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

Injuries missed at initial operation have the potential to cause the most disastrous complications in trauma patients. Over the past 5 years, 12 patients have required re-operation for 14 injuries missed at initial laparotomy and/or thoracotomy. Six missed injuries were vascular, two each in the thorax, pelvis, and retroperitoneum. The other eight were visceral: three small bowel (one patient), two pancreatic, and one each of the heart, ureter, and diaphragm. Five patients (42%) died, three with missed vascular and two with missed visceral injuries. Three died due to complications directly related to their missed injuries, while the unrecognized injury did not play a significant role in the other two. Indications for re-operation in patients with vascular injuries were hypotension in two patients, persistent output from drains in three, and refractory acidosis in one. Re-exploration in visceral injuries was for clinical sepsis in three patients, DIC in one, cardiac tamponade in one, and persistent chest tube drainage in one. Eleven of the 12 patients presented to the E.D. in shock. All patients had multiple injuries with a mean of 3.25 organ systems injured. Hypotension, coagulopathy, and/or hypothermia (T less than 92 degrees) were felt to have contributed to missing the injury in five of the patients with vascular, and three of the patients with visceral injuries. In the four other patients, injuries were missed due to inadequate exploration or a low index of suspicion in the presence of multiple injuries.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Injuries missed at operation: nemesis of the trauma surgeon. 339 94

Denver type peritoneo-venous (PV) shunting for intractable ascites was performed in 16 patients also treated with endoscopic injection sclerotherapy (ST) for variceal haemorrhage. Indications, timing and results of shunt insertion are detailed and discussed. Serial ST for eradication of varices could be completed in 10 patients a median of 7 months before PV shunting. The postoperative risk of bleeding was increased four times, i.e. the number of GI bleedings per month of follow-up, was 0.05 and 0.21 (p less than 0.05) respectively, before and after shunt operation. Two patients experienced their first variceal bleeding and 6 patients rebled during a median follow-up of 3 months after PV shunting. The Denver shunt succeeded in resolving ascites clinically in 13 patients within 7 days with a median decrease in weight of 10 kg, parallel to increased urinary output and reduced serum-creatinine. Three patients did not benefit from the shunt procedure due to terminal neoplastic disease (one patient), and severe hepatorenal failure, although the shunts were proven patent. Serious complications included clinically important consumptive coagulopathy, DIC-syndrome (two patients), myocardial infarction (one), pulmonary embolism (three), and sepsis following intervention of obstruction (one).
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PMID:Peritoneo-venous shunting and endoscopic sclerotherapy in patients with portal hypertension. 349 19

The entity of NBTE is reviewed in this article. Historic aspects, epidemiology, and pathogenesis are discussed. The clinicopathologic findings are emphasized as well as the potential for antemortem diagnosis and therapy. NBTE is diagnosed infrequently before death. Clinical suspicion is aroused in patients with an underlying process such as malignancy, DIC, or a spectrum of other diseases and evidence of pulmonary and/or systemic embolization. Systemic infection must be excluded. Two-dimensional echocardiography can be utilized to confirm the diagnosis. Anticoagulation therapy with heparin may prevent embolization.
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PMID:Nonbacterial thrombotic endocarditis: a review. 354 96

A series of patients with meningococcal infections have been studied and divided in two groups: Group I patients with meningococcal sepsis and group II, those with meningococcal meningitis. Patients in group I presented with more severe encephalopathy, shock, DIC and acute systemic complications. Both groups showed a marked hypoaminoacidemia compared with normal controls (other than for the sulfur containing amino acids and phenylalanine). The concentration of aromatic and basic amino acids, the phenylalanine/tyrosine ratio, the transaminase levels and the negative nitrogen balance were higher in group I patients. The ratio of branched chain to aromatic amino acids was lower in group I. All these differences were statistically significant. The close association between the metabolic derangements and clinical manifestations may help in the understanding of several physiopathological aspects of meningococcal infections.
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PMID:Significance of the changes in plasma amino-acid levels in meningococcal infection. 365 98

In spite of all the scientific and technical advances in recent years, shock that is not rapidly correctable with fluid can have a morbidity rate exceeding 80%. Consequently awareness of such precipitating factors as sepsis and early diagnosis and treatment are essential. Treatment should be rapid and should follow a previously outlined protocol. Such protocols should include correction of the precipitating problem and aggressive resuscitation to assure adequate ventilation and oxygenation of the blood and optimal oxygen delivery to the tissues. Fluid and blood should be given as needed until filling pressures begin to rise rapidly with further fluid infusion. With hemorrhagic shock in previously healthy individuals, a hemoglobin level of 10.0 g/dL is usually adequate. In older, septic, or cardiogenic shock patients, a hemoglobin level of 12.5 to 14.0 may be preferable. If an optimal preload does not increase cardiac output to normal or higher levels, inotropic agents should be used. If shock still persists, one must be sure that the arterial pH is not excessively high or low. Glucocorticoids may then be given in low dose (200 mg hydrocortisone) in case some degree of adrenal insufficiency is present. They can also be given in high doses (equivalent to 150 mg/kg hydrocortisone) early in septic shock primarily to prevent excess complement activation and to preserve membrane integrity. Vasopressors may occasionally be required if there is excessive vasodilation, especially if there is persistent hypotension in the presence of high-grade coronary or cerebral artery stenosis. Vasodilators may be used to try to correct myocardial ischemia (nitroglycerin), excessive preload (nitroglycerin), or excessive afterload (nitroprusside or hydralazine). Combinations of vasodilators and inotropic agents may be required in some patients with high systemic vascular resistance and persistently low cardiac outputs. Mechanical assist with IABP can be of great value in persistent cardiogenic shock. Diuretics may occasionally help prevent renal failure in patients who are persistently oliguric after blood flow and pressure are restored. Heparin is occasionally of value if DIC develops with no concomitant fibrinolysis. Antibiotics are important in septic shock and may also be important if persistent shock has reduced gastrointestinal mucosal integrity so that bacteria and bacterial products can enter the portal system.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Science and shock: a clinical perspective. 389 56

In a controlled study of fibronectin supplementation in sepsis, 11 ICU patients in septic shock were scheduled to receive either cryoprecipitate from 20-40 donors (n = 6) or 250-300 ml of stored plasma (n = 5) (two infusions over 24 h). We wanted to: compare some "conventional" DIC variables in the ICU (platelet count, prothrombin complex = NT, FDP) to additional variables: Fibronectin (Fn), fibrinogen (Fg), F V, FVIII R:Ag, F VIII:C activity, F XII, plasminogen (Plg), antiplasmin (AP), antithrombin (AT), kallikrein inhibiting activity (KI) and spontaneous proteolytic activity (SPA): study the effects of cryoprecipitate or plasma infusion on three variables. Samples were taken before the first infusion, and 24 and 48 h after. At onset, high levels (p less than .001 when compared to blood donors) of Fg, VIIIR:Ag and VIII:C were seen. KI levels were within the normal range. F V was low (p less than .05). Fn, NT, XII, Plg, AP and AT were markedly low (p less than .001). SPA showed great variation. When compared to 28 patients with severe infections, but not in septic shock, the ICU group had higher VIIIR:Ag (p less than .05) and VIII:C (p less than .01), and lower XII, Plg, AP and AT (p less than .001). FDP was elevated in all ICU patients. Five patients were thrombocytopenic, and in these a pattern with low levels of Plg and AT was observed. Fn did not correlate well to the other variables measured. These results indicate a marked activation of coagulation and fibrinolysis in these severely ill patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Fibronectin and other DIC-related variables in septic ICU patients receiving cryoprecipitate. 393 20

A nephelometric method is described for determination of plasminogen and two types of plasmin inhibitors in human plasma having different affinity toward plasmin. This method is based on the kinetic analysis of effects of whole plasma and plasmin inhibitor fraction obtained from plasma on the activity of exogenously added plasminogen which was determined by measuring the decrease of light scattering of fibrin suspension. With this method we have determined the activity of plasminogen and two types of inhibitors in the plasma of normal subjects and patients with high fibrinogen degradation product values. They include patients with various malignant tumors with DIC, chronic renal failure, sepsis, vascular diseases, and liver cirrhosis with hepatoma.
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PMID:Nephelometric determination of plasminogen and plasmin inhibitors in human plasma using fibrin suspension as a substrate. 622 10

Infants with platelet counts below 100,000/mm3 should be evaluated for the cause of the thrombocytopenia. A maternal history to determine previous illnesses and particularly thrombocytopenia, drugs taken, and perinatal complications is important, and a maternal platelet count must be obtained. Physical examination of the infant is revealing in the TAR and giant cavernous hemangioma syndromes and may suggest intrauterine infection. A complete blood cell count (CBC) should be done to look for associated anemia and neutropenia or for polycythemia. Red cell morphology may be helpful. A bone marrow examination may be necessary if the etiology is unclear after the initial studies are done. Investigation of the well child will usually find an etiology for the thrombocytopenia. It is important to consider and test for isoimmune thrombocytopenia and intrauterine infection. In the ill infant multiple factors may contribute to a low platelet count, and a single, precise etiology often cannot be established. Thrombocytopenia with or without DIC may be an important indicator of sepsis. Platelet transfusions are helpful if the thrombocytopenia is due to decreased production or intrinsic platelet defects. In disorders with increased platelet destruction, donor platelets may survive long enough to be of some benefit. In ill infants treatment of the underlying problem often results in resolution of the thrombocytopenia. Transfusions should be used for the bleeding child and for the infant with severe thrombocytopenia who is the product of a vaginal delivery. In addition to being therapeutic, platelet transfusions may also assist in diagnosis.
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PMID:Thrombocytopenia in the newborn. 635 31

Of 53 surgical cases complicated with severe infection who were admitted to The Second Department of Surgery of Osaka University Hospital between 1975 and 1982, 9 cases were suffered from sepsis with positive blood culture for Candida albicans. All cases developed DIC and subsequent multiple organ failures (MOF), which was likely triggered by fungal sepsis because of the absence of any coexisting pathogens. Fungal sepsis was developed following a long term massive antimicrobial therapy in 7 cases and also following a long term steroid therapy in 1 cases. No apparent portal of fungal entry was confirmed except 3 cases with a positive fungal culture for central venous catheter. Six cases were fatal without improvement of DIC or MOF, to whom no early administration of antifungal agents was performed due to lack of recognition of fungal virulence. However, 3 cases were completely recovered from DIC and MOF by treatment with antifungal agents and anticoagulants. These observations suggest that DIC due to fungal sepsis may be eradicated by recognition of fungal virulence and by appropriate treatment with antifungal agents and anticoagulants.
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PMID:[Fungal sepsis and DIC in surgical patients]. 642 97

The plasma fibronectin level was determined by immunoelectrophoresis in patients under intensive care. The decrease in plasma fibronectin concentration was most pronounced in patients with sepsis and DIC. Survival of these patients was related to the extent of decrease of the plasma fibronectin concentration. Burn injury and the associated surgical treatment were followed by a decrease in fibronectin concentration which then normalized in 24-48 h after the burn injury. It is concluded that serial determinations of plasma fibronectin are essential for studying the relation of a low plasma fibronectin with the clinical condition.
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PMID:Plasma fibronectin concentration in patients admitted to intensive care unit. 672 57


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