Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Significant advances have been made since the introduction of methotrexate towards the improvement of long-term survival in patients with brain metastases from gestational trophoblastic disease. Early diagnosis via computed tomography of the head and beta-hCG serum testing along with aggressive, multiagent intervention have greatly improved patient prognosis from this once highly fatal condition. Although toxicity is commonly associated with this treatment, death from sepsis or drug reactions is unusual. Surgery has been found useful only to relieve intracranial pressure and is discouraged as part of diagnosis.
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PMID:Diagnosis and management of brain metastasis from gestational trophoblastic disease. 165 73

This study describes institutional maternal mortality (MM) in the Thika subdistrict of Nairobi, Kenya, and also identifies socio-demographic and gynecological factors that have a bearing on MM. This study was retrospective from January 1981-January 1985 and prospective thereafter to September 1988. It was based on maternal death case reports from 3 main institutions offering maternity delivery services. The case reports were studied for maternal complications in pregnancy, labor and puerperium, for age, parity, fate of fetus, antenatal record, primary and secondary causes of mortality. Gynecological cases of death such as abortions, ectopic pregnancies, and trophoblastic disease were also considered. There were 164 MM and 86,248 live births. Results indicated that: 1) maternal age of 15-19 years does not appear to be at increased risk because of the numbers of those 19; 2) the risk is greater for primipara's and grandmultipara's. Marital status, education, and occupation did not influence MM; 3) more than 63% of MM occurred in the 1st week of admission; only 2.1% of these mothers had attended antenatal clinic, they started late in their pregnancy and the antenatal care received was inadequate; 4) the diagnosis as to causes of death for most of the cases was clinical; 5) sepsis of any association was a factor and was found to be very high in the post-operative MM with the triad of hemorrhage, ruptured uterus and hypertensive disease prominent. 6) Of the 164 MM, 9.8% were avoidable in the hospitals with their facilities; 51.2% were avoidable in hospital with improved facilities; 29.2% were avoidable elsewhere and only 9.8% were totally unavoidable.
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PMID:Socio-demographic and gynaecological variables of maternal mortality in a Kenyan subdistrict: January 1981-September 1988. 236 45

Nine patients with gestational trophoblastic disease resistant to multiagent chemotherapy, CHAMOCA, received methotrexate, bleomycin, and etoposide (VP 16-213) combination therapy. Eight patients achieved complete remission. There was no drug-related death. The importance of vigilant search and prevention of sepsis was emphasized. Alternative combination chemotherapy for drug-resistant choriocarinoma was discussed.
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PMID:Etoposide, methotrexate, and bleomycin in drug-resistant gestational trophoblastic disease. 242 94

Eleven patients were treated with cisplatin, vinblastine, and bleomycin (PVB) combination chemotherapy after failure of conventional triple-agent therapy with methotrexate, dactinomycin, and cyclophosphamide for gestational trophoblastic disease. Of ten evaluable patients, five (50%) achieved negative titers. Sustained remission was achieved in only two patients (20%). Major hematologic toxicities and two deaths due to sepsis occurred in this group of patients. Although this combination does exhibit activity, its clinical use in the treatment of refractory trophoblastic disease is limited.
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PMID:Cisplatin, vinblastine, and bleomycin combination therapy in resistant gestational trophoblastic disease. 242 85

The purpose of this study was to determine activity of etoposide-platin combination chemotherapy for chemorefractory gestational trophoblastic disease. A retrospective review of patients treated with etoposide-platin chemotherapy for chemorefractory trophoblastic disease was conducted. Patients received etoposide 100 mg/m2 and cisplatin 20 mg/m2 on Days 1 through 5 of 14- to 21-day cycles. Patient characteristics, responses, and toxicity were recorded. Seven women received etoposide-platin for chemorefractory disease. The median WHO prognostic index score upon initiation of therapy was 16 (range, 10-20) and patients had received a median 6 cycles of prior combination chemotherapy. Five patients developed grade IV neutropenia, four developed neutropenic sepsis, and two required platelet transfusions. Two patients developed significant deterioration of renal function. Six (86%) patients had complete responses, with normalization of hCG values, but only three (43%) patients with low pretherapy hCG levels have had sustained remissions. Etoposide-platin chemotherapy is an active regimen for the treatment of women with chemorefractory gestational trophoblastic disease but has significant hematologic and renal toxicity when used as salvage therapy. Future studies should investigate the incorporation of etoposide-platin into initial therapy of women with high-risk disease.
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PMID:Etoposide-platin combination therapy for chemorefractory gestational trophoblastic disease. 770 78

Persistent gestational trophoblastic disease is potentially fatal, but the majority of patients are cured with chemotherapy. Any developments in treatment are therefore being directed towards maintaining efficacy and reducing toxicity. We evaluated efficacy and toxicity of methotrexate, etoposide and dactinomycin (MEA) as first-line therapy for high risk disease and etoposide and dactinomycin (EA) as second-line therapy for methotrexate-refractory low risk disease in a retrospective analysis of 73 patients (38 MEA, 35 EA) treated since 1986 at a supra-regional centre. The median follow-up period was 5.5 years and the median number of cycles received was 7. The overall complete response rate was 85% (97% for EA, 75% for MEA). Of eight patients who failed to respond, four have since died and four were cured with platinum-based chemotherapy. Alopecia was universal. Grade II or worse nausea, emesis, or stomatitis was observed in 29%, 30% and 37% respectively. Fifty-one per cent experienced grade II/III anaemia, 8% grade II or higher thrombocytopenia and 64% grade III or IV neutropenia; in six cases this was complicated by sepsis. Fifty-four per cent of patients went on to have a normal pregnancy. No patient has developed a second malignancy. In conclusion, the MEA and EA chemotherapy regimens for persistent trophoblastic disease are very well tolerated, do not appear to affect future fertility and are associated with excellent, sustained complete response rates.
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PMID:Persistent gestational trophoblastic disease: results of MEA (methotrexate, etoposide and dactinomycin) as first-line chemotherapy in high risk disease and EA (etoposide and dactinomycin) as second-line therapy for low risk disease. 1078 22

This was a rare case where a patient presented clinically as a case of post abortal sepsis and ultrasound showing the picture of an intramural degenerating fibroid. Her serum and urine both were negative for beta human chorionic gonadotropin (betaHCG). Patient succumbed to choriocarcinoma 1 month later. Failure to detect urinary and serum betaHCG lead to maternal mortality due to the choriocarcinoma. The failure to detect, certain degradation products of HCG which may predominate in gestational trophoblastic neoplasia, by many common HCG testing kits lead to the error of diagnosis. Only 3 of the 7 common commercial serum HCG tests appropriately detects nicked HCG and its free betaHCG, DPC immulite assay, being the most sensitive method. Though of rare occurrence, this awareness is important for diagnosis and follow-up of gestational trophoblastic neoplasia and could have been life saving in our case.
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PMID:Choriocarcinoma with negative urinary and serum beta human chorionic gonadotropin (betaHCG)--a case report. 1638 73