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

Widespread use of antibiotics and change in pathogenesis altered the bacteriology of infected aortic aneurysms. In the past, bacterial endocarditis was the major source of emboli infecting the aorta. Now, gram-negative sepsis in elderly patients is often the initiating event of infection in atherosclerotic aneurysms. Four cases of gram-negative infection in aortic aneurysms were treated. The etiology, presentation, and surgical management are reviewed. Three abdominal aortic aneurysms were infected during urinary tract sepsis and one infection occurred with Salmonella septicemia. The clinical triad of fever, abdominal pain, and a pulsatile abdominal mass led to a preoperative diagnosis in three of four patients. Debridement of infected tissue and bypass through non-infected tissue planes remain the cornerstones of modern surgical management. Despite prompt diagnosis and proper surgical management, the mortality of gram-negative aortic infection remains high because of early rupture and extensive atherosclerotic disease.
J Cardiovasc Surg (Torino)
PMID:Gram-negative bacterial infection of aortic aneurysms. 329 84

Thirteen myoplasties using the sartorius muscle were performed on 12 patients from 1980 to 1985 for "healing problems" in the groin with subjacent synthetic grafts. Persistant aseptic lymphorrhea was the indication for 4 patients. In 3 other cases, bacterial cultures from the wound were positive. In 2 other patients there was clinical evidence of sepsis with purulent discharge from the wound and an exposed graft. In 3 cases myoplasty was used as a preventive measure after reoperation on patients in poor general condition. Follow-up extends from 3 to 54 months. There was only one recurrence observed at 19 months which was successfully treated by segmental resection of the infected graft and insertion of a new prosthesis through the obturator canal. No recurrence was observed among the other patients as judged by clinical observation and biological tests for inflammation, echotomography, CT scan and indium scintigraphy. The treatment of choice for an infected prosthesis should be removal of the graft and extra-anatomic bypass in the majority of cases. However in some situations, excision of the wound and myoplasty using the sartorius muscle may be of some value and needs further evaluation.
J Cardiovasc Surg (Torino)
PMID:Treatment of lymphorrhea with exposed or infected vascular prosthetic grafts in the groin using sartorius myoplasty. 333 77

In a patient who died of complications of severe pulmonary hypertension, right ventricular failure, and sepsis, antemortem two-dimensional (2-D) echocardiography and magnetic resonance imaging (MRI) studies demonstrated a right ventricular mass which at autopsy proved to be thrombus. The diagnostic features of this mass as imaged by these two methods are compared. This case was complicated in that the patient had a history of right atrial myxoma that had been successfully removed three years previously, and a history of several prior pulmonary emboli. Gated MRI depicted the size, shape, and surface characteristics of the mass more clearly than 2-D echocardiography because MRI provided better contrast and spatial resolution. Both techniques were useful in localizing the mass and showing if it was fixed or mobile. Depiction of tumor attachment was unclear with echocardiography but very clear with MRI. MRI also showed a left pulmonary artery thrombus that was not visualized by 2-D echocardiography. Both techniques provided chamber dimension measurements showing enlargement of the right atrium and ventricle. This case demonstrates that gated MRI provides high-quality images of cardiac anatomy and masses. Gated cardiac MRI should be considered at least complementary and potentially superior to two-dimensional echocardiography in the evaluation of intracardiac masses in certain patients.
Cathet Cardiovasc Diagn 1988
PMID:Comparison of gated cardiac magnetic resonance imaging and two-dimensional echocardiography for the evaluation of right ventricular thrombi: a case report with autopsy correlation. 339 69

Polyvinylpyrrolidone-iodine (PI) is a widely used antiseptic agent, safe and effective, in the treatment and prophylaxis of wound sepsis. By continuous irrigation it is frequently used to treat suppurative mediastinitis after median sternotomy. We describe a 63 year old woman with a suppurative mediastinitis, treated with continuous PI irrigation who developed an acute oliguric renal failure. The withdrawal of PI was followed by a complete improvement of renal function. Herein we present our case and a review of the literature about the systemic toxicity of PI.
J Cardiovasc Surg (Torino)
PMID:Acute renal failure in a patient treated by continuous povidone-iodine mediastinal irrigation. 341 39

Secondary aortoenteric fistula may be treated directly by local repair or by excision of all prosthetic material with extra-anatomic revascularisation. We have reviewed our experience with 14 aorto-enteric fistulae encountered between 1960 and 1984. Two patients who were not treated surgically died. Direct repair was attempted in seven patients, two of whom had no prosthetic material present and survived. Five patients had prosthetic grafts which were not removed and four died from recurrent aortic haemorrhage. There were five other patients who had prosthetic grafts which were removed prior to extra-anatomic reconstruction. Three of these died in the peri-operative period, two from sepsis but only one from aortic stump bleeding. The operative mortality was 58%. The overall survival was only 36% (5 of 14 patients) but there was less chance of recurrent aortic haemorrhage when all prosthetic graft material was removed and direct repair avoided.
J Cardiovasc Surg (Torino)
PMID:Lessons learnt in the management of aortoenteric fistulae. 349 41

Improvements in both mechanical circulatory support devices and immune therapy promise a wider use of sequential mechanical support as a bridge to orthotopic cardiac transplantation. The intra-aortic balloon pump, the left and right ventricular assist pumps, and the pneumatic artificial heart represent the range of devices capable of keeping a patient alive who is awaiting a donor organ. The major difficulty in using circulatory support devices is infection, which is caused by their required percutaneous tubes. We report here our experiences with mechanical circulatory support devices as a bridge to cardiac transplantation. In a series of 31 consecutive transplant procedures, six patients have required preoperative mechanical circulatory support. The intra-aortic balloon pump was used in two patients for 2 and 14 days, respectively, before transplantation. Both patients are well 10 and 11 months after the transplant procedure. Two patients required the left ventricular assist device for 11 and 21 days and are alive 3 weeks and 8 months, respectively, after transplantation. One patient was supported by the pneumatic artificial heart for 10 days before a donor heart became available but died of septic shock 17 days after transplantation. A second patient received a pneumatic artificial heart 7 days after transplantation when the heart transplant failed. He has been in stable condition for 45 days but is recovering from renal failure. Our early experiences indicate that either partial or total mechanical support as a bridge to transplantation is successful if overwhelming sepsis or renal failure can be avoided.
J Thorac Cardiovasc Surg 1986 Dec
PMID:Mechanical support of the circulation followed by cardiac transplantation. 353 35

Fifteen pediatric patients (ages 5-17 years) with renovascular hypertension (RVH) are reported. The diagnosis was made by arteriogram in all patients as the intravenous pyelogram was not helpful in this group. Five patients had a coarctation of the abdominal aorta. Four of these had associated renal artery stenosis. Renal artery stenosis alone was present in 14 patients, unilateral in 8, and bilateral in 6. Three of the former had a contralateral hypoplastic kidney. A nephrectomy was performed in 2 patients, both of whom continue to be hypertensive. Renal revascularization was performed in 13 patients; one of these died of sepsis. Eight are normotensive, 2 are improved (normotensive with diuretics), and 2 remain hypertensive. The follow-up is from 1 to 15 years.
J Cardiovasc Surg (Torino)
PMID:Renovascular hypertension in pediatric patients. 365 34

Autologous pericardium was used to reconstruct different parts of the left ventricle in 25 desperately ill patients. Fourteen patients had intractable sepsis resulting from infective endocarditis and myocardial abscess and 10 patients had noninfectious disorders. Of the patients with infections, 12 had valvular endocarditis with periannular abscess and three had interventricular septal abscess. The noninfected patients had acute rupture of the ventricular wall after mitral valve replacement (one patient) heavily calcified or surgically absent mitral anulus (three patients), or rupture of the interventricular septum after acute myocardial infarction (six patients). The interventricular septum, the posterior wall of the left ventricle, and the periannular areas were reconstructed by suturing appropriately tailored pericardial patches directly to the endocardium. In patients who also required valve replacement, the prosthetic valve was partially or completely secured to the pericardial patch. There were three operative deaths. All three patients were in either septic or cardiogenic shock before operation and in none of them was the death related to the pericardial patch. All 22 survivors have been observed from 3 to 34 months, an average of 14 months. There has been no case of patch dehiscence, patch aneurysm, prosthetic valve dehiscence, or recurrent endocarditis. Autologous pericardium appears to be safe for reconstruction of the left ventricle. It is easy to handle and problems with suture line bleeding are practically nonexistent.
J Thorac Cardiovasc Surg 1987 Nov
PMID:Reconstruction of the left ventricle with autologous pericardium. 366 99

In resection of abdominal aortic aneurysm, ligation and division of the left renal vein may be necessary in order to expose the perirenal aorta. This manoeuvre is possible, with conservation of the left kidney function, because of the extensive venous collateral circulation of the left kidney. It is of crucial importance however, that ligation of the vein is performed close to the inferior vena cava. A case is presented where ligation of the left renal vein was performed in relation to an operation for a ruptured abdominal aortic aneurysm. After the operation there was initially dysfunction of the left kidney, and later on sepsis-induced uraemia. The renal function stabilized at a moderately reduced level. No permanent kidney damage related to the venous ligation could be demonstrated. In the literature serious renal damage has been reported in 10 cases out of 89 reported ligations of the left renal vein. Ligation of the left renal vein is thus a reasonably safe and acceptable procedure for surgical exposure in difficult aortic procedures.
J Cardiovasc Surg (Torino)
PMID:Ligation of the renal vein during resection of abdominal aortic aneurysm. 372 50

Since 1973, 11 patients have had emergency valve replacement for severe mitral insufficiency and cardiogenic shock within 1 month (mean 10.0 days) of acute myocardial infarction. Mean age was 60 years (range 44 to 71 years). Nine infarcts affected the inferior wall, one patient had a prior myocardial infarction, and only two patients had a history of cardiac symptoms. Ten patients had pulmonary edema, five were oliguric (less than 0.5 ml/kg/hr for 12 hours), four required endotracheal intubation, nine required preoperative intra-aortic balloon support, and three had had a cardiac arrest. Preoperative cardiac index averaged 1.7 L/m2/min even with pharmacologic and circulatory support. Eight patients had cardiac catheterization and nine had echocardiograms. Left ventricular ejection fraction varied from 23% to 83% (mean 51%) and was not prognostic. Five patients had papillary muscle rupture and six patients had papillary muscle dysfunction. The mitral valve was replaced with a mechanical prosthesis in all patients. Five had simultaneous coronary artery bypass grafts. Three of five patients with papillary muscle rupture and two of six with papillary muscle dysfunction survived hospitalization. Two patients could not be weaned from cardiopulmonary bypass, two patients died within 24 hours of low cardiac output, and two patients died 3 weeks postoperatively of acute tubular necrosis and sepsis following prolonged preoperative cardiogenic shock. The interval from onset of shock to operative therapy averaged 1.7 days for survivors versus 9.3 days for nonsurvivors. Although the amount of viable left ventricular mass cannot be measured preoperatively, we recommend early operation, before other organ systems fail, for patients having severe mitral insufficiency and cardiogenic shock within 30 days of acute myocardial infarction.
J Thorac Cardiovasc Surg 1985 Apr
PMID:Operation for acute postinfarction mitral insufficiency and cardiogenic shock. 387 81


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