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

An accepted experimental model for midgut volvulus was used to produce small bowel strangulation obstruction of 48 hours duration in Sprague-Dawley rats. A 93% perioperative mortality rate resulted after release of the volvulus. Treatment with three cytoprotective agents at the time of volvulus release resulted in the following mortality rates: superoxide dismutase, 89%; ibuprofen, 50%; prostaglandin E1 (PGE1, 11%. The predominant cause of death in all treatment groups was bowel infarction, with a smaller number succumbing to either sepsis or circulatory collapse. Concomitant administration of ephedrine or indomethacin to suppress prostaglandin E1's splanchnic vasodilatory activity did not cause any increase in mortality. A trial of aspirin, to simulate PGE's antiplatelet actions, showed no reduction in mortality when compared with detorsion alone. Prostaglandin E1 and, to a lesser extent, ibuprofen, appear to have cytoprotective effects during reperfusion of bowel compromised by volvulus, independent of their influence on the mesenteric vasculature and thrombogenesis.
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PMID:Cytoprotective agents in experimental small bowel volvulus. 355 71

Improved survival of patients receiving high-dose steroid therapy in sepsis and adult respiratory distress syndrome (ARDS) has been reported, but such therapy and its benefits remain controversial. Recently research has been directed toward manipulation of the arachidonic acid cascade. Improved survival and hemodynamics with administration of nonsteroidal anti-inflammatory drugs (NSAID) have been reported in animal models of sepsis and ARDS. The purpose of this study was to compare the effects of steroids (methylprednisolone) and NSAID (ibuprofen) in a porcine model of septic ARDS induced by a continuous infusion of live Pseudomonas aeruginosa. Cardiopulmonary parameters were monitored in animals intubated, paralyzed, and ventilated at a 250 ml tidal volume and 0.5 Fio2. Pigs were randomly assigned to one of five groups: groups I and II received respective doses of 12.5 mg/kg ibuprofen and 30 mg/kg methylprednisolone at 20 and 210 minutes after baseline; group III had P. aeruginosa only; groups IV and V received respective doses of ibuprofen and methylprednisolone at 20 and 210 minutes of sepsis. Significant pulmonary edema, increased intrapulmonary shunting, hypoxemia, hemoconcentration, and systemic hypotension occurred with P. aeruginosa infusion. In septic animals treated with ibuprofen normal systemic arterial pressure was maintained, hemoconcentration was decreased, and oxygenation was improved with a significant decrease in shunting and pulmonary edema. Administration of methylprednisolone improved hemoconcentration and cardiac index, but no significant effect on pulmonary edema, intrapulmonary shunting, or oxygenation was observed. The results of this study demonstrated a significant beneficial effect of ibuprofen and we would encourage controlled clinical trials of this drug in the management of sepsis and ARDS. On the other hand, methylprednisolone was found to be relatively ineffective in treatment of circulatory collapse and ARDS associated with sepsis.
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PMID:A critical comparison of the hematologic, cardiovascular, and pulmonary response to steroids and nonsteroidal anti-inflammatory drugs in a model of sepsis and adult respiratory distress syndrome. 376 92

Four infants, aged 16 to 28 days (mean 23 days), were seen in the emergency room with acute cardiovascular collapse and with normal heart rate and rhythm. During evaluation for cardiovascular collapse, no infant had sepsis; cardiac assessment revealed normal intracardiac anatomy but global cardiac chamber enlargement and poor left ventricular systolic function, which resolved with supportive treatment. However, three of the four infants demonstrated ventricular preexcitation on their surface electrocardiogram and, subsequently, two infants had transient episodes of tachycardia. During a transesophageal pacing study to evaluate inducibility and electrophysiologic characteristics of tachycardia, sustained tachycardia was initiated in all four infants. Reentrant tachycardia used an accessory atrioventricular connection as evidenced by the presence of preexcitation during sinus rhythm (three infants), the ability to initiate and terminate tachycardia by programmed electrical stimulation (four infants), minimum ventriculoatrial interval recorded in the esophagus (V-Aeso) exceeded 70 ms (four infants), transient bundle branch block during tachycardia prolonged the cycle length and the V-Aeso by 30 to 50 ms (three infants). Findings in these infants suggested prior episodes of prolonged tachycardia as the probable etiology of the cardiovascular collapse.
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PMID:Cardiovascular collapse in infants: association with paroxysmal atrial tachycardia. 406 61

The regular finding of Pseudomonas aeruginosa in Burns Units has always been a source of worries. Following a brief review of the natural history of this micro-organism, the authors examine all possible therapeutic measures. They underline the importance of measures aimed at controlling environmental and epidemiological factors and at improving surveillance. These measures, together with baths, topical applications of antibacterial agents and prophylactic vaccination and serotherapy tend to circumscribe the infection. When therapeutic measures are not as effective as expected and natural defences collapse, sepsis develops with clinical features that male diagnosis uneasy. The conditions in which antibiotics are given are peculiar in burned patients, and the therapeutic approach to Pseudomonas infections is particularly difficult in such cases.
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PMID:[Role of Pseudomonas aeruginosa in infection in burn patients]. 623 5

That a decline in oxygen consumption (VO2) might herald onset of septic shock prior to hemodynamic collapse is suggested by previous observations in humans and animals in which VO2 appeared to be suppressed in systemic sepsis, despite normal or supranormal cardiac output, and in cellular and mitochondrial preparations exposed to endotoxin, despite adequate flow of perfusate. That a supranormal VO2 might be one of the best predictors of ultimate survival is suggested by data collected from humans during various stages of septic shock. To evaluate VO2 as an early indicator of sepsis, the effect of endotoxemia was observed in 20 rhesus monkeys divided into groups according to hypodynamic, normodynamic, and hyperdynamic blood flow states; the effect of sepsis was observed in seven preterminal septic humans during the final hours of their lives. VO2 was measured using a new device that evaluates expired gases by means of a relatively simple feedback-controlled gas replenishment technique. In neither the primates nor the humans was it possible to demonstrate a flow-independent depression of VO2. VO2 was distinctly elevated in each of the humans over some interval during the final day of life. These observations, plus an in-depth review of the literature, suggest that other variables, particularly peripheral vascular resistance, systemic and regional blood flow, and oxygen extraction fraction attempt to accommodate in an effort to sustain VO2. Probability of survival in sepsis appears to be enhanced by VO2 and cardiac output that are supranormal; yet even when VO2 is elevated, death can ensue within minutes to hours. Significant decline in VO2 is a grave prognostic sign, almost always preceded by a relatively easily detected hemodynamic change. Systemic VO2 appears to represent neither a specific early indicator of sepsis nor a certain prognosticator of survival outcome; it might provide useful information regarding adequacy of resuscitation.
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PMID:Oxygen consumption in septic shock: collective review. 638 53

Patients requiring long term intensive care and/or prolonged ventilatory support, are frequently undergoing progressive malnutrition, occasionally complicated by a hypercatabolic state. Sepsis, fever and the requirements for postoperative healing will add further nutritional demands on such patients. In contrast to starvation, critically ill patients maintained on protein-free energy-deficient diet do not adapt to utilization of their lipid to provide energy needs. Mobilization of endogenous fat stores is reduced, and this reduction leads to increased gluconeogenesis from amino acids derived from muscle protein to meet the increased energy needs. Low serum albumin, possible low surfactant production, devitalization of the alveolo-capillary membrane and impaired immunocompetence could contribute to the development of pulmonary transudation, alveolar collapse, low compliance and pulmonary infection. Such sequelae of a protein-free energy-deficient diet would delay weaning patients off prolonged mechanical ventilation. Nutritional assessment, which may be determined serially, and means of nutritional support are outlined.
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PMID:Nutritional support in long term intensive care with special reference to ventilator patients: a review. 678 7

The data on one of sepsis variations, bacterial or endotoxin shock (BS) are presented. BS is caused by gram-negative flora among which the first place belongs to E. coli, but may also be caused by gram-positive bacteria. BS is characterized by an acute onset with chills, hyperthermia, leukocytosis and early development of circulatory collapse which may cause early death of the patient. The direct of mediated effect of endotoxin on the vascular wall causing paralytic distention of the microcirculatory bed with deposition of the blood in it is recognized in the pathogenesis of BS. Subsequently, under conditions of hypoxia and acidosis disorders of hemocoagulation develop in the form of disseminated intravascular coagulation which may result in cortical necrosis of the kidneys, necrosis and apoplexy of the adrenals, hypophysis, acute ulcers in the gastrointestinal tract, necroses and hemorrhages in some other organs.
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PMID:[Bacterial (endotoxic) shock]. 699 29

Open window thoracostomy (OWT) was created in 12 patients with empyema and sepsis after conventional therapy with antibiotics and drainage had failed. After creation of OWT all infections subsided within ten days to four months and all fistulae closed within one to four months. Complete obliteration of the empyema cavity by granulation tissue occurred in 11 of 12 patients within one to eight months, depending upon the size of the space. All patients tolerated the procedure well. Creation of OWT has not caused lung collapse in any of the patients due to fibrosis caused by the preceding infection. There was no complication or death. OWT is a safe procedure recommended in all patients with empyema resistant to conventional therapy. It does not need to be restricted to post-pneumonectomy cases. Operative closure of bronchopleural fistulae, a major surgical undertaking with an uncertain outcome, is usually unnecessary.
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PMID:Empyema and bronchopleural fistula. Experience with open window thoracostomy. 711 63

Candida organisms were cultured from 452 of 1,513 hospitalized burned patients during a 6-year study period. Of the 172 patients with colonization of the eschar by this fungus, only 20.7% subsequently developed invasive candidal sepsis. The mortality of untreated Candida burn wound infection was 100%, and with aggressive medical-surgical therapy, 91.6%. Candidemia was present in 52 patients and 76.9% of these died. Candida infection was seen as a preterminal phenomenon, coincident with a generalized collapse of patients' defensive and homeostatic mechanisms. For this reason, mortality was high and the infection rarely responded to treatment. Control of this lethal complication rests with prevention by the judicious use of intravenous broad-spectrum antibiotics and expeditious closure of the burn wound.
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PMID:Candidiasis in the burned patient. 721 86

A few cases of improvement in secondary renal amyloidosis following surgery (in particular, removal of the amylogenic foci) have been published, but cases of aggravation are much more numerous. The authors report on three patients whose renal function deteriorated dramatically after extra-renal surgery (pneumonectomy, aortic valve replacement, mitral valve replacement). None of the usual precipitating factors, such as DIC, cardiovascular collapse, sepsis or renal vein thrombosis, could be detected, but two patients had been under extracorporeal circulation. Such accidents appear to be unpredictable and irreversible. They can be seen in primary or secondary amyloidosis and whether or not surgery involves an amylogenic focus. Indeed, in two of their patients the diagnosis of amyloidosis was unknown before the operation. This suggests that in patients with suspected amyloidosis no major surgical operation should be undertaken without prior renal biopsy.
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PMID:[Dramatic aggravation of renal amyloidosis after surgery. Three cases (author's transl)]. 730 69


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