombosis results from a multifactorial process involving venous stasis, lesion of the vascular wall, and anomalies of blood composition. All the clinical risk factors for deep venous thrombosis are related to 1 or more of these elements. Risk factors related to stasis include immobilization, postoperative or postpartum status, pregnancy, and Cockett's syndrome. Risk factors related to lesions of the vascular wall include hip surgery, trauma, age, sepsis, varices and obesity, and postthrombotic syndrome. Risk factors related to blood anomaly include postoperative status, pregnancy, oral contraceptive use, cancer, nephrotic syndrome, hypercoagulability, trauma, and heredity. The most common clinical risk factors for deep venous thrombosis are age, surgical intervention, trauma, burns, cancer, pregnancy and delivery, oral contraceptive use, varices, obesity, and postthrombotic syndrome. The relative risk of deep venous thrombosis among OC users is 4.0 overall and higher for those with type A blood. The pathogenic mechanisms are similar to those of pregnancy except that the fibrinolytic capacity is not change. The principal mechanism is perhaps the declining level of antithrombin III, observed with estrogens and some progestins. Among methods of prevention are different forms of compression, use of heparin alone or in combination with other drugs, and oral anticoagulants.
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PMID:[Epidemiology and etiopathogenesis of deep venous thrombosis of the lower limbs]. 224 Apr 6

The axillary vein was evaluated as an alternative access site for central venous catheterization in critically ill infants and children. Children were placed in the Trendelenberg position (when possible) with arm abducted 100 to 130 degrees. The vein was entered parallel and inferior to the artery. Success rate for catheterization was 79% (41/52). Catheter diameter range was 3 to 8.5 F and catheter length range was 5 to 30.5 cm. Median patient weight was 7.0 kg (3.0 to 59 kg). Median age was 0.91 years (14 days to 9 years). All central lines ended in the subclavian, innominate, or superior vena cava. Median catheter duration was 8 days (2 to 22 days). A total of 338 patient catheter-days were studied. Central venous pressure was successfully monitored in five of five attempts. Complications with insertion (3.8% of attempts) included one pneumothorax and one hematoma. Complications during catheter duration (9.8% of catheters, 1.1% per catheter-day) included one instance each of venous stasis, venous thrombosis, catheter sepsis, and parenteral nutrition infiltration. No complication contributed to a patient mortality. Success and complication rates were comparable with those in jugular catheterization studies in children. The axillary approach is an acceptable route for central venous catheterization in critically ill infants and children.
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PMID:Percutaneous catheterization of the axillary vein in infants and children. 231 66

Altered clotting encompasses a wide spectrum of clinical conditions ranging from bleeding disorders to abnormal clot formation. DIC is an abnormal overstimulation of the normal coagulation process resulting from several clinical conditions that illustrate these extremes. In orthopaedic patients, DIC can develop following trauma (crush injuries), tissue necrosis, fat embolism, gram-negative or gram-positive sepsis, and venous stasis (bedrest). Because of its occurrence as a secondary process and its subtle development, DIC can elude early recognition, diagnosis, and treatment.
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PMID:Disseminated intravascular coagulation: a nursing challenge. 260 99

From 1959 until 1981, 157 children were treated for portal hypertension by esophageal varices ligation in 13 cases and by portosystemic shunt in 144 cases. The age of the patients at operation was correlated with the cause of portal hypertension : mean age was six and a half years for cases with extra-hepatic blockage, and ten years for cases with cirrhosis. In 73% of cases, the shunt was undertaken following a bleeding episode from esophageal varices; at the present time, the decision to undertake a prophylactic type of shunt would be much more questionable. Central splenorenal shunt and mesocaval shunt were the operations most frequently performed by the different surgical teams in charge of these children (respectively 69 and 47 cases). Among the postoperative complications, three cases of venous stasis in lower limbs occurred after a mesocaval shunt; one child died two and a half years after a central splenorenal shunt from pneumococcal sepsis. During the last two years, there is a tendency in our group to perform a Warren shunt for intrahepatic portal hypertension, and a mesocaval shunt with jugular vein interposition in the case of extrahepatic portal hypertension. Recurrence of bleeding from esophageal varices after simple ligation has been observed in 64% of the cases; after portosystemic shunts, the anastomosis was a success in 89.3% of the cases. Whereas a significant fall in portal pressure after completion of the anastomosis is of good prognostic value, the fact that in some cases intraoperative measurement of pressure before and after shunting may show no difference does not imply a secondary thrombosis of the anastomosis, since this complication was seen in only 13% of the cases in these conditions.
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PMID:[Surgical treatment of portal hypertension in children. Retrospective study of 157 cases (author's transl)]. 708 42

The current standard therapy of aortic graft infection is connected with a high incidence of operative and late complications. The usefulness of autogenous tissue revascularization techniques as promising therapeutic alternatives is limited by the complexity of these procedures and by the lack of suitable donor vessels. Since several authors have shown that serious venous stasis of the donor leg does not occur after superficial femoral vein (SFV) resection, we have started to use this deep leg vein for arterial in situ reconstructions in the treatment of aortic graft infection. During the past 3 years seven patients have received autogenous SFV grafts in this way. There were no intraoperative deaths. Two critically ill patients with severe Pseudomonas sepsis and extensive retroperitoneal abscess each died on the 4th postoperative day, due to acute massive bleeding in the operating area. In all of the five survivors infection could be eradicated; only one limb had to be amputated. Mild to moderate transient swelling of the lower extremity without stasis was regularly seen after SFV resection. During follow-up one patient died of cardiac arrest 5 months postoperatively. The remaining four patients are still alive with patent SFV grafts at 6, 22, 30 and 36 months after the operation.
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PMID:[The superficial femoral vein in aorto-iliac position--suitable as autogenous vascular replacement in deep prosthesis infection?]. 896 58

Total hip arthroplasty (THA) and total knee arthroplasty (PTG) are surgical interventions aiming at functional improvement. They therefore cannot accommodate any "collateral damage" produced, notably by symptomatic thromboembolic events (STE). Use of the necessary thromboprophylaxis has made STEs rare (<3% after THA and 2% after TKA). Pulmonary embolism (PE) is exceptional (0.3%) and only accounts for 15% of the deaths occurring in the 1st postoperative month. However, atherothrombotic disease is significantly associated with thromboembolic venous disease. The causes of STEs are mechanical, directly related to surgical maneuvers, but also biological (familial or acquired thrombophilia, hypercoagulability, particularly associated with hip surgery). Delayed resumption of walking, which promotes venous stasis, has been improved by modern pain management techniques. There is consensus on the need to prolong thromboprophylaxis after THA, but it is more controversial after TKA and depends on the added risk factors. In France, prolonged prevention is widespread. The relatively low STE rate should be put into perspective with the risk of hemorrhage. The surgeon should be particularly attentive to the risk of bleeding at the operative site because it generates a risk of sepsis, and a risk of stiffness for TKA. The risk of hemorrhage essentially results from the misuse of all the anticoagulants, particularly observed with the anti-vitamin K medications because their use is more restricted. The risk of hemorrhage has become quite comparable to the risk of thromboembolism with prophylaxis. To prevent this event, the prescriber must know the characteristics of each drug : Tmax, half-life, mode of elimination, as well as the risk of accumulation in the patient receiving such treatment (creatinine clearance). Currently, the thrombohemorrhagic risk for each patient must be assessed. Per os treatment with Dabigatran etexilate is highly advantageous because it is easy to use, there is no thrombopenia induced by heparin, and there is no need for complementary monitoring exams, thus reducing costs. Efficacy in terms of prevention and hemorrhagic risk, demonstrated in phase II studies, must be confirmed by widespread used in real-life conditions.
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PMID:[Antithrombotic prophylaxis after THA and TKA: the surgeon's point of view]. 1987 2

Neonates are the pediatric population at highest risk for development of venous thromboembolism (VTE), and the incidence of VTE in the neonatal population is increasing. This is especially true in the critically ill population. Several large studies indicate that the incidence of neonatal VTE is up almost threefold in the last two decades. Central lines, fluid fluctuations, sepsis, liver dysfunction, and inflammation contribute to the risk profile for VTE development in ill neonates. In addition, the neonatal hemostatic system is different from that of older children and adults. Platelet function, pro- and anticoagulant proteins concentrations, and fibrinolytic pathway protein concentrations are developmentally regulated and generate a hemostatic homeostasis that is unique to the neonatal time period. The clinical picture of a critically ill neonate combined with the physiologically distinct neonatal hemostatic system easily fulfills the criteria for Virchow's triad with venous stasis, hypercoagulability, and endothelial injury and puts the neonatal patient at risk for VTE development. The presentation of a VTE in a neonate is similar to that of older children or adults and is dependent upon location of the VTE. Ultrasound is the most common diagnostic tool employed in identifying neonatal VTE, but relatively small vessels of the neonate as well as frequent low pulse pressure can make ultrasound less reliable. The diagnosis of a thrombophilic disorder in the neonatal population is unlikely to change management or outcome, and the role of thrombophilia testing in this population requires further study. Treatment of neonatal VTE is aimed at reducing VTE-associated morbidity and mortality. Recommendations for treating, though, cannot be extrapolated from guidelines for older children or adults. Neonates are at risk for bleeding complications, particularly younger neonates with more fragile intracranial vessels. Developmental alterations in the coagulation proteins as well as unique pharmacokinetics must also be taken into consideration when recommending VTE treatment. In this review, epidemiology of neonatal VTE, pathophysiology of neonatal VTE with particular attention to the developmental hemostatic system, diagnostic evaluations of neonatal VTE, and treatment guidelines for neonatal VTE will be reviewed.
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PMID:Neonatal Venous Thromboembolism. 2863 78