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)

Published reports have indicated that patients with Kartagener's syndrome (dextrocardia, sinusitis and bronchiectasis) have no significant lung mucociliary clearance. With a radioaerosol technique we measured over a 6-hour observation period the tracheobronchial clearance of 8 patients with dextrocardia, chronic bronchial sepsis and chronic sinusitis (DC). The tracheobronchial clearance of these patients was significantly reduced (p less than 0.02) compared with that of 29 healthy subjects of similar age. However, even when allowance was made for productive coughing during the observation period, the reduced clearance was much better than anticipated from published reports in patients with Kartagener's syndrome, which confined their observations to a 2-hour period. The tracheobronchial clearance of the DC patients, adjusted for productive coughing, was as bad as that found in an older group of patients with chronic obstructive airways disease who refrained from expectorating during the equivalent test period. Our study implies one or more of the following possibilities: (a) a spectrum of mucociliary impairment in patients with DC; (b) an effective cough clearance deeper in the lung than hitherto believed, and (c) two-phase flow of mucus cephalad as an effective clearance mechanism in patients with DC.
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PMID:Impaired mucus clearance in patients with chronic bronchial sepsis, sinusitis and dextrocardia. 342 Mar 7

The amount of oxygen in mixed venous blood (SvO2) is a reliable indicator of the status of oxygenation of tissue in most clinical settings. Monitoring levels of SvO2 might, therefore, aid in managing critically ill patients. A recently developed adult pulmonary arterial catheter provides continuous measurement of SvO2 via fiberoptic bundles incorporated into the catheter, in addition to measuring hemodynamic pressures and cardiac output by thermodilution. We evaluated 100 consecutive fiberoptic catheters for accuracy and reliability of the system in 86 critically ill adult patients and determined the clinical usefulness that knowledge of SvO2 provided. Over a range of hemoglobin saturations from 24 to 85 percent, the correlation coefficient between in vivo SvO2 vs photometrically measured samples for 199 paired measurements was 0.95. Mean duration of usage for 33 catheters in the medical intensive care unit was 6.1 days; all catheters functioned normally until clinical conditions permitted removal. Continuous measurements of SvO2 detected unsuspected increases in tissue oxygen consumption during coughing spasms and positioning of the patient. In nine of 13 patients with hypoxemic respiratory failure requiring positive end-expiratory pressure (PEEP), we found a strong correlation (r = 0.88) between oxygen delivery and SvO2. Of the four patients not showing correlation, two had sepsis, and two had nearly normal values of SvO2 and oxygen delivery at all levels of PEEP studied. Continuous measurement of SvO2 improves monitoring of patients, facilitates titration of respiratory therapies, detects abrupt changes in tissue oxygen consumption, and identifies levels of PEEP associated with greatest oxygen delivery.
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PMID:Clinical experience with continuous monitoring of mixed venous oxygen saturation in respiratory failure. 648 14

Out of 130 children under 12 years of age with a diagnosis of typhoid fever, nine were under two years of age; the youngest was five months old. Six patients were males and the most frequent findings were: high fever, poor physical condition, vomiting, diarrhea, malnutrition, dehydration, meteorism, liver and spleen enlargement, cough, bleeding disorders and central nervous system abnormalities which were suggestive of sepsis. The clinical diagnosis was confirmed in all patients through the isolation of Salmonella typhi in blood cultures. The Widal reaction showed higher than 1/160 "O" and "H" agglutinin titers in five out of six patients in which it was performed. Neutrophilia was observed in all cases, with a shift to the left in five of them. Anemia was present in all of them. The following complications were found: hepatitis (1 case), hepatitis and meningitis (1 case), bronchopneumonia (1 case), and bleeding abnormalities (4 cases). Two of the patients died; the deaths were attributed to late diagnosis and insufficient antibiotic treatment.
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PMID:[Typhoid fever in children under 2 years of age]. 727 78

To determine whether inexperienced health workers can recognize severe infection in infants less than 3 months of age, a study was conducted of 200 infants with cough, fever or 'not feeling well'. The presence or absence of five symptoms: cough, difficulty in breathing, feeding problem, fever or history of convulsions, and ten signs: appearing ill, respiratory rate > or = 60/min, chest indrawing, grunting, cyanosis, wheeze, lethargy, 'too hot', 'too cold' or abdominal distension, were recorded by a health worker, who made a diagnosis of 'ill' or 'mildly ill'. Each infant was then reviewed by an experienced paediatrician who made a diagnosis of 'ill' (pneumonia, sepsis, meningitis or other severe illness) or 'mildly ill'. Using these diagnoses as the 'gold standard', the sensitivity, specificity, and positive predictive values of each parameter were calculated. In 89% of the 200 infants, the health worker made the correct diagnosis. Forty infants were admitted. In 36 instances (90%) the health worker made the correct decision. The most discriminating symptoms and signs were 'not feeding well', 'appears ill', chest indrawing and grunting. A respiratory rate > or = 60/min was 78% sensitive and 69% specific. Our study suggests that inexperienced health workers can recognize severe illness in infants under 3 months of age.
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PMID:Recognition of illness in very young infants by inexperienced health workers. 750 92

In patients admitted to the hospital with community-acquired pneumonia, intravenous antimicrobials can be safely switched to oral administration when the patient shows evidence of early clinical improvement. In our institution, patients are switched to oral antibiotics when: (A) cough and respiratory distress are improving, (B) patient is afebrile for at least 8 h, (C) the white blood cell count is returning toward normal, and (D) there is no evidence of abnormal gastrointestinal absorption. Patients with respiratory infections of unknown etiology are switched to an oral antibiotic with the same spectrum of activity as the intravenous empiric antibiotic. Combining our prospective clinical studies, we have patient outcome data for more than 150 patients admitted to the hospital with community-acquired pneumonia, who were treated with switch therapy. The clinical cure rate was 99.3%. The total hospital savings for 1994 based on the 80 patients with community-acquired pneumonia who were treated with switch therapy was $114,080. Discontinuation of intravenous lines will decrease the patient's risk for local cellulitis, abscess formation, septic thrombophlebitis, line sepsis, and endocarditis. The early hospital discharge associated with switch therapy will decrease the patient's risk for other nosocomial infections such as urinary or respiratory tract infections. Switch therapy is associated with a clinical cure rate that is equivalent to conventional therapy. In the area of cost-effective use of antibiotics, switch therapy should be considered as one of the primary options for health care cost containment.
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PMID:Switch therapy in community-acquired pneumonia. 758 43

Clinical effects of sulbactam/cefoperazone (SBT/CPZ) was studied on variety of bacterial infections in the fields of internal medicine focused mainly on respiratory infections. The total 135 infections were consisted of 103 respiratory infections, 15 urinary tract infections, 4 sepsis, 7 biliary tract infections, and 6 other infections, of which 86 patients had underlying diseases. The daily doses of SBT/CPZ were 2 to 6 g divided into 2 to 3 times i.v. or d.i.v., and the duration of administration was from 3 to 35 days. The clinical effects were judged by the attending doctors based on the changes in fever, cough, rales, chest rentogenograms, white blood cell counts, CRP values, ESR, etc. The total efficacy rate was 76.9%, and 69.0% of the isolated organism was eradicated by SBT/CPZ. The side effect was noted in 1 case, and the abnormal laboratory findings were noted in 1 case, however it was difficult to determine whether they were due to SBT/CPZ. These results suggest that the clinical usefulness of SBT/CPZ for the infections in the fields of internal medicine.
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PMID:[Multicenter study of the effects of sulbactam/cefoperazone on bacterial infections in the fields of internal medicine focused mainly on respiratory infections in Tochigi Prefecture]. 825 94

Chronic granulomatous disease of childhood is an inheritable disorder of phagocytic cell respiratory burst resulting in recurrent, life-threatening, catalase-positive infections. The lung is the most common site of infection, and pulmonary disease is the primary cause of death in greater than 50% of children with chronic granulomatous disease. Still, the role of surgery in management of this disease remains undefined. Between 1974 and 1990, 19 patients with chronic granulomatous disease required 31 thoracic interventions at our institution. Patients ranged in age from 2.5 to 27 years (mean age, 15 years). Seventeen of 19 patients (89%) had had previous pulmonary infections. Patients presented as toxic (temperature > 38.5 degrees C, chest pain, and cough) in 22 instances before the 31 procedures. Aggressive surgical intervention for diagnosis and extirpation of localized infections was undertaken with lobectomy/pneumonectomy with or without other procedures (5), bisegmentectomy (2), segmentectomy with or without other procedures (5), or wedge with or without other procedures (13). In five instances, an empyema was drained; a chest tube for a sterile collection was placed in one instance. There was one intraoperative death, and 3 patients died 22 to 600 days postoperatively with overwhelming sepsis. The mean hospitalization was 101 days (range, 24 to 600 days). Wound complications occurred in 5 patients, requiring 17 separate anesthetic debridements. A change in therapy was dictated by the results of the procedure in 23 of 31 instances (74%). Thoracic surgeons must be aware of this rare cause of immunosuppression in these children and, due to the unusual nature of the pulmonary infections, should follow an aggressive approach in their diagnosis and management.
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PMID:Surgical management of pulmonary infections in chronic granulomatous disease of childhood. 846 36

Sixty patients with rheumatoid arthritis who were administered weekly low dose methotrexate (MTX) were retrospectively analyzed for their untoward effects of MTX by interviewing to the patients and by the medical records. Cough and sputa were the most frequent symptoms (23.3%) and gastrointestinal symptoms were the next (20%). Five of 60 patients (8.2%) showed liver function test abnormalities, and four (6.7%) exhibited transient exacerbation of arthralgia for several hours to a few days after MTX administration. Three patients (5%) suffered from interstitial pneumonitis. Hair loss was seen in 3 patients (5%), and headache, leucocytepenia, fever, skin eruption, abnormal taste, hemorrhagic cystitis, and flashing were experienced in a patient, respectively. Three (5%) suffered from fungal infection, and herpes zoster, sepsis, and osteomyelitis were experienced in each one patient, respectively. MTX was withdrawn in three patients (5%) because of cough and sputa the drug was withdrawn in other three patients because of the interstitial pneumonia, and was drawn in another three patients because of transient exacerbation of arthralgia. The drug was withdrawn in each one patient, because of nausea and vomiting, skin eruption, osteomyelitis, and sepsis, respectively. Overall, MTX were withdrawn in 21 patients (35%), and, of those, 13 patients (21.7%) because of untoward effects and 8 patients (13.3%) because of the lack of efficacy.
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PMID:[Untoward effects of low dose methotrexate therapy in rheumatoid arthritis]. 877 88

The aetiology and outcome of hospitalized patients with moderate to severe community-acquired pneumonia (CAP) were evaluated in 60 adult patients (38 male 22 female, mean age 68.4 years). They were randomized for treatment with either ceftazidime or imipenem/cilastatin intravenously for 7 days. Bacteriological diagnoses were made in 25 cases (41.6%): Streptococcus pneumoniae (5), Haemophilus influenzae (5), Pseudomonas spp. in particular Pseudomonas aeruginosa (8), Staphylococcus aureus (4), Chlamydia spp. (2), Mycobacterium tuberculosis (2) and Moraxella catarrhalis (3); mixed organisms were found in 4 patients. Forty-two patients (70%) responded satisfactorily to the regimens with improvement in sputum purulence cough and dyspnoea scores; there was no difference in response between the two groups. Sixteen patients (26.6%) underwent bronchoscopy on day 4 because of inadequate response to the antibiotics regimens, and 9 of them (15%) required a modification of the initial treatment with addition of erythromycin in 5 patients vancomycin in 1 cloxacillin in 1 and antituberculous drugs in 2. Three out of the 60 patients (5%) died of pulmonary sepsis: the aetiological agents were M. tuberculosis in one, Pseudomonas spp./methicillin-resistant S. aureus in another, but were not identified in the third. We conclude that treatment with either ceftazidime or imipenem/cilastatin was efficacious for moderate to severe CAP in Hong Kong.
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PMID:Hospitalized patients with community-acquired pneumonia in Hong Kong: a randomized study comparing imipenem/cilastatin and ceftazidime. 915 75

This study involved 25 elderly (> 65 years old) patients (pts) with unresectable non small cell lung cancer (NSCLC) who were not eligible for polychemotherapy. The diagnosis of NSCLC was histologically or cytologically documented, and all of them had measurable or evaluable disease. The median age of the patients was 71 (range 65-77); 9 had been pretreated. The pts received 25 mg/m2 of vinorelbine weekly or bi-weekly depending on the results of blood tests. The treatment continued until disease progression or tolerance. No complete response was achieved: 3 pts (12%) had a partial response (RP) (8-12-14 months), 13 (52%) stable disease (SD) with an improvement in symptoms, such as cough and/or pain, and 9 pts (36%) progressed. Compliance with the therapy was acceptable. The main toxicity was hematological: neutropenia was observed in 16 pts, with only 1 case of grade 4 neutropenia without sepsis; grade 1-2 anemia occurred in 8 patients. The other toxicities included grade 1-2 neurotoxicity in 8 pts, chemical phlebitis in 2 pts and grade 3 cardiotoxicity reversible with medical treatment in 1 patient. The median survival time was 10 months (lower quartile 5 months, upper quartile 23 months) (Kaplan and Meyer method). Vinorelbine can be considered a rational choice in elderly pts with advanced NSCLC who are not suitable for aggressive polychemotherapy, with the aim of improving their quality of life in terms of symptoms and outpatient treatment.
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PMID:Vinorelbine chemotherapy in non small cell lung cancer: experience in elderly patients. 926 13


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