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

Postsplenectomy, 41 patients previously treated for Hodgkin's disease were given pneumococcal vaccine, and type-specific antibody levels were measured before and after immunization. Postimmunization antibody levels in patients with Hodgkin's disease were significantly lower than those in normal control subjects for 10 of the 12 serotypes measured. Mean postimmunization antibody level for patients (587 +/- 427 ng of antibody nitrogen/mL) was much lower than that for control subjects (1787 +/- 694). Antibody levels tended to increase with time from therapy for Hodgkin's disease, and several patients who had not received therapy for more than 3 years had normal responses to immunization. Despite vaccination, one patient developed pneumococcal meningitis and another, pneumococcal bacteremia. Both infected patients had low postimmunization mean antibody levels (282 and 137 ng/mL, respectively). Postsplenectomy sepsis in patients with Hodgkin's disease is related to a humoral immune deficiency probably induced by radiation and chemotherapy, and this immune deficiency persists for several years.
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PMID:Response of patients with Hodgkin's disease to pneumococcal vaccine. 3 21

Recipients of solid organ allografts require lifelong immunosuppression in order to prevent graft rejection and to maintain graft function. In general, such immunosuppression greatly impairs the cellular immune system, as this level of the immune system is principally responsible for self and non-self recognition. The consequences of allograft transplantation in terms of patient and graft survival when transplants are given to individuals who have a preexisting humoral immune deficiency characterized by a deficiency of the serum levels of one or more of the major Ig classes have not yet been reported. From February 1, 1981 through December 31, 1990, a total of 43 adult patients with a deficiency of 1 or more Ig classes received a ABO-matched liver allograft at this institution. This sample represents 2.5% of a total of 1684 adults transplanted during this interval. These 43 liver graft recipients could be divided into 3 major groups based upon the presence of an IgG, IgM, or IgA deficiency. IgG deficiencies were defined as levels less than 50 mg/dl. Patient and graft survival for the IgA-deficient group was significantly reduced (P less than 0.04 and P less than 0.009, respectively) compared with both the IgG- and IgM-deficient groups. The latter two groups did not differ from controls without an Ig deficiency for these same two endpoints. The major causes of death in the IgA-deficient group were sepsis and opportunistic infection. A third of the deaths in the IgA-deficient group occurred in the perioperative period (first 30 days) while greater than 50% of the deaths occurred within the first 3 months, and all deaths occurred before the first year. Based upon these data, the following conclusions can be made: (1) serum IgA deficiency but not IgG or IgM deficiency is associated with an increased post-OLTx death and graft loss rate; (2) the majority of these deaths are due to sepsis or an opportunistic infection; and (3) most of the deaths occur early. These data suggest that recognition of a deficiency of IgA prior to organ grafting necessitates meticulous attention to the prevention of infection in the immediate perioperative period if patient and graft survival of these patients is to be improved.
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PMID:The association of IgA deficiency but not IgG or IgM deficiency with a reduced patient and graft survival following liver transplantation. 149 40

Burn patients, multiple trauma patients, and patients undergoing major surgical operations often suffer from acquired immunologic deficits that predispose them to life-threatening sepsis. This paper reviews the current research in this area, with emphasis on identifying the components of the immune response affected by injury, elucidating the mediators of immunologic change, and determining new therapeutic approaches for correcting immunologic deficits. Lessons learned from the study of immune deficiency disease are reviewed, as are basic observations of burn- and trauma-induced immune depression.
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PMID:Trauma, sepsis, and the immune response. 332 8

The most frequent cause of death in patients with severe burns is septicemia. Septicemia correlates with a decreased cellular immune defence in the patient. In the case of our patients with severe burns particularly a T-lymphocyte deficiency could be detected. This cellular immune deficiency induced by the thermic trauma was treated with thymostimulin (TP-1 Serono), an immunomodulating polypeptide preparation, which mainly influences T-lymphocytes. In this connection the efficacy of thymostimulin should be tested with respect to the incidence and course of the septicemia in patients with burns. 90 patients with burns of second and third degree and a risk of mortality of more than 20% according to Lynch have been included in the study. The efficacy of thymostimulin was proved by means of immunological tests and in the assessment of the posttraumatic clinical course. In the patient group treated with thymostimulin we were able to observe a significantly higher power of resistance to infections. This not only resulted in a decreased absolute mortality but also in a decreased mortality due to septicemia. The incidence of sepsis, however, could not be significantly influenced by the treatment. The E-rosette positive cells (= T-lymphocytes) as well as the T gamma-cells which are also responsible for the suppressor cell activity, could be normalized by the treatment, whereas the alterations of the TIa (turbidimetric immunoassay) positive cells were less evident.
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PMID:Thymostimulin in the antiinfectious treatment in patients with burns. 349 38

We treated eight children, aged 7 weeks to 17 years, for lung abscess. Each abscess followed an episode of aspiration or a bacterial pneumonia. Associated conditions were leukemia, congenital immune deficiency, endocarditis, cerebral palsy, and prematurity. Seven of the 8 children had polymicrobial infections, usually containing both aerobic and anaerobic bacteria. The success of medical treatment by antibiotics and chest physiotherapy was age related; 3 of the 8 children, aged 10 to 17 years, recovered on this regimen, whereas five children, aged 7 weeks to 7 years, required catheter drainage or resection for cure. Drainage by catheter pneumonostomy was performed for solitary peripheral bacterial abscesses. A large intercostal catheter was inserted into the cavity, either operatively or percutaneously. Wedge resection was performed for multiple, central, or fungal abscesses. Pneumonostomy was curative in 3 of 4 children. One chronic abscess recurred after pneumonostomy and required resection. Wedge resection was curative in the two children who came to thoracotomy; lobectomy was not necessary. Although all eight children recovered from their lung abscesses, three of them died within a year of sepsis. Lung abscess today occurs in immunocompromised children who are vulnerable to fatal infections. Chest physiotherapy is unlikely to achieve good drainage in children under 7 years of age. Medical failures can be identified within the first week of treatment. Early and aggressive surgical treatment is indicated in such children, and may be lifesaving.
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PMID:Drainage of pediatric lung abscess by cough, catheter, or complete resection. 373 40

Main complication of different diseases is the paralytic ileus. The basis of all pathophysiological mechanisms is a decrease of the immune deficiency in the intestinal wall. At first the intestinal water-, electrolyte- and protein metabolism is disturbed. Secondly we can measure an endotoxinemia and a bacteriemia with all complications. In the end a complete septic shock and an insufficiency of the organ "gut" can be observed. The patients die - in absence of treatment - because of intraabdominal sepsis and peritonitis.
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PMID:[Pathophysiology and morbidity of paralytic ileus (including peritonitis)]. 384 May 53

Fifteen splenectomised and 15 normal subjects were studied, in absence of any intentional immunisation, for pokeweed mitogen induced synthesis of antipneumococcal capsular polysaccharide antibodies in vitro by peripheral blood mononuclear cells. Results showed that removal of the spleen had caused a persistent immune deficiency of circulating B cells capable of synthesising IgM antipneumococcal capsular polysaccharide. In vitro synthesis of polyclonal IgM and IgG by peripheral blood mononuclear cells of subjects without spleens was also depressed. These defects were due to an abnormality of the B cell compartment. These data are evidence of the major role of the spleen in the control and production of a consistent part of pokeweed mitogen responsive circulating B cells and add another facet to the complex immune dysfunction of splenectomised subjects. The findings, moreover, may help in understanding the susceptibility of splenectomised people to pneumococcal sepsis and the delayed and impaired antibody response to pneumococcal vaccine.
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PMID:Impaired antipneumococcal antibody production in patients without spleens. 391 17

Splenectomy continues to be the most commonly chosen method of management of traumatic injury to the spleen. However, patients of all age groups who have undergone splenectomy have significant impairment of immune functions as demonstrated by decreased production of IGM, tufsin, and properdin. This immune deficiency has been clinically manifested by an increased incidence of postsplenectomy pneumonia and sepsis which is reduced but not eliminated by the use of pneumococcal vaccine and/or prophylactic antibiotics. This paper presents the results of a study of the feasibility of repair and replantation of injured spleens using microsurgical techniques. Twenty cats had their spleens removed, finger-fractured, and debrided. The cats were then assigned to one of four groups. Group I had the entire spleen replanted but only 75% of the parenchyma revascularized. Group II had 75% of the parenchyma revascularized and replanted. Group III had 50% revascularized and replanted, and Group IV 25% revascularized and replanted. Patency of the anastomoses was assessed by postoperative arteriography. Restoration of reticuloendothelial (filter) function was assessed by the use of technetium sulphur colloid scans which showed preservation of reticuloendothelial function of the revascularized segments but absence of function in nonrevascularized segments which had been replanted. Histologic examination of replanted spleens harvested at 8 weeks showed normal architecture of red and white pulp in all areas that had been revascularized. However, in those spleens where the entire spleen had been replanted but only partially revascularized, the nonrevascularized segments were degenerated and atrophic.
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PMID:Debridement and replantation of the spleen with microsurgical restoration of blood flow. 402 93

Intravenous gammaglobulin is effective therapy of ITP and other autoantibody-mediated immune cytopenias. All children as well as adults unresponsive to splenectomy or with known immune deficiency are probably the best candidates for treatment with IVGG. Its major advantage, in addition to its efficacy of treatment and possible remission-inducing effect, is that it has the fewest side effects of any treatment of ITP so that it is the best maintenance therapy of patients when effective. Future uses of IVGG remain to be determined. Premature infants with a high mortality from sepsis and with hypogammaglobulinemia due to termination of pregnancy prior to transplacental antibody transfer may benefit from IVGG. A preliminary study suggested such benefit and also showed safety of IVGG treatment in that there was no impaired immune responsiveness of these prematures at 2 years of age (28). Another potential usage of IVGG involves the treatment of the hypogammaglobulinemia associated with certain types of malignancy. Patients with CLL, especially in the advanced stages, are often hypogammaglobulinemic. Multiple myeloma and Waldenstrom's macroglobulinemia are two other B-cell malignancies associated with antibody production defects which might benefit from antibody replacement therapy. Therapeutic IgG levels may be harder to obtain due to hypercatabolism of immunoglobulin. The issue of immune hyporesponsiveness during intensive chemotherapy is also unexplored. Secondary antibody responses do not seem to be impaired, but primary responses, as tested in numerous immunization studies, are decidedly impaired. Certain protocols, especially those treating high-risk acute leukemias and neuroblastoma during induction therapy are intensive with high rates of sepsis, and may warrant trials of prophylactic IVGG. Similarly, some form of humoral prophylaxis is becoming an important part of the handling of the patient undergoing bone marrow transplantation not only to prevent bacterial sepsis but also to prevent cytomegalovirus (CMV) interstitial pneumonitis. A likely additional usage is gammaglobulin replacement for patients undergoing plasmapheresis, especially if performed multiple times. Finally, the broad spectrum of antibacterial and antiviral antibodies present in the preparations (such as anti-CMV, anti-Group B strep, and antiendotoxin) and the ease and safety of delivery allow the preparations to be used in situations where a hyperimmune preparation might be desired and/or where more than one pathogen is possible. In summary, IVGG is a treatment capable of safely conferring significant benefits to selected patients.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Intravenous usage of gammaglobulin: humoral immunodeficiency, immune thrombocytopenic purpura, and newer indications. 404 Jul 95

High risk groups of infants with regard to sepsis are described. The first high risk group includes newborn babies, infants of the first 3 months of age, premature babies, the second babies with congenital defects of the immune system (classified and unclassified defects), the third babies with acquired immune deficiency conditions due predominantly to the pathology of therapy. Septicemia remains the main clinico-anatomical form of sepsis in infants. The morphological criteria of this form of sepsis are described. In the lack of decrease of sepsis incidence in infants pathology of a therapy plays a great role, but it should be remembered that sepsis nowadays is observed in babies who previously had died within a short period of time after birth or after the onset of the disease.
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PMID:[Features of sepsis in children today]. 720 Jul 66


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