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

In the immunocompromised patient, even mild forms of any combination of headache, meningismus, altered mental status, or focal neurologic signs should initiate an evaluation for possible CNS infection. The limited signs and symptoms of acute CNS infection are not due to specific organisms but to pathologic changes at the neuroanatomic site of infection. The initial clinical history, examination, laboratory, and neuroradiographic data will narrow the problem to one of several groups of agents, although it may not be possible to specify a single causative agent. It should be remembered that several concurrent infections (i.e., CMV and toxoplasmosis, aspergillosis, and bacterial sepsis) may be present. Thus, the clinician should rely on broad antibiotic coverage appropriate to the suspected causative agent or agents at the site of infection. It may be necessary to offer broad-spectrum antibiotic coverage for a CSF presentation that is subsequently found to result from a viral illness or from a noninfectious cause. However, one should avoid undertreating those infections for which specific therapy can be offered, and broad-spectrum treatment usually will not be regretted. Uncertainty in diagnosis following noninvasive procedures should lead to a brain biopsy. Although many of the infections discussed in this article have a poor prognosis, some of the most common pathogens, such as Cryptococcus, Listeria, and Toxoplasma, have effective specific therapies to which the patient should have access as rapidly as possible. The clinician who has successfully treated a patient with CNS infection should remain vigilant for late sequelae or recurrence of infection. Chronic treatment of some infections, such as toxoplasmosis or aspergillosis, may be necessary. The reintroduction of steroids for the treatment of an underlying cancer may reactivate previously treated disease, such as cryptococcosis, and periodic CSF surveillance is appropriate under these circumstances. Recurrence of the symptoms should raise the suspicion of recurrent or new infection, and the patient also should be evaluated with CT or MRI for the development of hydrocephalus or for new metastatic disease. In patients who have had varicella-zoster infection, postherpetic neuralgia and delayed arteritis may develop. Seizures, hearing loss, and neuropsychologic sequelae may follow any meningoencephalitis. The patient should always be reevaluated for the possibility of infection with a different opportunistic organism. CNS infections remain a major cause of morbidity and mortality in immunosuppressed patients with malignancies. In one series, 60% of such patients died as a result of their CNS infection, many at a time when the underlying disease had an otherwise good prognosis.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Central nervous system infections in cancer patients. 175 29

A 54-year-old man received insertion of an acupuncture needle into the region extending from the posterior neck to the back on two occasions for the treatment of shoulder stiffness. Two weeks after the second acupuncture, he developed fever, dysarthria and mictionary disturbance, finally reaching the condition of tetraplegia. He was immediately admitted to an emergency room in our hospital, and was diagnosed as sepsis with DIC, ARDS, heart failure, renal failure, liver failure, and myelitis. After one month, he recovered with transverse myelopathy as a residual deficit. Neurological findings showed transverse myelopathy below the level of Th2 at that time. Cervical CT revealed an irregular low density at the periphery of the cervical vertebra from the C2 to C4 level. Cervical MRI revealed an irregular swelling of his spinal cord from the C2 to C7 level. We explained the mechanism of transverse myelopathy in this case as follows. After the acupuncture, he suffered a focal infection of the region of needle insertion, and then the infection expanded to the cervical vertebra, thus causing osteomyelitis, sepsis, and finally cervical myelitis. Direct injury of the spinal cord and nerve roots as a complication of acupuncture was previously reported, but indirect injury of the spinal cord due to myelitis had not been reported except our present case. Careful attentions should be paid to the complications of acupuncture.
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PMID:[A case of transverse myelopathy caused by acupuncture]. 178 54

A rare case of bilateral renal cortical necrosis (BRCN) diagnosed only by the characteristic and specific findings of a contrast-enhanced CT scan during the acute initial phase of the disease is presented in this paper. Furthermore, twenty-eight patients of BRCN in the world literatures in English after 1980 were analyzed to investigate the changes in its clinical features over the past 15 years in comparison with the reported data before 1980 from two large centers in France (F) and India (I). Obstetric causes decreased from 68% (F) and 71% (I) before 1980 to 28% after 1980, whereas nonobstetric causes increased from 32% (F) and 29% (I) to 72% after 1980. Among the nonobstetric causes of BRCN, the leading causes were sepsis in 4 out of 12 patients (F) and snake bite in 6 out of 14 patients (I) before 1980, but, in contrast, drugs in 4 out of 21 patients after 1980. As a definite diagnostic procedure for BRCN, 95 to 100% before 1980 but 86% after 1980 performed renal biopsy, of which renal biopsy while living was done in only 42% (F) and 16% (I) before 1980 and 67% after 1980. None showed renal calcification in abdominal X-ray, and only 25% (3/12) had nonspecific echo findings in renal ultrasonography, whereas the high sensitivity for BRCN was noted in renal arteriography in 100% (6/6) and contrast-enhanced CT scan in 88% (7/8). The mortality of BRCN decreased from 55% (F) and 86% (I) before 1980 to 36% after 1980. This review of BRCN, in conclusion, revealed the distinctive changes over the past 15 years in the etiology with a higher incidence of non-obstetric causes than obstetric ones, diagnostic procedures with less dependence on renal biopsy but new trials of non-invasive radioimagings including CT scan and even MRI, and a further declining mortality rate.
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PMID:Bilateral renal cortical necrosis with the changes in clinical features over the past 15 years (1980-1995). 757 93

The spinal cord injury centre of Nizam's Institute of Medical Sciences, Andhra Pradesh, India has been functioning now for 8 months and offers its services to the population of 80 million in the state. To date, 92 patients with a spinal cord injury have been treated; 51 had a thoracolumbar spinal injury. This report presents the results of the management of these 51 patients. Preoperatively both CT and MRI were performed and the radiological findings were correlated with outcome. Twenty five had a thoracic and 26 a lumber location. Twenty nine patients underwent surgical treatment (15 thoracic and 14 lumbar) and the others were treated conservatively (10 thoracic and 12 lumbar). All these operations were carried out within 2 weeks following trauma, and methylprednisolone therapy was instituted in those who reached the hospital early. Contraindications for surgery included a delay in admission of more than 3 weeks following trauma, a focus of sepsis, bedsores, a generalised bone disorder such as osteopenia, and medical illnesses. Transpedicular screw-plate fixation was performed in 27 patients, and two patients underwent decompressive laminectomy and interlaminar bone and wire fixation. Delayed spinal decompression was offered to one patient to relieve radiculopathy. Fracture-dislocation spinal injury and those with transection of the spinal cord had the worst outcome, whilst patients with a wedge compression fracture and cord oedema fared better. Operated cases had a shorter hospital stay, and complications of immobilisation were limited. Positive psychological influence of mobilisation and early acclimatisation to the altered style of living with their disability were the most significant outcomes following surgery.
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PMID:Early surgery for thoracolumbar spinal cord injury: initial experience from a developing spinal cord injury centre in India. 764 63

Lemierre's disease consists of suppurative thrombophlebitis of the IJV in the presence of oropharyngeal infection and can be complicated by septic pulmonary emboli. If a patient has an oropharyngeal or deep neck infection and neck pain suspicious for IJV thrombosis, a CT or MRI is warranted to establish the diagnosis. Blood cultures should be obtained to establish the responsible organism. In most cases F. necrophorum, an anaerobic bacterium, is responsible for the sepsis. Once the diagnosis of Lemierre's disease is made, long-term, high-dose intravenous antibiotics with beta-lactamase anaerobic activity should be initiated. In cases with persistent sepsis and emboli despite appropriate medical management, ligation or excision of the IJV should be performed. Finally, if there is clinical or radiologic evidence of retrograde cavernous sinus thrombosis, the use of anticoagulants should be considered.
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PMID:Lemierre's syndrome: two cases of postanginal sepsis. 777 68

Inflammatory conditions of the aorta may present with non-specific clinical features, including unexplained fever. Indium-111 labelled leucocyte imaging may be performed in such patients to look for the presence of occult sepsis or to assess the activity of a known vasculitis. Of approximately 1100 patients to undergo leucocyte scintigraphy for these indications over a 5 year period, three had focal leucocyte uptake in the aorta. The final diagnoses were: (1) periaortitis in Wegener's granulomatosis; (2) aortic dissection in giant cell arteritis; and (3) streptococcal aortitis with impending rupture. In all three cases the uptake was initially not thought to be in the aorta, but in bowel, a paravertebral abscess and in the lumbar spine respectively. Further imaging with CT and MRI led to the correct diagnoses. As the aorta is a rare site of focal leucocyte uptake, errors in image interpretation are likely. The rapid diagnosis of inflammatory conditions of the aorta is essential, however, as they may be life-threatening if unrecognized; therefore awareness of the aorta as a potential site of uptake is important. Urgent referral for further imaging is imperative in these cases as a false or delayed diagnosis may lead to avoidable morbidity and mortality.
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PMID:Indium-111 labelled leucocyte uptake in aortitis. 782 92

Spontaneous splenic rupture as a complication of infectious mononucleosis was diagnosed in a 19-year-old woman. Sonographic and MRI investigations revealed subcapsular hematoma of the spleen without overt rupture. The patient was managed conservatively. Somatostatin treatment was initiated in order to reduce splanchnic blood flow. Further clinical course of the patient was favourable. Seven days after the diagnosis of splenic rupture the patient was discharged from hospital. Non-operative management should be considered in patients with subcapsular splenic rupture to avoid complications of splenectomy (e.g. post-splenectomy sepsis).
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PMID:Non-operative management in a case of spontaneous splenic rupture in infectious mononucleosis. 788 80

The diagnostic potential of Transesophageal Echocardiography (TEE) is well established in patients with suspicion for some life-threatening diseases as cardiogenic cerebral embolization, aortic dissection, intracardiac or thoracic masses, acute valvular dysfunction or sepsis of undetermined origin, which represent a relevant part in the activity of Intensive Care Units (ICU). Thus, an increasing role of TEE may be foreseen in this arena, also due to some of the known odds of ultrasound techniques compared to other imaging tools like CT scan or MRI (lower cost and beside availability). The aim of the present paper is to briefly review the main indications for TEE in ICU, and to report on some illustrative cases from our experience of I year in this field. Twenty-eight seriously-ill patients referred to our ICU between December 1991 and December 1992 were investigated for 1 of the following diagnostic problems: a) chest trauma with suspicion for aortic dissection and/or mediastinal bleeding; b) sepsis of undetermined origin; c) cerebral transient ischemic attack or stroke; d) assessment of cardiac function in potential heart donors. TEE was performed by means of commercially available instruments (either Hp Sonos 1500 or Esaote Sim 7000 Color Flow Mapping), with conventional monoplane probe or so-called wide-angle, "panoramic" probe, respectively. In most of the patients studied, TEE provided either unique or complementary, diagnostically useful, information. By panoramic approach, which yields imaging field up to 270 degrees, a comprehensive visualization of the heart, aorta and mediastinal structures was possible.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Transesophageal echocardiography in resuscitation. Indications and presentation of various clinical cases]. 820 47

The patient first noticed general muscle stiffness at the age of 36. Two years later, she suffered from a tonic-clonic seizure which brought her to a hospital for the first time. Choreoathetoid movement, ataxia and cognitive deficit were apparent. At the age of 44, tonic-clonic seizures became more frequent and she was admitted to our hospital as being status epilepticus. After the cessation of clinical seizures, she became appllic. Gradual increase of atrophic changes in cerebrum, cerebellum and brain stem were observed by MRI and CT. Hematological study showed that she had abnormal hemoglobin, Hb Takamatsu. Four of her five children were clinically examined; all of them showed abnormal EEG findings; three being mentally retarded and had clinical generalized convulsive seizures; two had hemoglobinopathy (Hb Takamatsu). The patient died from sepsis at the age of 50 and the autopsy was carried out. The brain weighed 930 gram. Histological findings confirmed the diagnosis of dentato-rubro-pallido-luysian atrophy; neuronal loss accompanied by gliosis in dentate nuclei, red nuclei, lateral part of globus pallidus, and subthalamic nuclei. The coincidence of the hereditary traits of two independent diseases, DRPLA and familial hemoglobinopathy (Hb Takamatsu) suggests closeness of their genetic loci.
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PMID:[A familial case of DRPLA diagnosed by an autopsy associated with hemoglobinopathy (Hb Takamatsu)]. 825 33

Mycotic pseudoaneurysms of the ascending aorta are rare cardiovascular lesions that carry the risk of potentially disastrous complications such as aortic rupture or widespread sepsis. Regardless of its location in the arterial system, this lesion carries a high mortality rate. Early diagnosis of mycotic pseudoaneurysm is paramount for optimizing the chances of surgical therapy. While imaging strategies of this lesion have included aortography, echocardiography, and computed tomography, the information gained from each of these individual studies may be acquired in a single MR imaging session. MRI offers the fundamental advantages of noninvasiveness, nonionization, and multiplanar imaging capabilities. Additionally, MRI provides excellent soft tissue contrast, a wide field of view, qualitative and quantitative flow analysis, and an independence of operator expertise or patient body habitus.
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PMID:Detection of mycotic pseudoaneurysm of the ascending aorta using MRI. 827 10


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