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

A 3-month-old Quarter Horse colt sustained a penetrating injury over the coronary band on the right forelimb resulting in an articular bone sequestrum and septic arthritis of the distal interphalangeal joint. Despite aggressive treatment for septic arthritis, severe osteoarthritis and ongoing sepsis resulted in persistent lameness. Facilitated ankylosis of the distal interphalangeal joint was performed using a combination of open surgical debridement, placement of an autogenous cancellous bone graft and stabilisation within a transfixation cast. Bony ankylosis of the joint was observed radiographically 7 weeks following surgery. Evaluation of the horse 30 months following surgery revealed complete fusion of the middle and distal phalanges, and the distal sesamoid bone. The horse is pasture sound and is used as a breeding stallion. This report describes the surgical approach and case management employed to achieve facilitated ankylosis as a treatment for unresolved septic arthritis of the distal interphalangeal joint. This is the first report of successful facilitated ankylosis of the distal interphalangeal joint in a foal.
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PMID:Facilitated ankylosis of the distal interphalangeal joint in a foal. 1518 28

A 3-year-old girl with phenotypic and cytogenetic manifestations of the ICF syndrome and DNA hypomethylation but without DNMT3B gene mutation is described. At age 3 months, she had an apneic spell that left her with spastic paraplegia and severe mental retardation. At age 8 months, she suffered meningococcal meningitis and sepsis. When seen by us at age 3 years with virilization, she had a cleft plate, macroglossia, and an atrial septal defect. An adenoma was surgically removed from the right adrenal cortex. Her serum immunoglobulin levels were normal except IgA at the low normal border. Her lymphocytes showed paracentromeric stretching of chromosomes 1 and 16 in 7% of metaphases, and multiradial figures involving these chromosomes in 1% of cells. Hypomethylation of classical satellite 2 DNA was observed with BstBI digestion, but in a lesser degree than those in the individuals with proven DNMT3B mutations. No mutation was found in the coding and promoter regions of the gene. Several alternative interpretations were considered to explain the low frequencies of chromosomal instabilities and the lower degree of DNA hypomethylation, and undetected DNA3B mutations. A mutation may be present in the gene but undetected, present in other DNA methyltransferases (DNMT) genes or in a DNMT-associated protein gene.
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PMID:ICF syndrome in a girl with DNA hypomethylation but without detectable DNMT3B mutation. 1532 30

A 3-month-old male infant presented with intermittent low-grade fever from the age of 1 month. On investigation, a non-homogenous opacity was found in the upper lobe of the right lung. A computerized tomographic scan revealed loss of aeration of the right upper lobe and partial collapse of the middle lobe. A provisional diagnosis of congenital cystic adenomatoid malformation of the lung (with episodes of infection) was made. We describe the use of a single lumen tracheal tube (TT) for thoracotomy and lobectomy in this infant. The surgical procedure was complicated by a flood of thick, semisolid caseous material from the TT tube causing hypoxia and inability to ventilate the infant. The problem was managed appropriately in the circumstances. The infant died on the 10th postoperative day after two episodes of pneumothorax and, finally, sepsis, and multiorgan failure. Histopathological examination of the tissues and smears revealed acid-fast bacilli in all fields and confirmed the diagnosis of perinatal tuberculosis. This appears to be the first report of its kind of an anesthetic complication of perinatal tuberculosis. A brief update on this condition and the importance of lung separation in infants undergoing thoracotomy is discussed.
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PMID:Perinatal tuberculosis: implications of failure to isolate the lungs in an infant undergoing thoracotomy. 1602 5

A 3.4-kg, 6-day-old infant presented to the pediatric intensive care unit with a 2-day history of poor feeding and tachypnea. Care at an outside hospital included endotracheal intubation, the administration of isotonic fluid (20 mL/kg), and antibiotics (ampicillin and gentamicin) for presumed sepsis. After arrival at our institution, physical examination revealed absent femoral pulses and hepatomegaly. Cerebral oximetry revealed a right-sided reading of 51% and a left-sided reading of 15%. Given the diminished femoral pulses and the disparity in the cerebral oximetry values, a tentative diagnosis of congenital heart disease with an obstructive left-sided lesion was entertained, and a prostaglandin E1 infusion was started at 0.05 microg/kg/min. The diagnosis of a type C interrupted aortic arch and a ventricular septal defect was confirmed by echocardiography. After stabilization and correction of metabolic abnormalities, the infant was taken to the operating room for repair of the interrupted aortic arch and placement of a pulmonary artery band.
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PMID:Cerebral oximetry using near-infrared spectroscopy aids in the diagnosis of interrupted aortic arch. 1870 27

Toll-like receptors (TLRs) that recognize pathogen associated molecular patterns and chemoattractant receptors (CKRs) that orchestrate leukocyte migration to infected tissue are two arms of host innate immunity. Although TLR signaling induces synthesis and secretion of proinflammatory cytokines and chemokines, which recruit leukocytes, many studies have reported the paradoxical observation that TLR stimulation inhibits leukocyte chemotaxis in vitro and impairs their recruitment to tissues during sepsis. There is consensus that physical loss of chemokine receptor (CKR) at the RNA or protein level or receptor usage switching are the mechanisms underlying this effect. We show here that a brief (<15 min) stimulation with LPS (lipopolysaccharide) at ~0.2 ng/ml inhibited chemotactic response from CCR2, CXCR4 and FPR receptors in monocytes without downmodulation of receptors. A 3 min LPS pre-treatment abolished the polarized accumulation of F-actin, integrins and PIP(3) (phosphatidylinositol-3,4,5-trisphosphate) in response to chemokines in monocytes, but not in polymorphonuclear neutrophils (PMNs). If chemoattractants were added before or simultaneously with LPS, chemotactic polarization was preserved. LPS did not alter the initial G-protein signaling, or endocytosis kinetics of agonist-occupied chemoattractant receptors (CKRs). The chemotaxis arrest did not result from downmodulation of receptors or from inordinate increase in adhesion. LPS induced rapid p38 MAPK activation, global redistribution of activated Rap1 (Ras-proximate-1 or Ras-related protein 1) GTPase and Rap1GEF (guanylate exchange factor) Epac1 (exchange proteins activated by cyclic AMP) and disruption of intracellular gradient. Co-inhibition of p38 MAPK and Rap1 GTPase reversed the LPS induced breakdown of chemotaxis suggesting that LPS effect requires the combined function of p38 MAPK and Rap1 GTPase.
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PMID:TLR signaling paralyzes monocyte chemotaxis through synergized effects of p38 MAPK and global Rap-1 activation. 2234 75

A 3-day-old male baby presented with clinico-radiological features of rectal atresia with colo-urinary fistula. There was no radiological evidence of congenital pouch colon (CPC), but per-operatively CPC of unusual anatomy was found. The CPC was intermediate between type I and type II of Narsimha's classification. The pouch had rudimentary appendix and proximal colovesical fistula. The distal end of CPC was free. In the first stage, diverting ileostomy was done. In follow-up, after 1 month because of rectourinary fistula baby developed hyperchloremic metabolic acidosis and uremic sepsis. First metabolic correction and control of sepsis were done. Thereafter, abdomino-posterior saggital approach was used for excision of colovesical fistula, appendectomy, coloplasty and colorectal anastmosis. The ileostomy was left undisturbed. The infant at present is waiting for the third stage ileostomy closure.
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PMID:A newer variant of congenital pouch colon with rectal agenesis: management strategy and review of the literature. 2267 56

A 3-day-old male baby presented with anorectal agenesis, sacral meningomyelocele (MMC), bifurcated scrotal raphae, abdominal distension and septicaemia. X-ray in the prone position cross table view showed high anorectal malformation. On exploration for colostomy, an 8 cm terminal (sigmoid and descending colon) colonic tubular duplication was found. Both the colonic segments were communicating proximally to each other and distally with urinary bladder, along with complete anorectal agenesis. The excision and repair of the colovesical fistula were done. The colonic segment communicating proximally to the normal colon was exteriorised by window colostomy. The high-resolution ultrasonography of the scrotum revealed two well-developed testis. The bifurcated scrotal raphae and sacral MMC were left to be treated in the future. Unfortunately, the baby died in the immediate postoperative period due to ongoing sepsis.
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PMID:Association of anorectal malformation with duplicated colon, sacral meningomyelocele and scrotal anomalies. 2268 33

A 3-year-old girl presented to the emergency department with seizures, low-grade fever and vomiting. She had tachycardia and a slow capillary refill. Blood pressure could not be measured. Because of suspected sepsis and/or meningo-encephalitis, broad spectrum antibiotics and antiviral medication were given together, along with volume expansion and anticonvulsive therapy. A few hours later, after a second seizure, the blood pressure was extremely high (156/116 mm Hg). The girl was treated with anticonvulsants and intravenous antihypertensive agents. MRI of the brain showed signs of posterior reversible encephalopathy syndrome. Cultures of blood and cerebrospinal fluid remained sterile. Further investigation into the cause of the malignant hypertension revealed hypokalemia, metabolic alkalosis and extremely high plasma renin activity, caused by a rare renal abnormality: bilateral renal segmental hypoplasia or Ask-Upmark kidneys.
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PMID:A 3-year old girl with seizures, hypokalemia and metabolic alkalosis. 2279 82

Renal damage in dengue haemorrhagic fever (DHF) has been reported in association with shock, haemolysis, rhabdomyolysis and sepsis. This report describes acute glomerulonephritis with DHF without the above-mentioned complications. A 3-year-old boy presented with fever, vomiting and oliguria. He had hypertension, deranged renal function and low serum complement (C3), and urine microscopy showed red blood cells and granular casts. The IgM and IgG ELISA (rapid test) for dengue virus were positive. He was managed with maintenance fluids, intravenous furosemide and supportive care. He made an uneventful recovery and was discharged 7 days after admission.
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PMID:Acute glomerulonephritis in dengue haemorrhagic fever in the absence of shock, sepsis, haemolysis or rhabdomyolysis. 2282 65

The incidence of natal tooth is uncommon and its management could be fraught with challenges. A 3 day old female presented with features of sepsis and a natal tooth. Treatment for sepsis was permitted and successfully instituted but definitive management of the natal tooth was deferred, for cultural reasons, by the parents. The case documents the occurrence of natal tooth and highlights the impact of cultural beliefs on management of some medical conditions. It underscores the need to develop the relationship between orthodox medical care and cultural beliefs, in susceptible communities, with a view to achieving optimal health care delivery.
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PMID:Natal tooth and cultural impact on its management in a tropical neonatal unit: a case report. 2428 57


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