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

We reviewed 105 cases of extraperitoneal bladder rupture admitted to our hospitals from 1959 to 1985. Primary suturing of the rupture was performed in 65 patients, and catheter drainage alone without suturing of the rupture was performed in 34. The incidence of blunt trauma causing the rupture of gross hematuria on admission, and of associated injuries was similar in both groups. There was a higher incidence of women older than sixty years in the group managed by catheter drainage alone, and a higher incidence of laparotomy for associated intra-abdominal injuries and a higher mortality rate in the group treated by primary suturing. There were three early complications in the group treated by suturing (hematuria with clot retention 2, sepsis contributing to death 1) and four early complications in the conservatively treated group (hematuria with clot retention 1, pseudodiverticulum with bone spike in its floor 1, persistent urinary fistula 1, and sepsis contributing to death 1). There were two late complications in 42 patients followed in the group treated by suturing (urethral stricture 1, frequency and dysuria 1), and three late complications in 14 patients followed in the conservatively treated group (hyperreflexic bladder 2, urethral stricture and vesical calculi 1). Catheter drainage alone for extraperitoneal rupture from external trauma was simple, quick to perform, and appealing in the multiple-injured patient. Although the early and late complication rates were higher in the conservatively managed group, there was no statistically significant difference from the group treated by primary suturing.
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PMID:Management of extraperitoneal ruptures of bladder caused by external trauma. 291 76

Methotrexate, Cisplatin, and Vinblastine (MCV) was followed by Cisplatin plus radiation therapy in 19 patients with muscle-invading clinical Stage T2-4NXM0 transitional cell carcinoma of the urinary bladder (including cystectomy candidates), to achieve local control and prevent distant metastases. Radical cystectomy was recommended for all patients who failed to reach a complete response (CR = biopsy negative and cytology not positive) following MCV and Cisplatin X 2 plus 4000 cGy. Completely responding patients, and those partially responding patients unsuited for cystectomy, were selected for bladder conservation treated with additional irradiation to the bladder tumor volume (total 6,480 cGy) plus one additional Cisplatin treatment. Dose reductions were required for stomatitis in 26%, mild bone marrow depression in 58%, and renal toxicity in 5% of the patients. During the Cisplatin/4000 cGy, mild dysuria occurred in 68% of patients and 36% had mild bowel hyperactivity. Serious complications have occurred in two patients to date. One patient had recurrent pulmonary emboli, marked reduction in bladder capacity, and diarrhea. A second had bladder perforation during cystoscopic evaluation after MCV and a small bowel obstruction after Cisplatin and 4000 cGy. There was no treatment-related sepsis. Three patients had initial complete transurethral resection of their tumors and therefore 16 patients are evaluable for tumor responsiveness to this protocol. Four patients (25%) were biopsy negative and cytology negative, whereas three additional patients (19%) were biopsy negative but cytology positive following initial MCV. Six patients (38%) were biopsy negative and cytology negative whereas three additional patients (19%) were biopsy negative and cytology positive following MCV and Cisplatin X 2 plus 4000 cGy pelvic radiation. Of the entire group, 9 patients were treated with full-dose radiotherapy. All of these patients are alive without evidence of tumor on rebiopsy of the original tumor site, but one has a persistent positive cytology. Seven patients had a radical cystectomy and 6 are disease free. The treatment of 3 patients deviated from the protocol. Overall, only one patient has developed distant metastases and currently 84% of the patients are disease-free, although follow-up is short. To date, this feasibility study has been clinically practical and well tolerated. The proportion of CR's suggests that this program may prove to be an organ-sparing and curative approach for a significant number of patients, but more experience and follow-up are required.
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PMID:Invasive bladder carcinoma: preliminary report of selective bladder conservation by transurethral surgery, upfront MCV (methotrexate, cisplatin, and vinblastine) chemotherapy and pelvic irradiation plus cisplatin. 318 28

An enterovesical fistula, an infrequent complication of Crohn's ileocolitis which is considered to constitute a difficult surgical problem, was encountered in 29 patients. These patients had been treated for Crohn's disease by medical means for years and several had previously undergone bowel resections. An exacerbation of the Crohn's disease occurred in all patients coincident with the appearance of dysuria or the obvious clinical presentation (fecaluria) of the fistula. Other manifestations of active Crohn's disease frequently coexisted. Radiographic evaluation was of limited help in establishing the presence of the fistula. Cystoscopy was suggestive of the diagnosis in 18 of 20 patients so examined. Treatment consisted of ileocecal resection with primary anastomosis (25) or exteriorization (4). The bladder defect was sparingly excised and closed with absorbable sutures. One patient developed a bladder leak which closed spontaneously. Recovery was uneventful in the others. An ileovesical fistula constitutes an indication for operation not only to eradicate the urinary sepsis but also to correct the other complications (malnutrition, obstruction, abscess) of Crohn's disease. To assure an uncomplicated course, emphasis must be placed on an individually designed correct approach to the (causative) intestinal problem, while the surgical aspects of the bladder defect can be a matter of routine.
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PMID:Enterovesical fistula complicating Crohn's ileocolitis. 642 41

Urinary tract infections (UTIs) are still one of the most common bacterial infections in pregnant and non-pregnant women. It is estimated that about 10-20% of all women suffer from a UTI at some point in life. The presence of UTI is defined as the existence of urinary symptoms such as frequency of urination and dysuria with or without bacteriuria or pyuria. The prevalence of bacteriuria in females varies from less than 1% in infants to 10% and more in older women. There are major differences in the clinical features between young and elderly women depending on the different pathogenesis, microbiology and general condition. Especially for elderly women, symptomatic and asymptomatic bacteriuria presents a risk factor for bacteraemia, sepsis and also increased mortality. During pregnancy, the prevalence of bacteriuria does not change but there are some changes in the pathogenesis that increase the rate of pyelonephritis. Asymptomatic bacteriuria rarely resolves spontaneously during this time. For non-pregnant women, short therapy strategies are recommended, preferably 3 days of trimethoprim-sulphamethoxazole (TMP/SMX) or quinolones. In pregnant women, therapy with amoxycillin or an oral cephalosporin is considered optimal.
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PMID:Uncomplicated urinary tract infections in pregnant and non-pregnant women. 840 50

Bladder drainage of exocrine secretions during pancreas transplantation can be associated with significant complications. We present a proactive approach to these complications consisting of early cystoenteric conversion (CEC). Although 81 patients underwent pancreas transplant between March 1985 and May 1995; 26 (32%) required CEC. Complications presented as urine leaks, other complications, and refractory metabolic acidosis. There were 13 patients who presented with a urine leak: 12 with acute abdominal pain, and 1 asymptomatic. Serum amylase and creatinine rose a mean of 823 IU and 0.61 mg/dl, respectively. The interval to CEC ranged from 2 to 45 months. One patient died of fungal sepsis. Postoperative complications included duodenojejunal anastomotic bleed (n = 1), negative relaparotomy (n = 1), myocardial infarction (n = 1), graft pancreatitis (n = 1), and wound infection (n = 1). Twelve patients presented with other complications: three women with cystitis (n = 2) or hematuria (n = 1), and nine men with urethritis (n = 6), scrotal edema (n = 2), or dysuria (n = 1), The interval to conversion ranged from 1 to 108 months. There were no deaths. One patient required relaparotomy for anastomotic bleed. One patient was converted because of refractory metabolic acidosis. Admissions and inpatient days were significantly reduced. Overall mortality was 3.8%, morbidity 23.1%, and graft salvage rate 96.1%. Leak-associated mortality was 7.7%, morbidity 38.5%, and graft salvage rate 92.3%. For other complications the mortality was 0, morbidity 7.7%, and graft salvage rate 100%. CEC is a safe, effective treatment for urologic complications of pancreas transplantation. Morbidity and mortality were acceptable; admissions and hospital days were decreased. Early CEC results in superior outcomes and improved quality of life. It is preferable to nondefinitive measures for management of urologic complications of pancreatic transplantation.
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PMID:Early operative intervention for urologic complications of kidney-pancreas transplantation. 967 65

Deep sepsis in the involved joint after hip or knee arthroplasty may be the result of hematogenous seeding from a remote infectious source. This mechanism has been used to explain the well-documented association between postoperative urinary tract infections and subsequent joint infection after hip or knee arthroplasty. However, it is unclear whether there is an association between preoperative bacteriuria and deep prosthetic infection. The purpose of this review is to identify perioperative risk factors associated with bacteriuria that have a positive correlation with deep joint sepsis following total hip or knee arthroplasty. The classic symptoms of dysuria, urgency, and frequency seen with urinary tract infections are often absent in the elderly despite the presence of urine coliforms; in these patients, pyuria (as indicated by the presence of more than 1x10(3) white blood cells per milliliter of noncentrifuged urine) may be used as a preliminary screening criterion. If there are irritative symptoms, the presence of more than 1x10(3) bacteria per milliliter of urine should be regarded as indicative of a urinary tract infection. If there is bacteriuria without symptoms of urinary irritation or obstruction, the current literature supports proceeding with total joint arthroplasty and treating those patients with urine colony counts greater than 1x10(3)/mL with an 8- to 10-day postoperative course of an appropriate oral antibiotic. Postponement of total joint surgery should be considered if preoperative evaluation reveals symptoms related to obstruction of the urinary pathway. Irritative symptoms in combination with a bacterial count greater than 1x10(3)/mL should also serve as an indication to postpone surgery. To diminish postoperative urinary tract infection, a bladder catheter should be inserted immediately preoperatively and removed within 24 hours of surgery to diminish the risk of urinary retention, which has been shown to increase the likelihood of a postoperative urinary tract infection.
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PMID:Perioperative lower urinary tract infections and deep sepsis in patients undergoing total joint arthroplasty. 1066 54

Transobturator tape is an artificial tape designed for urethral suspension to treat female stress urinary incontinence. This tape has two original features: its non-woven polypropylene structure is coated with silicone on the urethral surface in order to limit retraction of polypropylene and to establish a barrier to extension of periurethral fibrosis. transmuscular insertion, through the obturator and puborectalis muscles, reproduces the natural suspension fascia of the urethra while preserving the retropubic space. A preliminary study (40 implantations) confirmed the feasibility of this operation, the low morbidity (one complication: sepsis) and the encouraging results between 3 and 12 months; in the treatment of isolated incontinence (16 patients), no postoperative dysuria has been observed; 15 patients are totally continent and 1 patient is improved; in the treatment of prolapse associated with frank or potential incontinence (24 patients), transient postoperative dysuria was observed in 4 cases, with no postoperative incontinence.
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PMID:[Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women]. 1185 72

The aim of the study was to determine the etiology of meningitis and sepsis in the newborn at the State University Hospital of Haiti and evaluate the susceptibility 'in vitro' of the pathogens to the antibiotics commonly used. This was a prospective case series study over a 10-month period (May 1997-February 1998) of 42 newborns with sepsis and/or meningitis. Besides the clinical signs, a positive blood culture and/or a positive culture of cerebrospinal fluid was present in each case. Gram-negative bacteria were most commonly found as a cause of early onset sepsis, with Enterobacter aerogenes as the most common agent. There were no such difference between gram-negative and gram-positive in late onset sepsis. Group B Streptococcus was associated with neonatal meningitis (44 per cent of cases) which was more related to gram-positive bacteria (66 per cent). Risk factors were vaginal discharge and dysuria in mothers, and low apgar score in newborns. Thirty-three per cent of the pathogens found, among them Klebsiella pneumoniae, were resistant 'in vitro' to ampicillin and gentamycin. All were susceptible to amikacin. Enterobacter aerogenes is an important pathogen in the etiology of early onset sepsis in the newborn at the State University Hospital of Haiti, while Group B Streptococcus is the leading cause of meningitis in that age group. Resistance to gentamycin should be taken into consideration for the treatment of sepsis and meningitis in the newborn.
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PMID:Neonatal sepsis and meningitis in Haiti. 1498 70

Acute suppurative thyroiditis is a very uncommon disorder, most often arising in children with congenital conditions connecting the thyroid directly to the oropharynx, such as a piriform fistula or thyroglossal duct. Accordingly, the most common causative agents are those which can colonize the oral mucosa and spread to the thyroid contiguously, such as Streptococcus species, Staphylococcus species and anerobes. In adults, a hematogenous spread to a pre-existing altered thyroid gland is often the postulated pathogenetic mechanism, and it is exceedingly rare in the United States. We report the case of an 81-yr-old woman with acute suppurative thyroiditis secondary to Escherichia coli (E. coli) infection. The patient presented with fevers, chills, dysuria and recent painful neck swelling. Thyroid ultrasound and neck computed tomography revealed a multinodular goiter and an intra-thyroid abscess. An otolaryngology evaluation and barium swallow failed to show a piriform fistula. Thyroid hormone levels were consistent with hyperthyroidism. Urine cultures were positive for E. coli. The patient subsequently developed a clinical picture consistent with severe thyrotoxicosis, which rapidly resolved after medical treatment, appropriate antibiotics and surgical drainage of the thyroid. Abscess material also grew E. coli. Thus, acute suppurative thyroiditis secondary to sepsis can complicate an otherwise asymptomatic multinodular goiter and should be promptly treated with broad-spectrum antibiotics and/or surgical drainage to avoid serious consequences, including severe thyrotoxicosis.
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PMID:A case of acute suppurative thyroiditis complicated by thyrotoxicosis. 1725 97

Emphysematous cystitis is a rare disease of the bladder caused by gas-forming bacteria. Diabetics are the most commonly infected and the clinical picture ranges from dysuria to sepsis and peritonitis. The diagnosis is primarily radiological. Treatment ranges from catheterization and antibiotic treatment to prostatocystectomy. We report the case of a 74-year old male diabetic presenting who was found to have emphysematous cystitis with total necrotization of the bladder. To our knowledge this is the only reported case with a totally necrotized bladder in emphysematous cystitis.
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PMID:[Emphysematous cystitis with total necrotization of the bladder]. 1901 46


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