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)

The levels of C-reactive protein (CRP) were assayed in 282 serial sera of 70 patients with hematologic malignancies who were under antineoplastic medication, and surveyed with frequent blood cultures. The mean peak value of CRP in febrile patients with bacteriologically verified sepsis was 162 mg/l and differed significantly (p less than 0.001) from that (23 mg/l) of afebrile patients with negative blood cultures, but not from that (115 mg/l) of febrile patients without confirmed bacteremia. All the values in afebrile patients with negative blood cultures were less than 100 mg/l; 71% of their peak values were less than 40 mg/l. Thus the malignancy itself or its treatment did not considerably mount CRP response.
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PMID:Levels of C-reactive protein in patients with hematologic malignancies. 386 31

Two hundred bacterial septicemia occurring in neutropenic patients (PMN less than 1,000 microliter) were analyzed. Most of these patients had hematologic malignancies. The underlying disease, the degree of neutropenia the association of septic focus with the bacteremia, the responsive microorganisms and their evolution during hospitalization were studied as prognosis factors. The overall mortality was 32.5 p. 100. The mortality was higher in patients whose granulocyte count was lower than 500 microliter. The occurrence of major septic focus (pulmonary, perineal infection, diarrhea with abdominal distension, ORL, or cutaneous extensive focus) during bacteremia was a highly significant factor of bad prognosis. The mortality of bacteremias with and without major septic focus was respectively 62 p. 100 and 15 p. 100. A study of the distribution of the bacterias was performed in terms of mortality and duration of hospitalization. "Escherichia coli" and gram positive cocci were predominant during the two first days and mortality was then low. After that time, others Gram-negative bacterias appeared, especially "Pseudomonas aeruginosa" and the mortality was increasing until the twentieth day. Therefore, the authors raise the opportunity of antibiotic therapy according to the duration between the beginning of the hospitalization and the occurrence of sepsis in neutropenic patients. The role of the extensive use of a curative antibiotic association using colistine and nalidixic acid between 1974 and 1976 is discussed in the emergence of more gram positive cocci bacteremias between 1976 and 1978 than between 1974 and 1976 in the same intensive care unit.
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PMID:[Bacterial septicemia in neutropenia patients]. 666

Serum interleukin (IL)-6 levels measured by ELISA were correlated with the clinical course of 53 adults with hematologic malignancies in 95 episodes of chemotherapy-induced leukocytopenia (< 1000/microL). The median IL-6 level was 15 pg/mL (range, < 3-123) in 27 episodes without fever. This level was 14.5 pg/mL (range, < 3-187) 72-48 h before onset of fever, 78 pg/mL (range, < 3-170) 24 h before fever in episodes with unexplained fever (FUO), and 182 pg/mL (range, 63-1076) 24 h before fever in episodes with positive blood cultures (P < .001). Within 24 h after onset of fever, median IL-6 level was 171 pg/mL (range, 53-1134) in episodes of FUO, 444 pg/mL (range, 38-7973) in episodes with gram-negative bacteremia, and 2017 pg/mL (range, 76-7253) with gram-positive bacteremia (P < .01). IL-6 levels increased before death in all 13 patients who died of sepsis. Median level was 7253 pg/mL (range, 445-95,906) within 3 days of death. Determination of IL-6 may be useful for early assessment and as a prognostic tool in leukocytopenic fever.
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PMID:Increase in interleukin-6 serum level preceding fever in granulocytopenia and correlation with death from sepsis. 779 69

In 28 patients with hematologic malignancy, the clinical effect and the safety of sulbactam/cefoperazone (SBT/CPZ) were studied on 45 episodes during granulocytopenic stage after antineoplastic chemotherapy. The overall efficacy rate obtained with SBT/CPZ in combination with other drugs was 62%. The rates for sepsis, suspected sepsis and pneumonia were 67%, 94% and 38%, respectively. The efficacy in those cases that showed granulocyte count less than 300/microliters during the course of administration of SBT/CPZ was 53%, and in those cases that showed granulocyte counts recovery to more than 300/microliters was 73%. Prior antimicrobiological treatments had no influence on the efficacy of SBT/CPZ. SBT/CPZ showed an activity spectrum covering frequently isolated microorganism including Acinetobacter calcoaceticus, Pseudomonas aeruginosa, Enterobacter cloacae and Staphylococcus aureus. Mild adverse effect were observed in 4 episodes (8.8%). These result suggested that SBT/CPZ was thought to be a useful drug for empirical therapy in granulocytopenic patients with hematologic malignancies.
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PMID:[Clinical evaluation of sulbactam/cefoperazone for infections during the chemotherapy of hematologic malignancy]. 799 Feb 60

The characteristics of 554 febrile episodes in 126 patients with a hematological malignancy over a 6-year period (1985-90) were reviewed in order to study the current incidence and clinical significance of blood culture positivity. An infection was documented microbiologically in 28% and clinically in 30% of the episodes. Blood cultures were positive in 19% of the febrile episodes. The rate of blood culture positivity was unrelated to the type of hematological malignancy, to neutropenia and to the presence of infection foci. 21% (26/126) of the patients died of sepsis-related causes. Sepsis-related death occurred in 23% of the blood culture positive febrile episodes, with a median survival time of 2 days. Infection prophylaxis did not reduce either the rate of blood culture positivity or the rate of sepsis-related deaths. Thus, the small proportion of febrile episodes whose fever etiology could be established by blood culture represented 'the tip of the iceberg', i.e. rapidly lethal septic infections with a high mortality rate. This fatality could neither be predicted by a search for infection foci nor prevented by infection prophylaxis.
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PMID:Incidence and clinical significance of positive blood cultures in febrile episodes of patients with hematological malignancies. 819 Dec 44

Neutropenic colitis is a complication of the treatment of hematologic malignancies and, less commonly, of other disease entities. The septic, inflammatory process has a predilection for the terminal ileum and right colon. While the pathogenesis is not clear, mucosal injury caused by several different mechanisms and local opportunistic infection play significant roles. An association has been recognized between neutropenic colitis and sepsis caused by C. septicum. Patients present with fever, diarrhea, and acute abdominal pain and tenderness often localized in the right lower quadrant. Sonography and CT are helpful in demonstrating colonic wall thickening and pericolic fluid. Peritoneal lavage has been used to exclude perforation in these critically ill patients. Although there has been debate about whether medical or operative management is best, the optimal initial therapy includes supportive care with gastric decompression, fluid and blood product replacement, and broad-spectrum antibiotics. The indications for surgery include continued intestinal bleeding despite correction of coagulopathy and pancytopenia, free intraperitoneal air, and uncontrolled sepsis. At operation, a right colectomy with ileostomy and mucous fistula or, in selected patients, primary anastomosis is the procedure of choice. Timely return of functioning neutrophils and the eventual prognosis of the primary disease are crucial to the overall success or failure of treatment of neutropenic colitis.
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PMID:Collagenous colitis, eosinophilic colitis, and neutropenic colitis. 837 36

Thirty-one patients (median age, 44 years) with advanced hematologic malignancies were given thiotepa 15 mg/kg, and cyclophosphamide 120 (n = 14) or 150 (n = 17) mg/kg followed by unfractionated peripheral blood stem cell transplants (PBSCT) from genotypically identical siblings (n = 28) or one antigen mismatched family donor (n = 3). Donors were mobilized with granulocyte colony-stimulating factor 5 to 10 microgram/kg/d for 6 days and underwent two to three leukapheresis on days +5, +6, +7. The median cell yield per donor expressed/kg of recipients body weight was as follows: nucleated cells 13 x 10(8)/kg; CD34+ cells 6 x 10(6)/kg; colony-forming unit-granulocyte macrophage 38 x 10(4)/kg, and CD3+ cells 449 x 10(6)/kg. The diagnoses were chronic myeloid leukemia (n = 4), acute myeloid (n = 9) or lymphoid leukemia (n = 2), acute myelofibrosis (n = 2), multiple myeloma (n = 1), lymphoma (n = 6), chronic lymphocytic leukemia (n = 1) myelodysplasia (n = 6). Twenty-eight patients had advanced disease, 29 patients were first grafts, and 2 were second transplants 3 and 9 years after the first. Neutrophil counts of 0.5 x 10(9)/L and platelet counts of 30 x 10(9)/L platelets were both achieved on day +14 (median). Engraftment could be proven by sex markers or DNA polymorphism in 29 of 31 patients: one had early leukemia relapse and one patient was unevaluable because of early death. Acute graft-versus-host disease (GVHD) was scored as minimal or absent (grade 0 to 1) in 14 patients, moderate (grade II) in 13, and severe (grade III to IV) in four. Causes of death were leukemia (n = 4), acute GVHD (n = 4, with associated cytomegalovirus infections in three), sepsis (n = 1), liver failure (n = 1), multiorgan failure (n = 1), and hemorrhage (n = 1). The actuarial transplant mortality is 29%, the actuarial relapse rate 22%. Nineteen patients survive with a median follow up of 288 days (100-690). The actuarial 2-year survival is 57%. Three patients received PBSCT from family donors mismatched for one class II antigen: all engrafted, one developed grade I aGVHD; one died of leukemia on day +155; two are alive disease free 267 to 290 days postgraft. This study suggests that thiotepa cyclophosphamide followed by unfractionated PBSC allograft may be an alternative form of transplant for adults with advanced leukemia, also in the setting of one antigen mismatched donor. The engraftment is rapid with acceptable GVHD and relatively low transplant-related mortality.
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PMID:Thiotepa cyclophosphamide followed by granulocyte colony-stimulating factor mobilized allogeneic peripheral blood cells in adults with advanced leukemia. 870 95

The plasma level of soluble E-selectin (sE) reflects the activation of endothelial cells induced by cytokines such as tumor necrosis factor-alpha and interleukin-1 in vitro. These cytokines are important in the development of coagulation abnormalities in patients with sepsis. We compared the plasma levels of sE in patients with infections suspected of having disseminated intravascular coagulation (DIC) (n = 33) and in patients with underlying disorders other than infections, including solid tumors (n = 28), obstetric disorders (n = 13), hematologic malignancies (n = 13), and liver disease (n = 9), to clarify the involvement of cytokines in the development of coagulation abnormalities in patients with sepsis. Plasma levels of sE in patients with infection were significantly higher than in patients with the other underlying disorders. The plasma level of sE was also significantly higher in patients with infection with DIC (114.6 +/- 77.9 ng/ml, n = 21) than in patients with infection without DIC (54.5 +/- 53.1 ng/ml, n = 12, P < 0.02). There was no significant difference in sE level between patients with the other underlying disorders with and without DIC. The plasma level of sE was significantly correlated with the serum level of FDP(E) in patients with infection. The plasma level of sE was significantly higher in patients with infection with organ failure compared to patients without organ failure. There was no significant difference between patients with the other underlying disorders with and without organ failure. Plasma levels of tumor necrosis factor-alpha and interleukin-6 were detected in only 12.1% and 20.0% of patients with infections, respectively. These observations strongly suggest that plasma levels of sE reflect the activation of endothelial cells induced by cytokines, which may lead to DIC and organ failure in the presence of sepsis. Furthermore, determination of plasma level of sE may be useful for detecting the endothelial activation induced by cytokines in the pathologic conditions of sepsis, even when plasma levels of cytokines cannot be detected.
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PMID:Plasma levels of soluble E-selectin in patients with disseminated intravascular coagulation. 906 1

Five hundred two central venous catheters inserted in 366 patients were evaluated prospectively over a one-year period to determine the frequency and risk factors associated with catheter-related sepsis. For study purposes, in cases in which catheter infection was suspected but the initial blood cultures were negative, the catheters were replaced by guidewire technique; otherwise, the catheters were routinely changed after 21 days by guidewire technique. A catheter-related infection was suspected in 190 cases (190/502, 38%). A diagnosis of catheter-related sepsis was established in 50 patients, which represents 10% of the total number of lines (502). Over a total of 6428 days of catheter use, the infection rate was 0.8 cases of sepsis per 100 catheter-days. Staphylococcus epidermidis, Staphylococcus aureus, and Candida spp. were the most frequently isolated aetiological agents of sepsis. On univariate analysis, six variables affecting the rate of catheter-related sepsis were identified: neutropenia for more than eight days (p < 0.001); AIDS (p < 0.001); haematological malignancy (p < 0.001); administration of total parenteral nutrition (p = 0.001); duration of site use (p = 0.04); and high APACHE II score (p = 0.04). The logistic regression analysis revealed that AIDS and haematological malignancies were independent risk factors of catheter-related sepsis. Catheter replacement over a guidewire was no more likely to be associated with sepsis than was percutaneous catheter insertion. In conclusion, although the incidence of established catheter infection is much lower than the incidence of suspected infection, in most cases of suspected infection it is wise to change the catheter with the guidewire technique and wait for culture of the tip, rather than to remove the catheter immediately. Such a policy may help reduce the number of unnecessary catheter removals.
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PMID:Central venous catheter-related sepsis in a cohort of 366 hospitalised patients. 913 22

The postoperative complications observed in a group of 27 patients with hematological diseases that underwent splenectomy are reported: 21 patients had a non-malignant hematological condition, whereas the rest had a hematological malignancy. Seven complications presented in 6 patients (two wound infections, two severe post-operative hemorrhages, one incisional hernia, one sepsis by capsulated bacteria and one fatal hemophagocytic syndrome). The overall complication rate was 27%, whereas the fatal complication rate was 3%. The complication rate in patients with malignant diseases was 83%, whereas that in benign conditions was 9%. The size of the spleen was related with the complication rate (median weight of patients with complications was 990 g versus 132 g in those without complications; p < 0.01). The two patients that underwent splenectomy before age six months had complications, in one case related to parental negligence. In splenectomies performed for hematological disease the benefits must be balanced carefully against the risks.
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PMID:Splenectomy complications in hematological diseases. 983 Mar 25


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