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

Potential availability of transplantable organs from different types of injury fatalities was studied. Factors examined included target organ damage or disease, age of potential donor, duration of survival before circulatory arrest, and universal rejection factors such as sepsis, HIV infection, or systemic malignancy. Motor vehicle fatalities yielded the greatest proportion of potentially viable organs. Delay in discovery and universal rejection factors were important exclusionary issues for fatalities from suicide, homicide, and non-motor vehicle unintentional injury. There was no difference in organ damage or in duration of survival with higher speeds in fatal crashes, suggesting that states with 65 mph speed limits--and consequently higher death rates--may have greater potential availability of donatable organs than do those with 55 mph maximum. The increase in deaths at higher speeds, however, vastly outweighs the benefits of any possible increase in the potential for donor organs.
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PMID:Potential availability of transplantable organs according to factors associated with type of injury event. 155 28

Twenty-six patients underwent emergent (Group I) and 34 patients elective (Group II) cardiac transplantation (C. Tx.) from June 1985 through June 1989. Age, sex, etiology, presence of diabetes, renal failure and pulmonary artery pressures were comparable for both groups (P greater than 0.5). Twenty-two patients were in New York Heart Association (NYHA) Class IV for Group I and 17 for Group II. Group I included 12 patients on inotropic agents, five on intra-aortic balloon pump (IABP) and one on IABP and cardiopulmonary bypass (CPB). Elective patients were stable at home. Location of the donor heart and mean ischemic times were comparable for both groups. Early mortality (within 30 days) included four patients for Group I and two for Group II. There were four late deaths for Group I patients and six for Group II. Four deaths were due to infection, six to rejection, two to malignancy, two neurological and one each to suicide and multisystem failure. Immunosuppression regimen was similar for both groups. The number and severity of early and late rejection episodes were similar despite blood group crossing in 11 patients for Group I (P less than .01). Incidence of infection was comparable. Favorable lifestyles were comparable, including employment of 12 patients for Group I and 16 for Group II. Cumulative survival for the entire series was 70% at two years. The study indicates that the results of emergent and elective cardiac transplantation procedures are equally gratifying, that mortality is mainly related to rejection and sepsis complications and blood group crossing does not significantly increase the number of rejection episodes.
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PMID:Results of emergent versus elective cardiac transplantation procedures. 223 Jul 4

Accidental iron intoxication is one of the most serious and potentially fatal intoxications in young children. Occurrence in the adult population is rare and is usually associated with a suicide or homicide attempt. Heretofore, all reported cases have involved oral ingestion of ferrous and ferric salts of iron. In a case of fatal iron intoxication reported by Doolin and Drueck, in addition to swallowing a liquid form of ferrous chloride, the patient aspirated it and absorbed it through chemically burned and denuded areas of skin when he fell into a vat of saturated ferrous chloride at work. It is the purpose of this report to describe the first case of fatal iron intoxication in which the sole route of iron absorption was the burned skin. Clinical course of this patient paralleled that of acute oral iron intoxication with development of refractory acidosis, disseminated intravascular coagulation, respiratory and renal failure, and sepsis.
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PMID:Fatal transcutaneous iron intoxication. 322 Aug 52

The authors present 2 cases of post-abortion psychosis and discuss the etiology of this complication from the literature. Psychosis after abortion is rare, estimated at 0-1% in 2 studies, and 6 cases in 15 years experience of 32 psychiatrists in another. The suggestion that illegal abortion is more likely to precipitate psychosis is based in part on the greater possibility of gas embolism and consequent neurologi c lesions. Neurologic symptoms such as sensory, motor, pyramidal and ex trapyramidal signs and epileptic crises could results from scar tissue in the central nervous system. The first patient was a 31-year old mother of 1 illegitimate daughter, in conflict with her partner about having the abortion. After attempting abortion with soap solution she was hospitalized for coliform shock and sepsis complicated by gastric ulcers. 3 weeks alter she became psychoitic, with alternating aggressio n, exhibitionism, infantile behavior and catatonia. After release from the hospital she committed suicide. The second patient had marital conflicts, related to fear of pregnancy, and narcicistic desire for consumer goods instead of children. After she became pregnant with an IUD in place, the abortion commission, at first ambivalent, granted abortion, which required 2 curretage procedures. She had delerium and paranoia concerning her 5 abortions. The authors remarked that the trau ma of abortion may precipitate pscyhosis in a disturbed personality with inner or outer conflicts; it is impossible to predict when decompensation might occur, even if the pregnancy is carried to term.
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PMID:[2 cases of post-abortion psychoses]. 546 32

Obstetrician-gynecologists reviewed patient records of women delivering during January 1986-December 1992 to determine the maternal mortality rate and trends and the causes of maternal deaths in the maternity ward at the National University of Singapore. There were 26,173 deliveries and 9 maternal deaths (a maternal mortality rate of 22.9/100,000). The causes of maternal deaths were pulmonary embolism (underlying condition, systemic lupus erythematosus [SLE]), hemorrhage from multiple sites (thrombotic thrombocytopenia), acute exacerbation of SLE with interstitial pneumonitis, pulmonary fibrosis (systemic sclerosis), fulminant hepatitis (prior hepatitis and liver disease), and cerebral embolism (rheumatic heart disease with mitral valve replacement). There were also three incidental maternal deaths bringing the maternal mortality rate up to 34.4/1000. The incidental causes of death included septicemia from perforated peptic ulcer (uncontrolled thyrotoxicosis), multiple metastases from lung cancer, and suicide (family dispute over adoption of newborn). A cesarean section preceded 4 (44%) of the 9 maternal deaths. Two of these deaths were incidental maternal deaths. Cesarean section was related to two of the remaining six (33%) deaths. These findings show that traditional direct causes of maternal death (hemorrhage, sepsis, embolism, or hypertension) were not responsible for the maternal deaths at this tertiary facility. Instead, the women tended to have medical conditions that placed them at high risk of death regardless of pregnancy status.
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PMID:Maternal mortality: evolving trends. 781 Nov 98

Adult respiratory distress syndrome (ARDS) after tricyclic antidepressant (TCA) overdose has been reported, but has not received as much attention in the literature as hemodynamic instability, cardiac arrhythmias or seizures. This report concerns a 33-year-old female who ingested a large amount of imipramine in an attempted suicide. She developed deep coma, hypotension, cardiac dysrhythmias and seizures. Although she survived initially, ARDS developed and she died of severe hypoxia nine days later. Her lung injury may have been the result of a variety of factors including prolonged hypotension, aspiration pneumonia, sepsis or a direct action on the lung parenchyma by imipramine. The literature pertaining to etiology, epidemiology, pathophysiology and management of TCA-induced lung injury has been reviewed. In one series of severe TCA overdose, an ARDS rate of 9% was reported. The risk of developing pulmonary edema and ARDS should be considered in severe TCA-poisoned patients. To try to prevent this complication, early intubation should be considered to avoid aspiration, and cautious volume loading, plus judicious use of alpha-adrenergic agonists, is indicated to prevent protracted hypotension.
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PMID:Adult respiratory distress syndrome and late death following imipramine overdose: a case report. 785 Jun 87

Two hundred and one patients underwent restorative proctocolectomy between January 1985 and January 1993. The underlying disease was ulcerative colitis in 191 and familial adenomatous polyposis in ten patients. All patients had a J pouch and, except for 22 patients, total mucosectomy was performed. The procedure was technically successful in 200 cases (99.5%). There was no postoperative mortality, but two patients died soon afterwards due to unrelated causes (suicide, upper gastrointestinal bleeding). Early postoperative complications were observed in 33% of patients and 21% required reoperations, most often because of haemorrhage or pelvic sepsis. Late morbidity rate was 29% including reoperations in 31 patients (17%) and conversion to permanent ileostomy in five cases (2.5%). The most common late problems were anal sinus, stricture or fistula (11%) and episodic or chronic pouchitis (20%). The functional result was evaluated in 150 patients followed up for one year. the mean bowel frequency was 5.6 times in 24 hours, 19% of patients had minor anal soiling and 11% required a protective pad. It is concluded that restorative proctocolectomy has become the first choice for most patients with ulcerative colitis and familial adenomatous polyposis.
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PMID:Experience with restorative proctocolectomy in 201 patients. 828 69

Bladder reconstruction using bowel segments was advanced when intermittent catheterization proved so acceptable. Access to the reservoir by way of the urethra is often not possible in children, especially boys. Implantation of the isolated appendix into the bladder remnant or colon segment similar to a ureteral reimplant provides a continence mechanism with ready catheter access (the Mitrofanoff principle). Since 1982 we have applied this principle in 41 pediatric cases of bladder reconstruction (64% boys). Primary diagnoses included bladder exstrophy (46%) and myelomeningocele (34%). Extending the concept of a flap valve continence channel with a narrow tube into the reservoir, segments of tapered ileum and ureters were also used (appendix 61%, ileum 12%, ureter 27%). Results of continence (100%) and uncomplicated catheterization (93%) have been satisfactory. Unfortunately, the longer the experience (average 3.2 years of followup), the more stone formation we experienced (32%), which is due to mucus production and bacteriuria as the stone nidus. There were 2 deaths, including 1 from a renal stone obstructing the ureter with sepsis and 1 a likely suicide. Reoperation was required for 3 stomal revisions, 2 bowel obstructions and 7 stone removals in 3 of the 6 cases in which the bladder neck was closed. Unique aspects of these reconstructions are presented, such as our current preference to bury the stoma in the umbilicus (7 cases), placement of the ureteral segment into the perineum as a neourethra and an unusual conjoined twin reconstruction.
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PMID:Appendicovesicostomy (and variations) in bladder reconstruction. 843 67

Apoptosis (A O) is a pathological process by which cells undergo a form of inducible nonnecrotic cellular suicide. In vitro studies suggest that changes in the rate of macrophage (Mo) A O may be associated with elevated proinflammatory cytokine secretory capacity, such as interleukin-1 beta (IL-1 beta) (via IL-1 converting enzyme activation). Furthermore, it has been reported that Mo are activated during early (0-4 hours) experimental septic insult to act as sources of proinflammatory cytokines, such as IL-1. However, with the progression of sepsis, these same cells become refractory to further stimulation (appearing dysfunctional). Nonetheless, it remains unknown if this acquired immunosuppression (dysfunction) is associated with an acceleration in macrophage A O. To determine this, male C3H/HeN mice were subjected to sepsis (cecal ligation and puncture, CLP) or sham-CLP and 4 or 24 hours thereafter Mo were isolated from the peritoneum (PMo) and liver (KMo). Macrophage monolayers were lysed either after stimulation with lipopolysaccharide (LPS) (10 microgram/mL, 24 hours) in vitro or immediately (ex vivo) before LPS stimulation and the cytoplasmic cell fraction was retained. The extent of A O was determined using a cell-death enzyme-linked immunosorbent assay, which detects the presence of cytoplasmic oligonucleosomes and changes in the propidium iodide staining intensity. The results indicate that, early after CLP (4 hours) only PMo stimulated with LPS in vitro showed evidence of increasing A O. At 24 hours (late) after the onset of sepsis, the ex vivo extent of A O in PMo was increased but it was decreased in KMo. However, the addition of LPS in vitro results in a marked increase in both septic PMo and KMo A O. This latter result suggests that the inability of Mo to release cytokines in response to stiumulants, such as LPS during late sesis (24 hours), may be because of induciton of accelerated A O in these Mo populations.
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PMID:Is sepsis-induced apoptosis associated with macrophage dysfunction? 861 34

Apoptosis (Ao), is a process by which cells undergo a form of nonnecrotic cellular suicide. Although for most cells this is a constitutive process, it can be induced in immature and differentiating immune cell populations by stress mediators associated with inflammation. This inducible form of A(o) is referred to as programmed cell death. However, it is not clear whether hematopoietic cell populations such as the thymus and bone marrow are induced to undergo A(o) during polymicrobial sepsis. To assess this, thymocytes, bone marrow cells, or splenocytes (as a source of comparative nonhematopoietic cells) were harvested from C3H/HeN mice at 1, 4, or 24 hours after cecal ligation and puncture (CLP; to induce polymicrobial sepsis) or sham-CLP (Sham). The results showed that mixed bone marrow cells ex vivo, although not to the same extent as thymus, showed a marked increase in the percentage of cells in A(o), increased endonuclease activity, and a significant decrease in cell yield at 24 hours but not at 4 hours after CLP. Similar changes were not evident in splenocytes. Phenotypic, as well as morphologic assessment, indicated that most of the increase in apoptotic cells in the thymus was associated with the immature T cells (CD4+CD8+) and CD8-CD4- cells. In contrast, the increase in bone marrow cell A(o) was associated with only the B220+ cells, with no significant contribution from myeloid cells. Treatment of CLP mice in vivo with either RU-38486 or PEG-(rsTNF-R1)2 was unable to reverse the increased A(o) in the bone marrow of these animals. Taken together, these findings indicate that A(o) as a process induced by polymicrobial sepsis is not limited to the thymus, but can also be detected in the bone marrow. However, unlike thymic A(o), bone marrow is not affected directly/indirectly by glucocorticoids or tumor necrosis factor released during sepsis.
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PMID:Differential induction of apoptosis in lymphoid tissues during sepsis: variation in onset, frequency, and the nature of the mediators. 863 85


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