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

The diabetic neurogenic paralytic bladder is characterized by marked residual urine, secondary infection, pyelonephritis, sepsis, and azotemia. Initial manifestations were studied in diabetic patients with and without neuropathy and in nondiabetic controls, all without symptoms referable to the urinary tract. The nondiabetic controls and the diabetics without neuropathy were urologically normal. Eighty-three percent of the diabetic patients with neuropathy had objective evidence of neurogenic bladder involvement; however, there was no residual urine, infection, pyelonephritis, sepsis or azotemia. The disparity between early and late bladder involvement is determined by the factor of residual urine, which is the measure of advancing bladder neuropathy leading to decompensation. Progressive decompensation of the asymptomatic diabetic bladder may be a cause of the increased frequency of renal infection in diabetic patients.
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PMID:Development of urinary bladder dysfunction in diabetes mellitus. 735 22

Trauma and non-traumatic insults can cause muscle damage to such an extent that serious sequelae to other organs may result. Myoglobinuria and subsequent acute renal failure (ARF) is a well known and widely studied fact of such sequelae. Twelve cases of ARF (between 1990-1993) who have developed renal dysfunction after prolonged muscular exercise e.g., squat jumping, sit-ups and blunt trauma from sticks or leather belts mainly given by law enforcing personnel for certain issues were studied. None of them had previous history of myopathy, neuropathy or renal disease. All were critically ill on presentation and required renal support in the form of dialysis. Although morbidity was high in all, eleven of them recovered and one expired due to sepsis.
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PMID:Acute renal failure due to traumatic rhabdomyolysis. 759 12

Our experience and that of others indicate that the number of very distal bypass operations is growing. From the early 1970s, when we performed a few operations per year, our numbers have increased to 60 to 65 operations annually, about 20% of all infrainguinal open revascularizations. Amputation of one leg leaves a patient, should he survive for a few years, with a second limb that is at substantial risk of infection or gangrene. From over 20 years of experience with thousands of diabetic leg problems and approximately 600 paramalleolar bypasses, the following facts have emerged from our clinical practice. Primary pedal arterial arches are virtually never complete. This alone should not deter the surgeon from attempting paramalleolar bypass grafting. Clinical details such as neuropathy, sepsis, and general medical status and even family support should not be overlooked as "risk factors." The order of frequency for pedal distal anastomotic sites will be anterior tibial/dorsalis pedis, posterior tibial/common plantar artery, lateral plantar artery/medial plantar artery, and lateral tarsal artery. In each case the graft should be placed as proximal as possible on the vessel; tibial outflow should be considered. Use short grafts with distal inflow whenever possible. In the rare instance wherein no pedal target site is available, consider the isolated tibial segment. Failure of a very distal bypass procedure seldom results in an amputation that is more proximal than otherwise would have been required if no bypass were attempted. As a corollary, after sepsis is controlled and all lesions and amputations are healed, failure of the graft may spare the limb from further risk of amputation. In diabetics, the presence of a palpable popliteal pulse and absence of foot pulse are tantamount to identifying the paramalleolar bypass graft candidate. Even the presence of palpable pedal pulses does not exclude patients who could achieve limb salvage with pedal bypass. That determination depends upon an angiogram. Pulsation and flow are not equivalent. Just as the obligations of the surgeon who performs an amputation are not discharged until healing and rehabilitation are complete, likewise, the vascular surgeon's duties after paramalleolar bypass must include a return to the ambulatory status. Careful follow-up, ongoing explicit patient and family education about foot care, and orthotics and shoes will enhance the life and life expectancy of the bipedal patient.
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PMID:Bypass grafts to the ankle and foot. A personal perspective. 763 16

The initial diagnoses of associated injuries in patients with traumatic brain injury (TBI) are often overlooked because of the priority given to life-sustaining measures. Pelvic and abdominal injuries comprise less than 5% each of the concurrent injuries associated with TBI and multiple trauma. This report describes a 32-year-old man who sustained a moderate TBI with facial, pelvic, and extremity fractures secondary to a fall. His hospital course was complicated by sepsis, acute renal failure, and retroperitoneal hemorrhage. Admitted to the rehabilitation service 6 weeks after the fall, the patient was found to have a previously undiagnosed profound quadriceps muscle weakness. A diagnosis of femoral neuropathy was confirmed by electrodiagnostic studies and was attributed to compression by pelvic hematomas. Rehabilitation management included use of a solid ankle cushion heel (SACH) wedge, a functional knee brace, a progressive ambulation program, neuromuscular stimulation, and patient and family education with an emphasis on safety. The patient progressed rapidly with his rehabilitation program, improving from moderate assistance in all skills to independence in 3 weeks. This case illustrates the importance of the physiatrist's role in the early detection of associated injuries in patients with multiple trauma and TBI; it also illustrates some of the rehabilitation techniques that may be employed to aid a patient with a femoral neuropathy to regain junctional ability.
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PMID:The rehabilitative management of the traumatic brain injury patient with associated femoral neuropathy. 774 23

We report two cases of axonal sensori-motor polyneuropathies complicating sepsis and multiple organ failure (MOF) among severely burned patients (total burned surface area of 35 to 40 per cent) in which no other cause of neuropathy was retrospectively identified. No steroids or neuromuscular blocking agents had been given. The date of onset was not established but the diagnosis was late, between the 30th and 45th day, at the recovery of consciousness. Regression was incomplete, with severe sequellae especially in one patient who was unable to walk 10 months after the injury. Burned patients can present with many kinds of peripheral neuropathies. Postburn polyneuropathies with nerve conduction slowing were described by Henderson. Mononeuropathies can result from nerve compression complicating unfavorable postures in comatose patients or from nerve entrapment in ischemic limbs. Polyneuropathy in postburn sepsis with MOF does not appear to have been previously reported. Postburn sepsis usually occurs in young patients, without other cause of MOF; and therefore represents a relatively "pure" sepsis syndrome.
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PMID:[Neuropathies of septic syndrome with multiple organ failure in burnt patients: 2 cases with review of the literature]. 786 55

Thirty-four evaluable patients were treated with vinorelbine, a novel, semisynthetic vinca alkaloid, as first-line chemotherapy for advanced breast cancer. They received vinorelbine 25 mg m-2 i.v. given weekly for a maximum of 16 cycles. Two patients achieved a complete remission and 15 a partial remission, giving a response rate of 17/34 (50%; 95% CI of 34-66%); median response duration was 5.8 months. The median progression-free interval was 4.4 months and median survival 9.9 months. Treatment was generally well tolerated. Fatigue was the most common side-effect. The main reason for dose adjustments was myelosuppression; 68% of patients had WHO grade 3 or 4 neutropenia and there was one death attributed to neutropenic sepsis. Nausea/vomiting and neuropathy were mild and alopecia was uncommon. This study confirms vinorelbine as a highly active, well-tolerated agent in advanced breast cancer worthy of evaluation in combination chemotherapy regimens.
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PMID:A phase II, multicentre, UK study of vinorelbine in advanced breast cancer. 794 9

Familial visceral neuropathy is a rare cause of chronic intestinal pseudo-obstruction. It is characterized by progressive destruction of the gastrointestinal myenteric plexus resulting in dysmotility and associated early satiety, post-prandial bloating, recurrent nausea and vomiting, abdominal distension, chronic diarrhea, weight loss, and malnutrition. In its varying forms, there may be neuronal destruction in other parts of the peripheral and central nervous system. We report on four siblings who presented in their third or fourth decades with initial clinical features of chronic intestinal pseudo-obstruction and eventual progressive diffuse neuronal disease, characterized by leukoencephalopathy and peripheral neuropathy. Within 5 yr of presentation, all four patients died from inanition and sepsis, despite aggressive nutritional support. Their clinical and pathological features are characteristic of familial visceral neuropathy of the autosomal recessive form. This presentation may represent a unique syndrome characterized by a tetrad of polyneuropathy, ophthalmoplegia, leukoencephalopathy, and intestinal pseudo-obstruction.
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PMID:Familial visceral neuropathy as part of a diffuse neuronal syndrome: four fatal cases in one sibship. 817 58

Neuropathic complications of the burn patient are frequently undiagnosed. A retrospective study was performed looking at neuropathies in patients admitted to a tertiary care burns centre from 1984 to 1991. Nineteen out of a total of 800 patients had signs and symptoms of neuropathy, confirmed on neurophysiological testing. Most patients were severely burned with 11 patients (69%) having a total burn surface area of > 20%. Twenty-eight percent were full thickness burns. Mononeuritis multiplex was the most common finding in these patients, occurring in 11 (69%). This has not been reported before. Three patients (19%) had an isolated mononeuropathy, one (6%) had a radiculopathy and one had a generalized axonal polyneuropathy. Of the patients with mononeuropathy, nine had lesions only in burned areas and four had lesions in burned and unburned areas. Eleven patients had complications of sepsis with five also having renal failure. Age, sex, serum albumin, magnesium, phosphate, creatinine, the presence of sepsis and the number or type of drug did not correlate with the number of affected nerves nor the extent of recovery. The length of hospitalization and severity of the burns were the only two factors which correlated with the number of affected nerves. Vascular occlusion of the vasa nervorum, direct thermal injury or a disseminated neurotoxin are postulated as possible aetiological mechanisms.
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PMID:Neuropathy in burn patients. 838 17

Onion bulb formations involving cranial nerves are an unusual pathologic feature. We report the postmortem neuropathologic findings in a 69-year-old man with a longstanding neuropathy characterized by progressive muscle weakness, sensory ataxia and multiple cranial nerve abnormalities. Electrodiagnostic testing disclosed features of an acquired demyelinating polyneuropathy. Treatment with corticosteroids and plasmapheresis resulted in no change in his neurologic status, and the patient died after repeated episodes of pneumonia and sepsis. Autopsy showed widespread onion bulb formation in cranial nerves III, IV, V, VI, X, XI and XII, anterior and posterior spinal nerve roots, dorsal root ganglia and multiple peripheral nerves, some of which also had foci of epineurial perivascular inflammation. Muscle sections revealed severe neurogenic atrophy. This case demonstrates that, in longstanding acquired demyelinating neuropathy, the cranial nerves also undergo repetitive cycles of demyelination and remyelination resulting in severe weakness of the bulbar musculature and histologic features of hypertrophic neuropathy.
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PMID:Severe cranial nerve involvement in longstanding demyelinating polyneuropathy: a clinicopathologic correlation. 883 44

Between 1990 and 1993, we studied 14 cases of acute renal failure due to prolonged muscular exercise (e.g., squat jumping, sit-ups) and blunt trauma inflicted by law enforcement personnel using sticks or leather belts. None of the patients had a prior history of myopathy, neuropathy, or renal disease. All were critically ill and required renal support in the form of dialysis. Although the morbidity was high, 13 of the patients recovered normal renal function. One patient expired due to sepsis.
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PMID:Acute renal failure due to traumatic rhabdomyolysis. 887 95


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