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

We have previously shown that experimental peritonitis secondary to fecal bacteria plus barium sulfate suppresses delayed cutaneous hypersensitivity (DCH) in rats. We examined herein the role of barium sulfate. In a series of experiments presensitized rats were simultaneously skin tested with intradermal keyhole limpet hemocyanin and given an intraperitoneal injection of either (1) a mixture of four fecal bacteria in their nutrient broths, (2) bacteria and broths plus barium sulfate, (3) sterile broths plus barium, (4) sterile barium alone, (5) nutrient broths, or (6) saline. In rats given sterile barium we measured phagocyte delivery to subcutaneous polyvinyl alcohol sponges. We found that (1) the coadministration of barium sulfate was necessary for rats given bacteria to die (P = 0.03) or develop abdominal abscesses (P less than 0.005), (2) suppression of DCH occurred in 70% of rats receiving sterile barium sulfate vs 0% in saline controls (P = 0.0001), (3) early suppression of DCH was associated with subsequent death and abscess formation in rats given bacteria plus barium (P = 0.00002) and with intraabdominal barium collections in rats given barium alone (P less than 0.02), (4) barium sulfate administration caused suppression of phagocyte delivery to subcutaneous sponges: 23.2 X 10(6) cells/site vs 43.1 X 10(6) cells/site in saline controls (P less than 0.005). We conclude that barium sulfate itself has profound systemic effects in the rat model of intraabdominal sepsis. Early suppression of DCH is associated with a poor outcome in septic rats.
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PMID:Suppression of delayed cutaneous hypersensitivity and inflammatory cell delivery by sterile barium peritonitis. 368 6

Gelatine capsules containing Escherichia coli and Bacteroides fragilis in a standardized mixture with rat colonic content and barium sulfate were implanted intraabdominally into rats. Capsules of 0.75 g gave approximately 50% mortality whereas 0.35 and 1.10 g caused no or 100% mortality, respectively. In subsequent experiments, using the 0.75 g capsule, all animals became ill with signs of tachypnea, piloerection, low physical activity and hypersecretion of saliva 6-8 h after the implantation. The animals reduced their water and food intake substantially and the body weight decreased. A significant reduction in blood pressure, glucose and leukocyte and platelet counts was found 12 h after challenge. Blood cultures obtained at 12, 24, 48 and 60 h all grew E. coli but none B. fragilis. Succumbed animals revealed diffuse peritonitis with growth of E. coli and B. fragilis at autopsy, whereas surviving animals showed abscess formation at investigation on day 8 after challenge. It was concluded that the model closely resembled intraabdominal abscess formation with sepsis in man.
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PMID:Standardized intraabdominal abscess formation with generalized sepsis: pathophysiology in the rat. 388 37

A set of xiphopagus conjoined twins with prematurity, exomphalos, and intestinal obstruction was separated successfully. Preoperative evaluation included computerised axial tomography, 99mTc-HIDA scan, and barium enema. Major hepatobiliary and gastrointestinal anomalies were encountered. One twin is alive and well today. The other twin died one week postoperatively from sepsis. Postmortem studies showed she had a severe cardiac anomaly incompatible with normal life.
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PMID:Management of xiphopagus conjoined twins with small bowel obstruction. 394 59

Streptococcus bovis bacteremia has been associated with several gastrointestinal disorders, most notably carcinoma of the colon. This report describes a 57-year-old woman with short bowel syndrome in whom S. bovis bacteremia and an infection of an indwelling parenteral nutrition catheter developed. A barium enema revealed diverticula and a foreshortened small intestine. This case implicates the short bowel syndrome in the pathogenesis of S. bovis bacteremia and supports empiric antibiotic coverage for both skin flora and enteric pathogens in patients with Hickman catheter sepsis and known gastrointestinal pathologic conditions.
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PMID:Streptococcus bovis catheter infection and the short bowel syndrome. 396 50

A patient with Parkinson's disease developed a non-ketotic hyperosmolar diabetic coma precipitated by chest infection. Initial improvement from treatment with intravenous insulin, ampicillin and fluid therapies was followed by severe deterioration and hypovolaemic shock. Further improvement occurred only when therapy directed against Gram-negative sepsis was added. A barium examination later demonstrated aspiration of oral contents with pulmonary soilage. The differences between the easily recognized early fulminating 'aspiration syndrome' caused by aspiration of gastric contents of low pH and the aspiration of oral contents, which may remain occult for many hours, is highlighted. Life-threatening Gram-negative or anaerobic infection may then occur but remain undiagnosed because the original aspiration of foreign material is unsuspected.
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PMID:Aspiration of oral contents in Parkinson's disease. A case report. 403 2

A prospective, randomized clinical trial was undertaken to compare the value of a combination of two antibiotics for the prevention of postoperative septic complications after large bowel surgery. In group I the patients received three doses daily for 2 days of 80 mg gentamicin and 600 mg clindamycin, intravenously. Patients in group II received three doses daily for 2 days of 80 mg gentamicin and 500 mg metronidazole. Antibiotic administration was started in the operating room before the surgical procedure. The two antibiotics were administered by separate venous routes. One hundred and seven patients were allocated to either one of the two groups. Both groups were equally matched for gender, age, and surgical procedure. Bacteriologic specimens were taken in the wound as soon as the peritoneum was closed. They were immediately incubated for identification by aerobic and anaerobic cultures and sensitivity determinations. Cultures of one or more organisms were positive in 63 of 107 specimens. There was no difference between the two groups. No death occurred as a result of intra-abdominal complication, no reoperation was required, and in no case did peritonitis occur. Six wound abscesses and three delayed stitch infections were observed: five in group I and two in group II. Five clinical anastomotic leakages were observed (5.1%): two in group I and three in group II. They did not require treatment and healed spontaneously. Furthermore, five radiologic anastomotic leakages were present in 45 patients who received a control barium enema. No side effects were noted with metronidazole of with clindamycin. No clinical evidence of ototoxicity or nephrotoxicity was observed in patients receiving gentamicin. There is no statistically significant clinical difference between the combination of gentamicin and metronidazole or gentamicin and clindamycin. Both combinations are effective in preventing wound sepsis in large bowel surgery. Metronidazole and clindamycin were equally effective in preventing postoperative anaerobic infections. No resistance of anaerobic organisms to metronidazole was observed.
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PMID:Antibiotic prophylaxis in large bowel surgery: results of a controlled clinical trial. 633 62

Seven cases of gastrointestinal bleeding originating from peripancreatic blood vessels seen between 1977 and 1982 are presented. The bleeding originated either from true aneurysms, formed when the pancreatic inflammatory processes weaken the walls of peripancreatic blood vessels, from pseudoaneurysms which occurred after vascular leakage into pancreatic pseudocyst, or from veins. Gastrointestinal bleeding occurs when these entities rupture into gastrointestinal viscera. Hemorrhage of this nature must be considered in the clinical setting of patients who have a history of alcoholism, chronic relapsing pancreatitis, and known pseudocysts. Endoscopy, bleeding scans, and barium contrast studies are only occasionally helpful in diagnosis. Selective visceral angiography during acute hemorrhage is often diagnostic and concomitant arterial embolization techniques may offer a temporizing or permanent modality for hemostasis. This technique may be especially useful in the unstable, acutely ill patient with alcoholic hepatitis, sepsis, or an immature pseudocyst who poses a poor operative risk.
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PMID:Major gastrointestinal hemorrhage from peripancreatic blood vessels in pancreatitis. Treatment by embolotherapy. 660 4

A new inherited neuromuscular disease was identified in 4 patients (1 male, 3 females), offspring of consanguineous marriages, belonging to the same kindred. The proband was a 24-year-old female with history of ptosis and ophthalmoplegia since childhood and progressive intestinal pseudo-obstruction for the last 4 years of her life. A sural nerve biopsy showed axonal and demyelinating neuropathy. Muscle biopsies of pectoral and gastrocnemius revealed myopathic alterations with marked variation in muscle fiber size, atrophy of both fiber types and normal mitochondria. An upper gastrointestinal study showed barium in the stomach after 8 h and jejunal diverticula. Tests for absorption of fat, protein, carbohydrate, folic acid and vitamin B12 were normal. Serum levels of vitamin A and lipoproteins were also normal. The patient underwent partial gastrectomy and gastrojejunostomy. Postoperatively, she developed severe pancreatitis, sepsis, peritonitis and expired. Tissue samples from the proband and from her brother, revealed normal mucosa, but degeneration of smooth muscle of the stomach and small intestine. The myenteric plexus and vagus nerves were normal. The biochemical studies of contractile proteins (myosin, actin, tropomyosin) in the fresh and cultured smooth muscle cells of the proband obtained at the time of gastrectomy showed a 50-75% decrease in the synthesis of different contractile proteins. Turnover of contractile proteins and synthesis and turnover of collagen showed normal values. The reduction in synthesis of contractile proteins may account for the weak peristalsis and be a factor in the pathogenesis of the intestinal pseudo-obstruction.
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PMID:Inherited ophthalmoplegia with intestinal pseudo-obstruction. 668 98

Three patients with Boerhaave syndrome were successfully managed with nonoperative treatment. The diagnosis was delayed 5 days in one patient and 10 days in the other two. None of the patients appeared septic. Their conditions had been misdiagnosed as myocardial infarction, pneumonia and pulmonary embolism. Treatment consisted of intravenous hyperalimentation and administration of antacids and antibiotics. Cimetidine was also used in one patient. Two patients were discharged 14 days after diagnosis and the third on the 20th hospital day. Follow-up barium swallows showed complete healing in 2 months in all three patients. Conservative management of spontaneous esophageal perforation is feasible when (1) the perforation is already 5 days old, (2) there are no signs of severe sepsis, (3) esophageal barium study shows a wide-mouthed cavity draining freely back into the esophagus, and (4) the pleural space is not contaminated. When the diagnosis is made promptly, surgical therapy remains the treatment of choice, and patients managed conservatively who show signs of sepsis should be operated on without hesitation. Follow-up esophageal evaluation should be performed to confirm complete healing and to evaluate underlying disease.
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PMID:Boerhaave syndrome. Successful conservative management in three patients with late presentation. 678 84

A satisfactory bowel preparation is essential for adequate double contrast barium enema and colonoscopy. Efficient preparation is also important for reducing the risk of anastomotic dehiscence and sepsis in elective colorectal surgery. Traditional preparation by starvation, purgation and enemas is time consuming, unpleasant for patients, and in our experience results in a satisfactory preparation in only 23% of patients. Elemental diets are inefficient when used for only five days. Whole bowel irrigation with a nasogastric tube enables patients to be in hospital for only one day before operation and provides a satisfactory result in 61% of patients. Whole bowel irrigation is not recommended for stenosing tumours. Irrigation with saline causes sodium and water retention and the use of a balanced electrolyte solution (eg, Ringer's lactate) reduces the risk of these side effects. Oral mannitol has become popular but in our experience results in a satisfactory preparation in only 41% of patients. Mannitol is fermented by E coli to potentially explosive gas mixtures unless oral antimicrobials (neomycin and metronidazole) are used immediately before operation. Polyethylene glycol also causes osmotic catharsis without the risk of explosion. We currently favour nasogastric irrigation with polyethylene glycol and a balanced electrolyte solution, but there is still a place for traditional preparation over five days for patients with stenosing tumours of the left colon.
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PMID:Indications and techniques for bowel preparation in colorectal cancer. 687 84


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