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

The aim of this retrospective study was to assess the merits of axillofemoral bypass in elderly patients. 69 axillofemoral grafts were laid from 1981 to 1985 in 56 patients, all older than 70. They always were aimed at limb salvage due to aortoiliac obliterating lesions (the indications of sepsis of aorto-bifemoral prostheses have been excluded). 13 patients have had an axillo-bifemoral graft and 43 an unilateral axillofemoral graft. The lower anastomosis involved the common femoral artery in 30 cases, the deep femoral artery in 39. The patients were followed up for 1 to 74 months, with an average of 24 months. The operative mortality was of 10 cases (17%). During the first postoperative month, 3 major amputations were required. The cumulated survival rate at 60 months was of 18%, with the primary and secondary patency rates at 60 months being of 46% and 71%, respectively. We conclude that axillofemoral bypass is perfectly adapted to this population of elderly subjects, in whom a direct aortic approach is counterindicated.
J Mal Vasc 1991
PMID:[Value of axillofemoral bypass in the elderly]. 186 Nov

Eleven cases of foreign body (F.B.) (3 autochthonous and 8 of other sources) demonstrate the rarity but also the persistent reality of these accidents. Incidence between 1970 and 1985 was close to one F.B. per 3,000 vascular procedures. In 4 cases the F.B. followed surgical non-reconstructive surgery and in the other 7 cases revascularization procedure, material involved being most often textile, sponges in 7 cases and towel in one case. Circumstances leading to let F.B., without disculpating the surgeon, included long and difficult operations conducted as emergencies or requiring one or more recovery operations. Clinical findings of the F.B. were of post-operative sepsis (10 cases) of varied clinical expression. General (4 cases of septicemia) and local (3 thrombosis, 1 anastomotic hemorrhage) consequences were serious. Prognosis in patients with F.B. closely follows that of vascular sepsis, with maximum seriousness after bifurcated prosthetic shunt. An essential prognostic factor is early diagnosis of F.B.: it is dependent on a series of clinical and paraclinical etiologic arguments, particularly results of radiography of the operated zone, fistulography and echography. Surgical intervention is a function of initial operation and is that proposed for all cases of vascular sepsis, with the common denominator of the total revision of the operated zone and removal of foreign bodies. Prophylaxis of F.B. in vascular surgery follows the rules for general surgery; these have been enounced for the last 50 years but have failed to prevent the postoperative F.B. This rare but always possible accident justifies its knowledge by even the most serious, experienced vascular surgeon.
J Mal Vasc 1987
PMID:[Foreign bodies in the body following vascular surgery (11 cases)]. 355 6

A retrospective study was carried out in 30 patients after unilateral iliac endarterectomy, the contralateral limb being asymptomatic, to assess the evolution of the unoperated limb. Findings indicated 4 claudications uncovered by the unilateral operation, 8 secondary thromboses (including one asymptomatic lesion) of the unoperated iliac axis--repeat operation was necessary in only one patient. Findings emphasize the importance of control of risk factors to prevent secondary deterioration of an unoperated limb. The risk of thrombosis in the primarily asymptomatic side appears to lessen with immediate insertion of an aorto-bifemoral prosthesis, but risks inherent in prosthesis application--sepsis, false aneurysm--must be allowed for.
J Mal Vasc 1985
PMID:[The future of the asymptomatic leg after unilateral iliac artery repair]. 409 21

The present study involved 18 cases f axillo-femoro-distal bypass performed to revascularise either a popliteal artery (8 cases) or a leg artery (10 cases). The postoperative mortality (2 cases) was not directly related to the operative procedure. This type of operation was performed in particularly grave situations of severe ischaemia or sepsis. The results obtained were interesting in two-stage operations (7 good results in 11 operations) for ischaemia. In one-stage operations, corresponding to particularly grave situations, as well as in operations for sepsis (2 cases with 2 failures), the failure rate was by contrast very high. The results obtained were compared with those found in the literature. Such very long bypasses would finally appear to be justified in very grave situations in which there is no possibility of direct surgery with the aorta as the proximal source.
J Mal Vasc 1982
PMID:[Axillo-femoro-distal bypass. Study of a series of 18 cases (author's transl)]. 707 69

Between 1979 and 1993, 50 patients (33 men and 17 women) receiving chronic haemodialysis, underwent 53 cardiac surgical procedures in the department. The mean age was 56 +/- 13 years. The average duration of preoperative dialysis was 82 +/- 63 months. The average duration of cardiac symptoms before surgery was 35 +/- 52 months. Twenty-seven patients (54%) were in NYHA functional classes III or IV before surgery. Sixteen patients (32%) had preoperative left ventricular ejection fractions of less than 0.40. Twelve patients (24%) were emergency referrals. Twenty-nine patients underwent isolated coronary bypass surgery, 13 patients underwent isolated aortic valvular replacement which had to be repeated in one case, 3 patients underwent mitral valve replacement, which had to be repeated in 2 cases, and 5 patients underwent combined surgery. The average aortic clamping time was 75 +/- 32 minutes, the average cardio-pulmonary bypass time was 125 +/- 50 minutes. The surgical revascularisation of the coronary patients was incomplete in 37% of cases because of the severity of the underlying coronary artery disease. The average postoperative bleeding was 800 +/- 650 ml; 29 patients (58%) were transfused with an average of 4.3 +/- 3 units of blood. The global early mortality was 9 patients (18%); 10% in coronary bypass, 7% in aortic valve replacement and 50% in patients with more complex procedures. The causes of death were cardiac (n = 4), sepsis (n = 2) and multiple organ failure (n = 3). The morbidity was 39%, mainly due to low cardiac output.(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1995 Jan
PMID:[Cardiac surgery in chronic hemodialysed patients: immediate and long-term results]. 764 48

In 1993, infectious endocarditis (IE) remains a common and serious condition. Surgery has become an essential feature of treatment in many cases. The choice and optimal timing depend on many factors: the tolerance of the underlying cardiac disease is an important feature, surgery being indicated not only in cases of necessity (refractory cardiac failure) but also as treatment of choice in cases of episodic decompensation even if temporary when related to valvular dysfunction. In these conditions, if the lesion is severe aortic incompetence, surgery can be programmed in two or three weeks after initiating antibiotic therapy; the bacteriological indications are less common: fungal endocarditis, prosthetic valve endocarditis due to gram-negative bacilli or staphylococcus aureus endocarditis, or IE on native valves with persistent signs of sepsis after one week of antibiotic therapy; the occurrence of some complications may require urgent surgery: high degree atrioventricular block, septal perforation, ring or perivalvular abscess detected at echocardiography, single or multiple systemic embolism with persistence of large, mobile vegetations at echocardiography. Conversely, tricuspid valve endocarditis usually respond well to medical treatment alone: surgery (valvuloplasty with excision of vegetations, valvulectomy or, preferably, bioprosthetic valve replacement) is sometimes indicated in septic states related to certain pathogenic organisms. The operative indications in 1993 have become more extensive and earlier: analysis of surgical results shows that operative mortality depends mainly on the haemodynamic status at the time of operation, but also on the severity of the anatomical lesions, the nature of surgery, the type of endocarditis, native or prosthetic valve, and the causal organism.(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1993 Dec
PMID:[Surgery for bacterial endocarditis. When?]. 802 92

The indications for repeated excision for bronchial cancer may be raised in cases of a synchronous second (or subsequent cancer) or in the case of a local recurrence of the initial cancer which was operated upon. Ninety consecutive patients had a repeat operation for cancer over a 30 year period. There were 86 men and 4 women with a mean age of 59. The initial cancer had most often been treated with lobectomy or bilobectomy and was relatively localised (90% stage I or II). However, 7 patients had a pneumonectomy. The repeat operation was carried out for 30 recurrences and in 44 for secondary subsequent cancers and in 16 cases for a bilateral synchronous cancer. The second operative intervention led to 30 pneumonectomies, 29 lobectomies and 20 atypical excisions. On the otherhand 11 patients had an exploratory thoracotomy and on 10 occasions there was local regional recurrence. These secondary localisations were classified as 44 stage I, 9 stage II and 26 stage III. Eight patients had major loss of lung parenchyma with a pneumonectomy on one side and an atypical excision or a lobectomy on the other. Six patients (6.5%) died in the post-operative period (two from respiratory failure and two due to cardiovascular causes and two sepsis). The actual survival at 5 years was 20% in cases that had an excision. The prognosis was identical in cases having a resection for a recurrence or for secondary subsequent cancer or for bilateral synchronous cancers.(ABSTRACT TRUNCATED AT 250 WORDS)
Rev Mal Respir 1993
PMID:[Prognosis of repetitive excisions of bronchial cancer]. 823 24

Pseudoaneurysms of the abdominal aorta (PAAA) are late complications of aortic reconstruction that occur with an incidence varying from 4.8 to 6.3% associated with an operative mortality of 21 to 35%. Between 1987 and 1994, 16 patients with a PAAA (14 men and two women, with a mean age of 69.5 years, ranging from 55 to 82 years) were treated in our unit. An anastomotic rupture with a pseudoaneurysm diameter varying from 50 to 75 mm was present in five cases (group 1). The eleven other cases were aorto-enteric fistula, isolated in six cases (group 2) and associated with local and/or general sepsis signs in five cases (group 3). The mean interval from the time of the primary aortic graft, which was performed as treatment for aortic aneurysm in six cases and for aortoiliac occlusive disease in 10 cases, and the diagnosis of the PAAA, was 11.3 years. An in situ replacement of the aortic graft with an interposition of the greater omentum was performed in each patient of groups 1 and 2, associated with an enteric restoration in the latter. Group 3 patients were treated by removal of the infected graft with closure of the aortic stump and extra-anatomic bypass. During the post-operative period, five deaths (31%) and one limb amputation (6%) occurred, i.e. one death in group 1 (20%), one in group 2 (17%) and three in group 3 (60%) associated with a limb amputation (20%).(ABSTRACT TRUNCATED AT 250 WORDS)
J Mal Vasc 1995
PMID:[Late complications of abdominal aortic prostheses: false aneurysms and aorta-digestive fistulas]. 854 96

From December 1990 to July 1995 we performed 171 sub-inguinal revascularizations including 35 popliteal revascularizations and 146 revascularizations of an artery in the leg or foot. Five cases of infection were observed within a delay of 7 and 25 days after the operation. There were 3 men and 2 women (mean age 78 years). Four femoro-tibial bypasses were made for critical ischaemia (2 necroses of the toes, one eschar of the heal, one stage III). There was one femoro-popliteal bypass which was associated with a femoro-femoral for necrosis of the toes. Two bypasses were made with polytetrafluoroethylene, one with Dacron and two with the greater saphenous vein. Signs of sepsis were bleeding in 2 patients who had a venous bypass and septicaemia in 2 patients. Local skin necrosis and/or apparently infected discharge or patent pus were seen in all patients. Staphylococcus aureus was found in 4 patients and Enterobacter cloacae in one. Revascularization was done with an extra-anatomic bypass in 4 patients and with a cryopreserved in situ allograft in 1. Mortality was 20% and amputation rate was 40%. All exposed bypasses were infected but the severity of the infection varied depending on the causal germ, general signs and ischaemia of the limb. Conservative treatment has its limits: 1) intact anastomoses, 2) absence of bleeding, 3) patent bypass, 4) absence of generalized sepsis. Results of in situ revascularization depend on the virulence of the causal germ. Radical treatment (explanation + extra-anatomic revascularization) still has indications in infected infra-inguinal bypass surgery.
J Mal Vasc 1996
PMID:[Treatment of an exposed femorol-popliteal bypass: ex-situ replacement]. 871 85

The authors report two cases of pulmonary valve endocarditis which required emergency surgical treatment. A 74 year old patient with trivalvular endocarditis (pulmonary, aortic, mitral), due to Sptreptococcus D bovis, developed cardiogenic shock with acute pulmonary oedema and underwent double aortic and pulmonary valve replacement with Carpentier-Edwards prostheses and simple resection of a mitral valve vegetation. Another 36 year old drug addict developed isolated pulmonary valve endocarditis due to Staphylococcus aureus infection complicated by pulmonary regurgitation with right ventricular failure and by septic pulmonary embolism with persistent sepsis: he underwent pulmonary valve replacement with a Bravo 300 bioprosthesis. The postoperative course was uncomplicated in both cases, with interruption of the infection and normalisation of the haemodynamic status. The insidious and severe nature of pulmonary valve endocarditis is demonstrated by these two cases, confirming previous reports which have underlined the poor prognosis of this condition. Surgery has been shown to be effective and well tolerated and should be integrated early in the therapeutic strategy, the results being all the better when an aggressive attitude is taken.
Arch Mal Coeur Vaiss 1996 Apr
PMID:[Pulmonary valve replacement for endocarditis. Apropos of 2 cases]. 876 8


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