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

In the past six years, percutaneous catheter drainage (PCD) has been performed in the treatment of 99 patients with abdominal and retroperitoneal abscesses. Of these 99 patients, 15 had abscesses associated with an enteric fistula. Fistula sites included small bowel (five), colon (three), complex (three), duodenum (two) and one each for the stomach and common duct. Two of these 15 patients had an initially successful PCD, ten developed recurrent abscesses after the first PCD and the procedure failed in the remaining three patients. Of the ten patients with recurrent abscesses, eight were successfully treated by a second PCD while two required small-bowel resection. Of the three failures, all three required operation and eventually died of septic complications. The diagnosis of fistula was made at the initial PCD in only six of 15 cases. There was a significant correlation between PCD failure and presence of an enteric fistula (P less than 0.001 by chi-square test). These data suggest that the diagnosis of fistula associated with abdominal abscess is elusive, but once established, most recurrent abscesses can be successfully treated by a second PCD. Operative treatment of recurrent fistula-related abscesses should be reserved for persistent fistula drainage after a second PCD or for unresolved sepsis following the initial PCD.
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PMID:Percutaneous catheter drainage of abscesses associated with enteric fistulae. 333 83

A frequent complication (8.5 to 52.8%) of pancreatoduodenectomy (PD) for cancer, pancreatic fistula (PF) is difficult to treat, and an analysis of 30 cases of PD (27 for cancer, 3 for chronic pancreatitis) is used to determine risk factors and most effective therapy. Fistula developed in 6 cases (20%) and three risk factors were determined: preoperative renal impairment and hypoalbuminemia and ligature of pancreatic stump. Although not statistically significant, other factors--cancer, emergency surgery, fragile pancreatic tissue, thin Wirsung, pancreatojejunal anastomosis, absence of decompression of the raised jejunal loop--in this small series nevertheless provoked a marked increase in PF. One patient recovered after medical treatment, all five patients operated upon by whatever technique failing to survive. This agrees with literature data indicating heavy mortality (44.4 to 100%) after surgery. This should therefore be reserved for cases of PF failing to respond to adequate medical treatment, or with hemorrhage or intra-abdominal sepsis not controlled medically. The most effective therapy for PF is prophylactic, combining selection of patients as a function of risk factors, and treatment of pancreatic stump adapted to caliber of Wirsung and quality of remaining pancreatic tissue.
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PMID:[Pancreatic fistula following cephalic duodenopancreatectomy. Directed fistulization or total pancreatic exeresis?]. 337 2

In summary, the role of fibronectin in clinical medicine is not yet certain. Correlation of sepsis and organ failure with decreased fibronectin levels is still to some degree questionable; controlled clinical trials are urgently needed. The risk of hepatitis, AIDS, and other transfusion-transmitted diseases must be balanced by data substantiating the clinical efficacy of fibronectin therapy. To date, no results from controlled trials using purified fibronectin have been reported. Final judgement must be reserved pending results of appropriate human studies. It is likely, however, that even if fibronectin is proven to be clinically useful, the patient population which will achieve some benefit from its use will be restricted to septic and/or critically ill patients. As noted by Mosher and Grossman however, physicians treating such patients would likely welcome any new and effective therapeutic intervention.
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PMID:Fibronectin: applications to clinical medicine. 351 68

Central venous catheter-related infection and evidence for central venous thrombosis developed in five patients. On the basis of ongoing bacteremia after catheter removal and venographic confirmation, catheter-related septic central venous thrombosis (CR-SCVT) was confirmed. These patients were treated successfully with anticoagulation and antibiotics; none required surgical exploration or drainage.CR-SCVT is a complication of modern venous access techniques and is easily confused with sepsis from other anatomic sites. Even when recognized antemortem, CR-SCVT carries an excessive morbidity and mortality. The therapy for this complication is not standardized, but catheter removal, anticoagulation and a prolonged course of antibiotics are appropriate initial therapy. Surgical vein ligation or excision are reserved for refractory sepsis or abscess formation.
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PMID:Catheter-related septic central venous thrombosis--current therapeutic options. 376 99

Operations on the biliary tract in cirrhotic patients are reported to have a higher than normal risk of operative morbidity and mortality. We reviewed 39 cases from two university-based hospitals over a five-year period. Each patient had biliary tract surgery and biopsy-proven cirrhosis. Eight patients died (21%), and major complications were found in 12 surviving patients (35%). Local and systemic sepsis was the major contributor, accounting for all of the deaths and 17 of the 22 (77%) complications among survivors. Choledochotomy was done in ten patients; three of them died (30%) and nine major complications occurred in the remaining five. Preoperative risk factors found to be predictive of this high morbidity and mortality were ascites (50% mortality, 50% morbidity), prolonged prothrombin time (29% mortality, 38% morbidity), and a serum albumin level of less than 3.5 mg/dl (33% mortality, 40% morbidity). The presence of other major systemic disease was not significantly different between survivors and nonsurvivors. In 12 patients with no ascites and normal preoperative serum chemistry values, no deaths and only one minor complication occurred. We conclude that although biliary surgery in cirrhotic patients carries a high mortality, this risk can be assessed preoperatively. There appears to be a small subgroup of patients with cirrhosis and cholelithiasis who can have a favorable outcome. Operative therapy in these patients should be reserved for the complications of the biliary tract.
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PMID:Liver cirrhosis and biliary surgery: assessment of risk. 391 47

We reviewed the data on thirty-six supracondylar fractures of the femur (in thirty-four patients) that occurred after total knee arthroplasties that were done between April 1974 and December 1981. Patients who had osteoporosis, rheumatoid arthritis, one or more previous arthroplasties of the knee, or inadvertent breeching of the anterior aspect of the femoral cortex at operation appeared to be particularly at risk for a supracondylar femoral fracture. Malalignment of the component could not be implicated as a cause. Twenty-six fractures (in twenty-five patients) were treated by non-operative methods. Seventeen of them (65.4 per cent) healed and required no surgical treatment. Fourteen of the seventeen were followed for more than two years; they had no significant difference in the knee score and lost less than 10 degrees of motion. The nine remaining knees required revision of the arthroplasty because of non-union in four knees, malunion in two, loosening of the component in two, and extension lag in one. At an average of forty months after revision, the nine knees were rated as having one excellent, four good, three satisfactory, and one failed result. In contrast, only three of the five fractures that were treated by early open reduction and internal fixation had a satisfactory result, and one of them required a second bone-grafting procedure. One patient died perioperatively and another required an above-the-knee amputation because of sepsis. Of the three fractures that were initially treated by external fixation, one had an excellent and two had a good result at an average of forty-five months after fracture. We have found that supracondylar fractures that occur after total knee arthroplasty can be managed by either traction or application of a cast, or both, which usually results in healing of the fracture and a satisfactory outcome of the arthroplasty. Patients who have a poor arthroplasty result after non-operative treatment of the fracture usually can undergo a revision arthroplasty with the expectation of a satisfactory outcome. Operative treatment of the fracture should be reserved for patients who do not have osteopenia and in whom stable fixation can be achieved, for those who demand a highly functional arthroplasty, and for those in whom adequate closed reduction cannot be maintained.
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PMID:Supracondylar fracture of the femur after total knee arthroplasty. 394 Nov 20

Nine cases of acute acalculous cholecystitis were diagnosed in the surgical intensive care unit at Hartford Hospital during a 2 year period after abdominal, cardiovascular, and traumatic surgery. A tender mass in the right upper quadrant was suggestive but not diagnostic of the condition. Hyperamylasemia was seen in all patients. Ultrasonography is the most useful diagnostic tool; serial studies reveal progressive gallbladder dilatation and edema. Tube cholecystostomy was used in five patients and cholecystectomy in four. Cholecystostomy led to resolution of the inflammatory process in all five patients. Cholecystectomy should be reserved for those patients with extensive gallbladder necrosis. Six of the nine patients in the series died, all from multiple systems failure with concomitant sepsis. Hypotension is probably central to the development of acute acalculous cholecystitis. In the face of elevated intraluminal gallbladder pressure caused by ampullary edema and increased bile viscosity, hypotension may result in mucosal ischemia and necrosis with subsequent bacterial colonization. Acute acalculous cholecystitis represents another organ failure in critically ill patients who are experiencing progressive failure of multiple organ systems. An aggressive approach to the manifestations of organ failure, including acalculous cholecystitis, must be employed.
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PMID:Acute acalculous cholecystitis in the critically ill patient. 618 83

There is little uniformity in either the indications for operation, the classification of the pathology or the operative management of generalized or faecal peritonitis secondary to perforated diverticular disease. Nevertheless, this review has shown a clear advantage both in terms of immediate mortality and morbidity for primary resection over conservative operations in which the colon is retained in the abdomen. We propose that, when a clinical diagnosis of localized sepsis secondary to diverticular disease is made, the management should be nonoperative with systemic antibiotics and supportive therapy. Operation should be reserved for those patients with obvious generalized peritonitis or failure of conservative treatment. When operation is necessary the affected sigmoid loop should be resected and the operation completed as a Hartmann's procedure in all but the most favourable circumstances when a primary anastomosis may be considered after on-table irrigation of the colon.
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PMID:Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: a review. 638 23

The effect of total parenteral nutrition (TPN) as sole therapy was studied in 30 consecutive cases of complicated Crohn's disease. After insertion of a Broviac-type central venous catheter patients were nourished parenterally for 3 weeks in the hospital and then for an additional 9 weeks at home. During this time no medication or oral intake was allowed. Surgery was avoided in 25 patients by TPN. These patients returned to work, ate normal meals and needed no medical support. In 5 cases it was not possible to control the acute disease and the patients were treated by resection. During TPN, catheter-related sepsis occurred in 3 patients (0.9 cases/1000 days TPN) and catheter embolism in 2. Four other patients developed intrahepatic cholestasis. A relapse of Crohn's disease was observed in 17 cases 3-48 months after the course of TPN. The cumulative recurrence rate is 60 per cent after 2 years and 85 per cent after 4 years. Compared with the results of resection, obtained from a 10-year period before TPN was instituted at our hospital, the cumulative recurrence rate after TPN is four times higher. It is concluded that TPN is not an alternative to resection in the treatment of Crohn's disease and should be reserved for patients with multifocal lesions, when surgery is not advisable because of the risk of a short bowel syndrome.
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PMID:Total parenteral nutrition as the sole therapy in Crohn's disease--a prospective study. 640 50

The peritoneovenous shunt (PVS) is preferred over other treatment modalities in the treatment of the cirrhotic patient who has intractable ascites. The favorable effects on nutrition, pulmonary, and renal function, in addition to prompt control of ascites, frequently overshadow potentially life-threatening complications. We summarized our experience with the PVS in 70 patients with portal hypertension at Emory University, Atlanta, and identified the perioperative complications and operative mortalities. Late complications of sepsis and variceal hemorrhage were frequent and often were fatal. Of the multiple preoperative clinical and laboratory determinants, only the serum bilirubin level (greater than or equal to 3 mg/dL) was predictive of the operative mortality and longevity of survivors. The PVS should be reserved for patients with disabling, truly refractory ascites.
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PMID:Peritoneovenous shunts. Lessons learned from an eight-year experience with 70 patients. 647 96


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