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

"Postoperative erythroderma", the pathogenesis of this disease have solved as graft-versus-host disease (GVHD) due to blood transfusion, is fatal and impossible to cure for the time being. Therefore the prevention against the disease is very important. One woman and three men who underwent an operation and blood transfusion at our department died of this disease. They fell into high fever on 11-13 days, erythroderma on 12-16 days, liver dysfunction on 14 days, and leukocytopenia on 17-19 days, after surgery and transfusion. Eventually, they all suffered from thrombocytopenia, diarrhea, renal dysfunction, and sepsis which led to death. The clinical course, macroscopic and microscopic findings of them coincided with those of GVHD. Since 1989, we have tried following methods for prevention of postoperative erythroderma: Reducing blood transfusion, especially fresh blood and fresh thrombocyte plasma, by using predeposited autologous blood, autologous washed erythrocytes collected from the operative area before and after extracorporeal circulation (ECC), concentrated residual blood from the ECC using a hemoconcentrater, and 1,500 rad of cobalt-irradiation of fresh blood, fresh thrombocyte plasma, and blood collected within 7 days prior to the transfusion. Postoperative erythroderma has not been experienced by introduction of these methods since 1989.
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PMID:[Studies on so-called "postoperative erythroderma": report of four cases]. 214 58

One hundred porous surface replacements (PSR) were performed in 92 patients (63 men and 29 women) with a mean age of 53 (range 17-76). Follow-up times range from 1 to 4 years, with 48 patients having a follow-up of at least 2 years. Preoperative diagnoses were osteoarthritis (OA) 63, osteonecrosis (ON) 13, dysplasia 9, rheumatoid-ankylosing spondylitis 6, and other 9. Seventeen hips had metal-backed acrylic-fixed THARIES acetabular sockets, nine hips had a porous cobalt chrome hemispheric beaded acetabular component with adjuvant fixation screws and externally protruding screw hubs, and 74 hips had a porous chamfered cylinder-design acetabulum. Pain relief had been immediate and more complete than with acrylic-fixed or biologic-ingrowth stem-type replacement with comparable walking and function improvements. There have been no major systemic complications, sepsis, or loosening. There have been two transient peroneal nerve palsies and three trochanteric fibrous unions. There have been three reoperations, one for subluxation, one for "metalosis" due to mesh pad loosening, and one femoral neck fracture. Examination of one removed femoral surface component which has been histologically sectioned revealed excellent (90%) bone in-growth. Circumferential progressive radiolucencies developed at the bone-cement interface by 1 year in all of the 17 acrylic-fixed acetabular components. Reaming or seating defects were noted in 25% of the ingrowth components on postoperative radiographs. Radiographic analysis of immediate postoperative films of the chamfered cylinder design acetabular components frequently demonstrated bone-component interface radiolucencies which represented component seating defects. These initial interface radiolucencies became progressively more narrow over the first six months postoperatively suggesting "healing" of the reamed bone-component interface with trabecular bone around the chamfered cylinder acetabular components. Partial healing of initial interface voids with residual narrow radiolucencies were typical of the nine hemispheric-design acetabula with adjuvant screws and screw hubs. This new porous surface replacement (PSR) of the hip using porous ingrowth fixation avoids the major disadvantages of acrylic-fixed SR: excessive acetabular reaming and difficulty with acetabular revision. (When conversion to stem-type replacement is necessary the modular polyethylene socket liner can be exchanged.) The PSR has the prospect of enhanced fixation and improved longterm durability.
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PMID:Porous surface replacement of the hip with chamfered-cylinder component. 335 70

Fifty-seven porous surface replacements (PSR) were performed in 53 patients (36 men and 17 women) with a mean age of 54 years (range, 19-75 years). Follow-up examination times ranged from one year to 2.5 years with 33 patients having follow-up periods of at least two years. Preoperative diagnoses were osteoarthritis (OA), 37; osteonecrosis (ON), six; dysplasia, nine; rheumatoid ankylosing spondylitis, three; and other, two. Sixteen hips had metal-backed acrylic-fixed THARIES (total hip articular replacement by internal eccentric shells) acetabular sockets, nine hips had a cobalt chrome hemispherical beaded acetabular component with adjuvant screws, and 32 hips had a chamfer-cylinder designed acetabulum. Pain relief has been immediate and more complete than with acrylic-fixed or biologic-in-growth stem-type replacements with comparable walking and function improvements. There have been no major systemic complications, sepsis, or loosening. There have been two transient peroneal nerve palsies and three trochanteric fibrous unions. There has been one subluxation requiring reoperation. Histologic sections of the removed femoral surface component showed excellent (90%) bone ingrowth. Circumferential progressive radiolucencies developed at the bone-cement interface by one year in all of the 16 acrylic-fixed acetabular components. Reaming or seating defects were noted in 25% of the patients on postoperative radiographs. Serial radiographic analyses demonstrate progressive narrowing of all of the chamfered cylinder design and less in hemispherical design with screw fixation. These observations are encouraging and suggest healing of the bone-component interface with bony trabeculae in the porous-coated acetabular design. This new surface replacement (SR) of the hip uses porous-ingrowth fixation to overcome the major disadvantages of acrylic-fixed SR which are as follows: (1) excessive acetabular reaming, (2) poor long-term fixation, and (3) difficulty with acetabular revision.
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PMID:Porous surface replacement of the hip with chamfer cylinder design. 362 14

Saturated Ca2+ extrusion rate through the Ca2+ pump of erythrocytes was determined by the cobalt-exposure method in normal subjects and septic patients. From 48 normal subjects, the value of Vmax of erythrocyte Ca2+ pump was 14.83 +/- 0.49 mmol/L cells/hr; from 29 sepsis patients, it was 9.49 +/- 0.59 mmol/L cels/hr, significantly (P < 0.001) lower than that from the erythrocytes of normal subjects. When the severity of sepsis was evaluated by the septic severity score (SSS), a significant correlation (P < 0.0001) was observed between the Vmax of Ca2+ pump and the patient's SSS, indicating that the inhibition of Ca2+ pump depended on the degree of the pathological development of sepsis. Since the ATP-dependent Ca2+ transport in rat liver plasma membrane is also reduced during the late stage of sepsis [Lau et al., Circ Shock 38:238-244, 1992], impairment of the activity of Ca2+ pump appears to have a general pathophysiological significance in the development of severe sepsis.
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PMID:Erythrocyte Ca2+ pump is defective during sepsis. 760 Jun 35

At toxic doses, cardiotropic drugs may compromise cardiac output leading to circulatory shock. Specific treatment varies depending on the nature and the dose of the drugs ingested as well as causal mechanism including vasopegia, hypovolaemia, cardiogenic effects and sepsis. Progress in our understanding of the pharmacodynamic aspects of intoxication and the development of specific antidotes has led to reduced morbidity and mortality. In addition to the classical inotropes, mainly catecholamines and phosphodiesterase inhibitors, other therapeutic agents may have specific inotrope effects in such ad hoc situations. These include hypertonic alkaline saline solution, calcium, glucagon, hydroxocobalamine and other cobalt salts, oxygen and immunotoxicotherapy. Together with volum replacement, dobutamine at the dose of 7 to 20 micrograms/kg/min can usually restore cardiac performance in cases of carbamate-induced circulatory shock. In case of tricyclic antidepressant overdose, treatment should include respiratory assistance and infusion of alkaline sodium solutions to both reverse the extracellular acidosis and correct sodium balance. Catecholamines may be necessary in cases with severe hypotension. Major vasoplegia and impaired intraventricular conduction may be induced by overdoses of chloroquine and class I antiarrhythmic drugs. Signs of gravity are: ingested dose above 4 g, QRS > or = 0.12 s or systolic arterial pressure < or = 80 mmHg. Treatment with epinephrine, respiratory assistance and diazepam has been proven effective during the acute phase, but right catheterism is often required due to major haemodynamic instability during the first 72 first hours. Beta-blockers have both a bronchoconstrictor and respiratory depressor effects favouring cardiovascular failure by hypoemia. Symptoms occur in 30-40% of the cases of overdose. Shock results from the reduction in blood pressure and cardiac inotropism. Glucagon, isoprenaline and epinephrine, prescribed in that order, can considerably reduce mortality to less than 4%. Despite the development of specific molecules, the risk of mortality due to toxic shock caused by antiarrhythmics, chloroquine, colchicine, calcium inhibitors and paraquat remains high.
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PMID:[Shock caused by poisoning. Use of cardiotropic agents]. 797 61

One hundred eighty-six Microloc tricompartmental, cruciate-sparing, primary total knee replacements in 136 patients were performed between 1983 and 1987. Femoral components were made of cobalt-chrome-molybdenum alloy. The tibial component baseplates were made of titanium-aluminum-vanadium alloy. The baseplates were made with three small porous-coated pegs for fixation with or without cement, or with a central stem for fixation with cement. The polyethylene was affixed to the baseplate by a mechanical locking mechanism that was nonmodular. The articular surfaces of both components were flat mediolaterally and anteroposteriorly. The patellar components were dome shaped and metal backed with titanium-aluminum alloy. Seventy-three percent of the femoral components, 26% of the tibial components, and 48% of the patellar components were inserted without bone cement. The average time to maximum follow-up examination was 6.1 years (range, four to nine years). Of implants that had not been revised, 84.4% had good or excellent results (using the Hospital for Special Surgery scoring system) at final follow-up examination. The average range of motion of functioning implants at final follow-up examination was 108 degrees. Revisions for failure only of the metal-backed patellar component were performed in 22 knees (11.8%). Forty knees (21.5%) required revision for failure of the femoral-tibial articulation. Reasons for failure in this group included: polyethylene wear (57.5%); loosening (15.0%); tibial tray fracture (10.0%); sepsis (12.5%); and dislocation or ligament laxity (5.0%). An additional 15 functioning knees (8.1%) have radiographic evidence of progressive femoral-tibial subluxation. Future failure of these devices is considered likely. Polyethylene wear requiring revision was not statistically associated with patient age, gender, preoperative diagnosis, height, weight, or component size. Polyethylene failure leading to revision was related to the radiographic appearance of femoral-tibial component subluxation. This subluxation was most likely to occur after five years of component implantation. The development of progressive femoral-tibial subluxation was statistically associated with postoperative extremity malalignment, excessive varus positioning of the tibial component, bone grafting of the tibial plateau, the use of the small-pegged tibial component, and the use of this component without cement. Polyethylene wear associated with progressive femoral-tibial subluxation occurred at the periphery of the tibial plateau and along the raised portion of the tibial spine. The metal baseplate at the edge of the plateau was frequently exposed and worn. Bone lysis associated with the presence of polyethylene, metal, and cement debris was frequently observed.
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PMID:Progressive subluxation and polyethylene wear in total knee replacements with flat articular surfaces. 811 38

The records of 35 dogs and two cats with Broviac-Cookea catheters implanted during a one-year period at The Ohio State University Veterinary Teaching Hospital (OSU-VTH) were reviewed for complications. In 36 patients, the catheters were used for daily anesthesia associated with cobalt radiotherapy, and in one dog the catheter was used for parenteral hyperalimentation. The catheters were in place for a mean of 16.7 days. Complications occurred in five patients and included infection or sepsis (n = 3), local abscess formation (n = 1), and local induration (n = 1); all the complications resolved with appropriate therapy. Broviac-Cooke catheters should be considered for use in dogs and cats requiring frequent blood sampling, repeated intravenous access, or in those for which routine venous access is difficult or impossible. The complication rate is minimal (13%) and is similar to that reported in studies of humans with indwelling, silastic catheters.
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PMID:Complications of indwelling, silastic central venous access catheters in dogs and cats. 854 53

Elevated zinc serum concentrations have been shown to restore impaired immune response. Therefore, pharmacologic zinc supplementation has been used to improve immune function, particularly in intensive care patients. In these patients, Gramnegative sepsis, the symptoms of which are predominantly caused by LPS-induced release of monokines, represents a serious problem. We have recently shown that zinc enhances induction of TNF-alpha and IL-1 beta in cultures of PBMC by LPS. By fluorescence polarization and infrared spectroscopic measurements we found that zinc addition leads to decreased fluidity of the hydrocarbon chains of LPS. Experiments at different temperatures showed that the less fluid gel (beta) phase of LPS is more effective in cytokine induction than the more fluid liquid-crystalline (alpha) phase. Our studies suggest that the synergistic effect of zinc on monokine induction by LPS is caused by direct interaction of zinc with LPS altering the fluidity of the hydrocarbon chains. Although this effect is zinc specific, other divalent ions, like cobalt and nickel, with a complex structure and size comparable to those of zinc also enhance LPS-induced monokine secretion but to a much lesser extent. Our data indicate that the zinc level represents a relevant clinical parameter in the treatment of Gram-negative infection. This reveals potential risks in the therapeutic application of zinc.
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PMID:Zinc enhances lipopolysaccharide-induced monokine secretion by alteration of fluidity state of lipopolysaccharide. 881 25

In vitro cellular immune responses to metallic and polymeric implant materials in particulate form were measured preoperatively in 185 patients. The patients were candidates for either primary total joint replacement (n = 65) or revision arthroplasty (n = 120). Proliferative cellular responses to polymethylmethacrylate particles in patients with osteoarthritis at revision surgery for aseptic loosening were significantly higher than the responses of patients with osteoarthritis at either primary surgery or surgical revision for mechanical failure of the prosthesis or sepsis. The responses to particles of cobalt-chromium alloy at revision surgery were also higher than the responses at primary surgery. The responses were reevaluated in 32 patients after a minimum of 10 months following surgery to correlate individual changes in the biological responses with clinical progress. Reevaluation at early follow-up of patients who had undergone primary surgery revealed significantly elevated proliferative responses and in vitro cytokine production in response to polymethylmethacrylate and cobalt-chromium alloy particles compared with their preoperative responses. In contrast, the response at follow-up to polymethylmethacrylate was significantly reduced in patients who had undergone revision surgery, and this reduction corresponded with a marked improvement in pain, joint motion, and function following revision surgery. These data suggest that specific cellular responses to polymethylmethacrylate or cobalt-chromium alloy particles, or both, may be associated with loose or painful prostheses.
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PMID:Cellular immune responses to orthopaedic implant materials following cemented total joint replacement. 949 13

Although cementless arthroplasty with a tapered titanium femoral component has proven reliable in young patients with excellent bone quality, studies involving patients with poor bone quality are lacking. The present study evaluates the results of total hip arthroplasty (THA) using such a femoral component in patients with Type C femoral bone. Ninety-two THAs were performed in 81 patients aged 65 years and older using a tapered titanium cementless femoral component. Follow-up in 62 patients (72 hips) averaged 13.2 years (minimum, 10 years); 19 patients were lost to follow-up. According to Door's criteria, 20 femora were classified as Type A, 19 as Type B, and 33 as Type C. No stem was revised because of stem instability, thigh pain, or osteolysis. One stem was removed because of sepsis. Six acetabula were revised because of polyethylene wear and periacetabular osteolysis. Four patients reported mild thigh pain. Radiologic signs of osseous integration for cylindrical extensively porous coated cobalt-chrome femoral components are not valid for tapered titanium designs.
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PMID:Thirteen year results of total hip arthroplasty using a tapered titanium femoral component inserted without cement in patients with type C bone. 1456 Apr 20


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