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

We investigated the association between plasma catecholamines and the renal response to nonhypotensive sepsis. Arterial plasma catecholamines were measured in 16 sheep, before and 24 h after surgical induction of peritonitis. Animals were volume loaded with lactated Ringer's solution (8 L/24 h) before and after surgery; non became hypotensive. For analysis, animals were retrospectively divided into those with increased serum creatinine after 24 h of sepsis (group 1, n = 8) and those without (group 2, n = 8). Group 1 showed increased cardiac index and decreased systemic vascular resistance typical of severe sepsis, with decreased glomerular filtration rate (GFR), oliguria, sodium retention, increased plasma renin activity (PRA), decreased urinary kallikrein excretion, and increased urinary 6-keto-prostaglandin-F1 alpha excretion. Group 2 showed insignificant hemodynamic disturbance, and no significant renal response. Plasma catecholamines were equal in both groups at baseline. In group 1, there were uniform increases after 24 h in plasma norepinephrine (474 +/- 115 to 1183 +/- 158 [SEM] pg/ml; p less than .01) and plasma epinephrine (108 +/- 8 to 309 +/- 70 pg/ml; p less than .05). In group 2, neither plasma norepinephrine (343 +/- 59 to 330 +/- 56 pg/ml) nor plasma epinephrine (116 +/- 16 to 116 +/- 13 pg/ml) changed significantly. Plasma norepinephrine correlated inversely with GFR; plasma epinephrine correlated with PRA. The sympathetic nervous system may be involved in the renal response to nonhypotensive sepsis, both directly and via effects on other vasoactive hormone systems.
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PMID:Association between renal and sympathetic responses to nonhypotensive systemic sepsis. 316 6

High-energy phosphate metabolism in skeletal muscle is altered during sepsis, although the chronology of events is uncertain. Phosphorus 31 magnetic resonance spectroscopy was used to measure changes in muscle energy stores of the left hind limb musculature of adult male rats during sepsis. Following control scans, cecal ligation and puncture were performed and scanning was repeated 6, 24, and 48 hours after surgery. The ratios of phosphocreatine (PCr) to inorganic phosphate (Pi), a measure of energy stores, and adenosine triphosphate (ATP) to Pi ratio, a measure of the energy available for immediate use, were determined from peak heights. Intracellular pH was calculated using the distance between Pi and PCr peaks. In surviving animals, a 40% decrease in PCr/Pi ratio (+/- SEM) was observed by 24 hours (22.3 +/- 3.0 at time 0 vs 13.3 +/- 2.8 at 24 hours), whereas energy availability (beta-ATP/Pi) was statistically unchanged (18.2 +/- 2.2 at time 0 vs 15.2 +/- 1.2 at 48 hours). Intracellular pH did not change. Both PCr/Pi and ATP/Pi ratios were inversely correlated with time. In this model of documented peritonitis, skeletal muscle energy metabolism is rapidly altered following severe infection, and these changes can be detected using 31P magnetic resonance spectroscopy.
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PMID:In vivo phosphorus 31 magnetic resonance spectroscopy of rat hind limb skeletal muscle during sepsis. 317 91

Antithrombogenicity of pneumatic ventricular assist devices (VAD) for postoperative ventricular failure was evaluated macroscopically and microscopically in relation to VAD flow, coagulation parameters, and other potentially thrombogenic factors. A total of 12 sack type pumps were used in nine cases after operations for ischemic heart diseases (4 cases), valvular diseases (3 cases), and congenital anomalies (2 cases). Durations of pumping of each device ranged from 18 hours to 37 days (mean, 10.9 days). The clinical protocol for antithrombogenicity of the device indicates maintenance of ACT around 150 sec and keeping VAD flow more than 2.0 L/min. In our clinical series, however, heparin was given only in most cases to maintain activated clotting times (ACT) at 120-140 sec for the first three postoperative days. Minute ringlike thrombi were noted at connectors of cannula in two pumps after low flow (1.5 L/min) pumping for 5 days or after frequent on/off studies for weaning. A small thrombus (2 X 2 mm) and fine granular thrombi were noted on actuating bladders in two pumps that were used with frequent on/off studies or in a patient with severe sepsis during VAD pumping. Other VAD pumps were macroscopically free of thrombus. SEM analyses on surfaces of actuating bladders demonstrated mild to moderate platelet adhesions, which were correlated with platelet count, but not with other coagulation parameters including platelet agglutination and pumping duration. In cases with leucocytosis during VAD uses, leucocyte adhesion was noted as well without correlation to the coagulation parameters.
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PMID:Antithrombogenicity of ventricular assist devices for postoperative myocardial dysfunction. 319 22

Cardiopulmonary effects of 500 ml of 20% iv fat emulsion (Intralipid) infusion in two groups of patients who required mechanical ventilation were evaluated in our Critical Care Center. Group 1 included ten patients void of signs or symptoms of sepsis. Group 2 consisted of ten patients exhibiting clinical and laboratory signs and symptoms of sepsis. Data were measured before and immediately after Intralipid infusion and when serum lipemia cleared. Intralipid infusion precipitated a significant increase in venous admixture (Qsp/Qt) from 13.7 +/- 3.6 (SEM) to 18.0 +/- 6.5% and from 22.0 +/- 4.8 to 25.8 +/- 7.0% in groups 1 and 2, respectively. Mean pulmonary artery pressure (MPAP) increased from 22.7 +/- 4.2 to 29.2 +/- 8.1 mm Hg and 26.4 +/- 6.8 to 28.0 +/- 4.0 mm Hg in groups 1 and 2, respectively. When serum lipemia cleared, Qsp/Qt and MPAP returned to preinfusion levels. We conclude that Intralipid infusion increases pulmonary artery pressure and venous admixture in critically ill patients. These changes are temporary and coincidental with serum lipemia rather than presence or absence of sepsis. Adequate levels of oxygenation should be confirmed during Intralipid infusion in patients with borderline oxygenation.
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PMID:Cardiopulmonary effects of Intralipid infusion in critically ill patients. 337 Oct 22

We present an analysis of 42 cases of acute rupture of the diaphragm by blunt trauma. There were 31 men (74%) and 11 women (26%); the mean age was 32.8 years +/- 2.4 SEM. At admission, hypovolemic shock was present in 45% of the cases, pelvic fracture in 36%, and severe respiratory distress in 21%. Diaphragmatic rupture was suggested before operation by unilateral elevation of the diaphragm, supradiaphragmatic densities, and displacement of abdominal organs into the thorax, as shown by chest films and GI series in 18 cases (43%). The left hemidiaphragm was injured in 24 cases (57%), the right in 15 (36%), and both sides in three (7%). Of the 17 patients (40%) found to have an abdominal organ in the thorax, 12 had had a left-sided rupture. Only four patients (10%) had solitary diaphragmatic injuries. Associated injuries (usually two or more) occurred in 38 cases (90%); they were abdominal in 34, musculoskeletal in 26, neurologic in 16, and thoracic in nine. The injuries were repaired through a celiotomy in 33 cases, by thoracotomy in six, and by separate celiotomy and thoracotomy in three. Postoperative complications occurred in 29 cases, the most common being pulmonary (18), systemic sepsis (six), and recurrent bleeding (three). There were 14 deaths, for a mortality of 33%. Seven were operative and due to massive hemorrhage; the late deaths were caused by systemic sepsis in five and neurologic trauma in two. We conclude that (1) diaphragmatic rupture after blunt trauma must be suspected when specific radiologic findings are present; (2) solitary diaphragmatic injuries seldom occur; (3) in most cases, morbidity or mortality is caused by the severity of the associated injuries; and (4) most diaphragmatic injuries can be repaired through a celiotomy, and all of them should be repaired to avoid the sequela of entrapment of abdominal organs in the thorax.
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PMID:Diaphragmatic rupture due to blunt trauma: morbidity and mortality in 42 cases. 340 95

From March 1, 1979, to March 1, 1985, the University of Arizona received 223 cardiac donor referrals. Sixty-two were accepted: 15 local, 23 regional (less than 370 km or 200 nautical miles), and 24 distant (370 to 1556 km or 200 to 840 nautical miles). Thirty-eight donor deaths were due to motor vehicle accidents, 10 to gunshot wounds, 6 to cerebral disease, and 8 to other closed-head lesions. The mean time from injury to brain death was 65 +/- 5 hours (+/- standard error of the mean [SEM]) and from brain death to organ donation, 12 +/- 3 hours. The mean ischemic time for the donor hearts ranged from 30 to 233 minutes (mean +/- SEM, 128 +/- 7 minutes). Fifty patients, otherwise acceptable, were refused as cardiac donors because an ABO-compatible recipient was not available. Two regionally procured hearts failed at operation, 1 because of unrecognized donor sepsis and 1 from a patient on large-dose inotropic support. Although there was no difference in myocardial function, median survival with follow-up through June 30, 1985, of patients receiving locally, regionally, and distantly procured organs was 59 months, 18 months, and 21 months, respectively. Cumulative proportion 1-year survival was 93%, 56%, and 61%, respectively. The 2-year survival was 85% for patients given locally procured hearts, 43% for those with regionally procured hearts, and 38% for those with a heart from a distant donor. Survival curves showed significantly longer survival for locally procured organs than regionally or distantly procured organs (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The cardiac donor: a six-year experience. 351 87

Recent interest in the role of prostaglandin inhibitors as immunomodulators following major injury prompted us to study the effect of indomethacin on burn-induced immunosuppression in rats as measured by the delayed-type hypersensitivity (DTH) skin test response, ability to contain an intradermal bacterial challenge (10(8) Staphylococcus aureus 502A injected intradermally), and overall survival from spontaneous burn wound sepsis. Fifty male Sprague-Dawley rats sensitized to keyhole limpet hemocyanin (KLH) were subjected to a 30% full-thickness scald burn. Group 1 (n = 24) received indomethacin at 0.5 mg/kg intraperitoneally once daily with the first dose given immediately following the burn. Group 2 (n = 24) received vehicle only. Prostaglandin E2 measured by radioimmunoassay on day 17 was 2553 +/- 832 pcg/ml serum (+/- SEM) in the vehicle group and 1042 +/- 231 pcg/ml in the indomethacin group (P = 0.058, unpaired t test). Burn injury induced a decrease in the DTH response to KLH and an increase in the Staph lesion size (P less than 0.05) which was not corrected by indomethacin treatment. All animals developed spontaneous burn wound sepsis by day 14. Survival after 17 days in the indomethacin group was 100% compared to that of the vehicle group, 79%, P less than 0.05 (Fisher exact test). We conclude that despite unmeasurable corrections of the burn-induced suppression of the DTH response and local nonspecific bacterial defenses, low-dose indomethacin improves survival following burn sepsis.
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PMID:The effect of indomethacin on burn-induced immunosuppression. 362 43

Neutrophil function was assessed in patients undergoing anesthesia and surgery using a chemiluminescence (CL) assay. With the anesthetic agents enflurane and nitrous oxide, peroperative CL (99.1 mV; 13.8 SEM: postinduction but prior to surgery) was significantly lower than the preoperative value (146.5 mV; 14.1 SEM) with a mean fall of 30% (P less than 0.001). CL measurements taken 24 hr postoperatively were significantly increased (193.9 mV; 16.4 SEM) over the pre- and peroperative values, showing mean increases of 32 and 96%, respectively (P less than 0.001 in both cases). The inhibitory influence on CL appeared to be due to serum factors since peroperative patients' sera inhibited control neutrophils. Significantly depressed levels of the complement component C3 and IgG detected during the peroperative period (P less than 0.05) may explain this phenomenon. Postoperatively, C3 and IgG levels returned to normal. The transient decrease in peroperative neutrophil function may be a contributory factor to the establishment of postoperative sepsis in surgical patients.
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PMID:Impaired neutrophil function during anesthesia and surgery is due to serum factors. 368 4

The immune response of 22 morbidly obese patients was measured before and 6 months after gastric bypass. In-vivo skin testing was carried out using five recall antigens. In-vitro response assessed the ability of isolated lymphocytes to take up radioactive thymidine after culture with the same antigens. The mean (+/- SD) preoperative weight of the patients of 122 +/- 14 kg declined by 33.5 +/- 8 kg after 6 months. The number of positive skin tests increased from a mean (+/- SEM) of 1.8 +/- 0.17 to 2.1 +/- 0.17 (p = 0.2). Mean (+/- SEM) induration of the skin-test response assessed at 24 hours after antigen injection increased from 4.7 +/- 0.6 mm to 5.5 +/- 0.6 mm (p = 0.35) and at 48 hours from 5.4 +/- 0.7 mm to 6.9 +/- 0.9 mm (p = 0.05). One patient who was anergic before gastroplasty responded normally 6 months later after substantial weight loss. In-vitro response, expressed as a stimulation index (+/- SEM), increased from 4.71 +/- 0.65 to 7.95 +/- 1.56 (p = 0.06) for the average of all antigens and from 12.85 +/- 2.05 to 15.79 +/- 2.84 (p = 0.2) for the largest response. The authors conclude that the response to test antigens in vitro and in vivo is not reduced significantly 6 months after gastric bypass and profound weight loss. Patients with severe vomiting, rapid weight loss or sepsis may respond differently and require individual assessment.
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PMID:Immune response after gastric bypass and weight loss. 373 Sep 74

The increased susceptibility of severely injured patients to infection and death from sepsis has been attributed to abnormalities in cell-mediated immunity. The authors therefore assessed the relative number of peripheral blood T helper cells and T suppressor/cytotoxic cells and total T lymphocytes identified by the monoclonal antibodies (McA) OKT4, OKT8, and OKT3, respectively, in 25 patients with burns from 5 to 85% total body surface area (TBSA) (mean: 40%) and 21 patients with nonthermal injuries (mean Injury Severity Score (ISS): 21.4). Patients were compared to 21 healthy controls. Cells reacting with the McA were detected by flow cytometry, which enabled the examination of a population of cells the size of T lymphocytes, excluding larger contaminating cells that might bind the McA. Patients with burns of 30% TBSA or greater had a significant reduction (p less than or equal to 0.05) in OKT3+ cells up to 50 days post-burn. Both septic and nonseptic burn patients had reduced numbers of OKT3+ cells, as did patients after nonthermal injury, suggesting that this reduction was due to the injury itself. Patients with smaller burns (less than 30% TBSA) as a group did not have reduced OKT4+ cells, whereas those with larger burns showed significant reductions in OKT4+ cells (P less than or equal to 0.05) at 0 to 5, 6 to 10, 11 to 20, 21 to 30, and 41 to 50 days post-burn. Seven burn patients who became septic 10 days post-burn or later had significantly lower OKT4+ cells within 10 days of injury (mean: 33.75% +/- 7.4 SEM) than 10 patients who remained free of sepsis (mean: 42.2% +/- 5.4, p = 0.004). Patients with uncomplicated nonthermal injuries failed to show any significant reduction in OKT4+ cells. Following thermal injury, a reduction in OKT8+ cells was observed up to 10 days in patients with burns less than 30% TBSA, and up to 20 days in patients with larger burns. In both groups, at no time were increased OKT8+ cells found to correlate with clinical events. In patients with nonthermal injury, OKT8+ cells generally remained near the normal range.
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PMID:Changes in T lymphocyte subsets following injury. Assessment by flow cytometry and relationship to sepsis. 387 11


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