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

At Columbia-Presbyterian Medical Center during the six-year period 1968-1973, there were 1236 cases of sepsis from Gram-negative pathogens; 124 of these originated in the urinary tract. Of these 124 patients, 19 died-a mortality rate of 15.3 percent. There were 205 deaths among the 1236 patients with sepsis from Gramnegative organisms-a mortality rate of 16.6 percent. Previously, in the 1959-1964 and 1965-19067 periods, the mortality rates had been 56.3 percent and 19.6 percent respectively. The lowered mortality rate during 1968-1973 for urologic sepsis/shock was associated with improved management procedures: a) preventive measures such as postponement of urologic instrumentation and surgical intervention in patients infected with drug-resistant urea splitters, until the infection is under control, with emergency surgical patients being treated by susceptibility-tested drugs to control possible postoperative complications; b) early diagnosis and treatment of sepsis and immediate administration of bactericidal antibiotics parenterally; c) immediate restoration of fluid/electrolyte balance, with monitoring of renal and pulmonary functions and metabolic acidosis; and d) early administration of large pharmacologic doses of glucocorticoids, with monitoring of the microcirculation and use of beta-adrenergic isoproterenol.
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PMID:Urologic sepsis/shock. 0 4

This article presents an analysis of acute gastroduodenal mucosal lesions (AGML) based on a review of current literature and the personal experience of the authors. The pathology of AGML involes two distinct types of lesions, namely, superficial erosions confined to the acid-secreting gastric mucosa and presenting as erosive hemorrhagic gastritis, and acute ulcers that occur in the alkaline gastric mucosa and duodenum. The etiology of these two lesions is very likely different. Acut gastroduodenal ulcers, best known as stress ulcers, are probably "peptic" lesions, whereas erosive hemorrhagic gastritis appears to be due to pathologic back diffusion of hydrogen ions caused by a breakdown of the gastric mucosal barrier as a result of endogenous factors, such as gastric mucosal ischemia, and sometimes exogenous factors, such as alcohol, urea, and acetylsalicylic acid. Catecholamine hypersecretion resulting from severe stress, such as occurs in hypovolemia, sepsis, and hypercapnea, contributes to ischemia of the gastric mucosa by producing splanchnic vasoconstriction. The key to the diagnosis of AGML is early endoscopy in all cases of upper gastrointestinal bleeding. Therapy for AGML should begin with a trial of medical measures directed at restoring effective perfusion of tissues and removing hydrogen ions from the stomach by gastric washing. Medical therapy is effective in 80% of patients with erosive hemorrhagic gastritis, but surgical treatment is usually required in acute gastroduodenal ulcer. When surgery is necessary for either type of lesion, vagotomy with hemigastrectomy appears to be the most effective operation. The personal experience of the authors has involved 36 patients with AGML who were treated in three periods between 1968 and 1976. The mortality rate of patients with AGML has been reduced from 50% in the first 2 years to zero in the last 2 years by the use of emergency endoscopy for diagnosis, appropriate medical therapy, properly timed and executed surgery, and, most recently, selective angiography.
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PMID:Progress in the treatment of acute gastroduodenal mucosal lesions (AGML). 1 30

A prospective randomized matched pair study was designed to test the efficacy of the peritoneovenous (LeVeen) shunt as a treatment for massive cirrhotic ascites compared with traditional medical therapy. Patients who failed to lose weight while on a low salt diet and fluids restricted to 1000 ml daily were placed in the study group. Weight loss, decrease in abdominal girth and diuresis were significantly greater (P less than 0.01) for surgical patients than for their medically treated counterparts. The surgical technique is simple, quick and inexpensive. The surgical patients outlived their matched partners in 12 of 14 pairs where a definitive comparison was possible (P less than 0.02). The median stay in hospital after randomization was shortened from 32 days with medical therapy to 15 days for those undergoing the shunt operation. Those treated medically experienced a significant rise in mean blood urea nitrogen and K+ (P less than 0.02). Patients with alcoholic hepatitis, hyperbilirubinaemia (bilirubin greater than 154 mumol/l), peritoneal sepsis, severe coagulopathy and those who had recently bled from oesophageal varices are poor risks for the surgical procedure.
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PMID:Randomized prospective matched pair study comparing peritoneovenous shunt and conventional therapy in massive ascites. 49 60

Over a period of 2 years, 82 patients out of 2,390 (3.43%) admitted to an intensive care unit developed acute renal failure (ARF). The diagnosis of ARF was based on the usual criteria of oliguria, a rising blood urea nitrogen and creatinine, urine sodium concentration greater than 20 mmol/l and a U/P osmolality ratio less than 1.1. In 9.2% of patients the latter two criteria were misleading. Sepsis was the commonest cause of vasomotor nephropathy but in 20.7% potentially nephrotoxic agents had been administered before development of ARF. Overall mortality was 73.2%, with patients older than 50 years of age having the highest mortality. ARF is associated with prolonged bed occupancy--an average of 59.8 days for the dialysed patients with ARF versus an average length of stay of 8.4 days for the hospital overall.
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PMID:Aetiology, diagnosis, treatment and prognosis of acute renal failure in an intensive care unit. 54 32

Hormonal and substrate profiles and urinary nitrogen and urea excretion were measured in 78 underweight patients admitted for surgical investigation, who were placed into either a normo- or a hyperketonemic group, depending upon their levels of acetoacetate and beta-hydroxybutyrate. The two groups were otherwise similar in terms of weight loss, arm muscle circumference, triceps skinfold thickness, and serum protein levels. Before surgery only one-quarter of them were hyperketonemic displaying mean glucose, insulin, and glucagon levels characteristic of starvation-adaption, and excreted significantly less urinary nitrogen than in normoketonemic group. Those patients who underwent surgery tended to retain their presurgery hormonal and substrate profile. The normoketonemic group excreted significantly greater amounts of urinary nitrogen, depleted body protein to a greater extent as evidenced by larger changes in arm muscle circumference and serum protein levels, and mortality was greater. Interference with insulin-glucagon balance by sepsis and disease is suggested as a possible explanation for the failure of three-quarters of the patients to become starvation-adapted. The implications of this finding on the parenteral feeding of undernourished patients are discussed.
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PMID:Ketosis and nitrogen excretion in undernourished surgical patients. 57 67

The metabolic response to injury and illness as manifested by increases in energy expenditure and nitrogen losses makes it difficult for the clinician to evaluate calorie and protein needs. A method for determining daily calorie needs in hospitalized patients is presented. Average increases in resting metabolic expenditure for a group of patients following elective operation, skeletal trauma, skeletal trauma with head injury, blunt trauma, sepsis and burns were determined by indirect calorimetry and protein need by urinary nitrogen losses over extended time periods. Total daily calorie needs were then calculated, using the Harris-Benedict equation and adjusting this value upward using a previously measured activity and injury factor to arrive at the daily needs. Protein requirements may be determined on periodic 24 hour urine samples analyzed for the urinary urea nitrogen and adjusting this to a total nitrogen or protein equivalent. This approach to estimating the calorie nitrogen needs of the hospitalized patient under various degrees of stress more closely approximates the patient's variable needs at the height of the catabolic response and during convalescence.
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PMID:Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. 57 68

Six boys, 2 weeks to 5 years old, underwent cutaneous ureterostomy for massively dilated upper urinary tracts secondary to obstruction by posterior urethral valves. Cutaneous ureterostomies had been performed elsewhere in 2 patients. Two patients underwent transurethral fulguration of the valves initially with no improvement. Blood urea nitrogen, creatinine and serum electrolyte values continued to increase and, therefore, cutaneous ureterostomies were performed with dramatic improvement. Two patients presented with sepsis, one of whom had a positive blood culture. Both children had severe pyonephrosis and after the conditions improved with medical treatment cutaneous ureterostomies were done. The total number of surgical procedures required for all patients was 59, including renal biopsies, nephrostomies and cystoscopies. No kidneys, except for the severely dysplastic ones, were lost and all patients resumed normal growth rates and have had no urinary tract infections. All laboratory values are within normal limits.
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PMID:Posterior urethral valves managed by cutaneous ureterostomy with subsequent ureteral reconstruction. 66 Jul 48

Twelve patients with otherwise uncomplicated acute viral hepatitis (two were HBsAg-positive) developed renal failure. Apart from dehydration due to repeated vomiting in one patient, no factor responsible for precipitating renal failure could be identified. The clinical course was characterised by renal failure with plasma urea concentrations reaching maximum values of 26-69 mmol/l (175-416 mg/100 ml). Ten patients needed dialysis for up to two weeks. Seven patients recovered completely, while the other five died from sepsis. The types of renal failure were similar to those described in fulminant hepatic failure and cirrhosis--namely, functional renal failure in five patients and acute tubular necrosis in seven. Two of the patients with functional renal failure later developed tubular necrosis. The mechanism responsible for renal failure in acute viral hepatitis is uncertain, though endotoxaemia may contribute.
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PMID:Renal failure in otherwise uncomplicated acute viral hepatitis. 68 5

Renal failure developed in 20 patients following blunt civilian trauma. Ten recovered normal renal function; 8 currently survive. Survivors and nonsurvivors did not differ in age, time from trauma to anuria, mean blood urea nitrogen or creatinine level prior to the first or to subsequent dialyses. However, there was an increased incidence of sepsis and liver failure in those who died. When outcome was related to site of injury, patients with closed head injury and/or intra-abdominal injury had a worse prognosis than those with thoracic or extremity injury only. Only 2 patients with perforated bowel survived; both had peritoneal dialysis combined with peritoneal lavage with antibiotic solutions. Mortality in patients with posttraumatic renal failure remains high; however, death is usually a result of associated complications rather than a result of the renal failure. Aggressive management of other complications of the trauma, especially sepsis or potential sepsis, is necessary. We recommend peritoneal dialysis combined with peritoneal antibiotic lavage where there is a potential for posttraumatic intra-abdominal sepsis associated with renal failure.
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PMID:Acute renal failure following blunt civilian trauma. 84 28

The value and effects of treating renal failure by dialysis are analyzed in a series of 84 patients with various types of liver disease. Although none of the 25 patients with cirrhosis survived, six of 50 with fulminant hepatic failure recovered completely as did seven of nine patients with renal failure secondary to extrahepatic biliary tract obstruction or with liver and renal damage following episodes of severe hypotension. Dialysis was required for seven weeks before diuresis occurred in one patient in the latter group. Both peritoneal and hemodialysis satisfactorily controlled plasma urea and creatinine levels, except in patients with fulminant hepatic failure in whom this was only achieved by hemodialysis. Complications of dialysis were most common in patients with cirrhosis and fulminant hepatic failure and included hypotension, gastrointestinal bleeding, and intraperitoneal sepsis. Overall, the results show that dialysis is only worth attempting in those patients in whom recovery of the underlying liver lesion is possible, and even then treatment for prolonged periods may be necessary.
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PMID:Dialysis in the treatment of renal failure in patients with liver disease. 88 9


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