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At least 739 records · Page 41Linked to original sources
PubMed1989

[Infection as a cause of multiple organ failure. Definition, pathophysiology and diagnostic parameters].

DEFINITION: Several clinical observations support the hypothesis that bacterial sepsis is the main aetiological factor in at least half of the patients developing multiple organ failure. Sepsis is defined as the pathophysiological alterations and life-threatening clinical consequences of the action of microorganisms or their products invading the blood stream from a focus of infection. The clinical course of sepsis is highlighted by initial multiorgan insufficiency progressing to severe multiple system organ failure. PATHOPHYSIOLOGY: Pathogenetic bacteria and bacterial toxins arise from the septic focus, overcome the defence mechanisms of the body, continuously invade the blood stream, activate the biological cascade systems and initiate release of mediators from blood and tissue cells. Endotoxin and activated mediators cause endothelial and organ cell dysfunction and cell damage by at least three mechanisms: maldistribution of blood flow; cytotoxia; direct inhibition of oxygen-utilising cell enzymes. CLINICAL PICTURE: The septic disease begins with unspecific signs caused by invasion of bacteria, followed by alterations of the circulatory system, the blood clotting system, the metabolism, initiating vital organ dysfunctions and finally acute respiratory, renal, gastrointestinal, hepatic failure and septic encephalopathy. DIAGNOSIS: The clinical diagnosis of sepsis is based on the finding of an obvious septic focus with the presence of at least four of the following 5 criteria: (I) fever above 38.8 degrees C or hypothermia below 35.5 degrees C; (II) tachypnoea (greater than 24/min) or hypocapnia (PaCO2 less than 32 mmHg); (III) tachycardia (greater than 100 Bpm), (IV) leucocytosis (greater than or equal to 15.000/mm3) or leucopenia (greater than 5.000/mm3); (V) presence of at least one indicator for inadequate organ perfusion like mental alterations, hypoxaemia (PaCO2 less than 75 mmHg while breathing room air), hyperlactataemia (greater than 1,6 mmol/l), diuresis below 30 ml/h, drop in systolic blood pressure below 100 mmHg. A positive blood culture or a positive limulus test are frequent but are not considered to be obligatory for the diagnosis of sepsis.

Bacterial Infections↗
PubMed1982

[Problems after surgery of the colon (author's transl)].

After surgery of the colon 3 types of sequelae may be observed: 1. Acute intra- and postoperative complications, as insufficiency of the anastomosis, ileus, and rebleeding; sequelae of these acute complications may be stenosis of the stenosis and intraabdominal adhesions. 2. Chronic postoperative syndromes like blind-loop syndrome, diarrhoea and/or continence problems, problems arising from an anus praeter, disturbances of sexual and bladder function. These symptoms occur rather rarely after partial resection of the rectum or amputation of the rectum. 3. Recurrence of the main disease, especially cancer disease, be it a local recurrence or metastasis. A well organized follow-up of cancer patients may increase survival time only in a few cases, but it definitely may improve quality of life by different means.

Aftercare↗
PubMed1994

Nitric oxide: a new biological messenger molecule.

Nitric oxide, a recently discovered gaseous biological messenger molecule, has been found to play a fundamental regulatory role in the body. It is involved in the cardiovascular, immune, reproductive, and digestive physiology and its presence in the brain indicates that it will have a neuronal function as well. Several areas of research suggest that low levels or absence of nitric oxide may be the underlying cause of some forms of essential hypertension and impotence, while over-production could be the cause of neuronal damage, septic shock, and immune-related tissue damage.

Acetylcholine↗
PubMed1996

[A clinical evaluation of fluconazole in deep seated fungal infections associated with hematological disorders].

The effectiveness of fluconazole on deep seated fungal infections associated with hematological disorders was evaluated in a multicenter clinical study. The underlying diseases included acute myeloblastic leukemia, acute lymphocytic leukemia, malignant lymphoma, adult T cell leukemia, multiple myeloma and others. Fluconazole (FLCZ) was administrated 100-400 mg/day intravenously or orally to 79 patients with systemic fungal infections complicated with hematological disorders and it was possible to evaluate clinical efficacies in 60 patients. 27 patients were diagnosed as having determinate systemic fungal infections and 33 patients suspected fungal infections. The clinical efficacies were 81.5% (22/27) in patients with diagnosed fungal infections and 57.6% (19/33) in patients with suspected fungal infections. The overall clinical efficacy was 68.3% (41/60). No side effects such as gastrointestinal symptoms, vascular pain and renal dysfunction were observed in this study. As for abnormal laboratory test, transient increases in GOT, GPT, Al-P, LDH, serum Na, Cl and decrease in serum K were observed in 9 patients (11.4%). These results indicated that FLCZ has a high therapeutic efficacy on deep seated fungal infections in patients with hematological disorders.

Aged↗
PubMedDate not supplied

[A case report of Shy-Drager disease].

Shy and Drager in 1960 first described a disease of adult onset characterized by the progressive development of autonomic deficits. The most frequent symptoms are related to orthostatic hypotension, impaired gastrointestinal motility, and urinary and sexual dysfunction. Recently the syndrome has been linked to other degenerative disorders like striatonigral degeneration and olivopontocerebellar atrophy. This combination of degenerative diseases has come to be known as multiple system atrophy (MSA). Shy-Drager disease is most often met in 5 and 6 decade in men and women equally. Apart from autonomic dysfunction symptoms we can find a combination of signs connected with lesions localized in different regions of brain and cord. However, hypertonic-akinetic syndrome is the most often met in patients as an additional symptom. According to this to make a differential diagnosis is often difficult and possible only after autopsy. We describe the case of 57 years old male patient who was admitted to our Clinic because of episodes of orthostatic hypotension, urinary incontinence, sexual impotence; and parkinsonism. In MRI there were changes described as degenerative localized in different parts of brain an cord. Treatment of hypertonic-akinetic syndrome with levodopa/carbidopa and agonists of dopamine receptors increased the frequency of hypotonic episodes. High level of sensitivity to antiparkinsonian drugs is well known feature found in patient with Shy-Drager disease.

Echoencephalography↗
PubMed2007

[Clinical epidemiology of 1,087 patients with multiple organ dysfunction syndrome].

OBJECTIVE: To investigate the clinical epidemiological characteristics of multiple organ dysfunction syndrome (MODS) in China. METHODS: A multiple-center and prospective survey of the patients with MODS admitted to 37 hospitals in 11 provinces from March 2002 to January 2005. RESULTS: The original causes of the MODS were still severe infection, major operations, shock, cardio-pulmonary resuscitation, trauma, and severe acute pancreatitis. The age of 66.1% patients was over 60 years in 1 087 patients. The total mortality of the 1 087 patients was 60.4%. With the age increased, the mortality also increased. The mortalities of the group with simple dysfunction of the brain, lung, kidney, blood, cardiovascular system and gastrointestinal tract were higher than those of the group with the normal organ function. The mortality increased obviously with the numbers of the dysfunction organs. The methods of supportive treatment for the dysfunctional organs were more sophisticated than before. Especially the rates of administration of blood purification, parenteral alimentation, and enteral alimentation were higher. CONCLUSION: Although the methods of supportive treatment in the dysfunctional organs are more sophisticated, the mortality of the MODS was still as high as 60.4%. The number of patients with age higher than 60 years was 713 cases (66.1%), therefore how to manage senile-MODS has become a major problem. Cardiovascular system, the brain, kidney, gastrointestinal tract, lung, liver and blood were the main organs involved, and the mortality of dysfunction of cardiovascular system ranked the highest.

Adolescent↗
PubMed1998

Pharmacokinetics of drugs used in critically ill adults.

Critically ill patients exhibit a range of organ dysfunctions and often require treatment with a variety of drugs including sedatives, analgesics, neuromuscular blockers, antimicrobials, inotropes and gastric acid suppressants. Understanding how organ dysfunction can alter the pharmacokinetics of drugs is a vital aspect of therapy in this patient group. Many drugs will need to be given intravenously because of gastrointestinal failure. For those occasions on which the oral route is possible, bioavailability may be altered by hypomotility, changes in gastrointestinal pH and enteral feeding. Hepatic and renal dysfunction are the primary determinants of drug clearance, and hence of steady-state drug concentrations, and of efficacy and toxicity in the individual patient. Oxidative metabolism is the main clearance mechanism for many drugs and there is increasing recognition of the importance of decreased activity of the hepatic cytochrome P450 system in critically ill patients. Renal failure is equally important with both filtration and secretion clearance mechanisms being required for the removal of parent drugs and their active metabolites. Changes in the steady-state volume of distribution are often secondary to renal failure and may lower the effective drug concentrations in the body. Failure of the central nervous system, muscle, the endothelial system and endocrine system may also affect the pharmacokinetics of specific drugs. Time-dependency of alterations in pharmacokinetic parameters is well documented for some drugs. Understanding the underlying pathophysiology in the critically ill and applying pharmacokinetic principles in selection of drug and dose regimen is, therefore, crucial to optimising the pharmacodynamic response and outcome.

Adult↗
PubMedDate not supplied

Gastric emptying time in children with progressive muscular dystrophy.

Gastric emptying was evaluated in 11 male children (mean age 8.2 +/- 3.2 years) with progressive muscular dystrophy to detect gastrointestinal smooth muscle involvement. No patient had gastrointestinal symptoms. Gastric emptying studies were performed by using 500 microCi of technetium 99 m sulfur colloid bound to a scrambled egg, and scintigraphic measurements were taken continuously for 60 to 90 minutes. The gastric emptying studies were compared with those of eight male children (mean age 8.2 +/- 2.8 years) without gastrointestinal or muscular disorders. The mean percentage of retention of gastric isotope was significantly greater in the study group than in the control group. These data suggest that dysfunction of the smooth muscle of the upper gastrointestinal tract is detectable in children with progressive muscular dystrophy, even when gastrointestinal symptoms are absent.

Case-Control Studies↗
PubMedDate not supplied

Role of serum creatinine and prognostic scoring systems in assessing hospital mortality in critically ill cirrhotic patients with upper gastrointestinal bleeding.

BACKGROUND: End-stage liver disease is frequently complicated by episodes of gastrointestinal hemorrhage that are often associated with multiple organ dysfunction and require intensive care. This study aimed to identify specific predictors of hospital mortality in critically ill cirrhotic patients with gastrointestinal bleeding, and compare the prediction accuracy of the Child-Pugh score and two illness severity scoring systems frequently used for intensive care unit (ICU) patients. METHODS: 76 patients with liver cirrhosis and upper gastrointestinal bleeding were admitted to the ICU from April 2001 to March 2002. In addition, 27 demographic, clinical and laboratory variables, including parameters assessing liver and renal function and systemic hemodynamics, were analyzed as survival predicators. Finally, information required, calculating the Child-Pugh, Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation (APACHE) III score on the 1st day of ICU admission, was gathered prospectively. RESULTS: Overall, hospital mortality was 68.4%. Liver disease was generally attributed to hepatitis B viral infection. Furthermore, multiple logistic regression analysis showed that mean arterial pressure (MAP), Child-Pugh points, and serum creatinine (Cr) were significantly related to prognosis. The SOFA and APACHE III models displayed good areas under the receiver operating characteristic (ROC) curve. CONCLUSION: The rise of serum Cr levels above 1.5 mg/dL is common, and indicates a poor prognosis for critically ill cirrhotic patients with gastrointestinal bleeding. SOFA is a straightforward approach with excellent prognostic abilities for this homogeneous patient subset.

APACHE↗
PubMed2002

[Gastrointestinal motility and vegetative balance: correlations in peptic ulcer].

To evaluate changes in gastrointestinal motility and their correlations with vegetative dysfunction in duodenal ulcer, computed electrogastroenterography was made in 22 healthy subjects, 23 patients with uncomplicated duodenal ulcer and 45 patients with duodenal ulcer complicated by fat hepatosis, chronic cholecystitis and/or biliary dyskinesia, chronic pancreatitis, reflux esophagitis. The study was also made of the vegetative tonicity, vegetative reactivity, circadian urine excretion of vanilylmandelic acid. It was discovered that uncomplicated duodenal ulcer is characterized by intensive gastrointestinal motility correlating with parasympathicotonia and vegetative hyperreactivity. In patients with complicated duodenal ulcer gastric and intestinal motor activity is weaker than in patients with uncomplicated ulcer. They have parasympathicotonia and low vegetative reactivity but gastrointestinal motility does not depend much on functional state of the autonomic nervous system.

Adolescent↗
PubMedDate not supplied

Clinical characteristics of preoperative hypoalbuminemia predict outcome of cardiovascular surgery.

OBJECTIVE: To define the clinical characteristics and outcome of preoperative hypoalbuminemia in adult cardiovascular surgery. STUDY: Inception cohort. SETTING: Adult cardiovascular intensive care unit (CVICU). PATIENTS: Admissions to CVICU between January 1 and December 31, 1993. INTERVENTION: Preoperative hypoalbuminemia (serum albumin < or = 3.5 g/dL) was classified by the presence of malnutrition cachexia (body mass index of < or = 20 kg/m2), liver insufficiency (serum bilirubin > or = 2.0 mg/dL), history of congestive heart failure, or hypoalbuminemia alone. Demographics, chronic diseases, systemic hemodynamics, and laboratory data were obtained at preoperative and later on admission and during the stay in the CVICU. OUTCOME MEASURES: Postoperative organ dysfunction, nosocomial infections, length of mechanical ventilation, hospitalization and death. RESULTS: A total of 2,743 patients (91%) of 3,025 patients who were admitted to the CVICU were enrolled in the study. Preoperative hypoalbuminemia was found in 325 patients (12%): hypoalbuminemia and cachexia in 21 patients (6%), hypoalbuminemia and liver insufficiency in 26 patients (8%), hypoalbuminemia and history of congestive heart failure in 102 patients (31%), and hypoalbuminemia alone in 176 patients (54%). Clinical features of preoperative hypoalbuminemia were age > or = 75 years, female gender, left ventricular ejection fraction < or = 35%, hematocrit < or = 34%, serum creatinine > or = 1.9 mg/dL, systemic oxygen delivery < or = 350 mL/min.m2, acute stressful conditions (eg, infective endocarditis, acute myocardial infarction, or emergency surgery) and chronic obstructive pulmonary airway disease. Redo operations, combined valve and coronary artery bypass graft, mitral valve replacement, and thoracic aortic surgery were the commonest types of surgery performed in these patients. All types of hypoalbuminemia except for malnutrition cachexia increased the likelihood of postoperative organ dysfunction (cardiac, pulmonary, renal, hepatic, and neurologic), gastrointestinal bleeding, nosocomial infections, length of mechanical ventilation, stay in the CVICU, and hospital death. Cachectic hypoalbuminemia increased the requirement for postoperative parenteral nutrition and prolonged the length of stay in hospital. CONCLUSION: Preoperative hypoalbuminemia was attributed to malnutrition cachexia, liver insufficiency or congestive heart failure in < 50% of cardiac patients undergoing cardiovascular surgery. All types of hypoalbuminemia except for malnutrition cachexia increased the likelihood of postoperative organ dysfunction, nosocomial infections, prolonged mechanical ventilation, and death. The morbidity and mortality attributed to hypoalbuminemia could be explained by the underlying clinical characteristics rather than malnutrition cachexia in cardiac patients.

Aged↗
PubMed1995

[A case report of prosthetic valve replacement for malfunction of the Hancock valve in mitral position associated with recurrent peptic ulcer and renal dysfunction].

A 62-year-old woman was admitted with malfunction of the Hancock valve in mitral position. She had been suffering from gastroduodenal ulcer for about ten years. She couldn't take warfarin after 5 years later of the initial operation due to recurrent gastrointestinal bleeding. Judging from her age and renal dysfunction, we preferred mechanical valve to avoid the risks for the reoperation. After confirming the healed ulcer with administering omeprazole, we performed prosthetic valve replacement with SJM 29 M successfully. Postoperative course was uneventful and recurrence of the ulcer was not observed.

Female↗
PubMed1993

Anorectal dysfunction and rectal prolapse in progressive systemic sclerosis.

Our aim was to characterize the clinical spectrum of anorectal dysfunction among eight patients with progressive systemic sclerosis (PSS) who presented with altered bowel movements with or without fecal incontinence. The anorectum was assessed by physical examination, proctosigmoidoscopy, and anorectal manometry. There was concomitant involvement of the other regions of the digestive tract in all patients as determined by barium studies, endoscopy, or manometry: eight esophageal, three gastric, four small bowel, and two colonic. Seven patients had fecal incontinence, and four also had second-degree complete rectal prolapse. Abnormal anorectal function, particularly abnormal anal sphincter resting pressures, were detected in all patients; anal sphincter pressures were lower in those with rectal prolapse. Rectal capacity and wall compliance were impaired in seven of seven patients. Successful surgical correction of prolapse in three patients resulted in restoration of incontinence for six months and seven years in two of the three patients. We conclude that rectal dysfunction and weakness of the anal sphincters are important factors contributing, respectively, to altered bowel movements and fecal incontinence in patients with gastrointestinal involvement by PSS. Rectal prolapse worsens anal sphincter dysfunction and should be sought routinely as it is a treatable factor aggravating fecal incontinence in patients with PSS.

Aged↗
PubMed2006

Irritable bowel syndrome: recent and novel therapeutic approaches.

Irritable bowel syndrome (IBS) is a highly prevalent functional gastrointestinal disorder affecting up to 3-15% of the general population in Western countries. It is characterised by unexplained abdominal pain, discomfort and bloating in association with altered bowel habits. The pathophysiology of IBS is considered to be multifactorial, involving disturbances of the brain-gut-axis: IBS has been associated with abnormal gastrointestinal motor functions, visceral hypersensitivity, psychosocial factors, autonomic dysfunction and mucosal inflammation. Traditional IBS therapy is mainly symptom oriented and often unsatisfactory. Hence, there is a need for new treatment strategies. Increasing knowledge of brain-gut physiology, mechanisms, and neurotransmitters and receptors involved in gastrointestinal motor and sensory function have led to the development of several new therapeutic approaches. This article provides a systematic overview of recently approved or novel medications that show promise for the treatment of IBS; classification is based on the physiological systems targeted by the medication. The article includes agents acting on the serotonin receptor or serotonin transporter system, novel selective anticholinergics, alpha-adrenergic agonists, opioid agents, cholecystokinin antagonists, neurokinin antagonists, somatostatin receptor agonists, neurotrophin-3, corticotropin releasing factor antagonists, chloride channel activators, guanylate cyclase-c agonists, melatonin and atypical benzodiazepines. Finally, the role of probiotics and antibacterials in the treatment of IBS is summarised.

Animals↗
PubMed2006

Treatment options for autonomic neuropathies.

Autonomic disorders may present in a varied fashion. Symptoms that may require treatment include orthostatic intolerance, gastrointestinal distress, sudomotor abnormalities, and urologic and sexual dysfunction. Realistic treatment goals should be outlined for patients, with the expectations that symptoms can be improved, but that the disease is unlikely to be cured and long-term therapy may be required. Orthostatic intolerance is usually treated by a combination of pharmacologic and nonpharmacologic therapies. Nonpharmacologic therapies include compression stockings, adequate fluid and salt intake, and lifestyle modifications. Polypharmacologic therapy is often the standard and can include a volume-expanding agent (such as fludrocortisone) and a sympathomimetic agent. This combination will improve symptoms dramatically in most patients. Treatment of gastrointestinal disorders should address the particular symptom involved: gastroparesis, constipation, or diarrhea. Treatment of sexual and urogenital dysfunction often requires a combination of pharmacologic intervention and lifestyle modifications for peak effectiveness. Patient education is the cornerstone of treatment in any of the autonomic disorders. Given enough education and motivation, many patients will be able to participate in their treatment, which will provide a feeling of empowerment and control over a disease that is often frustratingly resistant to treatment.

Journal Article↗
PubMed2001

Small bowel motility and colonic transit are altered in dogs with moderate renal failure.

Although gastrointestinal complications are common in patients with renal disease, the effects of renal dysfunction on bowel motility and gut transit times are not well known. We assessed gastrointestinal electromyographic activity, gastric emptying rate, orocolonic transit time, oroanal transit time, and xylose absorption before and after surgically inducing a 66% decrease in glomerular filtration rate in dogs. Moderate renal failure induced no gross or microscopic gastrointestinal lesions but caused a 16-42% increase in gastrointestinal motility indexes. We found a 24% decrease in the propagation velocity of the myoelectrical migrating complex in the duodenojejunal segment, a 30% decrease in phase I duration in duodenal and jejunal regions, a 20% increase in the total irregular electrical activity of the small intestine, and a 22% increase in duration of the meal response in the duodenum and jejunum. Renal failure did not change xylose absorption, gastric emptying rate, and orocolonic transit time but decreased colonic transit time by 38%. The mean weight of feces was increased. These results indicate that moderate renal failure alters duodenojejunal motility and decreases colonic transit time.

Animals↗
PubMed1975

Gastrointestinal manifestations of the muscular dystrophies.

Five patients with acute megacolon with varied types of progressive muscular dystrophy are presented. Dysfunction of smooth muscle among patients with muscular dystrophy is reviewed. The extra gastrointestinal roentgen features are summarized. Recognition of the diffuse smooth muscular involvement among patients with muscular dystrophy is stressed for proper diagnosis and patient management.

Adult↗