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

Operations on the biliary tract in cirrhotic patients are reported to have a higher than normal risk of operative morbidity and mortality. We reviewed 39 cases from two university-based hospitals over a five-year period. Each patient had biliary tract surgery and biopsy-proven cirrhosis. Eight patients died (21%), and major complications were found in 12 surviving patients (35%). Local and systemic sepsis was the major contributor, accounting for all of the deaths and 17 of the 22 (77%) complications among survivors. Choledochotomy was done in ten patients; three of them died (30%) and nine major complications occurred in the remaining five. Preoperative risk factors found to be predictive of this high morbidity and mortality were ascites (50% mortality, 50% morbidity), prolonged prothrombin time (29% mortality, 38% morbidity), and a serum albumin level of less than 3.5 mg/dl (33% mortality, 40% morbidity). The presence of other major systemic disease was not significantly different between survivors and nonsurvivors. In 12 patients with no ascites and normal preoperative serum chemistry values, no deaths and only one minor complication occurred. We conclude that although biliary surgery in cirrhotic patients carries a high mortality, this risk can be assessed preoperatively. There appears to be a small subgroup of patients with cirrhosis and cholelithiasis who can have a favorable outcome. Operative therapy in these patients should be reserved for the complications of the biliary tract.
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PMID:Liver cirrhosis and biliary surgery: assessment of risk. 391 47

A study was undertaken to identify the nutritional parameters associated with a high risk of postoperative sepsis. The nutritional status of 162 cancer patients subjected to clean or clean-contaminated elective surgery was preoperatively evaluated according to the following parameters: percentage weight loss, arm circumference, triceps skinfold, arm muscle circumference, creatinine-height index, total serum protein, serum albumin, total iron-binding capacity, cholinesterase, peripheral lymphocytes, complement C3-C4 components, and skin tests. Patients were followed postoperatively according to a precise protocol to classify them as infected or noninfected. Postoperative sepsis was present in 40 patients who had significantly different mean values for four nutritional parameters from those of 114 patients with no complications, ie, total serum protein, 6.60 vs 6.99 g/dl, p = 0.008; serum albumin, 3.39 vs 3.66 g/dl, p = 0.001; total iron-binding capacity 301.32 vs 337.17 mmg/dl, p = 0.006; and cholinesterase, 2389.77 vs 2770.10 mU/ml, p = 0.005. Moreover, the relative risk and the attributable risk for these variables were evaluated and the significance was tested by the chi 2 test. By using multiple logistic analysis it appeared that only total serum protein and total iron-binding capacity gave an independent contribution to the risk of postoperative sepsis, while serum albumin disappeared and cholinesterase became non significant when the contribution of the first two variables was accounted for. It was also possible to identify, in a small number of patients, combinations of two variables that were associated with a very high risk of postoperative sepsis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:"Nutritional" markers as prognostic indicators of postoperative sepsis in cancer patients. 392 22

The conventional animal model of human portal systemic encephalopathy is the dog with Eck fistula. Dogs fed standard dog chow after Eck fistula manifest anorexia, weight loss, hepatic atrophy and encephalopathy. This study was done to determine the natural history of dogs undergoing Eck fistulas when adequate nutrition is maintained with a palatable diet. Twenty-four mongrel dogs were divided into four groups--Eck fistula fed standard dry dog chow (EF-SC) (n equals nine); sham operated fed standard chow (SO-SC) (n equals five); Eck fistula fed a liquid (Isocal) diet (EF-LD), LD), and sham operated fed a liquid diet (SO-LD) (n equals five). Dogs were sacrificed when they had clinical signs of encephalopathy or up to 120 days after operation. EF-SC dogs had a daily caloric intake approximately 40 per cent of that of the other groups. Two EF-SC dogs died of sepsis within two weeks of the operation, the other seven became encephalopathic between 46 and 91 days (a mean of 63.6 +/- 15.6). No other dogs had signs of neurologic deterioration. EF-SC dogs lost 19 +/- 9 per cent body weight and the serum albumin level decreased 14.5 per cent while the other groups maintained body weight and serum albumin levels. Both EF-SC and EF-LD groups had decreased liver weight to body weight ratios (LW X 100/BW) compared with sham operated upon dogs reflecting hepatic atrophy (1.97 +/- 0.7 and 2.2 +/- 0.23 versus 3.04 +/- 0.85 and 3.48 +/- 0.44). Results of histologic examination of the liver revealed hepatocyte atrophy, deglycogenation and lipid accumulation in EF dogs. We conclude from these data that providing dogs with Eck fistula a palatable diet prevents weight loss and malnutrition, but not hepatic atrophy. The lack of neurologic signs in well nourished dogs suggests to us that data concerning hepatic coma from the standard Eck fistula model should be interpreted with extreme caution.
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PMID:Adequate diet prevents hepatic coma in dogs with Eck fistulas. 394 90

To identify associations between abnormal measurements and development of life-threatening surgical sepsis, host-defence parameters were assessed in 2202 patients upon admission to hospital for operation. Measurements included the response to delayed type hypersensitivity (DTH) skin-test antigens, circulating blood-cell counts and hemoglobin levels, neutrophil adherence, chemotaxis, phagocytic and bactericidal function, and circulating serum albumin, serum globulin, serum immunoglobulin and complement levels. Sepsis was considered to be present when there was bacteremia, proven cholangitis or intracavitary abscess proven by operation or autopsy. The admission DTH response stratified patients into a reactive group (responding to two or more antigens out of five, 1373 patients), a relatively anergic group (with a response to one antigen, 306 patients) and an anergic group (with no antigen response, 523 patients). Sex, age and type of disease were similar in the three groups. There were abnormalities in neutrophil adherence, neutrophil chemotaxis, serum albumin and blood hemoglobin levels in all groups, compared with out-of-hospital controls. The reactive group had an 8% sepsis rate and a mortality of 4%, compared with 21% and 15% in the relatively anergic and 33% and 31% in the anergic groups respectively (chi 2 = 186, p less than 0.0001). The same observation was made in 1184 patients who were studied preoperatively: sepsis rates were 8%, 16% and 31% in the reactive, relatively anergic and anergic groups respectively (chi 2 = 76, p less than 0.0001) and mortality was 4%, 12% and 27% respectively (chi 2 = 99.7, p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Host-defence mechanisms in surgical patients: a correlative study of the delayed hypersensitivity skin-test response, granulocyte function and sepsis. 397 Dec 21

The phagocytic function of neutrophils has been studied in 50 Egyptians of both sexes and of various ages, suffering from burns of different depths and extents, and the results compared with data from 50 normal persons of similar sex and age. The nitro blue tetrazolium test (Gifford and Malawista, 1970), and the bacterial killing test (Quie et al., 1967), have been used during the first 24 hours, and then repeated at weekly intervals for 4 weeks. The phagocytic power showed no change during the study except in two patients with extensive burns during fatal septicaemia. The bactericidal capacity, and the formazan cell formation showed similar changes with a steady decrease from the first to the third weeks, followed by a rise during the fourth week. Similar changes were noticed in the serum albumin levels. The decline was more marked in burns of more than 50 per cent of the body surface area and during severe sepsis. Improvement coincided with healing.
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PMID:Phagocytic activity of polymorphonuclear leucocytes in burns. 398 43

An elemental diet was used to prepare 11 severely debilitated malnourished patients for operation. Indications included: 1) as a substitute for parenteral hyperalimentation when catheter sepsis occurred with the latter; 2) high small fistulae; 3) short bowel syndrome; 4) radiation enteritis; and 5) partial obstruction of the gastrointestinal tract. All patients were converted to a positive nitrogen balance as evidenced by a substantial gain in weight and in serum albumin levels. All tolerated corrective operations without difficulty and their wounds healed per primum.
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PMID:Use of elemental diets to correct catabolic states prior to surgery. 420 17

A continuous flow immunoadsorption system consisting of a cell separator, protein A-sepharose columns, and a semi-automatic elution component was developed to specifically remove circulating IgG. This system provides extensive absorption with an essentially unlimited column bed volume. Six dogs were treated a total of 19 times. In no case did fever, sepsis, or respiratory distress result from the treatment. Serial blood counts and tests of liver and renal function remained in the normal range. Ex vivo perfusion of one plasma volume caused an acute drop in IgG levels of approximately 50 percent. This was reflected in a similar decrease in specific antibody levels to sheep erythrocytes, bovine serum albumin, and canine parvovirus. Antibody kinetics following immunoadsorption were variable, but in several cases, antibody levels remained lowered. This immunoadsorptive system appears to be a safe and effective alternative to plasma exchange for removal of IgG antibodies.
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PMID:Specific removal of antibodies with an immunoadsorption system. 636 56

Serum albumin concentration is commonly used as an index of nutritional status and as an indicator of nutritional response in hospitalized patients receiving total parenteral nutrition (TPN). One hundred thirty-nine cancer patients receiving TPN for at least two weeks were studied. Albumin intake, serum albumin, fluid balance, and weight change was monitored from 14 to 100 days of TPN. Patients were classified into three groups: A) patients receiving no exogenous albumin; B) patients receiving less than 25 grams of exogenous albumin; and C) patients receiving at least 25 grams of exogenous albumin during their course of TPN. Linear regression analysis of serum albumin levels vs. time on TPN showed a minimal positive correlation for patients in groups B and C (r = 0.154 and r = 0.183, respectively). Further analysis showed a significant elevation of serum albumin levels only in patients in group C (p less than or equal to 0.05). Contingency table analysis showed statistically significant increase in the incidence of sepsis in patients treated with exogenous albumin (X2 = 10.50, df = 2, p less than 0.01). There was no relationship between the change in serum albumin concentrations and the number of patient deaths. In addition, no relationship between tumor burden and subsequent response of serum albumin levels were identified. Serum albumin levels do not increase in cancer patients receiving TPN, unless exogenous albumin is given. Serum albumin appears to be a poor index of nutritional response in cancer patients receiving TPN.
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PMID:Serum albumin levels in cancer patients receiving total parenteral nutrition. 640 95

This prospective randomized controlled clinical trial compares the effects of early parenteral nutrition and traditional delayed enteral nutrition upon the outcome of head-injured patients. Thirty-eight head-injured patients were randomly assigned to receive total parenteral nutrition (TPN) or standard enteral nutrition (SEN). Clinical and nutritional data were collected on all patients until death or for 18 days of hospitalization. Survival and functional recovery were monitored in survivors for 1 year. Of the 38 patients, 18 were randomized to the SEN group and 20 to the TPN group. Demographically, the two groups of patients were similar on admission. There was no significant difference in the severity of head injury between the two groups as measured by the Glasgow Coma Scale (p = 0.52). The outcome for the two groups was quite different, with eight of the 18 SEN patients dying within 18 days of injury, whereas no patient in the TPN group died within this period (p less than 0.0001). The basis for the improved survival in the TPN patients appears to be improved nutrition. The TPN patients had a more positive nitrogen balance (p less than 0.06), and a higher serum albumin level and total lymphocyte count. More adequate nutritional status may have improved the patients' immunocompetence, resulting in decreased susceptibility to sepsis. The data from this study strongly support the favorable effect of early TPN on survival from head injury.
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PMID:The favorable effect of early parenteral feeding on survival in head-injured patients. 640 49

Bone marrow transplantation (BMT) is associated with severe metabolic stress secondary to anorexia, mucositis, enteritis, and infection. We compared nutritional parameters and clinical outcomes of 22 patients who received prophylactic total parenteral nutrition (TPN) to those of 22 controls, matched for age and diagnosis, who received nutritional support ad libitum. Over the 5-week study period, the TPN group averaged caloric intakes greater than 1.5 X basal energy expediture (BEE) per day and gained 2.5% of body weight; the control group averaged less than 0.9 X BEE and lost 3.7% of body weight. Visceral protein status as reflected by serum albumin was not different. Engraftment of donor marrow cells was 3 days earlier (p less than 0.01) in the TPN group than in the controls, despite there being no significant difference in the number of marrow cells each group received. There was no difference in the two groups' clinical outcomes; mortality, duration of hospital stay, and incidences of sepsis, graft-versus-host disease, and return of malignancy were equivalent. Thus, patients who received prophylactic TPN engrafted sooner than patients who did not; however, overall clinical outcome was unaffected by TPN. Controlled studies of prophylactic TPN are indicated for the BMT patient population.
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PMID:Total parenteral nutrition in bone marrow transplantation: a clinical evaluation. 642 May 35


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