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)

Postoperative outcome was compared for 235 patients who were sterilized by unipolar tubal electrocoagulation and for 269 patients who were sterilized by the application of Hulka Clemens spring-loaded tubal clips. Clip application patients had fewer complications but experienced more postoperative discomfort than electrocautry patients. All the sterilizations were performed by the same physician at the Aberdeen Royal Infirmary from 1976-1978. All the patients received general anesthesia, administered by the same anesthetist. Operating time for the tubal electrocautery technique was 7.5 minutes and 5.5 minutes for the tubal clip procedure. 14 of the electrocautery patients and 6 of the clip application patients experienced complications. For the electrocautery patients 1) 11 experienced tubal bleeding and laporotomy to stop bleeding was required for 2 of the patients; 2) 1 patient received bowel damage; and 3) 2 patients had uterine perforations. For the 6 tubal clip patients 1) 2 had uterine perforation; 2) 1 had pelvic sepsis; and 3) in 3 of the patients clips were lost and not retrieved. Only 1 pregnancy was reported, and in that patient adhesions had obstructed the tube during the operation. Immediately following surgery the majority of the patients experienced mild abdominal pain. 9.4% of the clip patients and 1.3% of the electrocautery patients experienced severe pain. 48.5% of the electrocautery patients and 36.0% of the clip patients experienced shoulder pain. Laparoscopic clip sterilization was recommended as a safer technique than electrocoagulation.
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PMID:Outpatient laparoscopic sterilisation: Comparison between electrocautery and clip application. 644 41

Eighteen pediatric patients with infective endocarditis (IE) were reviewed for "failure" of chemoprophylaxis; none had had a previous dental procedure. Surprisingly, published reports reveal a similarly low prevalence of dental extractions preceding IE, only 3.6% for 1,322 cases. Although bacteremia was associated with 40% of 2,403 reported extractions, it also was found in 38% of patients after mastication, and in 11% of patients with oral sepsis and no intervention. In a hypothetical month, ending with a single dental extraction, the cumulative exposure to these "physiologic" sources of bacteremia is nearly 1,000 times greater than it is from extraction. The current American Heart Association recommendations for intramuscular or intravenous chemoprophylaxis are impractical, and the discomfort and inconvenience may impede good dental care. The Committee also implies that gingival bleeding allows bacterial access to the blood stream, whereas experimental studies establish the lymphatics as the only access. Although oral chemoprophylaxis for major dental procedures appears prudent, the British regimen of a single dose of amoxicillin administered orally is much simpler and probably more effective. However, scrupulous oral and dental hygiene is undoubtedly superior in preventing IE than any chemoprophylaxis regimen.
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PMID:How important are dental procedures as a cause of infective endocarditis? 648 31

The study objective was to investigate the effectiveness of a synthetic hydrophilic polymer used as a cervical osmotic dilator before vacuum aspiration in 1st trimester abortion. Lamicel is a polyvinyl alcohol polymer sponge impregnated with magnesium sulphate and compressed to form a thin cylindrical tent. When inserted into the endocervical canal and left in position the Lamicel absorbs and retains fluid from the cervical tissue because of its hygroscopic properties. In the process the Lamicel swells to 4 times its original diameter and is converted from a hard rigid tent into a soft sponge. 60 nullipara who were having vacuum termination of pregnancy in the 1st trimester at the Queen's Medical Center and City Hospital, Nottingham, UK, were recruited into the study. The patients were randomly allocated to 1 of 5 groups each composed of 12 patients. 4 of the groups were treated with Lamicel for various periods before abortion; the 5th group was not treated with Lamicel and constituted a control group. In the 4 treated groups the Lamicel was left in position for periods of 2, 6, 12, or 24 hours in groups 2, 3, 4, and 5, respectively, before abortion. In the control group (group 1) lamicel was not inserted. After insertion the patients were monitored for evidence of discomfort, uterine cramps, sepsis, syncope, or bleeding. These observations were continued for 24 hours after the operation. The patients ranged in age from 14-28 years and gestation at termination ranged from 10-13 weeks. A comparison of the pressure recordings of the control group with each of the treated groups showed a highly significant difference. The reduction of cervical resistance occurred mainly in the first 2 hours after insertion of the Lamicel. There was further reduction in resistance up to 6 hours, but the difference between groups 1 (2 hours) and 2 (6 hours) was not statistically significant, and there were no significant differences between any of the treated groups. Insertion of 5mm Lamicel was achieved without difficulty in 43 (90%) of the patients. A 3mm Lamicel was chosen for the remaining 5 patients because of cervical resistance encountered at the internal os. During insertion 16 patients (33%) experienced mild discomfort. This resolved spontaneously within 5 minutes. There were no problems associated with the removal of the tents and no other side effects were noted. There were no differences in the amount of blood lost during the operation or in the incidence of postoperative pain and bleeding between the 5 groups.
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PMID:Lamicel: a new technique for cervical dilatation before first trimester abortion. 684 49

Ninety-three patients for whom a colorectal operation was planned had their bowel prepared mechanically by orthograde irrigation. The tube was sited in the duodenum via the pylorus under X-ray and TV control. The procedure was discontinued in 2 patients (2%), 15 patients (16%) experienced nausea and vomiting, while 76 patients (82%) experienced no discomfort. The mean duration of the irrigation was 216 min (90-476 min) and the mean volume of fluid used 10.21 (5.0 -15.0 1). There were no significant differences between pre-irrigation and post-irrigation blood chemistry. Twenty-three patients developed postoperative abdominal wound sepsis (26.7%), 4 (4.7%) had an intraabdominal abscess; 9 out of 12 patients (75%) had perineal wound sepsis. Escherichia coli and Bacteroides were the dominant species cultured from colorectal mucosa during operation as well as from infected abdominal and perineal wounds. Although the irrigation technique seems to clean the bowel to a degree not previously seen, this in itself is no guarantee of avoiding post-operative wound sepsis after colorectal operations.
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PMID:Septic wound complications after whole bowel irrigation before colorectal operations. 703 15

1,850 subcutaneous infusions were given to 270 elderly patients (average age, 82) in a hospital geriatric department and in two nursing homes. The side effects were few and not serious. In 4 patients there was anasarca of the gluteal and genital regions but this disappeared promptly after giving diuretics. In a case of disseminated intravascular coagulation, ecchymoses appeared in the thighs. Sepsis, shock, tissue necrosis and other dangerous side effect mentioned in textbooks were not observed. The method is acceptable to most elderly patients and causes less discomfort than does the intravenous method. Since the infusion last only 2 to 4 hours, it enables the patient to be out of bed most of the day. Infusion by the subcutaneous route can be safely administered by trained nurses in institutions without a resident medical staff. It seems to be the method of choice for giving fluid supplements to elderly patients in nonemergency situations.
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PMID:Subcutaneous infusions in the elderly. 731 43

Butyrate analogues have been shown to increase fetal hemoglobin (HbF) production in vitro and in vivo. Sodium phenylbutyrate (SPB), an oral agent used to treat individuals with urea-cycle disorders, has been shown to increase HbF in nonanemic individuals and in individuals with sickle cell disease. We have treated eleven patients with homozygous beta thalassemia (three transfusion dependent) and one sickle-beta-thalassemia patient with 20 g/d (forty 500-mg tablets) of SPB for 41 to 460 days. All patients showed an increase in the percent of F reticulocytes associated with treatment, but only four patients responded by increasing their Hb levels by greater than 1 g/dL (mean increase, 2.1 g/dL; range, 1.2 to 2.8 g/dL). None of the transfusion-dependent thalassemia subjects responded. Increase in Hb was associated with an increase in red blood cell number (mean increase, 0.62 x 10(12)/L), and mean corpuscular volume (mean increase, 6 fL). Changes in percent HbF, absolute HbF levels, or alpha- to non-alpha-globin ratios as measured by levels of mRNA and globin protein in peripheral blood did not correlate with response to treatment. Response to treatment was not associated with the type of beta-globin mutation, but baseline erythropoietin levels of greater than 120 mU/mL was seen in all responders and only two of eight nonresponders to SPB. Compliance with treatment was greater than 90% as measured by pill counts. Side effects of the drug included weight gain and/or edema caused by increase salt load in 2/12, transient epigastric discomfort in 7/12, and abnormal body odor in 3/12 subjects. Two splenectomized patients who were not on prophylactic antibiotics developed sepsis while on treatment. We conclude that SPB increases Hb in some patients with thalassemia, but the precise mechanism of action is unknown.
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PMID:Oral sodium phenylbutyrate therapy in homozygous beta thalassemia: a clinical trial. 752 72

Initiation of intravenous (i.v.) infusions in hospital wards is a common surgical procedure. Unfortunately many of these infusions will fail due to phlebitis and/or extravasation. Such failure may cause considerable patient discomfort, interfere with i.v. therapy and increase the nurse's workload. I.v. problems with adults have been evaluated extensively, however little attention has been given to children. Heparin is effective in reducing thrombus formation and studies have demonstrated other properties as well, such as anti-inflammatory, anti-irritant, maintenance of endothelial integrity and homeostasis, and tissue healing. The purpose of this study was to determine if the addition of low-dose heparin to infusate would prolong infusion site survival in children. An experimental design was used whereby patients were randomly allocated into control and treatment groups. The treatment group received pre-mixed fluids containing 1 unit/ml of heparin whilst the control group received standard fluids. Data were collected using a standard form and information such as type and size of cannula, sex, age, date and time of cannulation, site, signs of phlebitis/extravasation, reasons for cannula removal and type of fluids and drugs infused, were recorded. Failure incidence was analysed by Cox's multivariate hazards model, life-table method and log rank tests. The results showed a highly significant difference (Chi 2 20.42, p < 0.0001) in decreasing infusion failure with the addition of low-dose heparin to infusate. Nursing implications could include a decrease in the incidence of extravasation and phlebitis, an increase in effective vein usage, fewer problems with i.v. flow rates, a reduction in medical/nursing hours associated with re-cannulations, less likelihood of systemic sepsis, and less patient worry and discomfort due to local venous reactions and re-cannulations.
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PMID:Nursing implications of low-dose heparin to infusate to improve infusion site survival in children. 813 25

To evaluate two different methods of managing segmental skeletal defects, 15 patients treated with the open bone graft (Papineau) technique were compared with 17 patients who had intercalary bone transport (Ilizarov) management. The treatment time was identical for both groups: 1.9 months in fixation for each centimeter of defect reconstructed. Both techniques shared several fixator-associated problems such as implant site sepsis and patient discomfort. Each method of treatment, however, had its own unique problems. For the bone grafted group, limited graft availability, donor site morbidity (three patients), and graft fractures (two patients) occurred. For the bone transport group, the main problems were failure of the docking site to unite without a supplementary graft (seven patients) and joint contractures (seven patients). A new synthesis of both techniques is described.
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PMID:Skeletal defects. A comparison of bone grafting and bone transport for segmental skeletal defects. 815 61

Thirty-nine Yucatan miniature swine were used in three fetal surgical experimental protocols. They involved antiarrhythmic administration, pacemaker implantation, and in-utero diagnosis of ventricular septal defect by intraoperative echocardiography. Because of problems encountered with surgical protocols in the initial stages, modifications were made to prevent fetal hypothermia and intraoperative mortality. These modifications included environmental temperature support, staple surgical techniques to reduce operative time, and development of fetal catheters designed to facilitate cannulation of small vessels. Postoperative care protocols were intensive and included antibiotics, analgesics, and supportive care designed to reduce discomfort and prevent abortion and sepsis. Thirty-seven of 39 sows survived the surgical procedures; experiments were performed on 117 fetuses. Twenty-two fetuses died either intraoperatively or postoperatively because of complications related to the experimental protocols. Modification of surgical and postsurgical protocols for these projects demonstrates the feasibility of using miniature swine as a model for fetal surgery, when their use was appropriate for anatomic and physiologic reasons.
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PMID:Fetal surgical protocols in Yucatan miniature swine. 869 29

Embryologically, the allantois connects the urogenital sinus with the navel. Normally, the allantois is oblitered before the birth and is represented by a fibrous cord, called urachus, extending from the dome of the bladder to the navel. Urachal formation is directly related to bladder descent. Incomplete obliteration sometimes occurs. Disease rarely occurs in urachus, but adenocarcinoma is the most fearful and rare, and it represents the 0.01% of the whole adult carcinoma, the 0.17-0.34% of the whole bladder malignancy, and the 20-30% of the bladder adenocarcinoma. Yet urachus may be seat of other kinds of benign pathologies characterized by incomplete obliteration of its lumen. Only if the ends of the urachus seal off, a cyst of that body may form and may become quite large, presenting a low midline abdomen mass. Adenocarcinoma may occur in a urachal cyst, particularly at its vescical extremity. Cystis usually have an asymtomatic course. Occasionally these cystis can be discovered during sonographic examination. If the cyst becomes infected, signs of general and local sepsis will develop, sometimes involving the peritoneum. Sometimes, in these cases, it is difficult to diagnose the presence of an adenocarcinoma and, particularly, its cystic variant. By using the common diagnostic instrumental device, we cannot reach a certain diagnosis, essential to perform a correct medical or surgical treatment. The case reported concerns a twenty-five years old man, over and over again examined, complaining of ipo-mesogastric abdominal pain, mild fever, increment of flogosis index and transaminasis, microscopic hematuria and urinal discomfort. Sonographic suprapubic examination, performed during urological consultation, showed an urachal neoplasm. Cystoscopy and TC evaluation didn't permit a certain preoperative diagnosis. A surgical explorative operation was performed and the neoplasm, a part of a bladder dome, omental flap and a part of rectus muscles, were removed. In order to reconstruct the abdominal wall we used a large Polypropilene patch. The hystological report outlined a large urachal cyst, a flogosis and a purulent necrosis invading the surrounding tissue and the peritoneum. The patient was discharged after twenty-five days and he had a good functional performance. In the light of the reported case, the surgical treatment seems to be the best solution before the onset of complications that should expose patients to difficult and demolitive surgical operations and that should protract the hospitalization.
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PMID:[Complicated urachal cyst: a difficult differential diagnosis]. 927 86


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