Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diaziquone (AZQ), a new lipid-soluble antitumor agent, was given by 15-30-minute infusion on a daily X 5 schedule to 47 children with refractory solid tumors and leukemia. The starting daily dose of 6 mg/m2 was escalated to 10 and 35 mg/m2 in patients with solid tumors and leukemia, respectively. In patients with solid tumors, myelosuppression was dose-limiting at a daily dose of 10 mg/m2. In patients with leukemia, prolonged pancytopenia and bone marrow hypoplasia were observed at daily doses greater than or equal to 25 mg/m2. At these higher doses, significant hyperbilirubinemia associated with sepsis was also seen. Corresponding increases of transaminases or alkaline phosphatase and significant hemolysis were not noted. The maximum tolerated dose for this daily dose schedule was 9 mg/m2 in children with solid tumors and 25 mg/m2 in children with relapsed leukemia. Responses to AZQ included stabilization of disease in osteosarcoma, neurofibrosarcoma, pinealoma, and ependymoma. A patient with juvenile chronic myelocytic leukemia in blast crisis converted back to the chronic phase. A patient with acute lymphoblastic leukemia had a substantial decrease in cerebrospinal fluid blast count. Bone marrow aplasia was achieved in children with acute lymphoblastic leukemia and acute nonlymphoblastic leukemia; however, remissions were not achieved. A phase II study of AZQ in children with refractory malignancies is now being performed by the Childrens Cancer Study Group.
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PMID:Phase I clinical evaluation of diaziquone in childhood cancer. 385 80

Recent immigration trends have resulted in an increased prevalence of amebic hepatic abscesses in southern states and in many northern American cities. Because amebic hepatic abscesses generally do not require drainage, differentiation from pyogenic hepatic abscesses is important. We, therefore, reviewed the records of patients admitted to the UCLA Medical Center from 1968 through 1983 to compare the clinical manifestations and to access the results of treatment of pyogenic and amebic hepatic abscesses. During this 15 year period, 82 patients (42 pyogenic and 40 amebic) with hepatic abscesses were admitted. Factors which distinguished patients with pyogenic abscesses included: age greater than 50 years; jaundice; pruritus; sepsis and shock; a palpable mass; elevated bilirubin level; elevated alkaline phosphatase level, and abnormal abdominal roentgenograms. Patients with amebic abscesses of the liver were more likely to have Mexican ancestry, recently traveled to an endemic area, abdominal pain, diarrhea, abdominal tenderness, hepatomegaly and positive amebic serology. Hepatic scans and ultrasonography were excellent methods of detecting the presence of but not the type of hepatic abscess. Over-all, the mortality was 40 per cent for patients with pyogenic abscesses whereas all 40 of the patients with an amebic abscess survived. However, operative mortality was only 4.5 per cent for the 22 patients with pyogenic abscess who were managed with systemic antibiotics and surgical drainage. We conclude that many clinical and laboratory parameters can aid in the differentiation and, as a result, management of patients with pyogenic and amebic hepatic abscesses.
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PMID:Differentiation of pyogenic from amebic hepatic abscesses. 394 89

The clinical records of 216 patients with proven acute cholecystitis treated by cholecystectomy form the basis of this retrospective study. Common bile duct stones were present in 12.4 per cent of these patients. Thirty per cent of the patients with elevated SGOT values, 26.2 per cent of the patients with elevated alkaline phosphatase, and 23.1 per cent of the patients with elevated amylase had common duct stones. The authors found that 17.6 per cent of patients with bilirubin between 1.5 and 2.9 mg/dl had common duct stones, whereas 71.4 per cent of common bile ducts with a bilirubin greater than 5 mg/dl contained stones. Six of 28 patients with common duct stones had normal bilirubin. Cholangiograms were normal in 115 of the 154 cholangiograms performed; six of these common ducts were explored, and no common duct stones found (false-negative cholangiograms 0.0%). Cholangiograms showed stones in 24 patients; common bile duct stones were recovered from 20 of these patients (accuracy rate 83%, false-positive cholangiograms 17%). Wound infections occurred in seven patients (3.7%). Sepsis resulted in death of three patients, and the other two deaths resulted from multi-system failure. This study demonstrates operative cholangiograms to be the most accurate method of detection of common duct stones, and its routine use in patients undergoing cholecystectomy is recommended.
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PMID:Acute cholecystitis. Evaluation of factors influencing common duct exploration. 395 67

The clinical syndrome of "shock liver," also known as ischemic hepatitis, is characterized by sudden elevation (to more than 20 times the upper limit of normal) of SGOT and SGPT in response to cellular anoxia, followed by resolution to near normal levels within seven to ten days. In our experience with ten cases, systemic hypotension was documented in only four, but processes characterized by decreased cellular perfusion were identified in all and included cardiac failure or arrhythmia, sepsis, cerebrovascular accidents, renal failure, and chronic obstructive pulmonary disease. We were also able to document the transient rise in serum bilirubin and alkaline phosphatase levels and prolonged prothrombin time that followed the transaminase elevations by 24 to 48 hours in most cases, followed by rapid resolution. In neither of the two cases in which tissue was available by biopsy after resolution of the biochemical abnormalities did we find the classic histologic picture of necrosis in zone 3 ("centrilobular necrosis"). The clinical picture of shock liver is so characteristic and resolves so rapidly that there should be no confusion with other causes of marked elevations of transaminase levels.
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PMID:Shock liver. 407 Nov 67

In consultation the authors were requested to evaluate a middle-aged diabetic woman for an apparent episode of biliary sepsis. The patient had been admitted to the dermatology service with a four-day history of rash and pruritus. This was initially thought to represent an allergic reaction to dicloxacillin in someone with a previous history of penicillin hypersensitivity. Persistent right upper quadrant pain, fevers, elevations of serum alkaline phosphatase, and a radionuclide scan which did not demonstrate a functioning gall bladder led to a cholecystectomy for acute cholecystitis and possible biliary sepsis. This diagnosis was not confirmed. Ultimately, this case illustrated the need to review carefully recent changes in any patient's drug regimen. Reactions to commonly prescribed agents may cause syndromes which are difficult to distinguish from episodes of apparent sepsis.
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PMID:Exfoliation, cholestasis, and apparent biliary sepsis in a woman with adult-onset diabetes. 409 May 34

A 52 yr old Caucasian female (F. E.) had hemolytic anemia, a leukemoid reaction, and fatal sepsis due to Escherichia coli. Her leukocytes ingested bacteria normally but did not kill catalase positive Staphylococcus aureus, Escherichia coli, and Serratia marcescens. An H(2)O(2)-producing bacterium, Streptococcus faecalis, was killed normally. Granule myeloperoxidase, acid and alkaline phosphatase, and beta glucuronidase activities were normal, and these enzymes shifted normally to the phagocyte vacuole (light and electron microscopy). Intravacuolar reduction of nitroblue tetrazolium did not occur. Moreover, only minimal quantities of H(2)O(2) were generated, and the hexose monophosphate shunt (HMPS) was not stimulated during phagocytosis. These observations suggested the diagnosis of chronic granulomatous disease. However, in contrast to control and chronic granulomatous disease leukocytes, glucose-6-phosphate dehydrogenase activity was completely absent in F. E. leukocytes whereas NADH oxidase and NADPH oxidase activities were both normal. Unlike chronic granulomatous disease, methylene blue did not stimulate the hexose monophosphate shunt in F. E. cells. Thus, F. E. and chronic granulomatous disease leukocytes appear to share certain metabolic and bactericidal defects, but the metabolic basis of the abnormality differs. Chronic granulomatous disease cells lack oxidase activity which produces H(2)O(2); F. E. cells had normal levels of oxidase activity but failed to produce NADPH due to complete glucose-6-phosphate dehydrogenase deficiency. These data indicate that a complete absence of leukocyte glucose-6-phosphate dehydrogenase with defective hexose monophosphate shunt activity is associated with low H(2)O(2) production and inadequate bactericidal activity, and further suggest an important role for NADPH in the production of H(2)O(2) in human granulocytes.
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PMID:Complete deficiency of leukocyte glucose-6-phosphate dehydrogenase with defective bactericidal activity. 440 Dec 71

Liver metastases are a common cause of death in colon carcinoma. The dual blood supply of the liver permits regional perfusion while hepatic catabolism fo 5-fluorouracil (FU), floxuridine (FUdR) permit higher drug exposures than systemic (IV) administration. We have studied the effect of continuous intra-arterial chemotherapy (FU: 5-10 mg/kg/day and FUdR: 0.2 mg/kg/day) and whole liver irradiation (1000 rad every 4 weeks, total dose of 3000 rad) for metastatic colon carcinoma to liver. Eighteen patients with metastases to liver only are reported using this combination therapy. Seven patients had percutaneous placement of a catheter via the brachial artery, two had operative placement of a catheter via the gastroduodenal artery, all of which were connected to the Cormed infusor system, nine had operative placement of the Infusaid implantable pump with catheter placement into the hepatic artery via the gastroduodenal artery. The median survival for the entire group was 241 days. In those patients whose liver function tests (bilirubin and alkaline phosphatase) were less than two times normal, the median survival was 770 days. The median survival of the patients with greater than two times normal LFT's was 178 days. Two patients died of complications of the treatment. One who developed irreversible radiation hepatitis but at autopsy had only two areas of microscopic tumor foci in the liver and another who had received only 15 days of infusion and 1000 rad to liver. This patient developed irreversible chemical enteritis secondary to chemotherapy infusion into the superior mesenteric artery. Three patients have undergone abdominal reexploration and one at autopsy, who were found to have no gross evidence of tumor in the liver despite previous pathologic confirmation. It appears that some patients with minimal tumor burdens can have sterilization of their tumors. There were three cases of reversible liver function abnormalities. Complications associated with conventional intra-arterial chemotherapy (artery thrombosis, catheter sepsis and dislodgement, pump infusion variation and pump failure) were not seen with the Infusaid delivery system. The pump is refilled every 2-3 weeks via percutaneous puncture. All therapy was given on an outpatient basis. Pump acceptance and tolerance was 100%. Intra-arterial chemotherapy can now be accomplished without the morbidity associated with it in the past. The combination of chemotherapy and liver irradiation may offer improved survival in selected patients.
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PMID:Intra-arterial chemotherapy using an implantable infusion pump and liver irradiation for the treatment of hepatic metastases. 621 14

The marked conjugated hyperbilirubinemia in a 72-year-old patient with myocardial infarction and sepsis is reported. The serum bilirubin, which was predominantly composed of conjugated bilirubin, was elevated to 21 mg/100 ml, while serum bile acid and alkaline phosphatase levels were normal or slightly elevated. Postmortem examination of the liver revealed slightly proliferated bile ductules and some bile thrombi with little liver cell necrosis.
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PMID:Conjugated hyperbilirubinemia in an autopsy case with myocardial infarction and sepsis. 649 90

Between the years 1981 and 1983 we treated with Ceftriaxone (Cx) 34 children--aged 15 days to 13 years--affected with serious infections: 18 infections of lower respiratory tract, 1 sepsis caused by E. Coli, 1 meningitis with cloudy cerebrospinal fluid, 1 submandibular adenitis with otitis, 1 otitis, 12 infections of the urinary tract caused by Proteus mirabilis, E. Coli, Klebsiella oxitocica and Klebsiella pneumoniae. Whenever bacteria were isolated by cultures, sensibility in vitro to Cx was tested. Cx was given i.m. or i.v. at a dose ranging from 50 to 135 mg/Kg/die according to the age and the seriousness of the infections; in 17 children Cx was administered once daily, in the other patients in two divided doses. The following laboratory measurements were obtained before, during and after treatment: complete blood cell count, platelet count, total bilirubin, creatinine, SGOT, SGPT, alkaline phosphatase and urinalysis. Patients were also monitored daily for clinical signs and symptoms such as fever, general conditions, heart rate, respiratory rate, blood pressure. Twenty children showed a good clinical response (1 sepsis, 1 otitis, 1 adenitis, 1 meningitis, 12 infections of the urinary tract, 4 infections of the lower respiratory tract); urine sterilization was achieved after three days of therapy in all patients with infections of the urinary tract. Remarkable clinical and radiological improvement in 9 patients with infections of lower respiratory tract was observed while in only 4 children with bronchopneumonia therapy was ineffective although the dosage of Cx was adeguate; in these patients a further antibiotic treatment was necessary for a complete recovery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Evaluation of the efficacy and tolerance of ceftriaxone in childhood]. 654 91

Eight high risk patients, median age 79 years, with a distal obstruction of the common bile duct and serious clinical symptoms of acute obstructive cholangitis were treated by EPT. In seven patients, impaction of a stone in the common bile duct was found and in one patient, an obstructing cancer. EPT was performed without immediate complications and followed by obvious drainage of purulent bile in all patients. Repapillotomy with stone extraction was necessary in three patients 5, 6, and 10 days after the first EPT. The papillotomy was followed by immediate symptom relief, normalization of body temperature, and a decrease in leukocytes and bilirubin and alkaline phosphatase values within the first several postoperative days. Average hospitalization time was 8 days, ranging from 4-17 days. The patient with pancreatic cancer died 3 months after the EPT. One other patient died in pseudomonas sepsis 17 days after an uncomplicated EPT. ERCP controls in the other six patients have been normal and they all remain symptom free. Since early decompression is mandatory in these patients and laparotomy with internal decompression is associated with a high morbidity and mortality, endoscopic decompression should probably be the recommended treatment in patients with obstructive, septic cholangitis prior to employing this therapeutic option.
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PMID:Endoscopic papillotomy (EPT) in acute obstructive suppurative cholangitis. 654 23


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