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

Since elective and emergent nontransplant-related surgical procedures are frequently necessary in renal allograft recipients, it becomes essential to determine the incidence and outcome of these operations in this population. For this reason, a retrospective analysis of 273 consecutive renal transplants performed in 254 patients between January 1978 and November 1985 was accomplished. During this interval, 139 patients underwent 162 nontransplant-related surgical procedures. In the 44 patients who underwent 55 emergent or semiemergent procedures, 8 patients (18 percent) died in the postoperative period. All deaths occurred in patients who underwent major abdominal or thoracic procedures for perforated viscera, gastrointestinal bleeding, or empyema and lung abscess, and all deaths were secondary to sepsis and multiple organ failure. In the survivors of emergent procedures, the mean preoperative and discharge serum creatinine levels were 2.87 mg/dl and 2.82 mg/dl, respectively. In the 95 patients who underwent 107 elective procedures, most of which were performed under general anesthesia, the operative mortality was 4.2 percent. In patients with stable renal allograft function at the time of operation, mean serum creatinine levels preoperatively and at the time of discharge were not significantly different (1.74 mg/dl versus 1.64 mg/dl). In conclusion, emergent operative procedures for intraabdominal or thoracic catastrophes are associated with a high mortality rate in renal allograft recipients. On the other hand, elective surgical procedures can be undertaken with an acceptable mortality rate and no adverse affects on graft function. Of utmost importance in these patients is the close monitoring of the immunosuppressive regimen and the early detection and treatment of potential septic complications.
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PMID:General surgical procedures in renal allograft recipients. 353 25

Hypocalcemia has been documented in critically ill patients, including those with sepsis and shock. However, its incidence and significance in bacteremic patients without shock has not been established. In the present study the presence of hypocalcemia was evaluated in a group of 67 consecutive bacteremic patients, as compared with 64 infected but nonbacteremic patients. After correction of serum calcium level for serum protein, 25 of the bacteremic patients (37.3%) had "corrected" hypocalcemia (less than 8.5 mg/dL [2.12 mmol/L]), compared with only three in the nonbacteremic group (4.5%). The incidence and magnitude of hypocalcemia in gram-positive and gram-negative infections was similar. In hypocalcemic patients, the "corrected" calcium level was found to be inversely correlated with day of disease and attained a nadir on day 6 to 8 of bacteremia. This nadir was significantly lower in male than in female subjects. Hypocalcemic patients had a significantly higher maximal temperature than normocalcemic ones, but hypocalcemia was unrelated to serum levels of albumin, transaminase, and creatinine.
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PMID:Bacteremic hypocalcemia. A comparison between the calcium levels of bacteremic and nonbacteremic patients with infection. 354 15

Between January 1982 and December 1986, among the 750 patients with the acquired immunodeficiency syndrome (AIDS) who were treated at two adjacent hospitals in New York City, 78 (10.4 percent) needed evaluation for renal disorders. Reversible acute renal failure due to nephrotoxic injury, ischemic injury, or both was present in 23 patients (30 percent) (Group I). The remaining 55 (70 percent) had massive proteinuria, azotemia, or both (AIDS-associated nephropathy; Group II), and irreversible uremia developed in 43. In an additional 18 patients, all of whom had a history of intravenous narcotic drug use, AIDS was diagnosed after the initiation of maintenance hemodialysis for chronic renal failure (Group III). Survival for more than six months after the onset of chronic uremia occurred in only two subjects in Group II; all patients in Group III died within three months of the diagnosis of AIDS. Death in the patients in Groups II and III followed a syndrome of "failure to thrive" characterized by inanition unresponsive to intensive nutritional support and hemodialysis. In contrast, 8 of 17 patients with acute renal failure (Group I) and a serum creatinine concentration above 6 mg per deciliter regained renal function (serum creatinine level, less than 2.0 mg per deciliter). Four of the seven lived for 10 to 24 months, whereas the other four died of sepsis within a month. Our observations suggest that maintenance hemodialysis is not effective in prolonging life either in patients with AIDS-associated nephropathy and uremia or in patients with end-stage renal failure in whom AIDS develops during the course of maintenance dialysis. Hemodialysis may be useful in the management of potentially reversible acute renal failure in patients with AIDS.
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PMID:The types of renal disease in the acquired immunodeficiency syndrome. 356 58

Postoperative acute renal failure, especially associated with oliguria, carries a high rate of mortality and morbidity. This complication can frequently be avoided if physicians are knowledgeable about preventable or modifiable risk factors. Patients who have underlying renal disease, sepsis, volume depletion or other conditions associated with renal hypoperfusion, or who have severe liver disease, are at particular risk. Exposure to nephrotoxic agents and wide fluctuations of intravascular volume are key conditions that can usually be minimized. Managing patients with chronic advanced renal failure (creatinine clearance 10 to 25 ml per minute) requires close interaction between the internists, anesthesiologists and surgeons. Understanding associated metabolic and organ system disorders is necessary to prevent complications and preserve remaining renal function. Chronic renal failure should not be a contraindication to an elective or emergent surgical procedure.
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PMID:Preserving renal function in surgical patients. 357 22

Aminoglycoside antibiotics are frequently used for the treatment of suspected and confirmed sepsis in the newborn patient. In an attempt to evaluate gentamicin dosing based on serum creatinine concentrations, two groups of neonates were studied (infants less than 34 weeks n = 8 and greater than 34 weeks n = 14). The dosing interval was adjusted per protocol depending on the serum creatinine concentrations. Analysis of the results indicate reasonable therapeutic serum gentamicin trough and peak concentrations in most infants.
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PMID:An evaluation of gentamicin dosing according to renal function in neonates with suspected sepsis. 360 61

Six horses had been admitted to the hospital because of illness other than renal failure; diarrhoea, myositis, abdominal pain and/or suspected bacterial sepsis. Hypotension and disseminated intravascular coagulopathy were frequent findings in the horses. Abnormally high serum creatinine concentration and urine specific gravity of less than 1.022 were found in the horses with acute renal failure. Hyponatraemia and hypochloraemia were the most common abnormal electrolyte findings. Pronounced hyperkalaemia was not found. Variable degrees of tubular necrosis were seen in three of the four horses that had kidney sections submitted for microscopic examination. Renal cortical necrosis occurred in one horse. Intravenous fluid and electrolyte replacement was the most important therapy in those cases that were non-oliguric. Furosemide, mannitol and dopamine were used in horses with oliguria. The prognosis was generally good if the predisposing cause could be corrected and the acute renal failure was not oliguric.
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PMID:Acute renal failure in six horses resulting from haemodynamic causes. 360 51

In a retrospective study of patients 18 years of age and younger over a 28-year period, 48 children had pancreatitis. Epigastric pain, nausea, and emesis were present in 90%. Hyperamylasemia was present in 34 children; elevated amylase/creatinine clearance ratio was helpful in diagnosing ten others. In four children, pancreatitis was diagnosed at laparotomy. Etiology of the pancreatitis was idiopathic in 16, drug-induced in 12, all of whom had received corticosteroids. Nine developed pancreatitis after blunt trauma; seven had obstruction of the pancreaticobiliary drainage system. Two children developed pancreatitis in association with sepsis, and two had recurrent hereditary pancreatitis. Thirty of the 48 patients were managed nonoperatively while operations were required in 18. Seven had drainage of pancreatic pseudocysts, four had a pancreatectomy, and four underwent laparotomy with debridement and drainage of necrotic pancreas. Bilioenteric bypass procedures were performed to prevent recurrent pancreatitis in three patients; while duodenojenjunostomy sphincteroplasty and cholecystectomy were performed in one child each. Cure was achieved in 38 of 48 children treated for pancreatitis and its complications; each subsequently grew and developed normally. Hemorrhagic pancreatitis occurred in seven children, six of whom died. Seven deaths occurred, all in the medically treated group. Fifteen of the 18 children treated operatively did well in long-term follow-up. Although rare, pancreatitis is a serious cause of abdominal pain in childhood; almost half of the children will benefit from operation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgical management of pancreatitis in childhood. 361 58

Postoperative mortality has been directly attributed to renal failure in approximately 5 per cent of patients after surgery for obstructive jaundice. An analysis of 334 patients undergoing biliary tract surgery was undertaken to identify the perioperative factors associated with the development of renal impairment, and to estimate the contribution of renal failure to mortality. Thirty-eight patients (11 per cent) developed postoperative renal impairment (a two-fold increase in serum creatinine postoperatively or a rise of greater than 100 mumol/l). Ninety-three factors were examined in these and 196 control patients. Stepwise logistic regression analysis identified only three factors which were significantly associated with renal impairment: postoperative sepsis (P less than 0.0005), pre-operative serum bilirubin (P less than 0.0005), and pre-operative urea (P less than 0.05). Renal impairment developed at a median 4 days after surgery and was associated with a median of two additional major postoperative complications, particularly sepsis and haemorrhage, for which 17 patients underwent reoperation. Twenty-eight (74 per cent) of the patients with renal impairment died in hospital, but in only one case was the cause of death directly related to renal failure. Twenty patients received specific therapy for renal failure, but only one of these survived. Pre-operative obstructive jaundice and postoperative infection are the major factors associated with renal impairment after biliary tract surgery. Renal impairment appears to be related to postoperative complications rather than directly to the surgical procedure itself. The development of postoperative renal impairment predicts a low chance of survival but appears to be an indicator, rather than a direct cause of a poor prognosis.
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PMID:Renal impairment following biliary tract surgery. 366 54

The pharmacokinetic disposition of aminoglycosides in critically ill patients with sepsis was studied. In an open-label study of the disposition of gentamicin and tobramycin, individualized pharmacokinetic values of 100 critically ill patients in the surgical intensive-care unit were compared with those of a concurrently monitored group of 100 surgery patients who were not critically ill. The a priori computer-predicted dosage requirements of the critically ill patients were also compared with the dosages derived from their individualized pharmacokinetic values, and intrapatient variation in the critically ill patients was studied. Serum concentration-time data were analyzed using a one-compartment model and the DataMed Clinical Support Services system to provide individualized dosage requirements. Initial dosing guidelines were also generated for the critically ill patients using the a priori model of the DataMed Clinical Support Services program and patient demographic information. The critically ill patients were significantly older, had higher serum creatinine concentrations (SCr), and had lower elimination rate constants (k) and total body clearances (CL) than the surgery patients who were not critically ill. The volume of distribution (V) was not significantly different. The a priori computer predictions for the critically ill patients were significantly lower than the individualized values for V, CL, dose, and amount of drug per 24 hours. The dosing regimen from the a priori model was the same as the individualized regimen in only 2/100 patients. In the 76 critically ill patients who had a second pharmacokinetic analysis performed, there was a significant decrease in k and CL from the first analysis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Altered aminoglycoside pharmacokinetics in critically ill patients with sepsis. 366 67

Forty-two patients with proven intra-abdominal sepsis were studied in a prospective clinical trial. The following parameters were evaluated: (1) Nine parameters on admission: age, sex, obesity, malnutrition, history of cardiac, respiratory or renal disease, diabetes mellitus and malignant neoplasia. Four of these parameters had a prognostic value (p less than 0.05): age 65 years, diabetes mellitus and cardiac disease. (2) Thirty parameters representing the functional status of six organic systems during sepsis: respiratory, cardiovascular, nervous, kidneys, blood coagulation, liver. Six of these parameters had a prognostic values: PEEP 0-10 cm H2O to keep PaO2 greater than 60 mmHg (p less than 0.001), serum creatinine greater than 3.6 mg/dl (p less than 0.01), prothrombin time greater than 15'' or platelet count less than 100,000/mm3 (p less than 0.001), need of vasoconstrictive drug to keep arterial pressure greater than 100 mmHg (p less than 0.001), bilirubin greater than 3 mg/dl (p less than 0.01) and mental confusion. The combination of these ten statistically significant prognostic criteria for each patient showed that the mortality was 0 with 0-2 criteria, 36% with 3-5 criteria, 94% with 6-8 criteria and 100% with 8-10 criteria. Patients with more than five of these criteria had a significant higher mortality risk (p less than 0.001).
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PMID:Prognostic criteria in intra-abdominal sepsis. 367 39


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