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

To improve the past statistics of high mortality and morbidity in patients with TEN, definitive measures are required. Early referral and transfer to a burn center and withholding or withdrawing steroid therapy are two crucial factors. Therapeutic goals must be directed toward promotion of wound healing; correction of fluid and electrolyte abnormalities; provision of pulmonary care; prevention or correction of thermal disturbances; control of pain; prevention of physiologic and psychologic disabilities, which may hamper the return to activities of daily living; and above all, prevention of sepsis through protective isolation and refraining from use of invasive lines and catheters. Wound healing is best supported through gentle cleansing with physiologic saline; application of biologic or synthetic skin dressings or silver nitrate dressings; hourly eye care; nutritional support; and avoidance of infection or further injury of the dermis. Collaboration and teamwork by all health care providers are essential, and the quality of intensive nursing care makes the critical difference.
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PMID:Toxic epidermal necrolysis. 205 30

Between October 1987 and July 1990 a prospective, nonrandomized, preliminary study was carried out to assess the efficacy of Sandostatin in treating complex pancreatic and gastrointestinal disorders. The study group consisted of 18 women and 12 men, ranging in age from 23 to 80 years (mean 50 years), in whom conventional medical or surgical therapy, or both, had failed. Nineteen patients had pancreatic disease (5 had chronic pancreatitis, 8 acute necrotizing pancreatitis and 6 pancreatic fistula). Thirteen patients had disorders of the small intestine (7 had enterocutaneous fistula and 6 diarrhea-associated short-gut syndrome). Sandostatin was found to be effective in the closure of pancreatic (five of six cases) and enterocutaneous fistulas (five of seven cases), of benefit in controlling the pain associated with chronic pancreatitis (three of five cases) and of some use in achieving short-term control of intractable diarrhea in patients with short-gut syndrome (five of six cases). It was of particular benefit in the management of acute necrotizing pancreatitis. The standard principles of surgical management must be adhered to when using Sandostatin to treat patients with these disorders. Sandostatin can not correct underlying problems such as pancreatic-duct obstruction, malignant disease or unresolved sepsis. These preliminary results justify more widespread use of Sandostatin as part of a prospective randomized and controlled multicentre trial.
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PMID:Sandostatin in the management of nonendocrine gastrointestinal and pancreatic disorders: a preliminary study. 205 54

The results of 276 cemented revision total hip arthroplasties performed for aseptic failure between 1977 and 1986 have been reviewed. The mean time between revision and review was 75 months (range 30 to 144). Of 220 cases available for review, 159 were assessed clinically and radiographically, and 32 by postal questionnaire. Eighteen hips required further revision, 12 for loosening, two for sepsis, two for persistent pain, and one each for fracture and recurrent dislocation. A further six hips were radiologically and symptomatically loose. Pain was mild or absent in 83%. Over half were able to walk a mile or more; 70% flexed more than 70 degrees; 15% had a flexion deformity, but in only 7% was this more than 10 degrees. The mean Harris hip score was 74. Survival at five years was 95% and at 10 years, 77%.
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PMID:Revision total hip arthroplasty for aseptic failure. A review of 276 cases. 207 36

After a brief literature review, we analyze the results obtained with a retrospective study of 35 neonatal osteomyelitis diagnosed between 1-January-75 and 31-December-87. The valuated frequency was of 0.40% alive newborns. Between the antecedents, we find previous neonatal sepsis in 68% of the cases. The clinical general findings were less apparent, emphasizing among the local symptoms the pain to passive mobilization and swelling. From acute phase reactants, this study rebounds the high sensitivity of C reactive protein and globular sedimentation rate. The most frequently germ isolated was S. aureus followed by K. pneumoniae. The osteomyelitic injure was unifocal in 71% of the cases and the femur was the most probable bone to be affected. At the initial treatment we associated a beta-lactamic antibiotic with an aminoglycoside one in all cases, with surgical removal in 94%. The mortality was null, but grave arthritic sequels appeared in 14% of the patients. Finally, we propose the employance of seriated quantification of C-reactive protein in the follow-up and control of therapeutic efficiency.
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PMID:[Neonatal osteomyelitis. Study of a series of 35 cases]. 209 56

This study describes a prospective randomized controlled trial to evaluate whether suture of the peritoneal layer is necessary as a separate step in the closure of midline abdominal surgical wounds. Consecutive patients undergoing abdominal operation--elective and emergency surgery--through a midline abdominal wound were randomized to have the peritoneal layer closed with continuous catgut, or to have this step omitted. The linea alba was closed with interrupted stainless steel sutures, and the skin approximated with staples. Patients were evaluated for wound sepsis, wound dehiscence, and subsequent incisional hernia development. Postoperative pain was assessed by a self-administered visual analogue score, and by measuring narcotic requirements. There was no significant difference in narcotic requirements, pain scores, or wound complications between the 2 groups. Single-layer closure of the abdominal wall is quicker, less costly, and theoretically safer than layered closure, and it is recommended that separate suture of the peritoneum be abandoned.
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PMID:Is closure of the peritoneal layer necessary in the repair of midline surgical abdominal wounds? 804 38

Twenty adult patients presented with bacteriologically and histologically proven nontuberculous spinal sepsis. Thirteen patients presented with varying degrees of neurologic impairment. All patients underwent spinal decompression; in 11 this was combined with an anterior fusion using autogenous tricortical iliac grafts. All patients have recovered and are ambulatory, and no patient's disorder was made worse by surgery. Twenty-three separate organisms were cultured, only five of which were Staphylococcus. The antibiotic courses were shorter and pain relief more rapid with anterior fusion. All anterior bone grafts incorporated rapidly, and there was no progression of kyphosis or sequestration of grafts, regardless of organisms or level. The rational treatment of adult spinal sepsis necessitates the securing of tissue from the spine for histologic and bacteriologic examination. Pain relief, stabilization, and neural decompression can best be achieved with anterior decompression and fusion. Autogenous iliac crest grafts incorporate in the presence of sepsis.
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PMID:Pyogenic spinal sepsis in adults. 214 5

We describe a girl aged 17 y who died after a cardiac arrest secondary to septic shock. At autopsy, the enlarged, soft, and flabby heart showed microscopic evidence of acute myocardial infarction, myocardial edema, myocardiocyte loss, replacement fibrosis in the interventricular septum, and right and left ventricular hypertrophic nucleomegaly. The pathological diagnosis was that of cardiomyopathy due to prolonged selenium deficiency. The patient had been on total parenteral nutrition for 17 mo, following extensive bowel resection for intractable pain, nausea, and vomiting caused by chronic idiopathic intestinal pseudoobstruction. Seven months before death, when severe biochemical selenium deficiency was diagnosed, supplemental selenium was added to the infusion, and plasma selenium concentrations increased. In long-standing selenium deficiency, sepsis may contribute the final insult to a damaged myocardium, triggering symptomatic cardiac failure and sudden death.
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PMID:Cardiomyopathy associated with nonendemic selenium deficiency in a Caucasian adolescent. 216 25

The long-term CVC allows patients with a variety of diseases to lead a more normal and pain-free life. The use of these catheters has become commonplace in most hospitals, and the physician caring for patients in the ICU will be caring for increasing numbers of patients with an indwelling long-term CVC. Infections of these catheters can be manifested in many different ways: tunnel infections, exit site infections, catheter-related bacteremia, and septic thrombophlebitis. The overwhelming majority of these infections are caused by coagulase-negative staphylococci, but physicians should be aware of the wide variety of organisms that can infect the long-term CVC. The diagnosis of long-term CVC sepsis can be difficult, but the use of quantitative blood cultures for catheters left in place and the Maki method for culturing those catheters that are removed will aid physicians in their quest for diagnostic certainty. The great majority of catheter infections will resolve with antibiotic therapy alone without the need for catheter removal, but there are important exceptions to this general rule. Tunnel infections and fungal long-term CVC infections often require catheter removal for their resolution; septic thrombophlebitis and CR-SCVT require the addition of anticoagulation or fibrinolytic therapy to antibiotic regimens for resolution of the infection, and surgical debridement may be warranted if these modalities fail to resolve the infection.
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PMID:Infectious complications of indwelling long-term central venous catheters. 218 3

A variety of rheumatologic disorders affect the elderly. Some of these problems are seen almost exclusively in the elderly, such as temporal arteritis and pseudogout. Because of underlying chronic diseases, these patients are also at increased risk for joint infection and resultant sepsis. Evaluation of synovial fluid from the inflamed joint is important. Light microscopy evaluation with a red polarizing compensator can help diagnose crystal-mediated disease, such as gout or pseudogout. Examination of Gram stains can help diagnose infectious arthritis. Thus, appropriate processing of synovial fluid is mandatory for the diagnosis of many rheumatologic disorders that occur in the elderly. A variety of metabolic disorders are associated with pseudogout and should be searched for on laboratory evaluation. Appropriate laboratory evaluation and follow-up following the acute episode are important in the care of these patients. For example, temporal arteritis with resultant blindness is a feared disorder in the elderly. Transient blindness, headaches, jaw claudication, and an elevated Westergren sedimentation rate suggest this diagnosis. Aches and pain in the neck and shoulder area, especially in the morning, are typical of polymyalgia rheumatica. Polymyalgia rheumatica may also be a symptom of temporal arteritis.
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PMID:Acute rheumatologic disorders in the elderly. 218 87

We present a literature review on current techniques of intravenous regional anesthesia and intravenous regional antibiosis of the distal limb in cattle. Our own experiences performing a combined procedure of intravenous anesthesia and antibiosis (10 million I.U. benzylpenicillin sodium dissolved in 15-20 ml 2%-lidocaine hydrochloride) are discussed in detail. Complete anesthesia of the treated limb was achieved in 22 out of 23 cases (96%). The successfully treated animals did not express any symptoms of pain for the entire surgical procedure. In 2 out of 15 patients (13%) we observed serious post-surgical complications. The reason of which was extensive thrombosis of all veins distal of the tourniquet. The age of the clots at the time of slaughtering of the cows was determined histologically. A direct cause effect relationship between intravenous anesthesia/antibiosis and complication is indicated. We conclude that direct toxicity of the 2000-fold overdose of benzylpenicillin (as compared to generally accepted therapeutic levels) most likely caused the problem. We recommend to reduce the dose of penicillin in regional intravenous antibiosis to maximally 100,000 I.U., even in the case of local sepsis.
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PMID:[Intravenous congestion anesthesia/-antibiotic administration in cattle--indications,technics, complications]. 220 47


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