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)

Delayed hypersensitivity skin testing was performed in 129 critically ill patients. Six intradermal antigens were used: tuberculin, candidin, varidase, epidermophytin, trichophytin and CCB (a polyvalent microbial vaccine from the Pasteur Institute). The response was judged as positive when one test or more were positive. Patients were devided in four groups: group A (40 cases): non-infected patients, a priori without immunodeficiency; group B (14 cases); suspected of immunodeficiency (cancers, hemopathies, collagen diseases receiving corticosteroids); group C (24 cases): decompensated chronic respiratory insufficienceis; group D (50 cases): overwhelming sepsis (septicaemias, septic acute respiratory distress syndromes, thoracic empyemas, purulent meningitis, peritonitis, mediastinitis). A significant diminution of delayed hypersensitivity was observed in groups B, C and D. No relation was found between delayed hypertensitivity and prognosis in groups C and D.
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PMID:[Cell-mediated immunity study by skin testing in 129 critically ill patients (author's transl)]. 698 93

Hyperbilirubinemia in the newborn results not only in visible yellow discoloration of the skin but, in high concentration, may cause bilirubin encephalopathy. Such damage to the central nervous system may be subtle and not apparent for several years, as with visual-motor perceptive defects; or it may cause severe neurologic damage (Kernicterus)--even death. Sick and immature infants are the most vulnerable to bilirubin toxicity. Although this condition affects nearly half of all newborns to some degree, only about 10% require treatment. Two methods of treatment are really effective in correcting hyperbilirubinemia, exchange blood transfusions, and/or phototherapy with light radiation in the blue part of the visible spectrum. If the rate of production of bilirubin is excessive or an infant's capacity to conjugate and excrete the pigment is deficient, bilirubin will accumulate in plasma, and will be taken up by other lipid-containing tissues, collagen, and (unless firmly bound to albumin) brain tissue. Many factors combine to raise plasma levels of bilirubin to toxic levels; for example, acidosis, sepsis, hypoxia, hemolysis, hypoalbuminemia, and certain competitive albumin binders. Bilirubin is photolabile in vivo, and if the whole body is irradiated with visible light in the absorption band (450-490 nm) of bilirubin, the pigment will undergo photocatabolism. Under phototherapy bilirubin undergoes photoisomerization at the meso double-bond to conformations less lipophyllic. It is now known that the major photo products of bilirubin IX-alpha are an unresolved mixture of its E, Z and Z, E isomers, easily excreted by the liver. Thus, phototherapy will reduce the accumulation of bilirubin in skin and other tissues and in circulating plasma.
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PMID:Molecular basis of hyperbilirubinemia and phototherapy. 725 51

Previously asymptomatic aneurysms in ten patients ruptured within 36 days (mean, ten days) of a prior laparotomy. The laparotomy and associated intra-abdominal disease may have precipitated rupture of the unresected abdominal aneurysms by reduction of the collagen content of the aneurysm wall, thus making the wall weaker. The scar-like collagen fibers of an aneurysm wall provide the strength that permits the wall to resist rupture. There is a dynamic equilibrium between synthesis and lysis of this collagen. Lysis of collagen is enhanced by injury, such as laparotomy, and by nutritional depletion and local inflammation. Collagen lysis is greatest in the area adjacent to the injury, but also occurs at remote sites as well. Lysis is greatest during the first postoperative week, after which, in the absence of sepsis or starvation, synthesis exceeds lysis and the equilibrium is restored. A thin aneurysm wall may be weakened enough during this period of negative collagen balance to allow rupture.
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PMID:Laparotomy as a precipitating factor in the rupture of intra-abdominal aneurysms. 735 84

Inflammatory myofibroblastic tumor (IMT) or inflammatory pseudotumor is a spindle cell proliferation of disputed nosology, with a distinctive fibroinflammatory and even pseudosarcomatous appearance. Although the lung is the best known and most common site, inflammatory myofibroblastic tumor occurs in diverse extrapulmonary locations. We report our experience with 84 cases occurring in the soft tissues and viscera of 48 female patients and 36 male patients between the ages of 3 months and 46 years (mean, 9.7 years; median, 9 years). A mass, fever, weight loss, pain, and site-specific symptoms were the presenting complaints. Laboratory abnormalities included anemia, thrombocytosis, polyclonal hypergammaglobulinemia, and elevated erythrocyte sedimentation rate. Sites of involvement included abdomen, retroperitoneum, or pelvis (61 cases); head and neck, including upper respiratory tract (12 cases); trunk (8 cases); and extremities (3 cases). The lesions ranged in size from 1 to 17 cm (mean, 6.4; median, 6.0). Excision was performed in 69 cases. Eight had biopsy only. Five patients received chemotherapy or radiation in addition to undergoing biopsy or resection as initial treatment. Sixteen patients had multinodular masses involving one region. Clinical follow-up in 53 cases revealed that 44 patients were alive with no evidence of disease, four were alive with IMT, and five were dead. Thirteen patients had one or more recurrences at intervals of 1-24 months (mean, 6 months; median, 10 months). No distant metastases were documented. The five patients who died had complications either due to the location of the lesion (heart, peritoneum, retroperitoneum, or mesentery) or related to treatment (lymphoproliferative disorder following hepatic transplantation; sepsis following wound infection). The abdominal masses were the largest. All tumors were firm and white with infiltrative borders and focal myxoid change. Three basic histologic patterns were recognized: (a) myxoid, vascular, and inflammatory areas resembling nodular fasciitis; (b) compact spindle cells with intermingled inflammatory cells (lymphocytes, plasma cells, and eosinophils) resembling fibrous histiocytoma; and (c) dense plate-like collagen resembling a desmoid or scar. Immunohistochemistry demonstrated positivity for vimentin, muscle-specific actin, smooth muscle actin, and cytokeratin consistent with myofibroblasts. Based on this series, inflammatory myofibroblastic tumor is a benign, nonmetastasizing proliferation of myofibroblasts with a potential for recurrence and persistent local growth, similar in some respects to the fibromatoses.
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PMID:Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor). A clinicopathologic and immunohistochemical study of 84 cases. 866 41

Availability of oxygen and adequate blood flow to wounded tissues are important factors for the prevention of impaired wound healing. Oxygen is essential for the growth of new blood vessels, formation of collagen, and the prevention of infection. Subcutaneous tissue oximetry, an experimental technology for evaluating tissue oxygen and perfusion, is being researched for use in the evaluation of hypovolemia, hemorrhagic shock, sepsis, and would healing. This technology eventually may assist in the management of critically ill patients by promptly alerting physicians to decreased oxygen delivery and allowing for more timely intervention.
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PMID:Subcutaneous tissue oximetry: implications for wound healing and monitoring critically ill patients. 761 70

Group B streptococci (GBS) are important pathogens in neonatal sepsis, pneumonia, and meningitis. The ability of GBS to invade the collagen-rich amniotic membrane of the placenta has been shown in vitro. In the presence of GBS, the collagen fibrils of the amnion appear disordered, suggesting a role for GBS in premature rupture of membranes. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis, Sephadex G-200 column chromatography, and gelatin zymograms were used in this study to characterize cell-associated collagenolytic activities of GBS. The synthetic peptide 2-furanacryloyl-Leu-Gly-Pro-Ala (FALGPA), which mimics the primary structure of collagen, was degraded by GBS USF704, a clinical isolate from the placenta of a septic newborn. Cells of GBS USF704 (9 x 10(7) CFU/ml) hydrolyzed 902 nmol of FALGPA over a 24-h period. As reported for zinc metalloenzymes such as collagenase, the hydrolysis of FALGPA by GBS was inhibited by addition of EDTA or 1,10-phenanthroline. Boiling of the cells resulted in loss of activity, while higher activity was observed with crude GBS cell lysates (hydrolysis of 970 nmol of FALGPA in 1.5 h). Antiserum raised against collagenase from Clostridium histolyticum was found to cross-react with cell-associated proteins produced by GBS and to inhibit GBS FALGPA hydrolysis. Twenty-five additional GBS clinical isolates were screened and found to have various levels of FALGPA hydrolytic activity. These observations suggest a cell-associated collagenolytic activity by GBS which may be involved in premature rupture of membranes and neonatal disease.
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PMID:Cell-associated collagenolytic activity by group B streptococci. 796 Jan 47

Oral high-dose arginine supplementation is used for the experimental immunotherapy of tissue trauma and sepsis. Yet the adequate dosage required for immunomodulation has to be established and the toxicity of high-dose arginine has not been fully elucidated. Following a protocol for the treatment of diabetic long-term complications (oral daily doses of 30 mg/kg BW; blind, placebo-controlled prospective study with crossing-over design) we studied plasma levels of interleukins 1 alpha (IL-1 alpha) and 1 beta reflecting immunostimulation. Arginine supplementation in 29 patients with diabetes mellitus prompted a 2-fold increase of IL-1 alpha from baseline levels (P < 0.001) while IL-1 beta was unaffected. Implications for the treated panel of diabetic patients could be a reduction of collagen accumulation by enhanced collagenolysis and clearance of advanced-stage non-enzymatic glycosylation products. Based upon our data, low-dose arginine protocols for further immunotherapeutical studies should be discussed.
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PMID:Low-dose dietary L-arginine increases plasma interleukin 1 alpha but not interleukin 1 beta in patients with diabetes mellitus. 800 37

A prospective study was undertaken to compare the silver-impregnated collagen cuff (Vitacuff) with the bedside tunneled catheter. Fifty patients were randomly assigned to three groups: group I received triple-lumen catheters with Vitacuff application and a semiocclusive dressing material; group II received triple-lumen tunneled catheters with a semiocclusive dressing; and group III received triple-lumen tunneled catheters with collodion as a dressing material. In patients suspected of having central venous catheter sepsis, blood cultures were obtained through the catheter, the catheter was removed, and the tip was cultured semiquantitatively. Central venous catheter sepsis was defined as a positive catheter-tip culture and blood culture for the same organism. No catheter-related sepsis was seen in either the Vitacuff or the tunneled catheters with collodion dressing. In the tunneled catheters with semiocclusive dressing, there was one case of catheter-related sepsis and one case of insertion-site infection. There was also one insertion-site infection in the Vitacuff group, but there was no statistical difference in infection rates between the three groups.
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PMID:A prospective randomized trial comparing the silver-impregnated collagen cuff with the bedside tunneled subclavian catheter. 843 26

Anastomotic leakage remains the most important cause of morbidity and mortality in digestive surgery. Despite the development of new surgical techniques and devices, intestinal anastomose continue to be complicated by leakage even in the best and most experienced of hands. One may explain the persistence of anastomotic leakage in spite of these technical advances on the basis of the dynamic effect that multiple factors (shock, peritoneal sepsis, inadequate intestinal preparation, advanced age, malignancy, malnutrition, coagulopathy, steroid dependence, uremia, radiation therapy, diabetes, perforation, anemia, fecal soiling and deficiency of vitamin C, iron and zinc) have on the healing of an anastomosis. Awareness of these factors and proper precautions by the surgeon can make a high-risk anastomosis less prone to leakage. Collagen is the essential material for composing an anastomosis and the basis of a good surgical suture. Recognition an correction of factors that compromise collagen synthesis, should be the goal of the surgeon. Over the years, numerous anastomotic techniques have been proposed, but the search for the ideal technical anastomosis goes on. Traditional inverting methods ignore the basic principle of accurately opposing clean-cut tissues, and temporary clamping of the gut and crushing of mucosal tissue by intraluminal sutures may damage the microcirculation. Submucosa should always be included in the formation of an anastomosis because it is the strongest intestinal layer and because the collagen has its origin and its synthesis just in submucosa. Monofilament sutures may be more desirable for anastomosis. Staple sutures have minimum tissue reaction. Single layer extramucosal technique has many of the attributes of an ideal intestinal anastomosis. Single interrupted and continuous sutures are not opposite and both give satisfactory results.
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PMID:[Sutures in digestive surgery]. 869 52

A full-term infant with junctional epidermolysis bullosa (JEB) is described. The distribution and morphologic characteristics of generalized blistering in areas of pressure in conjunction with perioral and perinasal granulation tissue suggested the diagnosis of generalized gravis (Herlitz) JEB. The family history was consistent with autosomal recessive inheritance. Electron microscopy demonstrated a subepidermal cleft arising in the lamina lucida with hemidesmosomal hypoplasia, findings consistent with gravis JEB. Immunofluorescent antigenic mapping localized laminin and type IV collagen exclusively to the blister base and weak reactivity of bullous pemphigold antigen to both the roof and the base. Type VII collagen (LH 7:2 epitope) was detected solely at the base of the cleavage plane, and abnormal staining of laminin 5 (kalinin, GB3, nicein) and 19-DEJ-1 antigen was observed. The patient died of sepsis at age 3 months. DNA extracted from cultured keratinocytes for molecular genetic analysis demonstrated a mutation with the LAMB3 gene encoding the beta 3 chain of laminin 5. We present the clinical and laboratory findings and briefly review recent advances in the diagnosis and management of JEB.
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PMID:Generalized gravis junctional epidermolysis bullosa: case report, laboratory evaluation, and review of recent advances. 879 Feb 63


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