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

The results of 100 patients with primary active infective endocarditis treated surgically are presented. Hospital and late mortalities as well as postoperative complications in patients operated electively and not showing paravalvular infection approach those of routine procedures while frank circulatory failure and uncontrolled sepsis were associated with high death and complication rates. Paravalvular extension of the infection was associated with frequent postoperative leakage, reoperations and mortality. The present operative choices in eradicating paravalvular disease are described and the great importance of early operation is stressed.
Thorac Cardiovasc Surg 1982 Dec
PMID:Surgery for active infective endocarditis. 618 90

The incidence and causes of infectious complications after pleuro-pulmonary surgery occurring in our institution before 1968, from 1968 to 1975, and from 1978 to 1979 are compared. Soft tissue infections occurring in the operative region, in the pleural cavity and in the remaining lung tissue are assessed separately. From these data it is concluded, that infections of soft tissue have markedly decreased from 7 to 2% while secondary wound healing without purulent infection has fallen from 21% to 5%. The risk of infection thus has decreased below the average figures of general surgery. A comparatively high number of wound infections however, have to be expected after decortication of thoracic empyema. The incidence of postoperative empyemas predominantly related to postoperative bronchial fistulae after lung resection has decreased from 4% to one percent in segmental or lobar resections. Serious infections of the remaining lung with abscess formation have become rare indeed (0.2%). Inflammatory atelectasis caused by bronchial obstruction has remained at a constance level of one to 2% throughout the years. There were 2 cases of lethal bacterial sepsis in 1,566 pulmonary procedures before 1973, but none thereafter. Increasing attention will have to be paid to mycotic superinfections rather than to primary bacterial infections since such superinfections of the tracheo-bronchial tree and of the pleural cavity have increased from less than one percent to approximately 3% during the recent 10 years.
Thorac Cardiovasc Surg 1983 Apr
PMID:Infections after pleuro-pulmonary surgery. 619 Feb 53

Over a 2 year period ending in April, 1981, 268 premature infants with birth weight below 1,750 gm underwent operation for a "hemodynamically significant" patent ductus arteriosus. Operations were performed in 13 centers participating in a collaborative study, which was primarily designed to evaluate the role of indomethacin in the management of patent ductus arteriosus. No patient died during the operations, which were done at a median age of 10 days. Eight infants (3%) died within 36 hours after operation. In only one was the death directly attributable to the operative procedure. Hospital mortality (23%) and postoperative morbidity, which included bronchopulmonary dysplasia, pneumothorax, and sepsis, were unrelated to birth weight, age at operation, and degree of preexisting pulmonary disease or preoperative treatment of the infant with indomethacin. Results indicate that surgical ligation is a safe and effective procedure for treating patent ductus arteriosus with large left-to-right shunting in small premature infants.
J Thorac Cardiovasc Surg 1984 Jun
PMID:Surgical closure of patent ductus arteriosus in 268 preterm infants. 637

By means of a volumetric respirometer, oxygen consumption and carbon dioxide production were measured in 15 patients with chest trauma who required mechanical ventilation. From the primary measurements, respiratory quotient, daily energy balance, and cumulative energy balance were calculated. There was a moderate increase in metabolic rate, which generally returned to normal during the first week after trauma. A late increase in oxygen consumption was associated with sepsis, large energy deficit, and death in three patients. Carbon dioxide overload caused by excessive feeding caused difficulty in weaning three patients from the ventilator. Measurement of oxygen consumption and carbon dioxide production is helpful in the management of patients with chest trauma and respiratory failure.
J Thorac Cardiovasc Surg 1984 Apr
PMID:Metabolic studies in chest trauma. 642 11

During a 7 year period, 38 consecutive patients (31 male and seven female) had repair of an infected sternotomy wound. Their mean age was 56 years (range 13 to 78 years). Sternotomy was performed for cardiac disease in 34 patients. Staphylococcus aureus was the most commonly cultured organism. All patients required sternal debridement, and 17 had resection. Reconstruction was with muscle flaps in 37 patients, omental transposition in one, and both in four. Sixty-seven muscle transpositions were performed (63 pectoralis major, three rectus abdominis, and one latissimus dorsi). The mean number of operations was three (range one to seven). No deaths occurred within 30 days postoperatively. Significant early complications occurred in nine patients. The mean duration of hospitalization was 24.9 days (range 8 to 67 days). All patients were dismissed with a healed sternum. The mean length of follow-up was 24.8 months (range 1 to 81 months). None of the five late deaths were related to sepsis or to wound reconstruction. Recurrent sternal infection occurred in five patients (13.2%). Four of the five patients responded to additional debridement and muscle transposition, and the fifth patient refused further treatment. Of the 38 patients, 33 were alive at the time of this report, 32 with excellent results. We conclude that muscle transposition is an excellent method of management for recalcitrant median sternotomy wounds.
J Thorac Cardiovasc Surg 1984 Sep
PMID:Management of recalcitrant median sternotomy wounds. 647 86

Since 1971 we have seen 15 children with the diagnosis of purulent pericarditis. The causative organism was Hemophilus influenzae in seven, Staphylococcus aureus in three, and five were due to other organisms. In one child the diagnosis was unsuspected until autopsy. The other 14 patients were all treated with intravenous antibiotics to which the organism was sensitive. One child had an immediate pericardiectomy because of tamponade. The other 13 patients had pericardiocentesis for diagnosis and initial therapy. Pericardiocentesis alone resulted in recovery of four patients and failed in nine, including all seven patients with H. influenzae. These nine had recurrent tamponade or a persistent picture of sepsis that was unresponsive to repeated pericardiocenteses and necessitated operative intervention. The procedure used was subxiphoid tube drainage in two patients. One recovered and the other required further operation. The remaining seven patients were treated with pericardiectomy. All pericardiectomy patients recovered without complications or recurrent symptoms. Survivors are asymptomatic with no evidence of pericardial constriction. We recommend immediate pericardiocentesis for diagnosis and initial therapy. Early pericardiectomy should be performed if the causative organism is H. influenzae, if tamponade occurs after initial pericardiocentesis, or if fever persists despite appropriate antibiotics.
J Thorac Cardiovasc Surg 1983 Apr
PMID:Surgical treatment of purulent pericarditis in children. 660 Dec 11

Aneurysms of the extracranial internal carotid artery are rare and only 4 cases have been treated at the Wellesley Hospital since 1969. These aneurysms usually present as a painless lump in the neck and the 4 cases to be described manifest unusual presentations. One patient with a history of facial sepsis presented in the Emergency Department with what was thought to be a neck abscess. This was incised and drained before the true nature of the swelling was appreciated. Two patients presented with nerve palsies, one with a hypoglossal palsy due to stretching of the hypoglossal nerve over a large aneurysm and the second with recurrent laryngeal nerve palsy as a result of rupture of a false aneurysm from disruption of a saphenous vein patch inserted following carotid endarterectomy 9 months earlier. The fourth patient presented with a carotid bruit and had a stenosis distal to the aneurysm. Although rare, carotid aneurysms require recognition and early treatment if neurological sequelae are to be avoided.
J Cardiovasc Surg (Torino)
PMID:Unusual aneurysms of the extracranial carotid artery. 668 97

Patients with primary lung abscess who do not respond to medical management are usually candidates for a lobectomy. Percutaneous tube drainage, used routinely and with good results before the antibiotic era, has nearly been forgotten. Seven patients with lung abscesses and severe sepsis were in critical condition, not permitting pulmonary resection. They were treated by tube drainage. Prompt clinical recovery occurred in all, with complete resolution of abscesses within 4 to 24 days. When medical therapy of lung abscess fails, tube drainage should be considered in preference to a lobectomy. It is safe and curative and avoids unnecessary loss of functioning lung parenchyma. Lobectomy should be considered in patients who have major life-threatening bleeding or massive pulmonary necrosis.
J Thorac Cardiovasc Surg 1984 Feb
PMID:Percutaneous drainage of lung abscess. 669 22

The clinical manifestations and results of management in twenty-five patients treated for infected vascular grafts are reviewed. The overall incidence of infection in this series of prosthetic grafts is 1.4%. Staphylococcus aureus was found to be the single most common infecting organism and multiple organisms were found in nine patients. Therapy was divided into three methods of management: local therapy alone resulted in a mortality of 45% and an amputation rate of 36.3%; partial graft excision resulted in a mortality of 20% and an amputation rate of 60%; total graft excision resulted in a mortality of 22% and an amputation rate of 22% as well. All amputations were above-knee amputations and the most common cause of death was continuing sepsis. The overall mortality of 32% and a loss of limb rate of 44% are testimony to the serious nature of this problem.
J Cardiovasc Surg (Torino)
PMID:Infected arterial grafts: clinical manifestations and surgical management. 670 73

Valve replacement in patients with a small aortic anulus can cause difficult technical problems or leave the patient with a significant residual transvalvular gradient. Between August, 1977, and June, 1983, 35 patients with a small aortic root (21 mm or less) underwent aortic valve replacement with Ionescu-Shiley pericardial xenograft valves. They ranged in age from 29 to 76 years (mean 52.8 years) and in weight from 64 to 91 kg (mean 76.3 +/- 3.6 kg). Preoperatively, 26 patients were in New York Heart Association Functional Class III-IV. The valve sizes used were 17 mm in three cases, 19 mm in 16 cases, and 21 mm in 16 cases. There were four hospital deaths (11.4%) resulting from sepsis or low cardiac output. There were no late deaths. Cumulative duration of follow-up was 819.4 patient-months. Twenty-four (78%) of the 31 surviving patients are asymptomatic. Up to the time of review, there have been no episodes of thromboembolism, infective endocarditis, perivalvular leak, valve thrombosis, or primary tissue valve failure. Fifteen patients were hemodynamically evaluated 2 to 47 months (mean 14.3 months) after operation. The average resting transvalvular gradients for 19 and 21 mm valves were 15.1 and 10.8 mm Hg, respectively. Our experience suggests that the Ionescu-Shiley pericardial xenograft valve is a valid alternative in the surgical treatment of patients with a small aortic root.
J Thorac Cardiovasc Surg 1984 Aug
PMID:The Ionescu-Shiley valve: a solution for the small aortic root. 674 17


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