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

The purpose of this study has been to provide information on the mortality and morbidity rates for operation on nonbleeding cirrhotic patients and to identify factors that portend a grave prognosis. A review of 102 cirrhotic patients who underwent a variety of major therapeutic operations revealed a mortality rate of 19.6 percent. Mortality rates were significantly increased (p less than 0.05) by emergency operation (45.8 percent), gastrointestinal related operation (27.6 percent), ascites (37.5 percent), a bilirubin concentration greater than 3.5 mg (44.4 percent), a prothrombin time increase greater than 2 seconds (36.1 percent), a partial thromboplastin time increase greater than 2 seconds (50 percent), an alkaline phosphatase concentration greater than 70 units (40.9 percent), an operative blood loss greater than 1,000 ml (33.3 percent), and the presence of one or more postoperative complications (39.6 percent). Mortality rates were not increased after extremity, genitourinary, or gynecologic operations, an albumin concentration less than 3 g, a serum glutamic oxalacetic transaminase concentration greater than 40 units, hepatomegaly, and a history of previous gastrointestinal bleeding. When significant risk factors were added, mortality rates were significantly associated (p less than 0.001): zero to one factors 5.1 percent, two to three factors 19.4 percent, four to five factors 33.3 percent, and more than six factors 66.7 percent. The complication rate was 47.1 percent and included liver failure (42.2 percent), sepsis (18.6 percent), and bleeding (8.8 percent). Thus, in cirrhotic patients a clear need for operation must exist, liver function must be optimized preoperatively, and the most simple and expeditious procedure must be performed to avoid excessive blood loss and postoperative complications.
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PMID:Morbidity and mortality after operation in nonbleeding cirrhotic patients. 660 65

Ten inpatients at the Second Department of Internal Medicine, Mie University Hospital, developed infections in the course of treatment for hematopoietic disorders and were administered cefoxitin (CFX). Patients suffered from the following infections: pharyngitis, 2; bronchitis, 2; pneumonia, 2; sepsis, 2; bacteremia, 1; suspected cases of bacteremia, 2; and fever of unknown origin, 1. The number of infections totaled 12 as 1 patient with pharyngitis also developed sepsis and 1 patient with pneumonia developed bacteremia. Duration for the administration of CFX ranged between 5 and 18 days with a total dosage of between 30 and 108 g. Of the 10 patients treated with CFX, 9 were treated concomitantly with micronomicin (MCR), doxycycline (DOXY), or sulbenicillin (SBPC), some were treated concomitantly with only 1 of the drugs and some were treated concomitantly with 2 of the drugs. The following clinical results were obtained: Following treatment, 4 patients were considered "excellent", 5, "good", and 3, "poor". Clinical efficacy rate was 75%. Four strains of Gram-positive cocci (1 strain of S. aureus, 2 strains of S. epidermidis and 1 strain of Streptococcus sp.) and 3 strains of Gram-negative rods (2 strains of P. aeruginosa and 1 strain of E. cloacae) were found in the clinical specimens of the 10 patients. These results differed somewhat from reported data that Gram-negative rods such as E. coli, Klebsiella sp., Pseudomonas sp., Serratia sp., are dominant. No serious side effects requiring cessation of treatment were observed. Elevations in the levels of S-GOT, S-GPT, serum alkaline phosphatase, blood urea nitrogen, etc. were observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical experience with cefoxitin in infections associated with hematopoietic disorders]. 667 23

The influence of diabetes on mortality and morbidity following operations for obstructive jaundice has been assessed in 118 consecutive patients, all of whom received antibiotic cover, subcutaneous heparin and intravenous mannitol. 44 patients had diabetes mellitus (37%). There were 12 post operative deaths (10%). Factors which significantly contributed to mortality included; admission values for alkaline phosphatase, creatinine, haematocrit, bilirubin and age of patient over 70 years. Although mortality was not increased in diabetics, wound sepsis was significantly more common (20% and 4% respectively; p less than 0.02). The majority of infections were due to antibiotic sensitive Staphylococcus aureus. Diabetes did not influence survival after operation for malignant disease.
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PMID:Influence of diabetes on mortality and morbidity following operations for obstructive jaundice. 669 98

Post-traumatic acalculous cholecystitis is a potentially lethal complication that may develop in patients during hospitalization for trauma. Three case reports illustrate that obscuration of many early diagnostic symptoms and signs may make this complication particularly treacherous in the neurosurgical patient. Suspicion should be aroused by unexplained fever, leukocytosis, elevated serum bilirubin and alkaline phosphatase values, and developing intolerance to oral or tube feedings. There may be a rapid progression to signs of an acute abdominal condition. Symptoms are most likely to occur 1 week to 1 month after the episode of trauma. Patients of all ages are susceptible. Diagnosis is best confirmed by noninvasive iminodiacetic acid hepatobiliary scanning accompanied by ultrasound or abdominal computed tomographic scanning. The treatment of choice is emergency cholecystectomy. The cause is most likely multifactorial and is probably related to hypotension, sepsis, or biliary stasis with subsequent cystic duct obstruction. Although this disease is rare, its incidence is apparently increasing, and a high index of suspicion is warranted in the neurosurgeon involved in the care of the biliary tract disorder.
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PMID:Post-traumatic acalculous cholecystitis on a neurosurgical service. 682 28

Twenty-three patients with advanced prostate cancer who had failed previous hormone therapy were treated with cyclophosphamide, doxorubicin, and methotrexate on a 3-week course. Of the 22 evaluable patients, over one-half had poor performance status, increased acid and alkaline phosphatase levels, and pain. Parameters which improved in greater than 50% of cases included acid and alkaline phosphatase levels, pain, performance status, and measurable lesions (lung and soft tissue). Initial parameters associated with a significantly decreased survival were age greater than 66 years, increased pain, poor performance status, and increasing alkaline phosphatase. Prior radiation therapy was associated with increased drug toxicity, lower doses of chemotherapy, and decreased survival (not significant). There was a significant relationship between the degree of improvement of acid phosphatase, alkaline phosphatase, pain, and performance status to increased survival. Three categories of response were defined based on these parameters. The mean survival of seven patients with partial response (106 weeks) is significantly longer than that of seven with measurable response (57 weeks) and eight with no response (26 weeks). Four patients had severe leukopenia and one died of sepsis. These results compare favorably with previous reports of chemotherapy treatment of advanced prostate cancer.
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PMID:Treatment of advanced prostate cancer with cyclophosphamide, doxorubicin, and methotrexate. 712 21

After major surgery some patients, especially those with an infectiouss process or sepsis, develop jaundice which has been called reactive hepatitis, toxic hepatitis, septic hepatitis or benign postoperative cholestasis; these terms do not have a very precise connotation. Eighty patients with postoperative sepsis and jaundice where studied, excluding those with liver or biliary tract disease, hepato-toxic drugs or repeated halogenated anesthetics. All of them had complete laboratory tests, cultures and percutaneous liver biopsy when it was feasible. Thirty five patients were submitted to percutaneous liver biopsy and they are the material for this paper. There was no correlation with the type and duration of the operation, postoperative complications, shock or kind of anesthesia. The main laboratory changes were leukocytosis, neutrophilia, elevation of the bilirubins mainly the direct type and increase of the alkaline phosphatase; transaminases were within normal limits. Cultures were positive in 76% of the cases predominating E. coli, Pseudomonas a. and Proteus, anaerobics were present in 22.8% of the cases. The liver biopsy showed lymphoctic infiltration, hyperplasia of the Kupffer cells, hepatic regeneration and turbid tumefaction; pericholangitis, focal necrosis, retention of pigment and steatosis were less frequent. We consider that the best denomination of these complications is benign postoperative cholestasis.
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PMID:[Postoperative reactive hepatitis in the septic patient]. 728 Apr 56

Hepatobiliary dysfunction in patients receiving nutrition support is frequent. Other reasons for elevated enzyme levels including drugs, recent anesthesia and surgery or sepsis often coexist. Liver test abnormalities in adults are usually milder than in children and frequently self-limited and are 10 times more likely to occur with total parenteral nutrition (TPN) than tube enteral nutrition. Patients on short-term TPN usually have mild-to-moderate elevations in transaminase and alkaline phosphatase levels and steatosis or portal triaditis on biopsy. Patients who are infected while on TPN are at greater risk of developing steatosis and intrahepatic cholestasis. Strategies to correct abnormalities include alteration of the caloric mix in the TPN, cyclic infusions, metronidazole, enteral nutrition and inclusion of L-glutamine in the TPN formula. Patients on long-term home parenteral nutrition may develop persistent elevations in liver tests and steatohepatitis. Both acalculus and calculus cholecystitis occur with increased frequency in patients on long-term TPN. Biliary sludge precedes calcium bilirubinate stones: predisclosing factors include nil per os, prior ileal resection and use of narcotics or anticholinergics.
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PMID:Hepatobiliary complications in adults receiving nutrition support. 785 Sep 98

One hundred and one cases of Klebsiella bacteraemia from the National University Hospital, Singapore, were reviewed retrospectively. There were 54 (53.5%) males and 47 (46.5%) females. Mean (+/- SE) age was 54 (+/- 2.4) years. Overall mortality was 26%. Nosocomial infections accounted for 20%. Underlying diabetes mellitus and malignancy were present in 36 and 26% respectively. The source of the bacteraemia was not known in 33% of cases, 17% had liver abscess, 29% had urinary tract infections, 9% had pneumonia, 10% had an abscess separate from the liver, and 3% had biliary sepsis. Elevated alkaline phosphatase (> 100 U-1) was seen in all cases of liver abscess (sensitivity 100%, specificity 27%). Nonsurvivors had a significantly lower platelet count than survivors (104 +/- 25 x 10(9)/l vs. 176 +/- 15 x 10(9)/l, unpaired t-test P < 0.05), and a platelet count of less than 150 x 10(9)/l was associated with a significantly higher mortality (37% vs. 11%, chi 2 P < 0.01). Nosocomial infection was associated with 45% mortality, whereas community-acquired infection had a lower rate of 21%, this was not statistically significant. Seventy-eight per cent of these Klebsiella isolates were sensitive to gentamicin and cotrimoxazole, and 100% to imipenem.
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PMID:Klebsiella bacteraemia: a report of 101 cases from National University Hospital, Singapore. 796 72

Acalculous cholecystitis, a recognized manifestation of acquired immune deficiency syndrome (AIDS), causes abdominal pain which can be relieved by cholecystectomy. The indications for cholecystectomy have remained undefined, however, because the cholecystitis is usually accompanied by generalized cholangitis and it is difficult to distinguish the relative clinical importance of the two problems. Since 1985, we have performed cholecystectomy on 8 patients with AIDS who had clinical manifestations of acute cholecystitis associated with a thickening of the gallbladder wall by 5 mm to 12 mm. Two of the 8 had gallstones and 4 had associated cholangitis. All had been treated with antibiotics for 20 to 180 days before surgery, but physical deterioration had progressed in every case. At the moment of surgical intervention, 4 patients had multiple organ failure. One patient died 3 days postoperatively, but the rest recovered rapidly with resolution of the abdominal pain and sepsis. Two patients died 20 days after surgery due to complications of AIDS. The remaining 5 died due to AIDS at 6, 9, 10, 12, and 14 months after surgery. Two of this group developed progressive cholangitis with raised serum alkaline phosphatase. Our experience indicates that cholecystectomy should be considered for the treatment of severe and persistent symptoms of hepatobiliary manifestations of AIDS notwithstanding the presence of cholangitis.
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PMID:Cholecystectomy for cholecystitis in patients with acquired immune deficiency syndrome. 808 61

The aim of this retrospective study was to determine whether total parenteral nutrition-related liver disease was improved by intravenous antibiotics given for systemic sepsis. Liver function tests were performed 1 month before, during and 1 month after one episode of sepsis treated for 4 weeks (mean, range: 2-12), with systemic antibiotics, in 12 patients receiving parenteral nutrition for 13 months (mean, range: 1-71) for short bowel syndrome in 10 of them. Cholestatic liver disease appeared in all during nutrition (mean serum alkaline phosphatase activity > 4 N). Liver test abnormalities observed at the beginning of antibiotics treatment were not significantly different from those observed 1 month before sepsis. Antibiotic administration was followed by a significant decrease (P < or = 0.03) in serum activities of alkaline phosphatases, ALT and AST and bilirubinemia of 38, 41, 23 and 47%, respectively. These results support the concept that parenteral nutrition-associated cholestatic liver disease may be related to intestinal bacterial overgrowth and suggest that it may be improved by intravenous antibiotherapy.
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PMID:[Total parenteral nutrition-related cholestatic hepatopathy, is it an infectious disease?]. 818 92


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