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

1. The most frequent causes of postoperative peritonitis are circumscribed abscesses, the postoperative ileus and the anastomotic leakage or breakdown of the digestive suture. 2. The mortality is 33%; procedures in upper abdominal surgery are accompanied by higher mortality than in colorectal surgery in cases of postoperative peritonitis. 3. The most frequent cause of death after reoperation is the generalized sepsis. 4. A mixed flora of spores are found in most cases; obligate anaerobic spores are found mostly after colorectal procedures, while typical "hospitalized spores" were present equally after all surgical treatment in abdomen. 5. Method of treatment is: early surgical reintervention, systemic application of antibiotics, peritoneal lavage in generalized peritonitis, sufficient drainage in local peritonitis and the open-wound-treatment of the abdominal cavage in severe forms.
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PMID:[Postoperative peritonitis. Patients, causes, therapy, prognosis]. 709 86

To define the most important diagnostic signs, symptoms and laboratory findings related to intra-abdominal sepsis in the early post-operative period, 15 binary variables were prospectively assessed in 100 febrile (greater than 39 degrees C) post-laparotomy patients admitted to an intensive care unit. Intra-abdominal sepsis was found alone in 55 patients and in association with an extra-abdominal focus in 11 patients. Fever was related to an extra-abdominal septic focus in 23 patients and no infectious cause was found in 11. Analysis (chi 2) indicated that 6 of the 15 variables were significantly associated with an intra-abdominal focus of infection. The predictive value of each variable, indicated by relative risk, ranked the six variables in order of diagnostic importances: no bacteraemia (1.67), leucocytosis (1.60), ileus (1.50), mental disturbances (1.41), contaminated first laparotomy (1.38), abdominal tenderness (1.22). The absence of bacteraemia was the most important finding separating intra- and extra-abdominal foci of infection. In a febrile post-laparotomy patient with any evidence of sepsis, the absence of bacteraemia should not lull the physician into a false sense of security but rather alert him to the likelihood of an intra-abdominal septic focus.
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PMID:Diagnostic features of early high post-laparotomy fever: a prospective study of 100 patients. 710 31

The authors describe three patients with similar clinical features and patterns of colonic injury following blunt abdominal trauma. Perforation was discovered 7 to 10 days after injury and was indicated by the clinical signs of systemic sepsis. A prominent sign of occult sepsis was post-traumatic pulmonary insufficiency. Blunt trauma to the colon was initially present but was not very impressive, consequently diagnosis was delayed. The large number of concomitant injuries and the subsequent sepsis led to a higher morbidity and mortality than in cases of penetrating injuries to the colon. The key to successful management of blunt colonic injuries is early diagnosis. Awareness of the type of injury and the magnitude of the deceleration force combined with the presence of persistent ileus may lead to earlier laparotomy.
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PMID:Delayed perforation of the colon in blunt abdominal trauma. 743 60

The indications for percutaneous endoscopic gastrostomy (PEG) and patient outcome, were examined prospectively in the setting of a general hospital. In the course of 26 months, 76 patients underwent PEG (median age 62 years (range 18-99)) and were followed up for 6887 patient days. The median (range) duration of PEG feeding was 93 (3-785) days. The procedure was carried out for neurological indications in 76% of cases (stroke 51%) and 53% of patients were severely malnourished (body mass index < 17 kg/m2) at the time of referral. In 12 (16%) patients swallowing recovered and the PEG was removed after a median (range) of 55 days (20-150). Three (4%) deaths were related to PEG (one oesophageal perforation, one haemorrhage, and one aspiration pneumonia). One patient developed peritonism and ileus, which resolved with conservative treatment. Minor complications included local sepsis 3%, tube blockage 12%, and tube connector leak 5%. During seven days of observation, demands on nursing time for routine care of the PEG were the same as for nasogastric tube feeding, median (range) 21 (4-42) v 16 (4-40) min/day respectively, but in about half the latter cases the tube had to be replaced at least once. Over 15 months, 29 patients were randomised to receive a 1.9 mm inner, 2.9 mm (9F) outer diameter Fresenius and 27 a 3.0 mm inner, 4.0 mm (12F) outer diameter Bower polyurethane tube and were followed for 2920 and 2388 patient days respectively. There was no difference in the insertion time (median (range) 20 (10-45) v 24 (10-45) min respectively) or number of patients with complications (three v eight patients NS), although there were more minor mechanical problems (three v 12, p < 0.01) with the 12F tube. The internal anchoring device of the 12F tube allowed its non-endoscopic removal, a method applicable too 16% of cases. No tubes were removed because of blockage.
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PMID:Percutaneous endoscopic gastrostomy in a general hospital: prospective evaluation of indications, outcome, and randomised comparison of two tube designs. 782 71

Ileus is common during sepsis; however, the etiology of this gastrointestinal dysmotility is unclear. The aim of our study was to determine the effects of a single, sublethal dose of endotoxin on canine gastrointestinal motility, gastric emptying, gastric acid secretion, and colonic transit. Six dogs underwent placement of manometric catheters in the stomach and small bowel and insertion of a gastric and a cecal cannula. After the animals recovered, fasting and fed gastrointestinal motility was recorded, and gastric emptying and colonic transit were studied with nonabsorbable liquid and solid markers, respectively. Following completion of baseline studies, each dog was given a single dose of Escherichia coli lipopolysaccharide (200 micrograms/kg intravenously) and the studies were repeated on Postendotoxin Days 1-3. The single bolus of endotoxin abolished the migrating motor complexes, decreased the fasting motility index, decreased hydrogen ion output, slowed liquid gastric emptying, and prolonged colonic transit for 2 days. Gastrointestinal motility and transit returned to baseline on Postendotoxin Day 3. In conclusion, a single, sublethal dose of endotoxin temporarily disrupts fasting and postprandial canine gastrointestinal motility and transit.
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PMID:Effect of endotoxin on canine gastrointestinal motility and transit. 783 Apr 12

Trauma, sepsis, and other conditions of stress are characterized by a hypermetabolic state, in which markedly increased substrate availability is required to meet energy demands for tissue repair and host defenses. Inability to meet these increased metabolic demands results in accelerated visceral protein depletion, impaired immune function, and impaired wound healing. In addition, alteration of the gut flora, impaired host immune defenses, or direct gut mucosal injury may result in gut barrier failure. All of the above derangements, acting in concert, may ultimately lead to sepsis or multiple organ failure. Since enteral nutrition improves resistance to experimentally induced infections, blunts the hypermetabolic response to injury, and maintains intestinal structure and function better than parenteral nutrition, there are many reasons to favor a policy of early enteral feeding in critically ill patients. We demonstrated the safety and efficacy of immediate enteral feeding in patients with major thermal injury, and have found this practice to be applicable to a wide variety of other critically ill patients. These patients had not been felt to be candidates for enteral nutrition due to unfounded fears related to the presence of ileus or fresh gastrointestinal anastomosis.
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PMID:Nutritional support of the gut: how and why. 792 44

A total of 25 patients at least 75 years old underwent continent urinary diversion via a modified Indiana Pouch during a 68-month period, 21 of these with simultaneous radical cystectomy or anterior exenteration. The preoperative medical conditions as well as the early and late operative morbidity and mortality are reviewed with a mean follow up of 27 months. Average age of patients was 78.5 years, and the mean age of survivors is 81 years. There were two early mortalities attributed to ileal gangrene with secondary sepsis and aspiration pneumonia. Postoperative complications (superficial wound infection, middle colic vein bleed, right ureteral leak, ileus) occurred in five patients, two of whom required re-operation. Mean hospital stay was 12.4 days and ranged from 9-20. There were only six late complications [ureteral stricture (3), small bowel obstruction (1), incontinence (1)] necessitating re-hospitalization and surgical intervention. Late infectious complications included recurrent urinary tract infections (3), pyelonephritis (2), and C. Difficile enterocolitis (2) all managed medically. In addition, 10 other patients have died, 9 from metastatic disease and 1 from intercurrent medical problems. Of the 13 remaining patients, 11 are disease free and all are continent with a mean follow-up time of 33 months. We conclude that continent urinary diversion via a modified Indiana pouch with radical cystectomy or anterior exenteration can be performed with minimal morbidity or mortality, even in an elderly population.
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PMID:Continent urinary diversion using a Modified Indiana Pouch in elderly patients. 794 43

Although clinical studies suggest enteral, as opposed to parenteral, feeding lowers morbidity and mortality rates following severe trauma and after sepsis, it is unknown whether gut absorptive capacity (GAC) is indeed maintained under such conditions. To study this, GAC was determined in patients with blunt trauma (n = 8) and with sepsis (n = 11) by the 1-hour D-xylose absorption test. Excluded were patients with ileus, nasogastric output of more than 600 mL/24 hours, or residual gastric content of more than 25 mL after the D-xylose test. Trauma patients (ISS 8-14) and patients with intra-abdominal sepsis had an initial D-xylose test within 24 to 48 hours of admission, at 72 to 96 hours, and then weekly until D-xylose absorption had returned to normal. D-xylose (25 g in 200 mL water) was given via nasogastric tube to patients and orally to healthy volunteers (controls: n = 8). Results show that GAC was depressed at 24 to 96 hours in both groups but returned to normal by 1 to 3 weeks after trauma or resolution of sepsis. Thus (1) gut absorptive capacity was severely depressed early after trauma and after the onset of sepsis; and (2) the 1-hour D-xylose absorption test provided a simple, quantitative assessment of GAC in critically ill patients. Hence, therapeutic agents that restore gut absorptive capacity may be useful for further reducing morbidity and mortality rates following trauma or the onset of sepsis.
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PMID:Severe depression of gut absorptive capacity in patients following trauma or sepsis. 801 1

The case records of 17 horses with atrophy of the right hepatic lobe were reviewed. Fifteen horses had signs of colic. Two horses had clinical problems that were unassociated with gastrointestinal tract disease. Ages ranged from 5 to 30 years (mean, 12.6 years) and there was no breed or sex predisposition. In clinically normal horses, the right hepatic lobe constitutes half of the total liver weight. The right hepatic lobe in the 17 horses in this study ranged from 11.0 to 38.3% of the total liver weight (mean, 27.8%). Findings on histologic examination of hepatic tissue from horses in the study were variable. Most had loss of hepatocytes, with condensation of hepatic stroma and thick wrinkled hepatic capsules. Additional findings in the horses included torsion of the large colon (15), ileus without gastric rupture (3), typhlocolitis (2), colon infarction secondary to mesenteric strangulation (1), colon infarction secondary to sepsis (1), strangulation of the small intestine from pendulous lipoma (1), and nephrosplenic entrapment (1). No morphologic evidence of angiopathic disease involving the arterial or venous blood supply to the right hepatic lobe was found. Additionally, there was no evidence of biliary tract disease in this portion of the liver. Right hepatic lobe atrophy is believed to result from long-term, insidious, compression of this portion of the liver from abnormal distention of the right dorsal colon and base of the cecum. The practice of feeding horses high-concentrate, low-fiber diets may contribute to atony of the right dorsal colon, with resultant distention that compresses the right hepatic lobe against the rigid, visceral surface of the diaphragm.
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PMID:Right hepatic lobe atrophy in horses: 17 cases (1983-1993). 804 7

During the last 16 years, 14 patients with a gallstone ileus were treated at our institution. In 11 cases we performed in addition to the enterolithotomy, a cholecystectomy and a resection of the fistula as one-stage repair. Despite the high average age (74.3 years) and the presence of various other serious morbidity in our patient population, we only observed a hospital mortality of 7.1%. Serious postoperative complications, such as sepsis and/or shock were not observed. Utilizing today's advanced anesthesia and proper intensive-care therapy, as well as early operative intervention and safe surgical technique, we believe that enterolithotomy with cholecystectomy and fistula resection as one-stage operation, should primarily be considered before performing enterolithotomy alone.
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PMID:[Experiences with simultaneous exploration of the bile ducts in surgical therapy of gallstone ileus]. 811 86


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