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)

The prophylactic and therapeutic efficacies of the immunomodulating agent RU 41.740 (a glycoprotein extract from Klebsiella pneumoniae) were studied in a murine model of intra-abdominal abscess formation with Bacteroides fragilis, Escherichia coli, and bran as an abscess-potentiating agent. Parenteral injection of RU 41.740, either before or after injection of an abscess-inducing mixture (AIM), was associated with significantly diminished incidence and size of abscesses. Abscess incidence and size were significantly decreased by oral administration of RU 41.740 after, but not before, AIM injection. Abscess formation and resolution are the results of complex interactions of host defence mechanisms with bacteria and potentiating agent, and RU 41.740 has been shown previously to activate both macrophage and neutrophil function. These results indicate that activation of non-specific defences may protect against abscess development in chronic sepsis.
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PMID:The effects of RU 41.740, a glycoprotein immunomodulating agent derived from Klebsiella pneumoniae, on intra-abdominal abscess formation in mice. 851 Jan 39

The ribonucleotide reductase inhibitor, hydroxyurea (HU), augments the cytotoxic effects of 5-fluorouracil (5FU) in vitro; both drugs are synergistic with interferon-alpha (IFN) in vitro. The aim of this phase I study was to determine the maximal duration of HU, 4.3 g/m2, administered as a parenteral infusion in combination with 5FU, 2.6 g/m2 administered over 24 hrs each week, + IFN, 9 MU, subcutaneously three times per week. There were 26 patients enrolled and evaluable. This included 14 patients with colorectal cancer of whom 13 had been previously treated, and 12 patients with other refractory malignancies (pancreas, cholangiocarcinoma, hepatocellular carcinoma, renal cell carcinoma, and others), of whom 10 were previously untreated. The dose-limiting toxicity of this regimen was myelosuppression. This prohibited dose escalation of HU above the starting dose (24 hrs) on a 6-weeks-on, 2-weeks-off therapy schedule. When filgrastim, 480 microg, was administered subcutaneously on days 3-6, the duration of HU could be extended to 48 hrs on a 2-weeks-on, 1-week-off therapy schedule. There were two instances of fatal infection, one in a patient with a rectovaginal fistula with neutropenic sepsis and the second in a patient with non-neutropenic Clostridium septicum sepsis. All therapy was administered in the ambulatory setting. There were three responders, all among previously untreated patients. High-dose parenteral hydroxyurea, 4.3 g/m2 administered over 24 hrs, can be safely combined with high-dose weekly 5FU, 2.6 g/m2 over 24 hrs + IFN, 9 MU subcutaneously three times per week, without filgrastim in the ambulatory setting. Parenteral hydroxyurea, 4.3 g/m2 over 24 hrs daily x 2 can also be combined with high-dose 5FU + IFN, but requires the addition of filgrastim to avoid severe myelosuppression.
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PMID:Phase I trial of high-dose infusional hydroxyurea, high-dose infusional 5-fluorouracil and recombinant interferon-alpha-2a in patients with advanced malignancies. 882 49

The incidence and type of infections were retrospectively analyzed in 21 infants with congenital nephrosis of the Finnish type (CNF). During the median follow-up time of 1.1 years the infants suffered from 63 verified and 62 suspected episodes of sepsis. These accounted for half of all infections recorded. Forty percent of bacteremias were caused by coagulase-negative staphylococci, 16% were caused by Staphylococcus aureus, 17% were streptococcal, and 24% were caused by Gram-negative bacteria. One infant died of pleural empyema, but otherwise the outcome of infections was good. The use of central venous lines tended to increase the rate of staphylococcal bacteremias but had no significant effect on the overall incidence of infections. Prophylactic use of antibiotics did not reduce the incidence of septic or other infections. Infants with CNF had low levels of serum IgG, but prophylactic immunoglobulin infusions (0.5-1.0 g once or twice a week) did not reduce the frequency of infections, probably because the infused IgG was quickly lost into the urine. The results indicate that infants with CNF often suffer from septic infections associated with the invasive treatment modalities. Parenteral antibiotics covering the hospital strains of bacteria (especially staphylococci) should be started without delay when a nephrotic patient is not doing well.
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PMID:Infections in infants with congenital nephrosis of the Finnish type. 909 Jun 51

Five patients, aged between 64 and 75 years with Salmonella-infected abdominal aortic aneurysms were surgically treated between 1993 and 1995 at the National Cheng Kung University Hospital. Cultures of aneurysmal wall tissue and blood yielded Salmonella enteritidis Group B in three patients and Salmonella choleraesuis in the remaining two. All patients presented with fever and abdominal or back pain. Pulsatile masses were noted in only two patients. Infrarenal abdominal infected aneurysms were demonstrated by computed tomography and aortography in each patient. The five patients underwent aneurysmal resection with in situ graft reconstruction from 1 to 20 days after the diagnosis was made. The graft was wrapped with an omental pedicle. Duodenal repair was performed in one patient due to an aortoduodenal fistula found during surgery. He died 19 days after surgery because of duodenal leakage and uncontrolled sepsis. Four patients survived and remained well 11 to 34 months (mean, 25 mo) after surgery. Postoperatively, only one patient developed adhesion ileus and required enterolysis. Parenteral antimicrobial therapy was continued in all patients after surgery for 2 to 4 weeks; only one patient had an additional 4 months of oral antibiotics. Although the number of patients was small, the survival rate was high, at 80%. Our experience suggests that Salmonella-infected aneurysms of the abdominal aorta can be successfully treated by resection of the aneurysm with extensive debridement followed by in situ graft interposition with omentum wrapping. Once diagnosed, the patients should be scheduled for surgery as soon as possible. Antibiotics should be continued parenterally for at least 2 to 4 weeks postoperatively. While long-term suppressive antibiotic therapy is usually recommended, it might not be essential with our surgical approach.
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PMID:Surgical experience with Salmonella-infected aneurysms of the abdominal aorta. 917 Aug 22

The time sequence and the mechanisms leading to the development of the hypertriglyceridemia of bacteremic sepsis are not fully understood. This study was conducted to determine the mechanisms leading to the early rise in serum triglycerides (TG). Bacteremic sepsis was induced in fasted and parenterally fed rats by intravenous infusion of live Escherichia coli colonies over a 1 h period every 24 h up to 96 h. Body temperature was elevated from 12 to 48 h after E. coli infusion in fasted rats and from 24 to 72 h after E. coli infusion in fed rats. The initial rise in serum TG was observed at 3 h after E. coli infusion; in fasted rats this elevation was maintained over 72 h. In the parenterally fed rats, hypertriglyceridemia was evident only at the 3 h time point. Serum concentrations of tumor necrosis factor alpha (TNF-alpha) were elevated significantly at 60 min after initiating the E. coli infusion, peaked at 90 min, and declined by 120 min. Immunization with neutralizing goat anti-TNF-alpha IgG did not block the initial increase in serum TG induced by E. coli. This early rise in TG in fasted E. coli-treated rats was accompanied by a 33% increase in TG secretion in comparison with control rats. TG secretion declined by 27% at 9 h and remained depressed at 12 and 24 h in comparison with time-matched control rats. By 24 h lipid accumulation was evident in the livers of the fasted and fed E. coli-treated rats. Most of the fasted E. coli-treated rats died by 72 h. Parenteral feeding extended survival of E. coli-treated rats until 120 h. These findings along with the observation that two mechanisms are involved in maintaining the elevation of serum TG during E. coli sepsis suggests that the hypertriglyceridemia may be important in host survival.
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PMID:Sequential alterations in tissue lipoprotein lipase, triglyceride secretion rates, and serum tumor necrosis factor alpha during Escherichia coli bacteremic sepsis in relation to the development of hypertriglyceridemia. 946 73

Parenteral nutrition (PN) has given life to patients with chronic intestinal failure who would otherwise have died. Home parenteral nutrition has improved the quality of life for many children. However, morbidity from this therapy remains significant with complications of line sepsis, lack of venous access, hepatic dysfunction, and pulmonary embolism. These complications are common in younger children. Detailed discussion must take place with the family regarding risks and benefits of PN. In those children developing complications of PN, intestinal transplantation is a logical extension of treatment. Early referral of patients for assessment is vital because significant mortality occurs when liver disease is established. Time is needed to counsel families on the potential benefits and risks of this treatment, including the physical and emotional demands made on the child and family. Overall worldwide survival for isolated small bowel transplantation is currently 50% and for combined small bowel and liver transplantation 40%. Significant complications are rejection, sepsis, and lymphoproliferative disease. Postoperative management can be complex and prolonged; child and parents require a great deal of physical and emotional support. The burden of care for parents decreases significantly after the first year. Small bowel transplantation offers a realistic alternative to PN. The choice of treatments is influenced by expected quality of life, which is just beginning to be evaluated.
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PMID:Quality of life issues: parenteral nutrition to small bowel transplantation--a review. 978 69

Parenteral nutrition associated cholestasis in preterm infants and newborn children is a frequent and serious disease with an incidence of 23% depended on duration of parenteral nutrition and birthweight. The incidence of liver cirrhosis is 40% when parenteral nutrition is given 74-242 days. The pathogenesis remains unclear. Several predisposing factors are discussed like immaturity, lack of hormonal stimulation by oral feeding, bacterial infection, liver toxicity of aminoacids and their products of photooxidation, lack of taurine, lack of antioxidation substances, hypermanganesaemia and pollution of infusion solutions. Furthermore sepsis during parenteral nutrition seems to multiply the risk of cholestasis. For prevention controlled studies recommend: 1. Early enteral nutrition. 2. The reduction of parenteral amino acids to less than 3 g/kg/d. 3. Light protection for parenteral solutions. 4. Cyclic infusion of parenteral nutrition. 5. The application of antibiotics (metronidazole, gentamicin) during parenteral nutrition. The most important therapeutic intervention is the beginning of oral feeding. Most of the time this leads to a decrease of icterus within two weeks. An icterus persisting longer than 3 weeks should be treated because of the risk of liver cirrhosis. Further therapeutic interventions are: 1. Cholecystokinin, good results in case studies which still has to be verified by a controlled study. 2. Ursodeoxycholic acid, its choleretic effectiveness is verified in several liver diseases by controlled studies, but it is not proven in parenteral nutrition associated cholestasis. 3. Laparoscopic biliary irrigation, successful in several case studies.
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PMID:[Parenteral nutrition associated cholestasis in the newborn]. 987 92

Intravenous erythromycin is a potent gastric prokinetic with demonstrated efficacy in the acute therapy of gastroparesis; long-term oral therapy has been limited by tolerance and modest efficacy. Our aim was to review our experience with prolonged administration of intravenous erythromycin in an ambulatory setting as therapy for severe gastroparesis, refractory to usual dietary and oral prokinetic regimens. We conducted a retrospective analysis of patients with gastroparesis treated with intravenous erythromycin for at least 1 month. Information on demographics; origin of gastroparesis; dosage, duration, and route of administration; clinical outcome in the short- and longer-term; and complications were determined. Eleven patients received a total of 14 courses of intravenous erythromycin for a median of 6.5 months (range, 1 to 19 months) at a median dosage of 300 mg/day (range, 150 to 1,000 mg/day). One patient received no benefit, two had complete responses, and all others reported some benefit. Two had dramatic relapse on cessation of therapy and subsequently improved on its resumption. Parenteral nutrition could be discontinued in one of four patients. There were four episodes of line sepsis; two required catheter removal. A nonocclusive thrombus developed at the site of a central line in one patient. Secondary infections or antibiotic resistance were not encountered. Prolonged administration of intravenous erythromycin in an ambulatory setting is feasible, well tolerated, and effective in patients with severe gastroparesis.
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PMID:Efficacy of prolonged administration of intravenous erythromycin in an ambulatory setting as treatment of severe gastroparesis: one center's experience. 1007 20

This study retrospectively evaluated the use of parenteral ciprofloxacin (PC) under the influence of a reserved antimicrobial drug program and an intravenous-oral stepdown program. During the first three months following its formulary introduction, 92 PC treatment courses were initiated. Fifty of these treatment courses in 49 adults were randomly selected for study. The hematology service accounted for 50% of the courses reviewed. The balance were initiated in the intensive care unit (16%), and six other services (34%). PC was used for the treatment of febrile neutropenia (50%), respiratory tract infections (20%), gram-negative sepsis (10%), and five other indications. Initial use of the intravenous formulation was considered appropriate in 92% of courses. Stepdown therapy occurred in 17 (34%) of treatment courses. Of the 26 patients considered candidates for oral therapy, seven patients (27%) were eligible for earlier stepdown and nine patients (35%) did not receive oral drug. According to our criteria, unnecessary use of the intravenous route occurred in 20% of PC treatment days. Mean total cost (acquisition plus delivery) of therapy per course was $668. This cost was higher in the hematology service (mean $990) than any other service (p = 0.0015). When stepdown therapy was employed the mean daily cost of therapy was $43.63 vs. $55.61 when the oral dosage form was not used (p = 0.04). Parenteral drug costs totalling $6245 were avoided by subsequent use of the oral dosage form. If full compliance with stepdown criteria had occurred, an estimated total savings of $10,769 could have been realized.
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PMID:Ciprofloxacin use under a reserved drug and stepdown promotion program. 1014 Oct 61

Sepsis in short-bowel syndrome (SBS) is in part due to bacterial translocation (BT). Parenteral nutrition (PN) is often necessary in SBS and promotes BT. The aim of this study was to asses the effect of the presence or absence of ileocecal valve (ICV) on BT in parenterally-fed rats with massive intestinal resection. Sixty-five adult Wistar rats underwent central venous cannulations and were randomly assigned to one of five groups receiving for ten days five treatment regimes: Sham (n = 17) standard rat chow + i.v. saline. PN (n = 17) fasting + PN. Res-Sham (n = 10) standard rat chow + i.v. saline + 80% gut resection. Res-PN (n = 11) fasting, PN + 80% gut resection. Res-ICV-PN (n = 10) fasting, PN + 80% gut resection including ICV. At the end of the experiment they were euthanized and mesenteric lymph nodes (MLN), spleen and peripheral and portal blood specimens were recovered and cultured. BT was found in 47% of PN animals, 91% of Res-PN rats, 100% of Res-Sham group and 60% of Res-ICV-PN animals, but not in Sham ones. 97% of BT+ animals had positive cultures in MLN and/or portal blood, whereas germs beyond liver were detected in 30% of Res-Sham, 37% of PN, 50% of Res-PN and 0% of Res-ICV-PN rats. The present study confirms that both massive intestinal resection and PN promote BT. In addition, it shows that animals deprived of ICV have lower incidence of BT in this setting than those with it and that the germs do not reach in them peripheral blood in the same proportions as in ICV-intact animals. These results suggest that the presence of an intact ICV favor BT in parenterally-fed rats with massive intestinal resection.
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PMID:Bacterial translocation is favored by the preservation of the ileocecal valve in experimental short bowel with total parenteral nutrition. 1053 61


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