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

In recent years progress in anaesthesia and surgery has led to improvements in care for traumatized patients. This progress not only affects emergency treatment, but also critical care. Although today a failure of one organ system can be successfully treated in most cases, the problem of multiple organ failure is still unsolved. Mortality even in young patients remains high (about 30 to 90%). Among the special problems are disturbances of the patients immune system, nosocomial infections with the development of sepsis and its impact on organ functions, hypermetabolism and metabolic failure. The improved insight into the cellular and humoral pathophysiology has led to changes in diagnostic and therapeutic procedures in these patients. Only an aggressive, combined effort of many medical specialties from the beginning and an early recognition and treatment of complications and organ dysfunctions can lead to optimal results.
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PMID:[Polytrauma as a cause of multiple organ failure]. 268 49

Prophylactic appendicectomy was performed on 56 consenting patients undergoing elective cholecystectomy. The control group consisted of 60 patients. Both groups were well matched in respect of age, sex, build and type of incision. All patients received a single i.v. dose of 1 g Cefazolin sodium and 500 mg Metronidazole at induction of anaesthesia. Postoperative wound sepsis occurred in 5.4% of the appendicectomy group and in 6.7% of the control group. Residual intra-abdominal sepsis did not occur in either group. The mean duration of postoperative hospital stay was 9.1 days (SD +/- 1.63) in the appendicectomy group and 8.5 days (SD +/- 1.85) in the control group. These differences were not statistically significant. Six (10.7%) of the appendices removed were abnormal, including two with inflammation. The conclusion of this study is that prophylactic appendicectomy can be performed safely during elective cholecystectomy provided that it is done without undue manipulation and the patient is protected with an effective prophylactic antibiotic regimen.
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PMID:Prophylactic appendicectomy during elective cholecystectomy: effects on morbidity. A prospective controlled study. 270 95

For much of the last decade, an increasing number of surgeons have been interested in objective assessment of cellular contributors to host defense function. In order to study many of these processes, it is apparently desirable that the cells be isolated to the extent feasible for the purpose of analyzing a more or less pure population of cellular elements. The purpose of this paper is to describe the physiologic activation of mononuclear cells that occurs as a result of the isolation process. Therefore, it follows logically that such cells are therein intrinsically less responsive to further physiologic manipulation in vitro. Analyses of such data without an awareness of this intrinsic aberration will undoubtedly lead to misinterpretation of the capacity of such cells for further modulation by immunostimulants or by the intrinsic processes related to injury, anesthesia, and operation. Furthermore, it may indicate that certain agents, e.g., cytokines, are unable to stimulate cellular function when, in fact, the defense function of the cell has been initially stimulated by the isolation procedure. Fractionation of human peripheral blood over Hypaque-Ficoll and subsequent purification of monocytes by adherence to plastic lead to an increase in the relative density of HLA-DR on monocytes. This increase occurred when carried out in endotoxin lipopolysaccharide (LPS)-contaminated or LPS-depleted reagents. LPS, added experimentally to whole blood, enhanced HLA-DR expression on monocytes without further manipulation. Monocyte HLA-DR expression measured in whole blood was reduced in patients with major sepsis (n = 19) compared to normal subjects (n = 10).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Experimental and clinical significance of endotoxin-dependent HLA-DR expression on monocytes. 273 99

Severe thermal injury is associated with bacterial sepsis; the intestine is considered a likely source of invasive organisms. Because IgA antibody in bile accounts for much of the specific immune defense of the upper intestinal tract in the rat, the effect of thermal injury on the quantity of IgA protein in bile was examined. Sprague-Dawley rats received a 20% to 30% body surface area burn under anesthesia. Eighteen hours later the common bile duct was cannulated and bile was collected for three hours. Total IgA protein in bile decreased 90% after thermal injury. The bile volume, the concentration of bile protein, and free secretory component did not change significantly. Although blood flow to the liver 18 hours after thermal injury was not changed, there was a significant reduction in total IgA concentration in the circulation; both monomeric (m-IgA) and polymeric IgA (p-IgA) were decreased. This finding may explain, in part, the reduced concentration of IgA protein in bile. Although not examined in this study, decreased local hepatic synthesis and/or transport of p-IgA across the hepatocyte may also contribute to the reduced IgA levels in bile.
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PMID:Effect of thermal injury in the rat on transfer of IgA protein into bile. 275 21

We reported a case of halothane-induced fulminant hepatitis with acute renal failure which developed 6 days after reexposure to halothane. The patient was a 58-year-old female. She had a history of liver dysfunction after exposure to halothane 6 years previously. She had surgical treatment of clubfoot under halothane anesthesia in other hospital. Preoperative physical examination and laboratory data were normal. On the 6th post-operative day she abruptly developed high fever and general fatigue. Next day, she was transferred to our hospital. At admission, fulminant hepatitis complicated with acute renal failure was diagnosed with severe liver and renal damage. She was immediately treated with plasma exchange, glucose-insulin therapy, and hemodialysis. Serum transaminase level returned to normal value within a week. However, despite repeated hemodialysis, renal function did not improve, and she died of P. aeruginosa sepsis on 28th day after the operation. It may be suggested that in this patient hypersensitivity to halothane has persisted during the six years.
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PMID:[A case of fulminant hepatitis after reexposure to halothane six years later]. 281 Jul 19

The aim of our study is to analyze the clinical features and outcome of digestive surgery in the aged. From Jan. 1979 to Dec. 1981, 1,389 operations under general anesthesia were performed on patients 75 years old and more. From this group, 163 patients (111 females and 52 males, mean age: 79 +/- 0.7 years) underwent surgery of the alimentary tract. The procedures were divided in: colorectal (48%), biliary (32%), gastric (10%), small bowel (6%), esophagus (1%) and others (3%). An operation for cancer was performed in 63 patients: palliative (69%), curative (31%). The mean length of hospital stay is 23 days (pre-op 7 days, post-op 16 days). Only 16% of the patients needed intensive care. Postoperative complications occurred in 43 patients (26%); cardiovascular (47%), psychiatric (26%), pulmonary (23%) and others (4%). The overall mortality rate is 10%: 6% for elective cases and 24% for urgent cases (49 patients). The mortality is related to: sepsis and peritonitis (53%), cardiopulmonary disease (23%), hemorrhage (12%), cachexia (12%). At discharge, 62% of the patients returned home directly, 18% to convalescent homes, 10% to unknown places and 10% in nursing homes. Our data supports the benefit of surgery in the aged.
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PMID:[Geriatric digestive surgery. An analysis of 163 cases]. 281 16

The aim of this study was to determine whether diabetes enhanced the sensitivity of the myocardium to the deleterious effects of in vivo-administered Escherichia coli. Diabetes was induced in two groups of animals. One group received 70 mg/kg streptozotocin (iv) and exhibited a severe diabetes with elevated fasting and fed blood glucose concentrations and a markedly abnormal response to an oral glucose load. The second group received 45 mg/kg streptozotocin, was mildly diabetic (termed "latent" diabetes), and was characterized by normal fasting blood glucose but slightly elevated fed blood glucose and an abnormal response to a glucose load. A third group of rats received vehicle and served as time-matched control animals. Four weeks after induction of diabetes, all animals were catheterized under ether anesthesia and some received intraperitoneal injections of live E. coli. In vitro myocardial performance was assessed using the isolated, perfused working heart preparation. Ventricular function curves were generated by changing left atrial filling pressure and measuring changes in heart rate, cardiac output, and aortic peak systolic pressure. Cardiac performance in the severe diabetic group was depressed at the highest preload but was unchanged at lower preloads. Function in the latent diabetic group was not different from control. Sepsis induced a slight decrease in cardiac performance in the control group and resulted in larger reductions in the latent and severe diabetic groups. A depression in aortic flow was the major consequence of sepsis in the latent diabetic group, whereas decreased coronary flow was the primary change in the severe diabetic group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Enhanced myocardial depression in diabetic rats during E. coli sepsis. 295 96

In a prospective, randomized, comparative study, patients undergoing elective major colorectal surgery received four six-hour doses of either sulbactam (a beta-lactamase inhibitor) with ampicillin (1 gm with 1 gm), or cefoxitin (2 gm) commencing at induction of anesthesia. The groups were well matched for age, sex, diagnosis, and surgical procedures. Three patients in the sulbactam group (N = 44), and four in the cefoxitin group (N = 48) developed significant wound sepsis. Minor wound sepsis occurred in an additional four sulbactam patients, and in five cefoxitin patients. There was no difference between the groups in deep sepsis or anastomotic leak rates (sulbactam, four patients; cefoxitin, seven patients). No serious side effects were recorded in either group. These results suggest that sulbactam combined with ampicillin provides a safe, effective alternative to cefoxitin for prophylaxis in colorectal surgery.
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PMID:Sulbactam/ampicillin compared with cefoxitin for chemoprophylaxis in elective colorectal surgery. 300 35

The effect of either prophylactic antibiotic or wound antiseptic on bile bacteriology, wound and other postoperative sepsis has been studied in a controlled prospective randomised trial of 243 patients undergoing biliary surgery at a district general hospital. Wound infection rates were significantly less in patients given intravenous ceftriaxone (1%) at induction of anaesthesia when compared to povidone iodine sprayed into the wound at the completion of surgery (9%) (P = 0.02). In all but one patient infected wounds grew organisms identical to those cultured from the bile. There were also fewer chest and urinary infections in the ceftriaxone group but this was not statistically significant.
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PMID:Ceftriaxone versus povidone iodine in preventing wound infections following biliary surgery. 305 8

Any beneficial effects of prostaglandin synthesis inhibitors on systemic hemodynamic derangements during sepsis may be offset by the effect of these inhibitors to reduce renal blood flow. To determine the specific role of prostaglandins in maintaining renal perfusion during hyperdynamic live Escherichia coli bacteremia in rats, we used in vivo video-microscopy and optical doppler velocimetry to quantitate changes in renal microvascular blood flow, and to determine if endogenous prostaglandins participate in these responses. E. coli infusions constricted preglomerular arterioles and decreased renal microvascular blood flow in decerebrate animals without drug anesthesia but dilated pre- and postglomerular arterioles in urethane-anesthetized rats. Local inhibition of renal prostaglandin production with mefenamate after E. coli infusion caused renal arteriolar constriction in both groups and decreased renal blood flow to indicate that renal prostaglandin production is an important mechanism for maintenance of renal microvascular blood flow during high cardiac output sepsis.
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PMID:Prostaglandins maintain renal microvascular blood flow during hyperdynamic bacteremia. 305 33


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