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Sample records for acute pleuropulmonary complications

  1. Pleuropulmonary blastoma presenting as a complicated pleural effusion.

    O'Brien, J

    2012-02-01

    Pleuropulmonary blastoma (PPB) is a rare tumour of mesenchymal cells. We present a case of PPB in a child, which presented to the emergency department with an extensive pleural effusion. We discuss the radiological features, pathology, classification and treatment of this condition. This case reiterates the importance of considering this diagnosis prior to surgical intervention, to improve the long term prognosis of this aggressive disease.

  2. [Anesthesia in the pleuropulmonary complications surgery of tuberculosis: a 79 cases study].

    Kane, O; Diouf, E; Beye, M D; Diarra, O; Ndoye Diop, M; Diouf, M; Ndiaye, M; Ka Sall, B

    2003-01-01

    Reported is a retrospective study carried out from Aristide Le Dantec Hospital in patients who underwent pleuropulmonary surgery after tuberculosis complication, from June 1995 to June 1999. The aim of this study was to evaluate the anaesthesiology procedures and outcomes of tuberculosis pleuropulmonary complications surgery. Seventy nine patients were studied. Their mean age was 34.63 years, and the sex ratio was 3.14. They all underwent general anaesthesia procedures with barbituric, morphinics et myorelaxants drugs. The peroperative complications noted were distributed as follow: 50 cases of haemorrhage needing transfusion, 18 cases of hypotension associated to the anaesthesia. In the intensive care period, we have noticed 30 atelectasia cases associated to a spastic bronchopathy, 3 cases of pulmonary oedema and 1 case of pulmonary infarctus. In the postoperative period, 8 cases of hemodynamic instability occurred, including 5 cases of cardiovascular collapsus treated by filling, and 2 septic shocks cases. An infectious bronchopneumopathy was noticed on 11 patients with two cases of septicaemia. The mortality rate was 6.3% (5 cases of death). The pleuropulmonary surgery in tuberculosis complication is very haemorrhagic, and therefore require an adequate preoperative preparation.

  3. Acute pleuropulmonary complications detected by computed tomography following myocardial revascularization Cirurgia de revascularização do miocárdio: complicações pleuro-pulmonares agudas caracterizadas por tomografia computadorizada de tórax

    Francisco S. Vargas

    2002-08-01

    Full Text Available INTRODUCTION: Pleuropulmonary changes are common following coronary artery bypass grafting surgery performed with a saphenous vein graft, with or without an internal mammary artery. The presence of atelectasis or pleural effusions reflects the thoracic trauma. PURPOSE: To define the postoperative incidence of changes in the lung and in the pleural space and to evaluate the influence of the trauma. METHODS: Thirty patients underwent elective coronary artery bypass grafting surgery (8 saphenous vein grafts and 22 saphenous vein grafts and internal mammary artery grafts with pleurotomy. Chest tubes in the left pleural space were used in all internal mammary artery patients. On the second (day 2 and seventh (day 7 postoperative day, patients underwent a computed tomography, and pleural effusions were rated as follows: grade 0 = no fluid to grade 4 = fluid in more than 75% of the hemithorax. Atelectasis was rated as follows: laminar = 1, segmental = 3, and lobar = 10 points. RESULTS: All patients had pleural effusion or atelectasis. Between day 2 and day 7, the number of patients with effusions or atelectasis on the right side decreased (P INTRODUÇÃO: O comprometimento pleuro-pulmonar é freqüente após cirurgia de revascularização do miocárdio independente do uso de veia safena ou de artéria mamária interna. A presença de atelectasias e derrame pleural tem sido atribuída ao trauma torácico. OBJETIVOS: Definir a incidência do comprometimento pleuro-pulmonar observado através de tomografia computadorizada, analisando a influência do trauma no desenvolvimento destas complicações. MÉTODOS: Trinta pacientes foram submetidos a cirurgia eletiva de revascularização do miocárdio (8 safena e 22 também mamária com pleurotomia. Foi drenada a cavidade pleural esquerda de todos os pacientes do grupo mamária. Realizada Tomografia Computadorizada do tórax no 2º e 7º dias pós-op, avaliando-se o derrame pleural (0: sem líquido e 4: derrame

  4. Pleuropulmonary manifestation of paragonimiasis

    Im, Jung Gi; Kim, Sang Joon; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1988-08-15

    Chest radiographic findings of 47 patients with pleuropulmonary paragonimiasis were analysed retrospectively. The diagnosis was based on the presence of Paragonimus Westermani (PW) ova from sputum, bronchial washing or needle aspirates (23 patients), PW specific antibody test by micro-ELISA (22 patients) and compliment fixation test (3 patients). 85% of the patients (40/47) showed pulmonary lesion such as focal air space consolidation (24), thin walled cysts (21), transient linear density in early active stage (18), nodular density (12) and burrow tracts (7). CT scans of 6 patients showed worm cysts and burrow tracts clearly and were also helpful in differentiating from lung cancer. 62% of the patients showed pleural lesion such as pleural effusion (17, bilateral in 4 patients), hydropneumothorax (8, bilateral in 6 patients) and pleural thickening (4). Thin walled cysts, migrating nature of the focal patchy pulmonary infiltration, transient linear shadow in the lung periphery, soap bubble appearenced cystic cavities, bilateral spontaneous pneumothoraces are the typical findings of pleuropulmonary paragonimiasis.

  5. Acute acalculous cholecystitis complicating chemotherapy for acute myeloblastic leukemia

    Olfa Kassar; Feten Kallel; Manel Ghorbel; Hatem. Bellaaj; Zeineb Mnif; Moez Elloumi

    2015-01-01

    Acute acalculous cholecystitis is a rare complication in the treatment of acute myeloblastic leukemia. Diagnosis of acute acalculous cholecystitis remains difficult during neutropenic period. We present two acute myeloblastic leukemia patients that developed acute acalculous cholecystitis during chemotherapy-induced neutropenia. They suffered from fever, vomiting and acute pain in the epigastrium. Ultrasound demonstrated an acalculous gallbladder. Surgical management was required in one patie...

  6. Pergolide-induced pleuropulmonary fibrosis

    Bleumink, G S; van der Molen-Eijgenraam, M; Strijbos, J H; Sanwikarja, S; van Puijenbroek, E P; Stricker, B H Ch

    2002-01-01

    Pleuropulmonary fibrosis is a rare, but well-recognized adverse effect of ergot alkaloids. We report on four patients who developed pleural and/or pulmonary fibrosis during treatment with pergolide and give characteristics of 87 cases with one or more symptoms of serosal fibrosis. Retroperitoneal an

  7. Acute acalculous cholecystitis complicating chemotherapy for acute myeloblastic leukemia

    Olfa Kassar

    2015-01-01

    Full Text Available Acute acalculous cholecystitis is a rare complication in the treatment of acute myeloblastic leukemia. Diagnosis of acute acalculous cholecystitis remains difficult during neutropenic period. We present two acute myeloblastic leukemia patients that developed acute acalculous cholecystitis during chemotherapy-induced neutropenia. They suffered from fever, vomiting and acute pain in the epigastrium. Ultrasound demonstrated an acalculous gallbladder. Surgical management was required in one patient and conservative treatment was attempted in the other patient. None treatment measures were effective and two patients died. Acute acalculous cholecystitis is a serious complication in neutropenic patients. Earlier diagnosis could have expedited the management of these patients.

  8. Pleuropulmonary blastoma: a case report.

    Ekmekci, Sümeyye; Aysal, Anıl; Olgun, Nur; Olguner, Mustafa; Çakmakci, Handan; Özer, Erdener

    2015-01-01

    Pleuropulmonary blastoma is rare embryonal tumor of infancy and early childhood and it often arises from lung and more rarely from the parietal pleura. We present this entity which has no systematic data associated with its incidence in order to discuss clinical, histopathological, immunohistochemical features and the differential diagnosis. A three-year-old boy presented with fever showed signs of upper respiratory tract infection. Radiological examination revealed a solid mass filling the right hemithorax. The patient underwent core needle biopsy, wedge biopsy and lobectomy. Biopsy and surgical material were examined histopathologically. The tumor was composed of predominantly solid areas consisting blastemal cells with spindle, polygonal and round nuclei in the myxoid stroma. Immunohistochemical staining of the tumor cells were positive with vimentin and desmin. MIB-1 labeling index was above 90%. Histological diagnosis was pleuropulmonary blastoma type 3. The surgically sampled adjacent diafragma was also infiltrated with the tumor. The patient was treated with chemotherapy and showed no signs of recurrence in the follow-up of 9 months. Pleuropulmonary blastoma is a very rare childhood cancer that needs to be kept in mind in the pathological differential diagnosis of thoracic tumors in the children.

  9. [Pleuropulmonary localizations of non-typhoid Salmonella infections].

    Le Chevalier, B; Jehan, A; Brun, J; Vergnaud, M

    1985-01-01

    Non-typhoid salmonella infections are extremely common, usually taking the form of a benign toxi-infection. In the context of the rare extra-digestive manifestations, the authors report 3 cases of pleuro-pulmonary involvement, in infections due to Salmonella Dublin. In 2 cases, the organism was identified from blood cultures, whilst in the 3rd case it was isolated from pleural fluid. As with other extra-digestive sites, pleuro-pulmonary involvement is favored by underlying pathology, accounting for the grave nature of the problem (amongst the 3 cases, gastrectomy and acute myeloblastic leukemia in one case and obliterative arterial disease in another case). Non-typhoid salmonella infections are sensitive to Sulfamethoxazole-trimethoprim which diffuses well in the respiratory system. They are also sensitive to Amoxicillin and to Chloramphenicol.

  10. Acute pancreatitis and acute renal failure complicating doxylamine succinate intoxication.

    Lee, Yang Deok; Lee, Soo Teik

    2002-06-01

    Doxylamine succinate is an antihistaminic drugwith additional hypnotic, anticholinergic and local anesthetic effects first described in 1948. In Korea and many other countries, it is a common-over-the counter medication frequently involved in overdoses. Clinical symtomatology of doxylamine succinate overdose includes somnolence, coma, seizures, mydriasis, tachycardia, psychosis, and rhabdomyolysis. A serious complication may be rhabdomyolysis with subsequent impairment of renal function and acute renal failure. We report a case of acute renal failure and acute pancreatitis complicating a doxylamine succinate intoxication.

  11. Pathophysiology of pulmonary complications of acute pancreatitis

    George W Browne; CS Pitchurnoni

    2006-01-01

    Acute pancreatitis in its severe form is complicated by multiple organ system dysfunction, most importantly by pulmonary complications which include hypoxia,acute respiratory distress syndrome, atelectasis, and pleural effusion. The pathogenesis of some of the above complications is attributed to the production of noxious cytokines. Clinically significant is the early onset of pleural effusion, which heralds a poor outcome of acute pancreatitis. The role of circulating trypsin, phospholipase A2, platelet activating factor, release of free fatty acids,chemoattractants such as tumor necrsosis factor (TNF)-alpha, interleukin (IL)-1, IL-6, IL-8, fMet-leu-phe (a bacterial wall product), nitric oxide, substance P, and macrophage inhibitor factor is currently studied. The hope is that future management of acute pancreatitis with a better understanding of the pathogenesis of lung injury will be directed against the production of noxious cytokines.

  12. Pleuropulmonary Manifestations in Juvenile Systemic Lupus Erythematosus; A Review and Descriptive Study in 64 Cases

    Sam Chitsaz

    2008-04-01

    Full Text Available Objective: Juvenile systemic lupus erythematosus (JSLE is a multisystemic autoimmune disease that can involve multiple organs such as: skin, kidney, musculoskeletal system, brain, and others as well as lung. Pulmonary manifestations may be an initial and/or life-threatening complication of SLE in children. The aim of this report is to describe the first pleuropulmonary manifestation of childhood lupus erythematosus.Material & Methods: We studied retrospectively 64 children with JSLE, diagnosed as JSLE at the Childrens Medical Center Hospital between 1995 and 2005. All met the American College of Rheumatology (formerly American Rheumatism Association, ARA revised criteria for SLE. They were evaluated for evidence of pleuro-pulmonary involvement.Findings: During the 10-yr study period, 64 patients were diagnosed as childhood-onset JSLE, who had the disease at or before the age of 16 (3-16 years. Fifty five patients (86% were females and 9 patients (14% were males (female: male ratio=6/1. Mean age of this group at the onset of the disease was 10 years (range 3-16. Eighteen cases (28% had pulmonary involvement. Pulmonary complications include: infectious pneumonia in 38%, pleuritis in 33%, pulmonary vasculitis in 11%, and acute lupus pneumonitis, chronic interstitial pneumonitis and pulmonary embolism (so-called lupus anticoagulant each one in 5.5%. Conclusion: The prevalence of pulmonary involvement in patients with JSLE varies according to the method used, but clinically significant pulmonary involvement in our series occurs in approximately 28%. There is few data regarding the treatment for most of the immune mediated pulmonary manifestations of JSLE.

  13. Acute gastrointestinal complications after cardiac surgery.

    Halm, M A

    1996-03-01

    Gastrointestinal problems, with an incidence of about 1%, may complicate the postoperative period after cardiovascular surgery, increasing morbidity, length of stay, and mortality. Several risk factors for the development of these complications, including preexisting conditions; advancing age; surgical procedure, especially valve, combined bypass/valve, emergency, reoperative, and aortic dissection repair; iatrogenic conditions; stress; ischemia; and postpump complications, have been identified in multiple research studies. Ischemia is the most significant of these risk factors after cardiovascular surgery. Mechanisms that have been implicated include longer cardiopulmonary bypass and aortic cross-clamp times and hypoperfusion states, especially if inotropic or intra-aortic balloon pump support is required. These risk factors have been linked to upper and lower gastrointestinal bleeding, paralytic ileus, intestinal ischemia, acute diverticulitis, acute cholecystitis, hepatic dysfunction, hyperamylasemia, and acute pancreatitis. Gastrointestinal bleeding accounts for almost half of all complications, followed by hepatic dysfunction, intestinal ischemia, and acute cholecystitis. Identification of these gastrointestinal complications may be difficult because manifestations may be masked by postoperative analgesia or not reported by patients because they are sedated or require prolonged mechanical ventilation. Furthermore, clinical manifestations may be nonspecific and not follow the "classic" clinical picture. Therefore, astute assessment skills are needed to recognize these problems in high-risk patients early in their clinical course. Such early recognition will prompt aggressive medical and/or surgical management and therefore improve patient outcomes for the cardiovascular surgical population.

  14. An unreported complication of acute pancreatitis

    G Muthukumarasamy; V Shanmugam; SR Yule; R Ravindran

    2007-01-01

    Acute pancreatitis constitutes 3% of all admissions with abdominal pain. There are reports of osteal fat necrosis leading to periosteal reactions and osteolytic lesions following severe pancreatitis, particularly in long bones.A 54-year-old man was admitted to our hospital with acute pancretitis, who later developed spinal discitis secondary to necrotizing pancreatitis. He was treated conservatively with antibiotics and after a month he recovered completely without any neurological deficit.This case is reported for its unusual and unreported spinal complications after acute pancreatitis.

  15. Acute complicated diverticulitis managed by laparoscopic lavage

    Alamili, Mahdi; Gögenur, Ismail; Rosenberg, Jacob

    2009-01-01

    PURPOSE: The classic surgical treatment of acute complicated sigmoid diverticulitis with peritonitis is often a two-stage operation with colon resection and a temporary stoma. This approach is associated with high mortality and morbidity and the reversal of the stoma is in many cases not performe...

  16. ICAM-1 and Acute Pancreatitis Complicated by Acute Lung Injury

    XiPing Zhang

    2009-01-01

    Full Text Available One of the most common complications of acute pancreatitis is acute lung injury, during which intercellular adhesion molecule-1 (ICAM-1 plays an important role by participating in leukocyte adhesion and activation as well as by inducing the “cascade effect” of inflammatory mediators, pulmonary microcirculation dysfunction and even acute respiratory distress syndrome, multiple organ failure or death. Although it is generally believed that the modulatory mechanism of ICAM-1 during this process is associated with the activation of nuclear transcription factor kappa B which is mediated by IL-1, IL-6, IL-18 and oxygen free radical, etc., further studies are still required to clarify it. Since the upregulation of ICAM-1 expression in the lung during acute lung injury is one of main pathogeneses, the early detection of the ICAM-1 expression level may contribute to the prevention and treatment of acute lung injury. Moreover, reducing pulmonary ICAM-1 expression levels through treatment with anti-ICAM-1 monoclonal antibody (aICAM-1 and antagonists of the neurokinin 1 receptor, etc., should have a positive effect on protecting the lungs during acute pancreatitis. This review aims to further clarify the relationship between ICAM-1 and acute pancreatitis complicated by acute lung injury, and therefore provides a theoretical basis for the formulation of corresponding therapeutic measures in clinical practice for acute pancreatitis.

  17. Acute pericarditis and renal failure complicating acute hepatitis A infection.

    Beyazit, Yavuz; Guven, Gulay Sain; Kekilli, Murat; Koklu, Seyfettin; Yolcu, Omer Faruk; Shorbagi, Ali

    2006-01-01

    Hepatitis A infection may result in acute hepatitis, and rarely, fulminant hepatitis may ensue. Extrahepatic manifestations of hepatitis A are uncommon. The authors present the case of a 77-year-old male who had development of acute renal failure and pericarditis during the clinical course of acute hepatitis A infection. He died as a result of septic shock on the fifth day of hospitalization. To the best of our knowledge, this is the first report of both these rare and serious complications appearing in the same patient.

  18. ACUTE SYMPTOMS AND COMPLICATIONS OF HEMODIALYSIS

    Bárbara Paula Magalhães de Deus

    2015-07-01

    Full Text Available Backgound and Objectives: Chronic Kidney Disease and the number of patients on renal replacement therapies have become more frequent in recent decades. Even with new technologies used in hemodialysis, which result in greater patient safety, acute symptoms and complications after the procedure may still occur. Recognizing these complications and knowing how to manage them is crucial to ensure a better quality of life for these patients. Content: This is a literature search on symptoms related to hemodialysis, carried out in electronic databases: Periodicals CAPES (Coordination of Higher Education Personnel Training, Brazil, Scientific Electronic Library Online - SciELO, LILACS and Pubmed, from which 30 articles were selected on the main complications observed and described during the course of hemodialysis. Conclusion: There was a prevalence of symptoms related to fluid and electrolyte imbalance and hemodynamic changes, especially headache. KEYWORDS: Renal Insufficiency Chronic; Symptoms; Renal Dialysis.

  19. Acute phlegmonous gastritis complicated by delayed perforation.

    Min, Sun Young; Kim, Yong Ho; Park, Won Seo

    2014-03-28

    Here, we report on a case of acute phlegmonous gastritis (PG) complicated by delayed perforation. A 51-year-old woman presented with severe abdominal pain and septic shock symptoms. A computed tomography scan showed diffuse thickening of the gastric wall and distention with peritoneal fluid. Although we did not find definite evidence of free air on the computed tomography (CT) scan, the patient's clinical condition suggested diffuse peritonitis requiring surgical intervention. Exploratory laparotomy revealed a thickened gastric wall with suppurative intraperitoneal fluid in which Streptococcus pyogenes grew. There was no evidence of gastric or duodenal perforation. No further operation was performed at that time. The patient was conservatively treated with antibiotics and proton pump inhibitor, and her condition improved. However, she experienced abdominal and flank pain again on postoperative day 10. CT and esophagogastroduodenoscopy showed a large gastric ulcer with perforation. Unfortunately, although the CT showed further improvement in the thickening of the stomach and the mucosal defect, the patient's condition did not recover until a week later, and an esophagogastroduodenoscopy taken on postoperative day 30 showed suspected gastric submucosal dissection. We performed total gastrectomy as a second operation, and the patient recovered without major complications. A pathological examination revealed a multifocal ulceration and necrosis from the mucosa to the serosa with perforation.

  20. [Pleuropulmonary infection caused by Mycobacterium smegmatis. Case description and literature review].

    Vonmoos, S; Leuenberger, P; Beer, V; de Haller, R

    1986-12-27

    The case is described of a patient with a tracheostomy subsequent to laryngectomy for carcinoma, who developed a pleuro-pulmonary infection due to Mycobacterium smegmatis complicating lipoid pneumonia after prolonged instillation of gomenol oil into the tracheostoma. The adjuvant property of lipids for the development of respiratory infections due to M. smegmatis and other rapid-growing mycobacteria is discussed in the light of the cases described in the literature.

  1. Acute transverse myelitis: an unusual complication of typhoid fever.

    Mishra, Kirtisudha; Kaur, Sharandeep; Basu, Srikanta; Gulati, Praveen; Parakh, Ankit

    2012-08-01

    Typhoid fever is associated with a wide spectrum of neurological complications. Acute transverse myelitis is a rare complication with only a few reports in adults and none in children. A 15-year-old boy with typhoid fever is reported who developed acute transverse myelitis in the 3rd week of illness. He was treated with antibiotics and corticosteroids and made a complete recovery.

  2. An Unusual Case of Colon Perforation Complicating Acute Pancreatitis

    Anthony A. Aghenta

    2009-08-01

    Full Text Available Colonic complications of severe acute pancreatitis occur rarely. Although there have been several theories on how pancreatic pseudocysts rupture into the colon, the exact pathogenesis remains unknown. We report an unusual case of pseudocysts complicating severe acute pancreatitis presenting with colonic perforation in a 71-year-old man with a history of chronic mesenteric ischemia. Pressure effects from a giant pseudocyst and intravascular volume depletion with acute insult on chronic mesenteric ischemia are highlighted as possible etiologic factors.

  3. Pancreaticobronchial Fistula: A Complication of Acute Pancreatitis

    Dorota Overbeck-Zubrzycka

    2011-01-01

    Full Text Available Context Pancreaticobronchial fistula is a rare complication of severe pancreatitis. Various diagnostic methods have been described previously. Case report The presentation, diagnostic methods, management and 5-year follow-up of a 40-year-old woman with severe gallstone induced pancreatitis complicated by a pancreaticobronchial fistula were reviewed. Diagnosis was made on the endotracheal intubation when amylase rich-fluid was drained via the tube and confirmed by CT scanning. Successful management was achieved by an open pancreatic necrosectomy, during which air bubbles were seen emerging from the pancreatic collection which supported the diagnosis of the fistula. Five-year follow-up did not reveal any complications. Conclusions Pancreaticobronchial fistulas have the potential to cause severe respiratory complications and mortality. Awareness of this condition is important in the treatment of complicated cases of pancreatitis.

  4. Severe Vascular Complications Of Acute Pancreatitis

    Głuszek Stanisław

    2015-10-01

    Full Text Available Acute pancreatitis (AP develops as a result of the imbalance of the mechanisms inhibiting the activity of enzymes in the pancreatic cells, which causes their autoactivation in the pancreas. The incidence of AP ranges from 10 up to 100 cases per 100,000 population per year in different parts of the world. The overall mortality rate for acute pancreatitis is 10-15%. The mortality rate in patients diagnosed with the severe form of acute pancreatitis is up to 30-40%.

  5. [Acute cholangitis secondary to ascariasis and complicated by liver abscesses].

    Rakotonaivo, A; Ranoharison, H D; Razarimahefa, S H; Rakotozafindrabe, R; Rabenjanahary, T H; Ramanampamonjy, R M

    2015-01-01

    Acute cholangitis secondary to ascariasis is rare and occurs mainly in areas of high endemicity. The clinical presentation is non-specific, sometimes complicated by liver abscess. Abdominal ultrasound plays an important role in diagnosis and therapeutic surveillance. We report the case of a 35-year-old Malagasy woman with an acute cholangitis secondary to ascariasis and complicated by liver abscesses and its course to full recovery under medical treatment.

  6. Complications of acute posterior vitreous detachment.

    Kanski, J J

    1975-07-01

    Of 201 patients whose presenting symptoms were acute entoptic phenomena or photopsia, or both, 150 patients had posterior vitreous detachment; 69 patients (46%) had retinal breaks; 18 (12%) had a vitreous hemorrhage without detectable retinal breaks; and two (1.3%) had peripheral retinal hemorrhages without retinal breaks or vitreous hemorrhage. Retinal breaks that occur in eyes in conjunction with acute posterior vitreous detachment are potentially dangerous and there is a possibility of delayed break formation.

  7. Acute stroke: postprocedural care and management of complications.

    de Carvalho, Flávio Augusto; de Figueiredo, Marcelo Marinho; Silva, Gisele Sampaio

    2012-03-01

    Endovascular treatment for acute ischemic stroke is an important alternative to thrombolysis with recombinant tissue plasminogen activator (rt-PA) for patients who present beyond the thrombolysis time window, those who are ineligible for rt-PA, or those who do not improve after intravenous rt-PA. These patients generally require special attention in the postprocedural period because, although not frequent, complications of endovascular procedures in acute ischemic stroke have the potential to be devastating. Neurocritical care is essential to reduce and appropriately treat complications after endovascular procedures. Neurointensivists and neurocritical care nurses are experts in both critical care and neurologic disorders and have special training to recognize early physiological derangements in patients presenting with acute stroke. Close attention to the serial neurological examination, blood pressure control, adequate management of glucose, temperature, and immediate identification of complications such as reocclusion and hemorrhagic transformation are key elements that exemplify the importance of postprocedural neurocritical care in acute ischemic stroke.

  8. Managing Acute Complications Of Sickle Cell Disease In Pediatric Patients.

    Subramaniam, Sathyaseelan; Chao, Jennifer H

    2016-11-01

    Sickle cell disease is a chronic hematologic disease with a variety of acute, and often recurring, complications. Vaso-occlusive crisis, a unique but common presentation in sickle cell disease, can be challenging to manage. Acute chest syndrome is the leading cause of death in patients with sickle cell disease, occurring in more than half of patients who are hospitalized with a vaso-occlusive crisis. Uncommon diagnoses in children, such as stroke, priapism, and transient red cell aplasia, occur more frequently in patients with sickle cell disease and necessitate a degree of familiarity with the disease process and its management. Patients with sickle cell trait generally have a benign course, but are also subject to serious complications. This issue provides a current review of evidence-based management of the most common acute complications of sickle cell disease seen in pediatric patients in the emergency department.

  9. Acute tubulointerstitial nephritis complicating Legionnaires' disease: a case report

    Daumas Aurélie

    2012-04-01

    Full Text Available Abstract Introduction Legionnaires' disease is recognized as a multi-systemic illness. Afflicted patients may have pulmonary, renal, gastrointestinal tract and central nervous system complications. However, renal insufficiency is uncommon. The spectrum of renal involvement may range from a mild and transient elevation of serum creatinine levels to anuric renal failure requiring dialysis and may be linked to several causes. In our present case report, we would like to draw attention to the importance of the pathological documentation of acute renal failure by reporting a case of a patient with acute tubulointerstitial nephritis complicating Legionnaires' disease. Case presentation A 55-year-old Caucasian man was admitted to our hospital for community-acquired pneumonia complicated by acute renal failure. Legionella pneumophila serogroup type 1 was diagnosed. Although the patient's respiratory illness responded to intravenous erythromycin and ofloxacin therapy, his renal failure worsened, he became anuric, and hemodialysis was started. A renal biopsy was performed, which revealed severe tubulointerstitial nephritis. After initiation of steroid therapy, his renal function improved dramatically. Conclusions This case highlights the importance of kidney biopsies in cases where acute renal failure is a complicating factor in Legionnaires' disease. If the presence of acute tubulointerstitial nephritis can be confirmed, it will likely respond favorably to steroidal treatment and thus irreversible renal damage and chronic renal failure will be avoided.

  10. Acute Appendicitis Complicated by Pylephlebitis: A Case Report

    Ricardo Castro

    2013-01-01

    Full Text Available Pylephlebitis is defined as septic thrombophlebitis of the portal vein. It is a rare but serious complication of an intraabdominal infection, more commonly diverticulitis and appendicitis. It has an unspecific clinical presentation and the diagnosis is difficult. The authors report a case of a 21-year-old man with acute appendicitis complicated by pylephlebitis. The diagnosis was made with contrast enhanced CT.

  11. PROSPECTIVE STUDY OF CT IN ACUTE PANCREATITIS AND ITS COMPLICATIONS

    Shivanand S .

    2015-09-01

    Full Text Available Visualization of the pancreas was far better by CT than b y ultrasound. Ultrasound had certain limitation. Due to bowel gas the pancreas may not be visualized. Extra pancreatic spread of inflammation and vascular complications was not always picked up by Ultrasonography. These limitations were overcome with the u se of CT which yielded more diagnostic information in the evaluation of acute pancreatitis. CT is a confirmative investigation in diagnosis and staging of acute pancreatitis. MCTSI is a very useful tool for the screening of patients with acute pancreatitis for the classification of severity accurately and to predict the clinical outcome. OBJECTIVES OF STUDY: To determine the value of computed tomography in evaluation of early diagnosis of acute pancreatitis. To evaluate the complications using computed tom ography severity index. MATERIAL AND METHODS: The study was conducted on 100 patients with clinical suspicion of acute pancreatitis, altered biochemical parameters (Serum amylase, Serum lipase in favor of acute pancreatitis, ultrasonography suggestive of acute pancreatitis and complications known case of chronic pancreatitis with features of acute symptoms who were referred to the department of Radiodiagnosis, Basaveshwar teaching & General Hospital, Kalaburagi. Before evaluating a patient by CT imaging, i nformed consent was obtained from the patient or guardian. The patient were informed about the radiation exposure in the examination. CT was carried out using Philips 6 slice scanner. Scan was obtained with both plain and contrast study. RESULT: 100 patien ts were included in the study. 83% patients were males and 17% patients were females. Majority of patients belonged to 31 - 40 yrs. of age group. Alcohol was the most common cause of acute pancreatitis. 73 patients had positive ultrasound finding while CT wa s positive in all cases. According to, MCTSI 63 patients had moderate, 26 patients had mild and 11 patients had severe

  12. Entamoeba histolytica pleuropulmonary infection. Case report and review of the literature.

    Chalhoub, Sanaa; Kanafani, Zeina

    2012-01-01

    Pleuropulmonary amebiasis is the 2nd most common extraintestinal site of amebiasis after liver abscess. We describe a man with pleuropulmonary amebiasis presenting with pulmonary consolidation and pleural effusion. In patients with pneumonia coming from endemic countries such as Lebanon, pleuropulmonary amebiasis should be considered in the setting of chocolate-colored sputum, negative respiratory cultures, and failure of antibacterial therapy.

  13. A Rare Complication of Acute Otitis Media: Otitic Hydrocephalus

    Ahmet Mutlu

    2013-06-01

    Full Text Available Acute otitis media is very common disorder in childhood. In this article we present a 6-years old boy who applied with diplopia, dysfunction of lateral eye movements on left eye, nausea, at 10th day of acute otitis media treatment. After the radiological images case was described as an otitic hydrocephalus clinic. Patient underwent medical treatment, lomboperitoneal shunt operation and simple mastoidectomy. We wanted to share the evaluation and the management steps of this very rare complication of acute otitis media.

  14. Right adrenal abscess -- an unusual complication of acute apendicitis.

    Dimofte, Gabriel; Dubei, Liviu; Lozneanu, Lili-Gabriela; Ursulescu, Corina; Grigora Scedil, Mihai

    2004-09-01

    Acute appendicitis represents one of the most frequent abdominal emergencies encountered in everyday surgical practice. Local infectious complications are not unusual and retroperitoneal abscesses after acute retrocaecal appendicitis have been previously described. The authors present the case of a 22-years-young female patient, admitted for a right iliac fossa abscess, secondary to gangrenous appendicitis. A right adrenal mass 35/40 mm was revealed during preoperative ultrasound evaluation, which evolved in an adrenal abscess that spontaneously drained 10 days after appendectomy and retrocecal drainage. Adrenal abscesses are exceptionally rare, with only a few cases being reported in the literature, but none of these after acute appendicitis.

  15. Coronary Artery Vasospasm Complicating Acute Myocarditis: A Rare Association

    Ferguson, David W.; Farwell, Allan P.; Bradley, William A.; Rollings, Robert C.

    1988-01-01

    A 17-year-old boy had a 2-day prodrome of fever and mild sore throat followed by 2 episodes of severe anginal chest discomfort and substantial transient ST-segment elevations in the anterior leads of the electrocardiogram. A subsequent evaluation showed the 2 episodes were most likely coronary vasospasm complicating acute viral myocarditis.

  16. Acute pancreatitis : a newly recognised potential complication of canine babesiosis

    A.J. Möhr

    2000-07-01

    Full Text Available This retrospective study describes 4 cases of canine babesiosis with histologically confirmed acute pancreatitis. In addition, 16 dogs with babesiosis are reported with serum amylase (>3500 U/l and/or lipase (>650 U/l activity elevations of a magnitude that would support a diagnosis of probable acute pancreatitis, although extra-pancreatic sources of the enzymes could not be excluded in these cases. Median time of pancreatitis diagnosis was 2.5 days post-admission, with primarily young (median age 3 years, sexually intact dogs affected. The development of pancreatitis was unrelated to the degree of anaemia at time of admission. In addition to pancreatitis, 80 % of cases suffered from other babesial complications, namely icterus (13, acute respiratory distress syndrome (6, immune-mediated haemolytic anaemia (6, renal failure (3, haemoconcentration (2 and cerebral syndrome (2. Acute respiratory distress syndrome, renal failure and cerebral syndrome were associated with a poor prognosis, with 4 of the 5 dogs included in the overall 26 % mortality rate having at least 1 of these complications. Haemolytic anaemia with ischaemia-reperfusion injury to the pancreas is proposed as a possible primary pathophysiological mechanism in babesial pancreatitis. Hypotensive shock, immune-mediated haemolytic anaemia, haemoconcentration and possibly altered lipid metabolism in babesiosis may also be involved. The previously postulated pro-inflammatory cytokine milieu of complicated babesiosis may underlie the progression, if not the primary initiation, of pancreatic pathology. Acute pancreatitis may represent the previously reported 'gut' form of babesiosis.

  17. An Unusual Complication of Foam Sclerotherapy: Acute Kidney Injury

    Müge EREK

    2014-09-01

    Full Text Available Sclerotherapy, in which an irritant solution is administered, is a method used to treat venous failure that results in complete venous destruction due to endothelial reaction and fibrosis. In recent years, foam sclerotherapy, in which a sclerosing agent (aethyl sclerole and air are mixed until they turn into foam and the resultant mixture is injected into noticeable veins directly and into other veins under ultrasonography in doses depending on the diameters of the varices, has been introduced. The drugs or gases used in foam sclerotherapy can cause local or systemic complications. Foam affects vessel endothelial cells and causes severe spasm in the vessel. It has been reported that endothelin-1 levels are high after foam sclerotherapy compared to the initial levels and that neurological complications vary with the endothelin levels. In this report, we present a case of acute kidney injury due to acute tubular necrosis probably caused by endothelin release following foam sclerotherapy.

  18. Acute hydrothorax complicating peritoneal dialysis: a case report

    2010-01-01

    Abstract Introduction Acute hydrothorax is an uncommon but a well-recognized complication of peritoneal dialysis. No single test is definitive for diagnosis. Although it is not a life-threatening condition, hydrothorax often requires abandonment of peritoneal dialysis. Delay in diagnosis can lead to worsening of the clinical status. Case Presentation A 33-year-old Caucasian woman with lupus, who was successfully treated with temporary peritoneal dialysis 17 years previously, presented with ac...

  19. Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis.

    Sagrini, Elisabetta; Pecorelli, Anna; Pettinari, Irene; Cucchetti, Alessandro; Stefanini, Federico; Bolondi, Luigi; Piscaglia, Fabio

    2016-02-01

    Gangrenous cholecystitis and perforation are severe complications of acute cholecystitis, which have a challenging preoperative diagnosis. Early identification allows better surgical management. Contrast-enhanced computed tomography (ceCT) is the current diagnostic gold standard. Contrast-enhanced ultrasonography (CEUS) is a promising tool for the diagnosis of gallbladder perforation, but data from the literature concerning efficacy are sparse. The aim of the study was to evaluate CEUS findings in pathologically proven complicated cholecystitis (gangrenous, perforated gallbladder, pericholecystic abscess). A total of 8 patients submitted to preoperative CEUS, and with subsequent proven acute complicated cholecystitis at surgical inspection and pathological analysis, were retrospectively identified. The final diagnosis was gangrenous/phlegmonous cholecystitis (n. 2), phlegmonous/ulcerative changes plus pericholecystic abscess (n. 2), perforated plus pericholecystic abscess (n. 3), or perforated plus pericholecystic biliary collection (n. 1). Conventional US findings revealed irregularly thickened gallbladder walls in all 8 patients, with vaguely defined walls in 7 patients, four of whom also had striated wall thickening. CEUS revealed irregular enhancing gallbladder walls in all patients. A distinct wall defect was seen in six patients, confirmed as gangrenous/phlegmonous cholecystitis at pathology in all six, and in four as perforation at macroscopic surgical inspection. CEUS is a non-invasive easily repeatable technique that can be performed at the bedside, and is able to accurately diagnose complicated/perforated cholecystitis. Despite the limited sample size in the present case series, CEUS appears as a promising tool for the management of patients with the clinical possibility of having an acute complicated cholecystitis.

  20. Acute concentrated phenol dermal burns: Complications and management

    Tapan Jayantilal Parikh

    2015-01-01

    Full Text Available Phenol burns can result in multiple organ failure. This is a case report of acute severe phenol dermal burn after accidental splash of 94% phenol on 35-year-old patient′s body who was brought to hospital after 90 min of exposure. Decontamination was done with high-density water and glycerol. Early complications in form of metabolic acidosis and acute renal failure required hemodialysis. Extensive protein denaturation was managed with IV albumin and high protein diet. Patient also developed pleural effusion and acute respiratory distress syndrome, but these were successfully managed by intercostal drain tube insertion and noninvasive ventilation. The patient survived after multiple organ failures and widespread burns despite the fact that it has been observed that outcome of phenol burns with >60 2 inches of skin affected or two or more organs failure involving renal system is nearly fatal.

  1. A STUDY ON SPECTRUM OF PLEUROPULMONARY INFECTIONS IN DIABETES MELLITUS

    Uday Manepalli

    2014-07-01

    Full Text Available The present study is an attempt to understand the spectrum of pleuropulmonary infections in Diabetes mellitus patients. Majority of patients with pleuropulmonary infections in this study have Type 2 DM and there is slight preponderance of males over females. In our study, majority number of patients (accounting for 38% were diagnosed with diabetes mellitus at the time of diagnosis of pleuropulmonary infection. The peak incidence of pleuropulmonary infections in this study were in the age group of third decade to fifth decade. Thus it would be prudent to screen all patients in this age group presenting with respiratory infection, for diabetes mellitus. Tuberculosis was the most common pleuropulmonary infection in diabetic patients in this study accounting for 59% of the cases followed by bacterial pneumonia and lung abscess. Majority of pleuropulmonary infections of non tuberculous etiology were due to gram negative organisms like Pseudomonas, Klebsiella, H.influenzae (42% and gram positive organisms like Staphylococcus and Streptococcus (27%. The application of this knowledge is very important in tailoring early appropriate antibiotic therapy for diabetic patients where culture facilities are not available, as even a short delay in initiating treatment may lead to rapid progression of infection leading to increased mortality and morbidity. B/L extensive lesion was the most common radiological pattern in diabetic patients with PTB while consolidation and lung abscess were the commonest patterns in diabetic patients with non tuberculous pleuropulmonary infections. Pulmonary Tuberculosis tends to occur with increased severity in diabetics as evidenced by the occurrence of B/L extensive lesion in around 40% of cases in our study. Further to support this, bacillary loads were high among diabetics with poor glycemic control (as assessed by increased grading of sputum positivity. Risk stratification of bacterial pneumonia in diabetes using CURB 65

  2. Systemic sarcoidosis complicated of acute renal failure: about 12 cases.

    Mahfoudhi, Madiha; Mamlouk, Habiba; Turki, Sami; Kheder, Adel

    2015-01-01

    The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It's a retrospective study implicating 12 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, biological and histological profile in these cases and then to indicate the interest to consider the diagnosis of sarcoidosis in cases of unexplained renal failure. Extra-renal complications, therapeutic modalities and the outcome were determined in all patients. Our series involved 12 women with an average age of 40 years. Biological investigations showed an abnormal normocalcemia in 7 cases, a hypercalcemia in 5 cases, a hypercalciuria in 10 cases and polyclonal hypergammaglobulinemia in 7 cases. An acute renal failure was found in all patients with a median creatinin of 520 umol/L. For all patients, the renal echography was normal however, the kidney biopsy showed tubulo-interstitial nephritis. The extra-renal signs highlighting pulmonary interstitial syndrome in 5 cases, a sicca syndrome in 4 cases, mediastinal lymph nodes in 2 cases, a lymphocytic alveolitis in 3 cases, an anterior granulomatous uveitis in 2 cases and a polyarthritis in 5 cases. Five patients benefited of hemodialysis. The treatment consisted of corticosteroid in all cases. The follow up was marked by complete resolution of clinical and biological signs. The diagnosis of renal sarcoidosis must be done quickly to prevent renal failure.

  3. Acute pancreatitis complicated with splenic rupture: A case report

    Bruno; L; Hernani; Pedro; C; Silva; Ricardo; T; Nishio; Henrique; C; Mateus; José; C; Assef; Tercio; De; Campos

    2015-01-01

    Atraumatic splenic rupture is an uncommon complication of acute pancreatitis. This report describes the case of a 30-year-old man with acute pancreatitis and splenic vein thrombosis complicated by splenic rupture. The patient was admitted to the emergency department with pain in the upper abdomen that had been present for six hours and was associated with vomiting and sweating. He was diagnosed with acute pancreatitis of alcoholic etiology. Upon computed tomography(CT) of the abdomen, the pancreatitis was scored as Balthazar C grade, and a suspicious area of necrosis affecting 30% of the pancreas with splenic vein thrombosis was revealed. Seventytwo hours after admission, the patient had significant improvement in symptoms. However, he showed clinical worsening on the sixth day of hospitalization, with increasing abdominal distension and reduced hemoglobin levels. A CT angiography showed a large amount of free fluid in the abdominal cavity, along with a large splenic hematoma and contrast extravasation along the spleen artery. The patient subsequently underwent laparotomy, which showed hemoperitoneum due to rupture of the splenic parenchyma. A splenectomy was then performed, followed by ultrasound-guided percutaneous drainage.

  4. Acute pancreatitis complicated with splenic rupture: A case report.

    Hernani, Bruno L; Silva, Pedro C; Nishio, Ricardo T; Mateus, Henrique C; Assef, José C; De Campos, Tercio

    2015-09-27

    Atraumatic splenic rupture is an uncommon complication of acute pancreatitis. This report describes the case of a 30-year-old man with acute pancreatitis and splenic vein thrombosis complicated by splenic rupture. The patient was admitted to the emergency department with pain in the upper abdomen that had been present for six hours and was associated with vomiting and sweating. He was diagnosed with acute pancreatitis of alcoholic etiology. Upon computed tomography (CT) of the abdomen, the pancreatitis was scored as Balthazar C grade, and a suspicious area of necrosis affecting 30% of the pancreas with splenic vein thrombosis was revealed. Seventy-two hours after admission, the patient had significant improvement in symptoms. However, he showed clinical worsening on the sixth day of hospitalization, with increasing abdominal distension and reduced hemoglobin levels. A CT angiography showed a large amount of free fluid in the abdominal cavity, along with a large splenic hematoma and contrast extravasation along the spleen artery. The patient subsequently underwent laparotomy, which showed hemoperitoneum due to rupture of the splenic parenchyma. A splenectomy was then performed, followed by ultrasound-guided percutaneous drainage.

  5. Accounts of severe acute obstetric complications in Rural Bangladesh

    Sikder Shegufta S

    2011-10-01

    Full Text Available Abstract Background As maternal deaths have decreased worldwide, increasing attention has been placed on the study of severe obstetric complications, such as hemorrhage, eclampsia, and obstructed labor, to identify where improvements can be made in maternal health. Though access to medical care is considered to be life-saving during obstetric emergencies, data on the factors associated with health care decision-making during obstetric emergencies are lacking. We aim to describe the health care decision-making process during severe acute obstetric complications among women and their families in rural Bangladesh. Methods Using the pregnancy surveillance infrastructure from a large community trial in northwest rural Bangladesh, we nested a qualitative study to document barriers to timely receipt of medical care for severe obstetric complications. We conducted 40 semi-structured, in-depth interviews with women reporting severe acute obstetric complications and purposively selected for conditions representing the top five most common obstetric complications. The interviews were transcribed and coded to highlight common themes and to develop an overall conceptual model. Results Women attributed their life-threatening experiences to societal and socioeconomic factors that led to delays in seeking timely medical care by decision makers, usually husbands or other male relatives. Despite the dominance of male relatives and husbands in the decision-making process, women who underwent induced abortions made their own decisions about their health care and relied on female relatives for advice. The study shows that non-certified providers such as village doctors and untrained birth attendants were the first-line providers for women in all categories of severe complications. Coordination of transportation and finances was often arranged through mobile phones, and referrals were likely to be provided by village doctors. Conclusions Strategies to increase timely

  6. Management of cardiogenic shock complicating acute myocardial infarction.

    Van Herck, Jozef L; Claeys, Marc J; De Paep, Rudi; Van Herck, Paul L; Vrints, Christiaan J; Jorens, Philippe G

    2015-06-01

    Cardiogenic shock complicates approximately 5-10% of cases with acute myocardial infarction and carries a poor prognosis. Early revascularization remains the cornerstone treatment of cardiogenic shock complicating myocardial infarction. Inotropic and/or vasopressor agents can be used for haemodynamic stabilization, although this comes at the expense of increased myocardial oxygen consumption and extended myocardial ischaemia. In recent years, the use of mechanical circulatory support has significantly increased. However, there is only limited data available from randomized trials evaluating the different percutaneous support systems. This review summarizes the available literature concerning the management of cardiogenic shock and gives an overview of the recommendations of the European and German-Austrian guidelines on cardiogenic shock.

  7. Acute Pulmonary Edema Associated With Propofol: An Unusual Complication

    Waheed, Mian Adnan; Oud, Lavi

    2014-01-01

    Propofol is frequently used in the emergency department to provide procedural sedation for patients undergoing various procedures and is considered to be safe when administered by trained personnel. Pulmonary edema after administration of propofol has rarely been reported. We report a case of a 23-year-old healthy male who developed acute cough, hemoptysis and hypoxia following administration of propofol for splinting of a foot fracture. Chest radiography showed bilateral patchy infiltrates. The patient was treated successfully with supportive care. This report emphasizes the importance of this potentially fatal propofol-associated complication and discusses possible underlying mechanisms and related literature. PMID:25493132

  8. Percutaneous liver biopsy complicated by hemobilia-associated acute cholecystitis

    Yair Edden; Hugo St Hilaire; Keith Benkov; Michael T Harris

    2006-01-01

    Liver biopsy is generally considered a safe and highly useful procedure. It is frequently performed in an outpatient setting for diagnosis and follow-up in numerous liver disorders. Since its introduction at the end of the 19th century, broad experience, new imaging techniques and special needles have significantly reduced the rate of complications associated with liver biopsy. Known complications of percutaneous biopsy of the liver include hemoperitoneum, subcapsular hematoma, hypotension, pneumothorax and sepsis.Other intra-abdominal complications are less common.Hemobilia due to arterio-biliary duct fistula has been described, which has only rarely been clinically expressed as cholecystitis or pancreatitis. We report a case of a fifteen year-old boy who developed severe acute cholecystitis twelve days after a percutaneous liver biopsy performed in an outpatient setting. The etiology was clearly demonstrated to be hemobilia-associated,and the clinical course required the performance of a laparoscopic cholecystectomy. The post operative course was uneventful and the patient was discharged home. Percutaneous liver biopsy is a safe and commonly performed procedure. However, severe complications can occasionally occur. Both medical and surgical options should be evaluated while dealing with these rare incidents.

  9. Pulmonary Thromboembolism Complicating Acute Pancreatitis With Pancreatic Ascites: A Series of 4 cases

    Ruchir Patel; Nirav Pipaliya; Prateik Poddar; Vikas Pandey; Meghraj Ingle; Prabha Sawant

    2016-01-01

    Acute pancreatitis is an inflammatory disease often associated with local and systemic complications. Portosplenic and splanchnic vascular complications of acute pancreatitis are common, but extrasplanchnic vessel thrombosis is less commonly seen. Among them, pulmonary thromboembolism is a very rare complication to be encountered with. We report four cases of acute pulmonary thromboembolism in patients with acute pancreatitis superimposed on chronic pancreatitis. All the patients had abdomina...

  10. [Treatment of extensive acute radiation burn and its complications].

    Li, Ye-yang; Wang, Jin-lun; Li, Gang; Lin, Wei-hua; Liang, Min; Huang, Jun; Sun, Jing-en

    2013-06-01

    This article reports the treatment of a patient suffered from acute radiation burn covering 41% TBSA, with deep partial-thickness and full-thickness injury, produced by exposure to a large-scale industrial electron accelerator. An open wound began to appear and enlarged gradually 10 weeks after the exposure. Serious wound infection with methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa, pneumonia, respiratory failure, systemic inflammatory response syndrome, nephropathy and hypoproteinemia developed successively since 3 weeks after the wound formation. Skin grafts failed to survive, resulting in enlargement of the wound. After being treated with proper measures, including parenteral nutrition, respiratory support with a ventilator, appropriate antibiotics, steroid administration for nephropathy, deep debridement for wounds followed by skin grafting, the patient was cured and discharged after undergoing 15 operations in 500 days. The clinical condition of an extensive acute radiation burn is complicated. We should pay close attention to the changes in functions of organs, and strengthen the therapeutic strategies to support the function of organs to reduce the incidence of systemic complications. The control of the infection and the timely and effective repair of the wound are still the key points of the treatment of an extensive local radiation injury.

  11. Surgical treatment of colorectal cancer complicated with acute intestinal obstruction

    S. N. Schaeva

    2016-01-01

    Full Text Available Background. The main reason for urgent complications of colon cancer is an acute intestinal obstruction (AIO. This is complex pathological condition in 90 % of cases caused by colorectal cancer (CRC.Objective – to evaluate radicality of the performed operations in complicated colorectal cancer in general surgical hospitals. Dependence of the severity of intestinal obstruction by tumor localization, its morphological characteristics, determine dependence of the type of the surgical operation performed on the severity of intestinal obstruction.Materials and methods. We have studied the data on 667 patients with colorectal cancer complicated by acute intestinal obstruction. These patients were treated in the period from 2001 to 2013 in general surgical hospital in the territory of Smolensk and Smolensk region. For the processing of the obtained results we have used software Statistica 6.1. Differences were considered statistically at p ≤ 0.05.Results. All the patients were divided into 3 groups by the expression of intestinal obstruction. Group 1 (n = 279 consisted of patients with the presence of decompensated intestinal obstruction (DIO, group 2 (n = 313 consisted of patients with subcompensated intestinal obstruction (SIO, group 3 (n = 75 included patients with compensated intestinal obstruction (CIO. In case of tumor localization in right halfof the colon we most commonly observed clinical picture of acute development of decompensated intestinal obstruction (p = 0.041. Subcompensated intestinal obstruction prevailed in case of tumor localization in left half of the colon and rectal localization. In general surgical hospitals it is not always possible to speak about radicality of surgical treatment, as in a large number of cases (62.5 % the number of examined lymph nodes was less than 4. When DIO patients are admitted in the clinic, the percentage of singlestage operations is equal to 7.5 % (n = 21. In case of DIO and SIO there was a high

  12. Acute hydrothorax complicating peritoneal dialysis: a case report

    Ranganathan Dwarkanathan

    2010-11-01

    Full Text Available Abstract Introduction Acute hydrothorax is an uncommon but a well-recognized complication of peritoneal dialysis. No single test is definitive for diagnosis. Although it is not a life-threatening condition, hydrothorax often requires abandonment of peritoneal dialysis. Delay in diagnosis can lead to worsening of the clinical status. Case Presentation A 33-year-old Caucasian woman with lupus, who was successfully treated with temporary peritoneal dialysis 17 years previously, presented with acute dyspnea and a right pleural effusion after recommencing peritoneal dialysis. Investigations eliminated infective, cardiac, and primary respiratory causes. Peritoneal dialysis-related hydrothorax was suggested by biochemistry, and a pleuroperitoneal leak was definitively confirmed by using a Tc-99 m DTPA (diethylene triamine penta-acetic acid scintigraphy scan. Subsequently, she underwent video-assisted thoracoscopy-guided talc pleurodesis and was able to return successfully to peritoneal dialysis. Conclusion Although our case is not the first report that describes the occurrence of acute hydrothorax in peritoneal dialysis, it is an important condition to recognize for the wider general medical community. Furthermore, this case demonstrates that peritoneal dialysis can be continued with a hydrothorax, provided the underlying cause can be corrected. We review the literature pertaining to the utility and reliability of different diagnostic approaches to hydrothorax.

  13. The role of levosimendan in acute heart failure complicating acute coronary syndrome

    Nieminen, Markku S; Buerke, Michael; Cohen-Solál, Alain

    2016-01-01

    Acute heart failure and/or cardiogenic shock are frequently triggered by ischemic coronary events. Yet, there is a paucity of randomized data on the management of patients with heart failure complicating acute coronary syndrome, as acute coronary syndrome and cardiogenic shock have frequently been...... defined as exclusion criteria in trials and registries. As a consequence, guideline recommendations are mostly driven by observational studies, even though these patients have a particularly poor prognosis compared to heart failure patients without signs of coronary artery disease. In acute heart failure......, and especially in cardiogenic shock related to ischemic conditions, vasopressors and inotropes are used. However, both pathophysiological considerations and available clinical data suggest that these treatments may have disadvantageous effects. The inodilator levosimendan offers potential benefits due to a range...

  14. Pathogenic aspects of pulmonary complications in acute pancreatitis patients

    Serge Chooklin

    2009-01-01

    BACKGROUND: Experimental and clinical observations show that proinlfammatory cytokines and oxidative stress are involved in the development of local and particularly systemic complications in acute pancreatitis (AP) patients. There are often pulmonary complications in such patients. The mechanisms through which lung injury is induced in AP are not fully clear. METHODS: In order to assess the role of activated neutrophils, pro- and anti-inlfammatory cytokines and adhesion molecules at the onset and development of respiratory complications and respiratory failure, we measured the serum levels of pro-inlfammatory (IL-1β, IL-6, IL-8, IL-18, TNF-α) and anti-inlfammatory (IL-1ra, IL-10) cytokines in 51 AP patients who had been diagnosed with pancreatitis-associated lung injury with and without the development of organ dysfunction. RESULTS: When admitted to the hospital, severe AP patients had increased concentrations of IL-1β, IL-6, IL-8, IL-18, and TNF-α. The concentration of IL-18 alone was considerably increased in the patients who later developed respiratory failure. The onset of acute respiratory distress syndrome in the AP patients was accompanied by an increase in the level of anti-inlfammatory cytokines, especially IL-10. It was noted that in severe lung injury, myeloperoxidase activity in the blood increased signiifcantly, but still relfected the processes taking place in the lung parenchyma. Increase in the concentrations of adhesion molecules preceded the development of pulmonary inifltration with respiratory failure symptoms, which provoked endothelial dysfunction and determined the capillary surface permeability for neutrophils and monocytes.CONCLUSIONS: In the pathogenesis of respiratory complications in AP cytokines, chemokines and adhesion molecules, in particular IL-1β, IL-6, IL-8, IL-18, TNF-α, ICAM-1, and E-selectin play major roles. At IL-18 concentrations >650 pg/ml, AP patients are likely to develop pulmonary dysfunction (sensitivity

  15. Endovascular treatment of acute type B dissection complicating aortic coarctation.

    Kassaian, Seyed Ebrahim; Abbasi, Kyomars; Mousavi, Mehdi; Sahebjam, Mohammad

    2013-01-01

    Surgical treatment poses a high risk to patients with concomitant aortic coarctation and dissection, and an interventional approach could be an alternative. We describe the case of a 52-year-old man with a long history of untreated hypertension and aortic coarctation who emergently presented at our institution with an acute Stanford type B dissection. The patient's elevated serum creatinine level, perfusion deficit in the right lower limb, and hypertension did not respond to medical therapy, and he did not consent to surgery. By endovascular means, we used a self-expandable stent-graft to cover the entry point of the dissection; then, we deployed a balloon-expandable bare-metal stent to correct residual stenosis. To our knowledge, this is the first report of the endovascular treatment of aortic coarctation complicated by type B dissection.

  16. Study on subsequent neurologic complications in children with acute leukemia

    Kobayashi, Naoaki; Shimazaki, Haruyo; Hoshi, Yasutaka; Akatsuka, Jun-ichi (Jikei Univ., Tokyo (Japan). School of Medicine)

    1989-06-01

    Twenty-seven children with acute leukemia were studied in order to detect the subsequent neurologic complications due to chemotherapy and radiation therapy. Twenty-four patients with ALL received central nervous system prophylaxis including cranial irradiation. The methods of evaluation consisted of electroencephalogram (EEG), computed tomography of the head (CT scan), soft neurological sign, intelligence quotient (IQ) and Bender Gestalt test. The patients with relapse showed severe abnormalities in various kinds of examinations. Younger children at diagnosis were associated with a higher abnormality rate of soft neurological signs and Bender Gestalt test. Factors which were found to be closely associated with a lower IQ score included younger children at diagnosis and longer duration of remission time. These results indicate the need for caution for the dosage of cranial irradiation for younger patients in CNS prophylaxis, and improvement of a lower IQ score in long-term survivors requires further investigation as to the appropriate intellectual environment for their development after remission. (author).

  17. Acute obstructive hydrocephalus complicating decompression surgery of the craniovertebral junction

    Ohya, Junichi; Chikuda, Hirotaka; Nakatomi, Hirofumi; Sakamoto, Ryuji; Saito, Nobuhito; Tanaka, Sakae

    2016-01-01

    Obstructive hydrocephalus has been described as a rare complication following foramen magnum decompression for Chiari malformation. However, there are few reports of obstructive hydrocephalus after spinal surgery for other pathologies of the craniovertebral junction (CVJ). The authors herein report a 52-year-old female with achondroplasia presenting with an 8-month history of myelopathy due to spinal cord compression at CVJ. She underwent resection of the C1 posterior arch and part of the edge of the occipital bone. A computed tomography (CT) scan obtained 1-week after the surgery revealed bilateral infratentorial fluid collection. The patient was first managed conservatively; however, on the 17th day, her consciousness level showed sudden deterioration. Emergency CT demonstrated marked hydrocephalus due to obstruction of the cerebral aqueduct. Acute obstructive hydrocephalus can occur late after decompression surgery at the CVJ, and thus should be included in the differential diagnosis of a deteriorating mental status. PMID:27366268

  18. Pictorial essay: Acute neurological complications in children with acute lymphoblastic leukemia

    Seema A Kembhavi

    2012-01-01

    Full Text Available Acute lymphoblastic leukemia (ALL is the commonest childhood malignancy with high cure rates due to recent advances in central nervous system (CNS prophylaxis. The disease per se, as well as the prophylactic therapy, predisposes the child to complications such as cerebrovascular events, infections, drug toxicities, etc. The purpose of this study is to highlight the pathophysiology and the imaging features (with appropriate examples of these complications and to propose a diagnostic algorithm based on MRI. Interpreting these scans in the light of clinical inputs very often helps the radiologist reach an appropriate diagnosis and help treatment and management.

  19. Tretinoin in pregnancy complicated with acute promyelocytic leukaemia.

    Leong, K W; Teh, A; Bosco, J J

    2000-06-01

    Acute promyelocytic leukemia (APL) in pregnancy poses serious danger to both the mother and fetus. Cytotoxic chemotherapy may cause teratogenicity to the fetus. APL is unique because it is usually associated with a coagulopathy that markedly increases the risk for the mother and fetus. A 21 year old lady with APL in her third trimester of pregnancy was treated with oral tretinoin. Tretinoin reversed the coagulopathy and normalised her blood counts without causing cytotoxic damage associated with cancer chemotherapy. Fetal distress occurred at 37 weeks of gestation and an emergency caesarean section was performed without complications and no blood transfusion support was needed as her coagulopathy and thrombocytopenia had resolved. A remission was achieved with only tretinoin induction. She subsequently had consolidation and maintenance chemotherapy. The mother and baby remain well at 4 years from completion of chemotherapy. A total of 10 pregnancies associated with APL have been reported in the current literature. Premature delivery and a fetal arrhythmia were the only complications. Although retinoin is considered teratogenic, its use so far in second and third trimester has been safe.

  20. AN UNCOMMON COMPLICATION OF A COMMON DISORDER: PNEUMOTHORAX, PNEUMOMEDIASTINUM AND SUBCUTANEOUS EMPHYSEMA COMPLICATING ACUTE SEVERE ASTHMA: A CASE REPORT

    Urvinderpal

    2014-05-01

    Full Text Available Pneumomediastinum (air in the mediastinum was first described as a complication of trauma in 1819 by Laennec. Although subcutaneous emphysema, pneumothorax and pneumomediastinum are relatively uncommon, but are important complications of bronchial asthma. Their sudden and usually unexpected onset may herald an emergency. We are reporting a case of a 72 year old male presenting with pneumothorax, pneumo- mediastinum and subcutaneous emphysema as a complication of acute severe asthma

  1. NIHSS and acute complications after anterior and posterior circulation strokes

    Godefroy O

    2012-02-01

    Full Text Available Mathieu Boone1, Jean-Marc Chillon2, Pierre-Yves Garcia1, Sandrine Canaple1, Chantal Lamy1, Olivier Godefroy1,3, Jean-Marc Bugnicourt1,2,31Department of Neurology, Amiens University Hospital, Amiens, France, 2INSERM ERI-12, and University of Picardie, 3Laboratory of Functional Neurosciences and Pathology (EA 4559, Amiens, FranceBackground: The purpose of this study was to determine whether the National Institutes of Health Stroke Scale (NIHSS score was associated with inhospital neurological and medical complications (NMC in patients with posterior circulation infarction.Methods: This retrospective study included all patients admitted to our stroke unit during a one-year period (n = 289. NMC included neurological deterioration (ie, worsening by 4 points or more of the NIHSS score during the hospital stay and all other medical complications based on what was recorded in the patients' charts.Results: Seventy-nine patients (27% experienced NMC. In posterior circulation infarction patients (n = 90, patients with NMC had a higher baseline NIHSS score (10.9 versus 2.2, P = 0.004 and a baseline NIHSS score >2 (78% versus 36%, P = 0.003. In stepwise logistic regression, an NIHSS score >2 (odds ratio: 8.2; 95% confidence interval: 1.64–41.0; P = 0.01 was associated with NMC. Similar results were observed for anterior circulation infarction patients but with a higher cutoff value for NIHSS score.Conclusion: In ischemic stroke patients, an increased baseline NIHSS score was associated with an increased risk of NMC. This association applied to anterior-circulation as well as posterior circulation stroke, although zero on the NIHSS for posterior circulation stroke does not mean the absence of NMC during hospitalization. The clinical significance of these findings requires further evaluation in larger prospective studies.Keywords: acute, stroke, rating scales, complications

  2. Cardiovascular Complications of Acute Amphetamine Abuse; Cross-sectional study

    Elham Bazmi

    2017-03-01

    Full Text Available Objectives: This study aimed to evaluate cardiovascular complications among patients who abuse amphetamines. Methods: This cross-sectional study took place between April 2014 and April 2015 among 3,870 patients referred to the Toxicology Emergency Department of Baharlou Hospital, Tehran University of Medical Sciences, Tehran, Iran. Those with clinical signs of drug abuse and positive urine screening tests were included in the study, while cases of chronic abuse were excluded. Cardiac complications were evaluated via electrocardiography (ECG and transthoracic echocardiography. Results: A total of 230 patients (5.9% had a history of acute amphetamine abuse and positive urine tests. Of these, 32 patients (13.9% were <20 years old and 196 (85.2% were male. In total, 119 (51.7% used amphetamine and methamphetamine compounds while 111 (48.3% used amphetamines with morphine or benzodiazepines. The most common ECG finding was sinus tachycardia (43.0%, followed by sinus tachycardia plus a prolonged QT interval (34.3%. Mean creatine kinase-MB and troponin I levels were 35.9 ± 4.3 U/mL and 0.6 ± 0.2 ng/mL, respectively. A total of 60 patients (26.1% were admitted to the Intensive Care Unit. The majority (83.3% of these patients had normal echocardiography results. The mean aortic root diameter (ARD was 27.2 ± 2.8 mm. Abnormalities related to the ARD were found in 10 patients (16.7%, three of whom subsequently died. Conclusion: According to these findings, cardiac complications were common among Iranian patients who abuse amphetamines, although the majority of patients had normal echocardiography and ECG findings.

  3. Orbital complications secondary to acute sinusitis– A 10 years retrospective review

    2015-01-01

    Abstract Introduction: Orbital complication may accompany acute sinusitis in all age, commonly preseptal or orbital cellulitis. Aim: To evaluate the clinical presentation, management, and outcome of orbital complications of sinusitis in patients treated at our institution. Methods: A case study of retrospective review of 10 patients with orbital complications secondary to acute sinusitis was conducted in our centre over a 10-years period. The clinical presentation, relevant investigations, m...

  4. Post-septal orbital complications of acute bacterial rhinosinusitis: Endoscopic anatomical considerations

    Ahmed A. Ibrahim

    2015-11-01

    The study was carried out on 240 patients suffering from acute rhino-sinusitis with 90 patients suffering from orbital post-septal complicating acute rhino-sinusitis. Eighty-five cases underwent orbital decompression, except 5 cases with orbital cellulitis; they were improved on medical treatment. Visual monitoring by the ophthalmological team on regular basis was performed, until clinical and radiological improvement of the condition. This study proves that there may be a relationship between anatomic variation and orbital infections complicating acute sinusitis or acute on top of chronic sinusitis.

  5. Prognostic importance of complete atrioventricular block complicating acute myocardial infarction

    Aplin, Mark; Engstrøm, Thomas; Vejlstrup, Niels G

    2003-01-01

    Third-degree atrioventricular block after acute myocardial infarction is considered to have prognostic importance. However, its importance in conjunction with thrombolytic therapy and its relation to left ventricular function remains uncertain. This report also outlines an important distinction...... between atrioventricular block in the setting of anterior and inferior wall acute myocardial infarction, with profound clinical and prognostic implications....

  6. Acute interstitial nephritis, a rare complication of Giardiasis

    Antonio De Pascalis

    2011-12-01

    Full Text Available Acute interstitial nephritis is a relevant cause of acute renal failure. Drugs are the predominant cause, followed by infections and idiopathic lesions. Acute interstitial nephritis as a form of hypersensitivity reaction is an uncommon manifestation in the setting of human parasitic infections. We present a case of acute interstitial nephritis in association with Giardia infection in a 54-year-old woman who developed an impairment of renal function after a prolonged period of slight fever and diarrhea. After an attempt to recover renal impairment by vigorous rehydratation, because of the unclear origin of the persisting renal failure, a percutaneous renal biopsy was performed and a diagnosis of severe acute interstitial nephritis was made. Steroid therapy was started and after six weeks, renal function had completely recovered. In cases of unexplained renal failure in patients affected by parasitic infections, interstitial nephritis should be considered and it is our opinion that a renal biopsy should be always performed.

  7. Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis

    Dankbaar, J W; van Bemmel, A J M; Pameijer, F A

    2015-01-01

    UNLABELLED: In patients with acute bacterial rhinosinusitis severe orbital and intracranial complications can occur. This review will illustrate the anatomic relationship between the paranasal sinuses and the orbital and intracranial compartments. Subsequently, the spectrum of orbital and intracrani

  8. A case of scrub typhus complicated by acute calculous cholecystitis.

    Lee, Su Jin; Cho, Young Hye; Lee, Sang Yeoup; Jeong, Dong Wook; Choi, Eun Jung; Kim, Yun Jin; Lee, Jeong Gyu; Lee, Yu Hyun

    2012-07-01

    We report a case of acute calculous cholecystitis through scrub typhus. A 69-year-old woman presented with a history of general myalgia, fever, and right abdominal pain. She referred to our hospital for surgical treatment of clinically suspected acute cholecystitis. Physicians concluded the cause of cholecystitis as gall bladder (GB) stone and proper antibiotics treatment of scrub typhus was started later. The patient developed acute respiratory distress syndrome and multi organ failure through scrub typhus. Five days after admission, the patient was treated with proper antibiotics and discharged on the 13th day after starting doxycycline treatment without any sequelae. In areas endemic for tsutsugamushi disease, even though a patient with GB stone presents with symptoms of acute cholecystitis, careful history and physical examination are required to reveal the existence of eschars or skin eruptions.

  9. Increased risk of complications in acute onset intestinal malrotation

    Wallberg, Sidsel Vang; Qvist, Niels

    2013-01-01

    Intestinal malrotation is a potentially life-threatening illness which presents in many different ways and the symptoms span from acute to chronic. The purpose of this study was to determine the clinical presentation of intestinal malrotation at all ages....

  10. Acute complications of tattooing presenting in the ED.

    Kluger, Nicolas

    2012-11-01

    Permanent decorative tattooing involves the introduction of exogenous pigments and/or dyes into the dermis to produce the permanent design. Despite improved hygiene in the tattoo parlors of Western countries, this procedure still carries risk. Various complications may occur right after tattooing, from benign complications such as transient limb edema, palpable lymph nodes, and contact eczema, to more severe ones such as the inoculation of virulent microorganisms into the dermis, potentially life-threatening cellulitis, and necrotizing fasciitis or cutaneous vasculitis. This review focuses specifically on the complications that occur within the first month of tattooing that emergency physicians may have to manage.

  11. Risk factors for medical complications of acute hemorrhagic stroke

    Jangala Mohan Sidhartha; Aravinda Reddy Purma; Nagaswaram Krupa Sagar; Marri Prabhu Teja; Meda Venkata subbaiah; Muniswami Purushothaman

    2015-01-01

    Objective: To assess the risk factors leading to medical complications of hemorrhagic stroke. Methods: We conducted an observational study in neurology, emergency and general medicine wards at a tertiary care teaching hospital in Kadapa. We recruited hemorrhagic stroke patients, and excluded the patients have evidence of trauma or brain tumor as the cause of hemorrhage. We observed the subjects throughout their hospital stay to assess the risk factors and complications. Results: During period of 12 months, 288 subjects included in the study, 89% of them identified at least 1 prespecified risk factor for their admission in hospital and 75% of them experienced at least 1 prespecified complication during their stay in hospital. Around 47% of subjects deceased, among which 64% were females. Conclusions: Our study has assessed that hypertension followed by diabetes mellitus are the major risk factors for medical complications of hemorrhagic stroke. Female mortality rate was more when compared to males.

  12. Rapid detection of sepsis complicating acute necrotizing pancreatitis using polymerase chain reaction

    Wei Zhong Zhang; Tian Quan Han; Yao Qing Tang; Sheng Dao Zhang

    2001-01-01

    @@INTRODUCTION Acute narcotizing pancreatitis usually takes a severe clinical course and is associated with multiple organ dysfunction .With the further understanding of pathophysiological events of acute pancreatisis and the therapeutic measuses taken by the clinicians ,the patients can pass through the critical carry stages ,and then the septic complication caused by rtanslocated bacteria, mostly gram-negative microbes from the intestines ensues[1].

  13. Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting

    Chawla, Ashish; Bosco, Jerome Irai; Lim, Tze Chwan; Srinivasan, Sivasubramanian; Teh, Hui Seong; Shenoy, Jagadish Narayana

    2015-01-01

    Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting at the emergency department. Early diagnosis and recognition of associated complications, though challenging, are essential for timely management. Imaging studies, including ultrasonography, computed tomography and magnetic resonance imaging, are increasingly utilised for the evaluation of suspected cases of cholecystitis. These investigations help in diagnosis, identification of complications and surgic...

  14. Intratemporal and intracranial complications of acute suppurative otitis media in children : renewed interest

    Dhooge, IJM; Albers, FWJ; Van Cauwenberge, PB

    1999-01-01

    In recent years, a rise in the incidence of intratemporal and intracranial complications of acute otitis media (AOM) has been mentioned in the literature. Lack of a well-developed immune system and difficulties in diagnosing AOM, can account for part of the rise in the incidence of complications of

  15. Compartment syndrome, rhabdomyolysis and risk of acute renal failure as complications of the lithotomy position.

    Bocca, G.; Moorselaar, R.J.A. van; Feitz, W.F.J.; Staak, F.H.J.M. van der; Monnens, L.A.H.

    2002-01-01

    Compartment syndrome, rhabdomyolysis and the risk of acute renal failure are potential complications of the lithotomy position. A six-year-old girl is described who developed a compartment syndrome with rhabdomyolysis after prolonged surgery in the lithotomy position. This complication occurred thre

  16. Magnetic resonance imaging for local complications of acute pancreatitis: A pictorial review

    2010-01-01

    Acute pancreatitis is a common disease characterized by sudden upper abdominal pain and vomiting. Alcoholism and choledocholithiasis are the most common factors for this disease. The choice of treatment for acute pancreatitis might be affected by local complications, such as local hemorrhage in or around the pancreas, and peripancreatic infection or pseudoaneurysm. Diagnostic imaging modalities for acute pancreatitis have a significant role in confirming the diagnosis of the disease, helping detect the exte...

  17. Bilateral psoas and bilateral perinephric abscesses complicating acute pyelonephritis in pregnancy

    2013-01-01

    Acute pyelonephritis complicates 1-2% of pregnancies and causes significant maternal and fetal morbidity and mortality. The diagnosis of renal tuberculosis (TB) is often delayed and commonly presents with sterile pyuria or along with other pyogenic organisms. We report a case where the diagnosis of renal TB was missed in a pregnant woman when she presented with acute pyelonephritis, septic shock, and acute renal failure. There was clinical recovery with antibiotics, but bilateral psoas and pe...

  18. [Tumor lysis syndrome in a pregnancy complicated with acute lymphoblastic leukemia].

    Álvarez-Goris, M P; Sánchez-Zamora, R; Torres-Aguilar, A A; Briones Garduño, J C

    2016-04-01

    Acute leukemia is rare during pregnancy, affects about 1 in 75,000 pregnancies, of all leukemias diagnosed only 28% are acute lymphoblastic leukemia, this is a risk factor to develop spontaneous tumor lysis syndrome, it's a oncologic complication potentially deadly if the prophylactic treatment its avoided. Cases of acute lymphoblastic leukemia associated with pregnancy has been poorly documented in the literature the association of these two entities to pregnancy is the first report published worldwide, so the information is limited.

  19. Hidden chromosomal abnormalities in pleuropulmonary blastomas identified by multiplex FISH

    Coze Carole

    2006-01-01

    Full Text Available Abstract Background Pleuropulmonary blastoma (PPB is a rare childhood dysontogenetic intrathoracic neoplasm associated with an unfavourable clinical behaviour. Cases presentation We report pathological and cytogenetic findings in two cases of PPB at initial diagnosis and recurrence. Both tumors were classified as type III pneumoblastoma and histological findings were similar at diagnosis and relapse. In both cases, conventional cytogenetic techniques revealed complex numerical and structural chromosomal abnormalities. Molecular cytogenetic analysis (interphase/metaphase FISH and multicolor FISH identified accurately chromosomal aberrations. In one case, TP53 gene deletion was detected on metaphase FISH. To date, only few cytogenetic data have been published about PPB. Conclusion The PPB genetic profile remains to be established and compared to others embryonal neoplasia. Our cytogenetic data are discussed reviewing cytogenetics PPBs published cases, illustrating the contribution of multicolor FISH in order to identify pathogenetically important recurrent aberrations in PPB.

  20. Pleuropulmonary Paragonimiasis mimicking Pulmonary Tuberculosis - A Report of Three Cases

    Singh T

    2005-01-01

    Full Text Available Paragonimiasis is an important cause of pulmonary disease worldwide. Infection in humans mainly occurs by ingestion of raw or undercooked freshwater crabs or crayfishes. The disease is well known in endemic regions of Asian countries, where culturally based methods of food preparation foster human transmission. Three patients with clinical and radiological features compatible with pulmonary tuberculosis had been treated for tuberculosis without remedy despite an inability to demonstrate acid fast bacilli in sputum smears. All patients had history of ingestion of raw crabs and crayfishes. The confirmed diagnosis of pleuropulmonary paragonimiasis was made based on the demonstration of Paragonimus eggs in the sputum, and high absolute eosinophilia in their peripheral blood and pleural fluid. All the patients had been treated with praziquantel successfully.

  1. Pleuropulmonary hydatid disease treated with thoracoscopic instillation of hypertonic saline

    Lakshmanan P

    2008-01-01

    Full Text Available Hydatid disease is caused by the larval stage of the cestode, Echinococcus granulo-sus. Man is the intermediate host in its life cycle. The most common organ involved is liver followed by lung. Although surgery remains the definitive treatment for symptomatic lesions, it is associated with considerable morbidity. Other less inva-sive treatment strategies as an adjunct to medical treatment that have been tried in various case series include percutaneous aspiration, instillation and re-aspiration of scolicidal agents (PAIR, and thoracoscopic removal of cysts located subpleurally. Here we report the case of a 58 year old gentleman with hepatic and pleuropulmo-nary hydatid disease who was subjected to medical thoracoscopy and instillation of hypertonic saline (3%, followed by medical management with albendazole with which complete resolution of the pulmonary cysts was achieved.

  2. Rare but numerous serious complications of acute otitis media in a young child.

    Van Munster, Mariëtte P E; Brus, Frank; Mul, Dick

    2013-03-12

    Acute otitis media is a very common disease in children. Most children recover with symptomatic therapy like potent analgesics, but occasionally serious complications occur. We present a 3-year-old girl who suffered from acute otitis media for already 2 weeks and presented with fever, abducens nerve palsy of her left eye and vomiting. She was finally diagnosed with an acute otitis media complicated by a mastoiditis, sinus thrombosis, meningitis and cerebellar empyema. Fusobacterium necrophorum was cultured from cerebrospinal fluid. The girl recovered following appropriate antibiotic and anticoagulation treatment.

  3. Pott's puffy tumor: a rare complication of acute otitis media in child: a case report.

    Urík, Milan; Machač, Josef; Šlapák, Ivo; Hošnová, Dagmar

    2015-09-01

    To describe a rare case of Potts' puffy tumor (PPT) in the zygomatic area, which developed as a complication of acute otitis media in a 6-year-old child. To date, only one case of PPT has been described in the literature as a complication of latent mastoiditis in an adult, and one case of PPT as a complication of acute mastoiditis in a 10-year-old child. Urgent surgical intervention, including evacuation of the purulent lesion, removal of inflamed soft tissue and osteolysis of the involved bone, and antromastoidectomy, intravenous treatment with broad-spectrum antibiotics, including G+, G-, anaerobes and fungi, and local therapy.

  4. Acute cytomegalovirus infection complicated by venous thrombosis: a case report

    Parola Philippe

    2005-08-01

    Full Text Available Abstract Background CMV-induced vasculopathy and thrombosis have been reported, but they are rare conditions usually encountered in immunocompromised patients. However more and more complications of CMV infections are recognized in immunocompetent patients. Case presentation We present a case report of a previously healthy adult with cytomegalovirus infection that was complicated by tibiopopliteal deep venous thrombosis and in whom Factor V Leiden heterozygous mutation was found. Conclusion This new case report emphasizes the involvement of cytomegalovirus in induction of vascular thrombosis in patients with predisposing risk factors for thrombosis. It is necessary to screen for CMV infection in patients with spontaneous thrombosis and an history of fever.

  5. Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting.

    Chawla, Ashish; Bosco, Jerome Irai; Lim, Tze Chwan; Srinivasan, Sivasubramanian; Teh, Hui Seong; Shenoy, Jagadish Narayana

    2015-08-01

    Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting at the emergency department. Early diagnosis and recognition of associated complications, though challenging, are essential for timely management. Imaging studies, including ultrasonography, computed tomography and magnetic resonance imaging, are increasingly utilised for the evaluation of suspected cases of cholecystitis. These investigations help in diagnosis, identification of complications and surgical planning. Imaging features of acute cholecystitis have been described in the literature and are variable, depending on the stage of inflammation. This article discusses the spectrum of cholecystitis-associated complications and their imaging manifestations. We also suggest a checklist for the prompt and accurate identification of complications in acute cholecystitis.

  6. Cardiac tamponade, an unusual complication of acute pancreatitis.

    Veron Esquivel, Daniel; Aello, Gerardo; Batiz, Fernando; Fernandez Barrera, Alejandro

    2016-03-11

    A 41-year-old Hispanic man was admitted to our hospital with the diagnosis of acute pancreatitis due to hypertriglyceridemia. During his stay, he developed sudden haemodynamic instability and clinical presentation suggestive of cardiac tamponade. A transthoracic echocardiogram confirmed the diagnosis. Echocardiography-guided pericardiocentesis was performed with immediate haemodynamic improvement. The patient's condition underwent favourable evolution. The pancreatitis was resolved and a control transthoracic echocardiography was performed showing no pericardial effusion. The pathophysiology of this rare entity is unknown. Early diagnosis and treatment are crucial. Although pericardiocentesis is the treatment of choice, there have been a few reports of medical treatment with encouraging results. Although the association of acute pancreatitis and tamponade are anecdotal in literature, medics should be aware of this association in order to perform prompt diagnosis.

  7. Acute esophageal and gastric injury: complication of Lugol's solution.

    Park, Jae Myung; Seok Lee, In; Young Kang, Ji; Nyol Paik, Chang; Kyung Cho, Yu; Woo Kim, Sang; Choi, Myung-Gyu; Chung, In-Sik

    2007-01-01

    Several new technologies have been developed to improve the diagnostic capability of conventional endoscopic techniques. One of these most frequently used methods is chromoendoscopy with Lugol's solution in the esophagus to detect malignant lesions. This method has been used for several decades and is generally considered as a safe method, only a few cases of side effects having been reported. We describe a case of acute esophageal and gastric mucosal damage after application of Lugol's solution during endoscopy in an 84-year-old woman. Endoscopists should be aware of the potential for adverse reactions to iodine staining.

  8. A STUDY OF POST-SURGICAL COMPLICATIONS IN ACUTE ABDOMEN CONDITIONS

    Bhooma Reddy Muthyala

    2016-09-01

    Full Text Available BACKGROUND The most common causes of the acute abdomen are acute appendicitis which may be perforated, typhoid ileal perforation, acute intestinal obstruction, gastroduodenal perforations, nonspecific abdominal pain, abdominal injuries, and acute cholecystitis. A summary of all the acute complications taken together will be the fact that all are associated with post-surgical complications. A sincere effort has been made to study the post-operative complications that a surgeon encounters while treating the acute abdomen cases. This study is intended to help the practising surgeons who deal with such complications. It also is intended to help the doctors who practice to identify such complications and thus refer the patients for immediate intervention. METHODS This study was conducted in the Department of General Surgery, Government Medical College, Nizamabad, Telangana. This study was done from June 2013 to May 2016. One hundred sixty patients who were admitted in the hospital after surgery for acute abdominal conditions were considered for the study. Thorough clinical examination was conducted and the complications that were encountered were noted and the complications were treated as per the need of the hour. The complications faced by the treating surgeon in each and every entity that was discussed earlier was duly noted and statistical analysis was conducted. All the statistical analysis was done using the latest SPSS software 2015 (California. RESULT In our study, the mean age of the study population was found to be 29.8 years. That means the majority of the patients who turn up in the Department of Emergency is young and generally in the third decade of life. In Acute Intestinal Obstruction and blunt abdominal injuries, significance of mortality is high (p<0.05. CONCLUSION The study was successful in proving that abdominal injuries are the main factors of causing morbidity and mortality in the younger generation. The surgical mode of

  9. Acute Kidney Injury Complicated Epstein-Barr Virus Infection in Infancy

    Gamze Ozgurhan

    2015-01-01

    Full Text Available Infectious mononucleosis is an acute lymphoproliferative disorder caused by the Epstein-Barr virus (EBV and seen most commonly in children and young adults. Clinical presentation of the disease is characterized by fever, tonsillopharyngitis, lymphadenopathy, and hepatosplenomegaly, whereas serological findings of this benign disorder include positive heterophilic antibody formation (transient increase in heterophilic antibodies and prominence of hematological lymphocytosis of more than 10% of atypical lymphocytes. An EBV infection is usually asymptomatic in childhood, but acute kidney injury can be a rare complication during its course. Most cases recover from the disease completely. Early recognition of EBV infection and estimation of its complication are important for its prognosis. In light of previous literature, we discuss the case evaluated as an EBV infection complicated by acute kidney injury in early childhood and results of tubulointerstitial nephritis shown on a renal biopsy that was later diagnosed as an EBV infection by serological examination.

  10. Hepatitis A complicated with acute renal failure and high hepatocyte growth factor: A case report.

    Oe, Shinji; Shibata, Michihiko; Miyagawa, Koichiro; Honma, Yuichi; Hiura, Masaaki; Abe, Shintaro; Harada, Masaru

    2015-08-28

    A 58-year-old man was admitted to our hospital. Laboratory data showed severe liver injury and that the patient was positive for immunoglobulin M anti-hepatitis A virus (HAV) antibodies. He was also complicated with severe renal dysfunction and had an extremely high level of serum hepatocyte growth factor (HGF). Therefore, he was diagnosed with severe acute liver failure with acute renal failure (ARF) caused by HAV infection. Prognosis was expected to be poor because of complications by ARF and high serum HGF. However, liver and renal functions both improved rapidly without intensive treatment, and he was subsequently discharged from our hospital on the 21(st) hospital day. Although complication with ARF and high levels of serum HGF are both important factors predicting poor prognosis in acute liver failure patients, the present case achieved a favorable outcome. Endogenous HGF might play an important role as a regenerative effector in injured livers and kidneys.

  11. A clinical study of complications of acute pancreatitis and their outcome

    Sajjad Hussain

    2015-02-01

    Conclusion: Ascites was the most common local complication, whereas pleural effusion was the most common systemic complication. Shock, acute respiratory distress syndrome, acute renal failure, pancreatic abscess, infection of the pancre- atic necrosis, upper gastrointestinal bleed, hypocalcaemia, portal vein thrombosis, and hepatic encephalopathy were com- plications with the poorest prognosis. It is important to identify patients with acute pancreatitis who have an increased risk of complications and death. The MOSF scoring system is simple to use, has better clinical utility, and helps in directing pre- cious resources to patients who benefit the most from intensive therapy. Patients with severe pancreatitis require intensive monitoring and support of a failing system in intensive care unit, the lack of which resulted in higher mortality in our study. [Arch Clin Exp Surg 2015; 4(1.000: 1-13

  12. VALIDITY OF CONTRAST ENHANCED CT IN THE ASSESSMENT OF ACUTE PANCREATITIS AND ITS RELATED COMPLICATIONS

    Mannivanan

    2016-03-01

    Full Text Available BACKGROUND In the earlier days, ultrasonogram was considered as one of the most important investigation for pancreatitis, later the clinicians started using cholangiography in acute pancreatitis, but today CT is considered as a gold standard test in the diagnosis of acute pancreatitis. Though the sensitivity of CT in diagnosing acute pancreatitis was not studied much particularly in a mild case, but a good-quality contrast enhanced CT demonstrates distinct pancreatic and peri-pancreatic abnormalities. AIM To assess the importance of computed tomography in diagnosing acute pancreatitis and its related complications. MATERIALS AND METHODS A prospective study was conducted on 150 patients with clinically suspected pancreatitis. CT was performed on all the patients with Siemens Spiral CT scanner Sensation 16 slice. Oral contrast of was 1000 mL given one hour prior to the scan in the form of taking 250 mL every 15 mins. The CT severity index (CTSI and the necrosis point scoring was used to assess the severity of acute pancreatitis. All the complications related to acute pancreatitis were also assessed. RESULTS The CT analysis in the detection of acute pancreatitis showed the sensitivity of 100% and the positive predictive value of 97.3%. The severity index of acute pancreatitis based on the CT imaging had shown that majority of the patients are with moderate (60.6% level of acute pancreatitis. The necrosis point scoring showed that 54.6% of the patients had necrosis involving less than 30% of the pancreas. Among the various complications detected by CECT the commonest were pleural effusion and ascites. CONCLUSION CECT is the most important gold standard technique both for diagnosis as well as for predicting the prognosis in acute pancreatitis. The clinicians should routinely send the patient for the CT imaging whenever there is a suspicion of pancreatitis clinically.

  13. Acute acalculous cholecystitis complicated with peritonitis caused by Lactobacillus plantarum.

    Tena, Daniel; Martínez, Nora Mariela; Losa, Cristina; Fernández, Cristina; Medina, María José; Sáez-Nieto, Juan Antonio

    2013-08-01

    Lactobacillus spp. rarely causes human disease. We report a case of a 57-year-old man with non-insulin-dependent diabetes and vascular disease admitted to our hospital with severe abdominal pain and fever. Signs of peritonitis were found upon examination. The patient underwent surgery, and a diagnosis of perforated cholecystitis with purulent peritonitis was made intra-operatively. A cholecystectomy was performed, and therapy with imipenem was initiated. Lactobacillus plantarum was isolated from bile and peritoneal fluid cultures 2 days later. The patient recovered well and was discharged on post-operative day 16 after 14 days of treatment with imipenem. To our knowledge, this is the second case reported of acute cholecystitis caused by Lactobacillus spp. This organism should be considered as a cause of biliary infections, especially in patients with underlying diseases. Correct identification is often difficult, but it is very important because these organisms are usually resistant to vancomycin and other antibiotics.

  14. Acute gingival bleeding as a complication of dengue hemorrhagic fever

    Saif Khan

    2013-01-01

    Full Text Available Dengue fever is mosquito borne disease caused by dengue virus (DENV of Flaviviridae family. The clinical manifestations range from fever to severe hemorrhage, shock and death. Here, we report a case of 20-year-old male patient undergoing orthodontic treatment presenting with acute gingival bleeding with a history of fever, weakness, backache, retro orbital pain and ecchymosis over his right arm. The hematological investigations revealed anemia, thrombocytopenia and positive dengue non-structural protein-1 antigen and also positive immunoglobulin M and immunoglobulin G antibodies for DENV. Patient was diagnosed as a case of dengue hemorrhagic fever and was immediately referred for appropriate management. This case report emphasizes the importance of taking correct and thorough medical history.

  15. [Mathematical analysis of complicated course of acute surgical diseases of abdominal cavity organs].

    Vozniuk, S M; Pol'ovyĭ, V P; Sydorchuk, R I; Palianytsia, A S

    2013-03-01

    In this paper we analyze the results of diagnosis and treatment of 130 patients with acute surgical diseases of the abdominal cavity, complicated by peritonitis. We proposed the method of estimating the severity of the patients using a coefficient of status severity (C(SS)), developed a scale for prediction of complicated outcomes of acute surgical pathology of the abdominal cavity and abdominal sepsis, which is adapted to the working conditions of local clinics. Using the C(SS) and the scale prediction, allowed timely identification of patients' risk group with possible complicated course, assign adequate treatment, reduce postoperative complications by 5%, relaparotomies by 4.4%, decrease postoperative mortality by 3.9%.

  16. Acute Sinusitis Resulting in a Craniotomy: An Uncommon Complication of a Common Infection

    Allison Price

    2012-01-01

    Full Text Available Acute bacterial sinusitis is a common infectious condition. Patients may initially present with an uncomplicated infection and later, despite appropriate initial antibiotic therapy, develop a potentially life-threatening complication. Interventions aimed at alleviating such unexpected events need be prompt and adequate. We describe a case of a patient who initially presented with signs and symptoms of acute sinusitis later to be diagnosed with a frontal epidural abscess.

  17. Acute Sinusitis Resulting in a Craniotomy: An Uncommon Complication of a Common Infection

    2012-01-01

    Acute bacterial sinusitis is a common infectious condition. Patients may initially present with an uncomplicated infection and later, despite appropriate initial antibiotic therapy, develop a potentially life-threatening complication. Interventions aimed at alleviating such unexpected events need be prompt and adequate. We describe a case of a patient who initially presented with signs and symptoms of acute sinusitis later to be diagnosed with a frontal epidural abscess.

  18. Severe crush syndrome complicated with acute pancreatitis: a case report and review of the literatures

    LIU Fang; ZHANG Ling; FU Ping; SU Bai-hai; CHEN Xiao-lei; LIU Ling; CHEN Wei-xia; TAO Ye; HUANG Song-min

    2009-01-01

    @@ Earthquake is one of the most catastrophic natural disasters. As we know, crush syndrome is the second most frequent cause of mortality after the direct impact of trauma.~(1-3) It is a serious clinical case that develops among casualties of earthquakes or other catastrophic events that may also result in a variety of ensuing uncommon complications. Cases of crush syndrome complicated with acute pancreatitis (AP) following the earthquakes are seldom reported.

  19. Acute axonal polyneuropathy with predominant proximal involvement: an uncommon neurological complication of bariatric surgery

    2006-01-01

    Bariatric surgery is frequently indicated in the treatment of morbid obesity. Previously unreported complications have been associated to this surgery; among them, neurological complications have gained attention. We report the case of a 25-year-old man submitted to gastric surgery for treatment of morbid obesity who developed, two months after surgery, acute proximal weakness in lower limbs. The electroneuromyography revealed axonal peripheral polyneuropathy with predominant proximal involve...

  20. Imaging of acute pancreatitis and its complications. Part 1: acute pancreatitis.

    Türkvatan, A; Erden, A; Türkoğlu, M A; Seçil, M; Yener, Ö

    2015-02-01

    Acute pancreatitis is an acute inflammatory disease of the pancreas that may also involve surrounding tissues or remote organs. The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Generally, imaging is recommended to confirm the clinical diagnosis, investigate the etiology, and grade the extend and severity of the acute pancreatitis. Ultrasound is the first-line imaging modality in most centers for the confirmation of the diagnosis of acute pancreatitis and the ruling out of other causes of acute abdomen, but it has limitations in the acute clinical setting. Computed tomography not only establishes the diagnosis of acute pancreatitis, but also enables to stage severity of the disease. Magnetic resonance imaging has earned an ever more important role in the diagnosis of acute pancreatitis. It is especially useful for imaging of patients with iodine allergies, characterizing collections and assessment of an abnormal or disconnected pancreatic duct. The purpose of this review article is to present an overview of the acute pancreatitis, clarify confusing terminology, underline the role of ultrasound, computed tomography and magnetic resonance imaging according to the proper clinical context and compare the advantages and limitations of each modality.

  1. Viral-bacterial interactions and risk of acute otitis media complicating upper respiratory tract infection.

    Pettigrew, Melinda M; Gent, Janneane F; Pyles, Richard B; Miller, Aaron L; Nokso-Koivisto, Johanna; Chonmaitree, Tasnee

    2011-11-01

    Acute otitis media (AOM) is a common complication of upper respiratory tract infection whose pathogenesis involves both viruses and bacteria. We examined risks of acute otitis media associated with specific combinations of respiratory viruses and acute otitis media bacterial pathogens. Data were from a prospective study of children ages 6 to 36 months and included viral and bacterial culture and quantitative PCR for respiratory syncytial virus (RSV), human bocavirus, and human metapneumovirus. Repeated-measure logistic regression was used to assess the relationship between specific viruses, bacteria, and the risk of acute otitis media complicating upper respiratory tract infection. In unadjusted analyses of data from 194 children, adenovirus, bocavirus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were significantly associated with AOM (P virus loads (≥3.16 × 10(7) copies/ml) experienced increased acute otitis media risk. Higher viral loads of bocavirus and metapneumovirus were not significantly associated with acute otitis media. In adjusted models controlling for the presence of key viruses, bacteria, and acute otitis media risk factors, acute otitis media risk was independently associated with high RSV viral load with Streptococcus pneumoniae (odds ratio [OR], 4.40; 95% confidence interval [CI], 1.90 and 10.19) and Haemophilus influenzae (OR, 2.04; 95% CI, 1.38 and 3.02). The risk was higher for the presence of bocavirus and H. influenzae together (OR, 3.61; 95% CI, 1.90 and 6.86). Acute otitis media risk differs by the specific viruses and bacteria involved. Acute otitis media prevention efforts should consider methods for reducing infections caused by respiratory syncytial virus, bocavirus, and adenovirus in addition to acute otitis media bacterial pathogens.

  2. A case report of acute acalculous cholecystitis due to Salmonella Paratyphi B complicated by biliary peritonitis.

    Benjelloun, El Bachir; Chbani, Leila; Toughrai, Iman; Ousadden, Abdelmalek; Mazaz, Khalid; Taleb, Kahlid Ait

    2013-01-01

    Non-typhoidal salmonella are a rare case of acute acalculouscholecystitis (AAC). Salmonella Paratyphi B, which accounts for one of the less invasive NTS serotypes, has rarely been reported to cause cholecystitis. We describe a case of 65-year old previously healthy man, who present with signs of acute abdomen, due to biliary peritonitis as a complication of acute acalculouscholecystitis caused by Salmonella paratyphi B. Our case illustrates the potential severity of infection with Salmonella Paratyphi B especially in older patient. High index of awarenessshould be considered in endemic areas.

  3. Emergency adrenalectomy due to acute heart failure secondary to complicated pheochromocytoma: a case report

    Padillo Francisco J

    2011-05-01

    Full Text Available Abstract Pheochromocytomas are catecholamine producing tumors arising mostly from chromaffin cells of the adrenal medulla. The most common clinical presentation is hypertension, mainly in the form of paroxymal episodes. Cardiovascular manifestations include malignant arrhythmia and catecholamine cardiomyopathy, mimicking acute coronary syndromes and acute heart failure. There are reports of pheochromocytomas presenting as acute coronary syndrome and rapidly leading to cardiogenic shock; the failure of intensive medical treatment in these cases has prompted the need for emergency adrenalectomy as the only remaining option. We report on a case of complicated pheochromocytoma presenting as cardiogenic shock, in which emergency adrenalectomy was performed following a total lack of response to intensive medical treatment.

  4. A Rare Case of Acute Phlegmonous Esophagogastritis Complicated with Hypopharyngeal Abscess and Esophageal Perforation

    Huang, Yuan-Chun; Cheng, Ching-Yuan; Liao, Chiung-Ying; Hsueh, Ching; Tyan, Yeu-Sheng; Ho, Shang-Yun

    2017-01-01

    Patient: Female, 60 Final Diagnosis: Acute phlegmonous esophagogastritis complicated with hypopharyngeal abscess • esophageal perforation Symptoms: Fever • painful swallowing • chest pain Medication: — Clinical Procedure: Drainage • debridement • esophageal reconstruction Specialty: Surgery Objective: Rare disease Background: Acute phlegmonous esophagogastritis is a life-threatening disease that may be combined with serious complications. We present the classical radiological and endoscopic features and treatment strategy of a middle-aged female patient suffering from acute phlegmonous esophagogastritis complicated with hypopharyngeal abscess, esophageal perforation, mediastinitis, and empyema. Case Report: A 60-year-old Taiwanese female presented at our hospital due to fever, fatigue, painful swallowing, and vague chest pain for 5 days. She had a past history of uncontrolled type 2 diabetes mellitus. On physical examination, general weakness, chest pain, odynophagia, and a fever up to 38.9°C were found. Positive laboratory findings included leukocytosis (leukocyte count of 14.58×103/μL, neutrophils 76.8%) and serum glucose 348 mg/dL (HbA1c 11.3%). A diagnosis of acute phlegmonous esophagogastritis with hypopharyngeal abscess was made based on typical computed tomography image features and clinical signs of infection. The patient received empirical antibiotic therapy initially; however, esophageal perforation with mediastinitis and empyema developed after admission. Emergency surgery with drainage and debridement was performed and antibiotics were administered. She was discharged in a stable condition on the 56th day of hospitalization. Six months later, a delayed esophageal reconstruction was performed. The patient has performed well for 9 months to date since the initial diagnosis. Conclusions: Acute phlegmonous esophagogastritis complicated with hypopharyngeal abscess and esophageal perforation is extremely rare, and requires immediate medical

  5. Myocardial infarction following recombinant tissue plasminogen activator treatment for acute ischemic stroke: a dangerous complication

    ZHOU Zhi-gang; WANG Rui-lan; YU Kang-long

    2012-01-01

    Thrombolysis with intravenous tissue plasminogen activator (t-PA) is currently an approved therapy for patients with acute ischemic stroke.Acute myocardial infarction (AMI) immediately following t-PA treatment for stroke is a rare but serious complication.A case of acute myocardial infarction (MI) following IV t-PA infusion for acute stroke was observed.This is a 52-year-old male with a known history of hypertension and chest pain,who subsequently developed MI four hours after IV t-PA was administered for acute ischemic stroke.The disruption of intra-cardiac thrombus and subsequent embolization to the coronary arteries may be an important mechanism.In addition.spontaneous recanalization of infarct-related arteries may be associated with 9reater myocardial salvage and better prognosis.

  6. Acute Appendicitis as Complication of Colon Transit Time Study; A Case Report.

    Ghahramani, Leila; Roshanravan, Reza; Khodaei, Shahin; Rahimi Kazerooni, Salar; Moslemi, Sam

    2015-07-01

    Colon transit time study with radio opaque markers is a simple method for assessment of colon motility disorder in patients with chronic idiopathic constipation. We report a case of acute appendicitis that was induced by impaction of radio opaque markers after colon transit time study. We think that this case report is first significant complication of colon transit time study until now.

  7. [Prognostication of malignization and acute complications of gastric ulcer disease, using multiparametric neuronet clasterization].

    Dzyubanovskiy, I Ya; Selskiy, P R; Viytovych, L E

    2015-03-01

    Results of examination of 20 gastric ulcer disease patients were analyzed for delineation of a high risk group for an acute complications occurrence, and in whom the conduction of organ preserving preventive operative interventions is expedient. For prognostication such following indices were applied: quantity of cells-producents of various immunoglobulins, mitotic and apoptotic indices, relative volume of damaged epitheliocytes, the patients' age.

  8. Pheochromocytoma presenting as an acute coronary syndrome complicated by acute heart failure: The challenge of a great mimic

    Giuseppe Damiano Sanna

    2016-10-01

    Full Text Available Pheochromocytoma is a rare neuroendocrine tumor with a highly variable clinical presentation. The serious and potentially lethal cardiovascular complications of these tumors are related to the effects of secreted catecholamines. We describe a case of a 50-year-old woman urgently admitted to our hospital because of symptoms and clinical and instrumental findings consistent with an acute coronary syndrome complicated by acute heart failure. Urgent coronary angiography showed normal coronary arteries. During her hospital stay, the recurrence of episodes characterized by a sudden increase in blood pressure, cold sweating, and nausea allowed us to hypothesize a pheochromocytoma. The diagnosis was confirmed by elevated levels of urinary catecholamines and by the finding of a left adrenal mass on magnetic resonance imaging. The patient underwent left adrenalectomy. Therefore, the initial diagnosis was critically reappraised and reviewed as a cardiac manifestation of a pheochromocytoma during catecholaminergic crisis.

  9. Acute Page kidney following renal allograft biopsy: a complication requiring early recognition and treatment.

    Chung, J; Caumartin, Y; Warren, J; Luke, P P W

    2008-06-01

    The acute Page kidney phenomenon occurs as a consequence of external compression of the renal parenchyma leading to renal ischemia and hypertension. Between January 2000 and September 2007, 550 kidney transplants and 518 ultrasound-guided kidney biopsies were performed. During that time, four recipients developed acute oligo-anuria following ultrasound-guided allograft biopsy. Emergent doppler-ultrasounds were performed demonstrating absence of diastolic flow as well as a sub-capsular hematoma of the kidney. Prompt surgical exploration with allograft capsulotomy was performed in all cases. Immediately after capsulotomy, intraoperative Doppler study demonstrated robust return of diastolic flow. Three patients maintained good graft function, and one kidney was lost due to acute antibody-mediated rejection. We conclude that postbiopsy anuria associated with a subcapsular hematoma and acute absence of diastolic flow on doppler ultrasound should be considered pathognomonic of APK. All renal transplant specialists should be able to recognize this complication, because immediate surgical decompression can salvage the allograft.

  10. Septic thrombophlebitis of the porto-mesenteric veins as a complication of acute appendicitis

    Yeon Soo Chang; Sun Young Min; Sun Hyung Joo; Suk-Hwan Lee

    2008-01-01

    Pylephlebitis, a rare complication of acute appendicitis,is defined as thrombophlebitis of the portal venous system. Pylephlebitis usually occurs due to secondary infection in the region drained into the portal system.We report a case of pylephlebitis caused by acute appendicitis. The patient was transferred from a private clinic 1 wk after appendectomy with the chief complaints of high fever and abdominal pain. He was diagnosed with pylephlebitis of the portal vein and superior mesenteric vein by CT-scan. The patient was treated with antibiotics and anticoagulation therapy,and discharged on the 25th day and follow-up CT scan showed a cavernous transformation of portal thrombosis.

  11. Review: Study progress on mechanism of severe acute pancreatitis complicated with hepatic injury

    ZHANG Xi-ping; WANG Lei; ZHANG Jie

    2007-01-01

    Study on the action mechanism of inflammatory mediators generated by the severe acute pancreatitis (SAP) in multiple organ injury is a hotspot in the surgical field. In clinical practice, the main complicated organ dysfunctions are shock, respiratory failure, renal failure, encephalopathy, with the rate of hepatic diseases being closely next to them. The hepatic injury caused by SAP cannot only aggravate the state of pancreatitis, but also develop into hepatic failure and cause patient death. Its complicated pathogenic mechanism is an obstacle in clinical treatment. Among many pathogenic factors, the changes ofvasoactive substances, participation of inflammatory mediators as well as OFR (oxygen free radical), endotoxin, etc. may play important roles in its progression.

  12. Hereditary angioedema type 2 presented as an orbital complication of acute rhinosinusitis.

    Somuk, Battal Tahsin; Göktas, Göksel; Özer, Samet; Sapmaz, Emrah; Bas, Yalcın

    2016-03-01

    Hereditary angioedema is an autosomal dominant and life-threatening disorder characterized by recurrent episodes of non-pitting edema affecting the skin, respiratory system and digestive tracts and caused by a congenital deficiency or function defect of the C1 esterase inhibitor. Preseptal cellulitis is defined as an infection of the tissues of the anterior orbital septum. It is generally caused by complications from an upper respiratory tract infection, dacryocystitis, dermal infection, and, rarely, sinusitis. The disease presents with orbital pain, edema on the eyelids, erythema, and fever. In this case, a child with hereditary angioedema type 2 who presented as mimicking a complication of acute sinusitis is discussed.

  13. [Acute renal failure as a complication of transarterial chemoembolization in a patient with hepatocellular carcinoma].

    La Spada, Emanuele; La Spada, Monica; Brusca, Tiziana; Campagna, M Elisa; Di Gesaro, Valeria; Terranova, Angela; Sandonato, Luigi; Soresi, Maurizio

    2007-04-01

    Transarterial chemoembolization (TACE) is included among the wide therapeutic tools for the treatment of hepatocellular carcinoma (HCC), tumour with high frequency and malignancy. The approach is invasive and, beyond the discomfort for the patient, it is charged by a number of side effects and complications. In this study we report the case of renal acute failure of hypovolemic origin, as a consequence of a TACE in a patient suffering from HCC, occurred after one week of intervention. The different possible mechanisms involved in the pathogenesis of this complication are discussed.

  14. Asymptomatic superior mesenteric vein thrombosis as unusual complication of acute cytomegalovirus infection: a case report

    Michele Bertoni

    2015-10-01

    Full Text Available We describe a 39-year-old male who presented with a fever of unknown origin, the diagnostic work-up of which disclosed an acute cytomegalovirus (CMV infection complicated by a partial superior mesenteric vein (SMV thrombosis. Further investigations revealed the presence of factor V Leiden mutation. Oral anticoagulant treatment with warfarin led to a complete recanalization of SMV two months after. A literature review on the association between CMV infection and portal system (PS thrombosis in immunocompetent patients was performed. We found that, in agreement with our case, in a minority of case reports patients did not complain of abdominal pain, but presented with a mononucleosis-like syndrome with malaise and prolonged fever and displayed a variable elevation of aminotransferase levels. Interestingly, most of them exhibited a limited extension of portal thrombosis. On the whole, these data suggest that PS thrombosis during acute CMV infection may be an underestimated complication.

  15. Acute mechanical circulatory support for fulminant myocarditis complicated by cardiogenic shock.

    Mody, Kanika P; Takayama, Hiroo; Landes, Elissa; Yuzefpolskaya, Melana; Colombo, Paolo C; Naka, Yoshifumi; Jorde, Ulrich P; Uriel, Nir

    2014-03-01

    In fulminant myocarditis complicated by cardiogenic shock, early mechanical circulatory support (MCS) may prevent cardiomyopathy and death. We sought to examine the outcomes of patients with fulminant myocarditis supported with MCS. A retrospective review of patients with acute cardiogenic shock treated with MCS from 2007 to 2013 was conducted, and patients with a diagnosis of fulminant myocarditis were included in this series. At our center, 260 patients received MCS for acute cardiogenic shock, and 11 were implanted for fulminant myocarditis. Eight received the Centrimag biventricular assist device (BIVAD), and three received veno-arterial extracorporeal membrane oxygenator (VA ECMO), though 1 VA ECMO-supported patient was transitioned to BIVAD due to refractory shock. The mean acute support time was 14.7 ± 4.4 days. Two patients required long-term left ventricular assist devices and were further supported for 55 and 112 days. Eight patients recovered with a mean ejection fraction of 54 ± 7 %, and one was successfully transplanted. Eight patients survived to discharge (73 %) with mean follow-up: 292.6 ± 306.8 days. All three deaths were due to neurologic complications. MCS should be considered in patients with fulminant myocarditis complicated by shock. With aggressive medical therapy, early utilization of MCS carries promising outcomes.

  16. Soluble Endothelial Selectin in Acute Lung Injury Complicated by Severe Pneumonia

    Daisuke Osaka, Yoko Shibata, Kazunori Kanouchi, Michiko Nishiwaki, Tomomi Kimura, Hiroyuki Kishi, Shuichi Abe, Sumito Inoue, Yoshikane Tokairin, Akira Igarashi, Keiko Yamauchi, Yasuko Aida, Takako Nemoto, Keiko Nunomiya, Koji Fukuzaki, Isao Kubota

    2011-01-01

    Full Text Available Background: Pneumonia is still one of the most frequent causes of death in the elderly. Complication of acute lung injury (ALI/acute respiratory distress syndrome (ARDS by pneumonia makes patients very ill due to severe respiratory failure. Biomarkers that can discriminate the presence of complicating ALI/ARDS are required for early detection. The aim of this research was to investigate whether soluble endothelial selectin (sES could be a biomarker for ALI.Methods: Serum sES levels were measured in 27 pneumonia patients, who were enrolled between April 2006 and September 2007. Among these patients, six had ALI or a condition that was clinically comparable to ALI (cALI. All patients who were enrolled were successfully treated and survived.Results: Circulating sES levels were elevated in pneumonia patients with ALI/cALI, and sES levels decreased following treatment of their pneumonia. Univariate and multivariate logistic regression analyses showed that sES was the only significant factor for identifying complicating ALI/cALI, independently of C-reactive protein (CRP and lactate dehydrogenase (LDH. By receiver operating characteristic (ROC curve analysis, the cut-off value for sES was 40.1 ng/mL, with a sensitivity of 0.8 and a specificity of 0.8.Conclusion: sES may be a useful biomarker for discriminating complicating ALI/cALI in patients with severe pneumonia.

  17. Current Concepts and New Trends in the Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction

    Benedek Theodora

    2015-03-01

    Full Text Available Cardiogenic shock (CS is a critical condition which often complicates the evolution of an acute myocardial infarction (AMI. At the same time, co-existence of chronic multi-vessel disease can lead to the development of cardiogenic shock in cases with pronounced haemodynamic instability. Different clinical studies have tried to identify the most appropriate treatment for critical cases of CS complicating AMI. This review aims to present the current status of recommended therapeutic strategies for severe cases of CS presenting as a complication of AMI, and try to shed light on the most appropriate therapeutic strategy as outlined in the current literature. The paper will discuss the different current strategies available for use in the treatment of this condition, includig interventional revascularisation, (complete or culprit, the role of new devices for providing mechanical circulatory support, and the potential role of new drug therapies and of hypothermia.

  18. Combined blood purification for treating acute fatty liver of pregnancy complicated by acute kidney injury: a case series.

    Tang, Wan Xin; Huang, Zhong Ying; Chen, Ze Jun; Cui, Tian Lei; Zhang, Ling; Fu, Ping

    2012-06-01

    Acute fatty liver of pregnancy (AFLP) complicated by acute kidney injury (AKI) is serious and life-threatening for the mother. The present study aimed to determine the clinical efficacy of combined blood purification treatment (CBPT) in patients with AFLP complicated by AKI. The CBPT involves plasma exchange (PE) combined with continuous venovenous hemofiltration (CVVH). The subjects were 17 patients with AFLP complicated by AKI. The CBPT was implemented based on the timely termination of pregnancy and general treatment. Changes in clinical manifestations, laboratory tests, liver ultrasounds, as well as Sequential Organ Failure Assessment (SOFA) and Glasgow scores were evaluated. The efficacy and adverse reactions of the CBPT were also assessed. The CBPT was smoothly performed without any obvious adverse reaction. After treatment, the clinical manifestations, laboratory examinations, and liver ultrasonography significantly improved. Therefore, the SOFA scores correspondingly decreased 1 week after treatment [9 (range 5-11) vs. 3 (range 0-10), P = 0.002], and the median was close to normal by the second week. The clearance rate of the total bilirubin in PE was significantly higher than that in CVVH (37.2 vs. 7.9%, P = 0.000). The incidence of acute pulmonary edema in CVVH was less than that in PE (0 vs. 41.2%, P = 0.007). Finally, the maternal mortality was 5.88% (95% CI: 0-29%). Overall, we think that CBPT aids in the recovery of liver and kidney function. Different blood purification methods may be combined to integrate and maximize their advantages to improve the prognoses of patients with serious AFLP.

  19. Primary percutaneous coronary intervention ameliorates complete atrioventricular block complicating acute inferior myocardial infarction

    Lee SN

    2014-11-01

    Full Text Available Su Nam Lee, You-Mi Hwang, Gee-Hee Kim, Ji-Hoon Kim, Ki-Dong Yoo, Chul-Min Kim, Keon-Woong MoonDepartment of Internal Medicine, St Vincent’s Hospital, The Catholic University of Korea, Suwon, South KoreaObjective: Complete atrioventricular block (CAVB in acute inferior ST-segment elevation myocardial infarction (STEMI is associated with poor clinical outcomes after noninvasive treatment. This study was designed to determine the effect of primary percutaneous coronary intervention (PCI in patients with CAVB complicating acute inferior STEMI, at a single center.Methods: We enrolled 138 consecutive patients diagnosed with STEMI involving the inferior wall; of these, 27 patients had CAVB. All patients received primary PCI. The clinical characteristics, procedural data, and clinical outcomes were compared in patients with versus without CAVB. Results: Baseline clinical characteristics were similar between patients with and without CAVB. Patients with CAVB were more likely to present with cardiogenic shock, and CAVB was caused primarily by right coronary artery occlusion. Door-to-balloon time was similar between those two groups. After primary PCI, CAVB was reversed in all patients. The peak creatinine phosphokinase level, left ventricular ejection fraction and in-hospital mortality rate were similar between the two groups. After a median follow up of 318 days, major adverse cardiac events did not differ between the groups (8.1% in patients without CAVB; 11.1% in patients with CAVB (P=0.702.Conclusion: We conclude that primary PCI can ameliorate CAVB-complicated acute inferior STEMI, with an acceptable rate of major adverse cardiac events, and suggest that primary PCI should be the preferred reperfusion therapy in patients with CAVB complicating acute inferior myocardial infarction. Keywords: major adverse cardiac events, PCI-capable hospital

  20. Nicardipine-induced acute pulmonary edema: a rare but severe complication of tocolysis.

    Serena, Claire; Begot, Emmanuelle; Cros, Jérôme; Hodler, Charles; Fedou, Anne Laure; Nathan-Denizot, Nathalie; Clavel, Marc

    2014-01-01

    We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. Clinical severity justified hospitalization in intensive care unit (ICU) each time. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. For all patients, the first diagnosis suspected was pulmonary embolism. The patients' condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. The use of intravenous nicardipine is widely used for tocolysis in France even if its prescription does not have a marketing authorization. The pathophysiological mechanisms of this complication remain unclear. The main reported risk factors are spontaneous preterm labor, multiple pregnancy, concomitant obstetrical disease, association with beta-agonists, and fetal lung maturation corticotherapy. A better knowledge of this rare but serious adverse event should improve the management of patients. Nifedipine or atosiban, the efficiency of which tocolysis was also studied, could be an alternative.

  1. Nicardipine-Induced Acute Pulmonary Edema: A Rare but Severe Complication of Tocolysis

    Serena, Claire; Begot, Emmanuelle; Cros, Jérôme; Hodler, Charles; Fedou, Anne Laure; Nathan-Denizot, Nathalie; Clavel, Marc

    2014-01-01

    We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. Clinical severity justified hospitalization in intensive care unit (ICU) each time. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. For all patients, the first diagnosis suspected was pulmonary embolism. The patients' condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. The use of intravenous nicardipine is widely used for tocolysis in France even if its prescription does not have a marketing authorization. The pathophysiological mechanisms of this complication remain unclear. The main reported risk factors are spontaneous preterm labor, multiple pregnancy, concomitant obstetrical disease, association with beta-agonists, and fetal lung maturation corticotherapy. A better knowledge of this rare but serious adverse event should improve the management of patients. Nifedipine or atosiban, the efficiency of which tocolysis was also studied, could be an alternative. PMID:25215245

  2. Nicardipine-Induced Acute Pulmonary Edema: A Rare but Severe Complication of Tocolysis

    Claire Serena

    2014-01-01

    Full Text Available We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. Clinical severity justified hospitalization in intensive care unit (ICU each time. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. For all patients, the first diagnosis suspected was pulmonary embolism. The patients' condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. The use of intravenous nicardipine is widely used for tocolysis in France even if its prescription does not have a marketing authorization. The pathophysiological mechanisms of this complication remain unclear. The main reported risk factors are spontaneous preterm labor, multiple pregnancy, concomitant obstetrical disease, association with beta-agonists, and fetal lung maturation corticotherapy. A better knowledge of this rare but serious adverse event should improve the management of patients. Nifedipine or atosiban, the efficiency of which tocolysis was also studied, could be an alternative.

  3. Imaging Features of the Pleuropulmonary Manifestations of Rheumatoid Arthritis: Pearls and Pitfalls

    Harbir S Sidhu

    2011-01-01

    Full Text Available Rheumatoid arthritis (RA is a common disorder that affects the joints. RA is a systemic disease associated with relatively frequent and variable pleuropulmonary manifestations. This article reviews the common and potentially serious thoracic sequelae in terms of pleural disease, pulmonary nodules, airways disorders, and interstitial disease, as well as pulmonary side effects of antirheumatic medication. An imaging-guided approach to classification of RA-associated lung disease is outlined and the comparative values of different imaging modalities are discussed. An appreciation of current knowledge of epidemiology, pathological correlation, and prognostic implications of different RA-associated lung disease is provided. We highlight importance of considering pertinent differential diagnoses to avoid misdiagnosis, and outline common pitfalls in dealing with pleuropulmonary rheumatoid disease.

  4. Post-streptococcal acute glomerulonephritis complicated by gouty arthritis: a case report.

    Kuniyoshi, Yasutaka; Kamura, Azusa; Yasuda, Sumie; Tashiro, Makoto

    2015-06-17

    Gouty arthritis is uncommon in childhood and adolescence. On the other hand, there has been no report of cases with development of gouty arthritis with post-streptococcal acute glomerulonephritis (PSAGN) in pediatric patients. Here we report the case of a mildly obese 12-year-old boy with PSAGN complicated by gouty arthritis of the left first metatarsophalangeal joint. On follow-up, it was confirmed that as serum C3 level returned to normal, urinary excretion of uric acid increased and serum uric acid level decreased, thereby resolving the burning pain of the left big toe. In this case, not only did renal insufficiency associate with PSAGN but also mild obesity may have led to hyperuricemia and gouty arthritis. In conclusion, clinicians should be aware that PSAGN may be complicated by gouty arthritis in obese pediatric patients.

  5. Acute axonal polyneuropathy with predominant proximal involvement: an uncommon neurological complication of bariatric surgery

    Machado Flavia Costa Nunes

    2006-01-01

    Full Text Available Bariatric surgery is frequently indicated in the treatment of morbid obesity. Previously unreported complications have been associated to this surgery; among them, neurological complications have gained attention. We report the case of a 25-year-old man submitted to gastric surgery for treatment of morbid obesity who developed, two months after surgery, acute proximal weakness in lower limbs. The electroneuromyography revealed axonal peripheral polyneuropathy with predominant proximal involvement. After treatment with immunoglobulin and vitamin supplementation, rapid clinical and neurophysiologic recovery was observed. We describe the clinical and electroneuromyographic features of this case, stressing the difficulty of initial diagnosis, particularly in the differential diagnosis with Guillain-Barré syndrome. We discuss the importance of nutritional follow-up and the eventual indication of routine vitamin supplementation in these patients.

  6. Acute axonal polyneuropathy with predominant proximal involvement: an uncommon neurological complication of bariatric surgery.

    Machado, Flavia Costa Nunes; Valério, Berenice Cataldo Oliveira; Morgulis, Roberto Naun Franco; Nunes, Karlo Faria; Mazzali-Verst, Sílvia

    2006-09-01

    Bariatric surgery is frequently indicated in the treatment of morbid obesity. Previously unreported complications have been associated to this surgery; among them, neurological complications have gained attention. We report the case of a 25-year-old man submitted to gastric surgery for treatment of morbid obesity who developed, two months after surgery, acute proximal weakness in lower limbs. The electroneuromyography revealed axonal peripheral polyneuropathy with predominant proximal involvement. After treatment with immunoglobulin and vitamin supplementation, rapid clinical and neurophysiologic recovery was observed. We describe the clinical and electroneuromyographic features of this case, stressing the difficulty of initial diagnosis, particularly in the differential diagnosis with Guillain-Barré syndrome. We discuss the importance of nutritional follow-up and the eventual indication of routine vitamin supplementation in these patients.

  7. The role of levosimendan in acute heart failure complicating acute coronary syndrome: A review and expert consensus opinion.

    Nieminen, Markku S; Buerke, Michael; Cohen-Solál, Alain; Costa, Susana; Édes, István; Erlikh, Alexey; Franco, Fatima; Gibson, Charles; Gorjup, Vojka; Guarracino, Fabio; Gustafsson, Finn; Harjola, Veli-Pekka; Husebye, Trygve; Karason, Kristjan; Katsytadze, Igor; Kaul, Sundeep; Kivikko, Matti; Marenzi, Giancarlo; Masip, Josep; Matskeplishvili, Simon; Mebazaa, Alexandre; Møller, Jacob E; Nessler, Jadwiga; Nessler, Bohdan; Ntalianis, Argyrios; Oliva, Fabrizio; Pichler-Cetin, Emel; Põder, Pentti; Recio-Mayoral, Alejandro; Rex, Steffen; Rokyta, Richard; Strasser, Ruth H; Zima, Endre; Pollesello, Piero

    2016-09-01

    Acute heart failure and/or cardiogenic shock are frequently triggered by ischemic coronary events. Yet, there is a paucity of randomized data on the management of patients with heart failure complicating acute coronary syndrome, as acute coronary syndrome and cardiogenic shock have frequently been defined as exclusion criteria in trials and registries. As a consequence, guideline recommendations are mostly driven by observational studies, even though these patients have a particularly poor prognosis compared to heart failure patients without signs of coronary artery disease. In acute heart failure, and especially in cardiogenic shock related to ischemic conditions, vasopressors and inotropes are used. However, both pathophysiological considerations and available clinical data suggest that these treatments may have disadvantageous effects. The inodilator levosimendan offers potential benefits due to a range of distinct effects including positive inotropy, restoration of ventriculo-arterial coupling, increases in tissue perfusion, and anti-stunning and anti-inflammatory effects. In clinical trials levosimendan improves symptoms, cardiac function, hemodynamics, and end-organ function. Adverse effects are generally less common than with other inotropic and vasoactive therapies, with the notable exception of hypotension. The decision to use levosimendan, in terms of timing and dosing, is influenced by the presence of pulmonary congestion, and blood pressure measurements. Levosimendan should be preferred over adrenergic inotropes as a first line therapy for all ACS-AHF patients who are under beta-blockade and/or when urinary output is insufficient after diuretics. Levosimendan can be used alone or in combination with other inotropic or vasopressor agents, but requires monitoring due to the risk of hypotension.

  8. Saving the limb in diabetic patients with ischemic foot lesions complicated by acute infection.

    Clerici, Giacomo; Faglia, Ezio

    2014-12-01

    Ischemia and infection are the most important factors affecting the prognosis of foot ulcerations in diabetic patients. To improve the outcome of these patients, it is necessary to aggressively treat 2 important pathologies--namely, occlusive arterial disease affecting the tibial and femoral arteries and infection of the ischemic diabetic foot. Each of these 2 conditions may lead to major limb amputation, and the presence of both critical limb ischemia (CLI) and acute deep infection is a major risk factor for lower-extremity amputation. Thus, the management of diabetic foot ulcers requires specific therapeutic approaches that vary significantly depending on whether foot lesions are complicated by infection and/or ischemia. A multidisciplinary team approach is the key to successful treatment of a diabetic foot ulcer: ischemic diabetic foot ulcers complicated by acute deep infection pose serious treatment challenges because high levels of skill, organization, accuracy, and timing of intervention are required to maximize the chances of limb salvage: these complex issues are better managed by a multidisciplinary clinical group.

  9. Infections in children admitted with complicated severe acute malnutrition in Niger.

    Anne-Laure Page

    Full Text Available BACKGROUND: Although malnutrition affects thousands of children throughout the Sahel each year and predisposes them to infections, there is little data on the etiology of infections in these populations. We present a clinical and biological characterization of infections in hospitalized children with complicated severe acute malnutrition (SAM in Maradi, Niger. METHODS: Children with complicated SAM hospitalized in the intensive care unit of a therapeutic feeding center, with no antibiotics in the previous 7 days, were included. A clinical examination, blood, urine and stool cultures, and chest radiography were performed systematically on admission. RESULTS: Among the 311 children included in the study, gastroenteritis was the most frequent clinical diagnosis on admission, followed by respiratory tract infections and malaria. Blood or urine culture was positive in 17% and 16% of cases, respectively, and 36% had abnormal chest radiography. Enterobacteria were sensitive to most antibiotics, except amoxicillin and cotrimoxazole. Twenty-nine (9% children died, most frequently from sepsis. Clinical signs were poor indicators of infection and initial diagnoses correlated poorly with biologically or radiography-confirmed diagnoses. CONCLUSIONS: These data confirm the high level of infections and poor correlation with clinical signs in children with complicated SAM, and provide antibiotic resistance profiles from an area with limited microbiological data. These results contribute unique data to the ongoing debate on the use and choice of broad-spectrum antibiotics as first-line treatment in children with complicated SAM and reinforce the call for an update of international guidelines on management of complicated SAM based on more recent data.

  10. Peripancreatic vascular abnormalities complicating acute pancreatitis: contrast-enhanced helical CT findings

    Mortele, Koenraad J. E-mail: kmortele@partners.org; Mergo, Patricia J.; Taylor, Helena M.; Wiesner, Walter; Cantisani, Vito; Ernst, Michael D.; Kalantari, Babak N.; Ros, Pablo R

    2004-10-01

    Objective: To determine the prevalence and morphologic helical computed tomography (CT) features of peripancreatic vascular abnormalities in patients with acute pancreatic inflammatory disease in correlation with the severity of the pancreatitis. Materials and methods: One hundred and fifty-nine contrast-enhanced helical CT scans of 100 consecutive patients with acute pancreatitis were retrospectively and independently reviewed by three observers. CT scans were scored using the CT severity index (CTSI): pancreatitis was graded as mild (0-2 points), moderate (3-6 points), and severe (7-10 points). Interobserver agreement for both the CT severity index and the presence of peripancreatic vascular abnormalities was calculated (K-statistic). Correlation between the prevalence of complications and the degree of pancreatitis was estimated using Fisher's exact test. Results: The severity of pancreatitis was graded as mild (n=59 scans), moderate (n=82 scans), and severe (n=18 scans). Venous abnormalities detected included splenic vein (SV) thrombosis (31 scans, 19 patients), superior mesenteric vein (SMV) thrombosis (20 scans, 14 patients), and portal vein (PV) thrombosis (17 scans, 13 patients). Arterial hemorrhage occurred in five patients (6 scans). In our series, no cases of arterial pseudoaneurysm formation were detected. The interobserver agreement range for scoring the degree of pancreatitis and the overall presence of major vascular abnormalities was 75.5-79.2 and 86.2-98.8%, respectively. The presence of the vascular abnormalities in correlation with the severity of pancreatitis was variable. Conclusion: Vascular abnormalities are relatively common CT findings in association with acute pancreatitis. The CT severity index is insufficiently accurate in predicting some of these complications since no statistically significant correlation between their prevalence and the severity of pancreatitis could be established.

  11. Coronary flow and hemorrhagic complications after alteplase and streptokinase administration in patients with acute myocardial infarction

    Kostić Tomislav

    2009-01-01

    Full Text Available Background/Aim. Up-to-date treatment of acute myocardial infarction (AIM has been based on as early as possible establishment of circulation in ischemic myocardium whether by the use of fibrinolythic therapy and/or urgent coronary intervention which significantly changes the destiny of patients with AMI, but also increases the risk of bleeding. The aim of this study was to compare coronary flow and bleeding complications in patients with acute myocardial infarction with ST-elevation (STEMI after administration of alteplase or streptokinase. Methods. The study included 254 patients with STEMI. The group I (n = 174 received streptokinase, and the group II (n = 80 received alteplase. We followed frequency of complications such as bleeding and hypotension in the investigated groups of patients, based on the TIMI classification of bleeding, as well as the transience of infarction artery in accordance with TIMI flow. Results. The patients with myocardial infarction after administration of alteplase had statistically significantly higher coronary flow (TIMI- 3, 72.5% as compared to the patients who received streptokinase, 39.2%. Hypotension as complication of fibrynolythic therapy administration occurred in a significantly higher percentage in the group of patients who received streptokinase. There was no statistically significant difference in the appearance of major bleeding in the groups of patients who received streptokinasis and alteplase (6.9% and 7.5%, respectively. Also, there was no difference in the appearance of minor and minimal bleeding among the investigated groups of patients. Conclusion. It was shown that alteplase in a higher number of patients provided TIMI-3 coronary flow as compared to streptokinese. In comparison with streptokinase, a combination of alteplase, enoxaparin and double antiplatelet therapy enabled earlier achievement of coronary flow through previously blocked coronary artery that was more complete (higher frequency of

  12. Impact of NOD2 polymorphisms on infectious complications following chemotherapy in patients with acute myeloid leukaemia.

    Yomade, Olaposi; Spies-Weisshart, Bärbel; Glaser, Anita; Schnetzke, Ulf; Hochhaus, Andreas; Scholl, Sebastian

    2013-08-01

    We sought to investigate the relationship between polymorphisms of the NOD2 gene and infectious complications following intensive induction chemotherapy in patients with acute myeloid leukaemia (AML). We hypothesised that single nucleotide polymorphisms (SNPs) of the NOD2 gene are associated with a higher rate of infections during the phase of severe neutropenia. In 131 AML patients receiving induction therapy, the presence of the three most frequent polymorphisms of NOD2 (Arg702Trp, Gly908Arg, Leu1007fsinsC) was analysed. SNP analyses by means of genomic PCR incorporating fluorescence-labelled probes with characteristic melting curves were performed using the LightCycler platform. Our data suggest a significantly lower probability of mucositis or enteritis in AML patients lacking any of the three evaluated NOD2 polymorphisms. Furthermore, bloodstream cultures of AML patients carrying either a missense or a frameshift mutation of NOD2 were significantly more frequently tested positive concerning Streptococcus spp. In contrast, the presence of NOD2 polymorphisms had no impact on such important infectious complications as systemic inflammatory response syndrome or sepsis, the rate of central venous catheter infections or the incidence of pneumonia including fungal infections. Our data represent one of the first reports investigating the impact of polymorphisms of the innate immune system on infectious complications in patients with neutropenia following chemotherapy. A correlation between NOD2 polymorphisms and infectious events in AML patients is demonstrated.

  13. Urgent hybrid approach in treatment of the acute myocardial infarction complicated by the ventricular septal rupture

    Radosavljević-Radovanović Mina

    2014-01-01

    Full Text Available Introduction. Ventricular septal rupture (VSR in the acute myocardial infarction (AMI is a rare but very serious complication, still associated with high mortality, despite significant improvements in pharmacological and surgical treatment. Therefore, hybrid approaches are introduced as new therapeutical options. Case Outline. We present an urgent hybrid approach, consisting of the initial percutaneous coronary intervention (PCI of the infarct-related artery, followed by immediate surgical closure of the ventricular septal rupture, for treatment of high risk, hemodynamically unstable female patient with AMI caused by one-vessel disease and complicated by VSR and cardiogenic shock. Since the operative risk was also very high (EUROSCORE II 37%, this therapeutic decision was based on the assumption that preoperative PCI could promptly establish blood flow and thereby lessen the risks, duration and complexity of urgent cardiosurgical intervention, performed on the same day. This approach proved to be successful and the patient was discharged from the hospital on the fifteenth postoperative day in stable condition. Conclusion. In selected cases, with high operative risk and unstable hemodynamic state due to AMI complicated by VSR, urgent hybrid approach consisting of the initial PCI followed by surgical closure of VSR may represent an acceptable treatment option and contribute to the treatment of this complex group of patients.

  14. Clinical features, acute complications, and outcome of Salmonella meningitis in children under one year of age in Taiwan

    Lee Meng-Luen

    2011-01-01

    Full Text Available Abstract Background Salmonella meningitis remains a threat to children below two years of age in both developing and developed countries. However, information on such infections has not been well characterized. We analyzed data related to twelve years of experience in order to clarify the comprehensive features of Salmonella meningitis in our patients, including admission characteristics, acute complications, and long-term outcome. Methods The records of patients with spontaneous Salmonella meningitis from 1982 to 1994 were retrospectively reviewed. The long-term outcome was prospectively determined for survivors at school age by the developmental milestones reported by their parents and detailed neurological evaluation along with intelligence, hearing, visual, speech and language assessments. Results Of the twenty-four patients, seizures were noted in fifteen (63% before admission and thirteen (54% during hospitalization. Acute complications mainly included hydrocephalus (50%, subdural collection (42%, cerebral infarction (33%, ventriculitis (25%, empyema (13%, intracranial abscess (8%, and cranial nerve palsy (8%. Three patients (13% died during the acute phase of Salmonella meningitis. The twenty-one survivors, on whom we followed up at school age, have sequelae consisting of language disorder (52%, motor disability (48%, intelligence quotient Conclusion Salmonella meningitis in neonates and infants had a wide spectrum of morbidity and acute complications, leading to a complicated hospital course and subsequently a high prevalence of permanent adverse outcome. Thus, early recognition of acute complications of Salmonella meningitis and a follow-up plan for early developmental assessment of survivors are vital.

  15. STUDY OF CLINICAL PROFILE OF DENGUE FEVER WITH SPECIAL REFERENCE TO ACUTE COMPLICATIONS

    Keshava

    2014-02-01

    Full Text Available ABSTRACT: Dengue is the arthropode borne viral infection transmitted by mosquitoes to humans. AIM: To study the various clinical manifestations and acute complications of dengue fever. METHODS: 100 cases of confirmed dengue infection admitted to KIMS, Bangalore between December 2009 and September 2011 were studied. A detailed clinical history and physical examination was done and baseline investigations were performed. The cases were followed-up daily for the clinical and laboratory parameters and were treated according to WHO guidelines. The data related to each of these cases was collected, compiled and analyzed. RESULTS: of the total 100 cases there were 61 male and 39 female. Age group of 21-30 (41 was most commonly affected Maximum number of patients was seen in the September, October, august, July. Commonest presentation was Fever (100% followed by Headache (78%, Myalgia (70%, Arthralgia (66%, low back ache (60%. On examination patients found to have icterus (22%, bleeding spots (26%, rashes (50%, Splenomegaly (18%, Hepatomegaly (15% and Ascites (9%, pleural effusion (16%, crepitations (7%. Platelet count was not very well correlated with the bleeding tendencies. Incidence of DHF was more with secondary Dengue infection than the primary dengue infection. The frequency of complications was high in the patients with secondary dengue infection than the primary infection. CONCLUSION: In our present study classical dengue fever was most common presentation followed by DHF and DSS. Hypotension, hemorrhagic spots, positive tourniquet test, jaundice, pleural effusion, ascites, neck stiffness are the common findings on examination associated with complicated forms of dengue. Bleeding, shock, hepatitis, polyserositis, meningitis, pneumonia are the complications seen in severe forms. On investigation Deranged liver function test, renal function test, secondary dengue infection, thickened gall bladder wall, hepatosplenomegaly on ultrasound abdomen

  16. Inter ventional therapy of diabetes mellitus type 2 complicated with acute cerebral hemorrhage by using dexmedetomidine

    Shan-Shan Zheng

    2016-09-01

    Full Text Available Objective: To study the effects of dexmedetomidine on cerebral injury, inflammation, oxidative stress and renal function of patients with diabetes mellitus type 2 complicated with acute cerebral hemorrhage. Methods: A total of 98 cases who had been diagnosed with diabetes mellitus type 2 complicated with acute cerebral hemorrhage and treated with interventional therapy in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2014 January 2016 were chosen to be our study subjects. Among them, 50 cases given dexmedetomidine treatment in the process of anesthesia were included in the dexmedetomidine group (Group A, while the other 48 cases treated with equal amount of normal saline were considered as the negative control group. The postoperative cerebral injury indexes and the serum biochemical indexes were detected after 24 h. Results: The contents of serum S100b [(2.1 ± 0.2 mg/L] and neuron-specific enolase (NSE [(14.2 ± 1.3 mg/mL] in Group A were all significantly lower than serum S100b [(2.9 ± 0.3 mg/L] and NSE [(16.6 ± 1.7 mg/mL] of patients in negative control group. The contents of cerebrospinal fluid S100b [(0.9 ± 0.1 mg/L] and NSE [(10.7 ± 1.3 mg/ mL] in Group A were all significantly lower than cerebrospinal fluid S100b [(1.3 ± 0.2 mg/L] and NSE [(15.3 ± 1.7 mg/mL] of patients in negative control group. The contents of erythrocyte sedimentation rate [(11.7 ± 2.5 mm/h], c-reactive protein [(2.3 ± 0.4 mg/L], urea nitrogen [(10.7 ± 1.2 mmol/L] and serum creatinine [(151.6 ± 14.9] mmol/L in Group A were all significantly lower than erythrocyte sedimentation rate [(23.6 ± 3.8 mm/h], c-reactive protein [(6.9 ± 1.1 mg/L], urea nitrogen [(16.7 ± 1.7 mmol/L] and serum creatinine [(192.5 ± 18.3] mmol/L of patients in negative control group. Conclusions: The application of dexmedetomidine in the interventional therapy of diabetes mellitus type 2 complicated with acute cerebral hemorrhage could

  17. Interventional therapy of diabetes mellitus type 2 complicated with acute cerebral hemorrhage by using dexmedetomidine

    Shan-Shan Zheng; Xin-Ye Qian; Si-Yuan Li; Xuan Zhao

    2016-01-01

    Objective: To study the effects of dexmedetomidine on cerebral injury, inflammation, oxidative stress and renal function of patients with diabetes mellitus type 2 complicated with acute cerebral hemorrhage. Methods: A total of 98 cases who had been diagnosed with diabetes mellitus type 2 complicated with acute cerebral hemorrhage and treated with interventional therapy in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2014 January 2016 were chosen to be our study subjects. Among them, 50 cases given dexmedetomidine treatment in the process of anesthesia were included in the dexmedetomidine group (Group A), while the other 48 cases treated with equal amount of normal saline were considered as the negative control group. The postoperative cerebral injury indexes and the serum biochemical indexes were detected after 24 h. Results: The contents of serum S100b [(2.1 ± 0.2) mg/L] and neuron-specific enolase (NSE) [(14.2 ± 1.3) mg/mL] in Group A were all significantly lower than serum S100b [(2.9 ± 0.3) mg/L] and NSE [(16.6 ± 1.7) mg/mL] of patients in negative control group. The contents of cerebrospinal fluid S100b [(0.9 ± 0.1) mg/L] and NSE [(10.7 ± 1.3) mg/mL] in Group A were all significantly lower than cerebrospinal fluid S100b [(1.3 ± 0.2) mg/L] and NSE [(15.3 ± 1.7) mg/mL] of patients in negative control group. The contents of erythrocyte sedimentation rate [(11.7 ± 2.5) mm/h], c-reactive protein [(2.3 ± 0.4) mg/L], urea nitrogen [(10.7 ± 1.2) mmol/L] and serum creatinine [(151.6 ± 14.9)] mmol/L in Group A were all significantly lower than erythrocyte sedi-mentation rate [(23.6 ± 3.8) mm/h], c-reactive protein [(6.9 ± 1.1) mg/L], urea nitrogen [(16.7 ± 1.7) mmol/L] and serum creatinine [(192.5 ± 18.3)] mmol/L of patients in negative control group. Conclusions: The application of dexmedetomidine in the interventional therapy of diabetes mellitus type 2 complicated with acute cerebral hemorrhage could

  18. Atraumatic splenic rupture as a complication of acute exacerbation of chronic pancreatitis, an unusual disease.

    Moya Sánchez, Elena; Medina Benítez, Antonio

    2017-02-27

    We report the case of a patient with acute exacerbation of chronic pancreatitis and he suffered an atraumatic splenic rupture. Splenic rupture not associated with trauma is a rare entity that can occurs in normal spleen (spontaneous) or damaged spleen (pathological). This entity may be associated with local inflammatory processes, such as pancreatitis. Ultrasound is a non-invasive technique which is used in unstable patients. CT is useful for making a diagnosis of extension in patients with hemodynamic stability. Atraumatic splenic rupture as a complication of chronic pancreatitis is an unusual disease that requires a high index of suspicion which allows us an early diagnosis because it is a treatable entity that compromises the patient's life.

  19. [Effectiveness of various dopamine doses in acute myocardial ischemia complicated by cardiogenic shock (an experimental study)].

    Kipshidze, N N; Korotkov, A A; Marsagishvili, L A; Prigolashvili, T Sh; Bokhua, M R

    1981-06-01

    The effect of various doses of dopamine on the values of cardiac contractile and hemodynamic function under conditions of acute two-hour ischemia complicated by cardiogenic shock was studied in 27 experiments on dogs. In a dose of 5 microgram/kg/min dopamine caused an optimum increase in cardiac productive capacity, reduction of peripheral resistance, adequate increase in coronary circulation and decrease in ST segment depression on the ECG. Infusion of 10 microgram/kg/min dopamine usually caused myocardial hyperfunction with an increase in total peripheral resistance and cardiac performance. Maximum dopamine doses (10 microgram/kg/min and more) were effective in the areactive form of cardiogenic shock. In longterm dopamine infusion it is necessary to establish continuous control over the hemodynamic parameters and the ECG to prevent aggravation of ischemia and for stage-by-stage reduction of the drug concentration and determination of the minimum maintenance dose.

  20. [Pulmonary contusion and acute respiratory distress syndrome (ARDS) as complications of blunt chest trauma].

    Michalska, Agata; Jurczyk, Agnieszka P; Machała, Waldemar; Szram, Stefan; Berent, Jarosław

    2009-01-01

    Blunt chest traumas are common nowadays due to development of motor transport. They are associated with high mortality rates because of serious injuries of internal organs. The mechanisms of injuries are complex and may cause damages ranging from small ones, such as bruises or abrasions, to life-threatening trauma. Among typical injuries there are rib fractures, sternal fractures, pneumothorax, hemothorax, diaphragm lacerations, pulmonary contusions, cardiac tamponade, cardiac rupture and many others. The authors of the article would like to emphasize the pathophysiology and diagnostic difficulties in such blunt chest trauma complications as pulmonary contusions and acute respiratory distress syndrome, for which no causal treatment is available and only early diagnosis and administration of symptomatic treatment may increase the patients' chances to survive. In Forensic Medicine Department, Medical University of Łódź, an opinion was issued on a case which illustrates the clinical problem.

  1. An Unusual Complication of Acute Necrotising Pancreatitis Detected by Endoscopic Ultrasound

    Surinder Singh Rana

    2014-05-01

    Full Text Available A 32 year old male patient diagnosed as alcohol related acute necrotising pancreatitis (ANP 2 months ago, now presented with abdominal pain and early satiety. Contrast enhanced computerized tomography (CECT showed 12 cm walled off pancreatic necrosis (WOPN (Figure 1. Endoscopic ultrasound (EUS revealed large WOPN and power doppler revealed vascularity in collection with pulsatile flow suggestive of blood leaking into collection (Figure 2. However, no abnormal vessel or pseudoaneurysm could be identified. CT angiography (CTA also showed normal major abdominal arteries (Figure 3. Since patient was symptomatic, after informed consent EUS guided transmural drainage was attempted. Now there was no vascularity in collection and procedure was successfully accomplished. A 7 Fr nasocystic drain (NCD was inserted and it drained purulent material. Patient had marked symptomatic relief but 6 hours later had severe pain and hematemesis with blood coming through NCD also. CTA revealed blood in WOPN but no abnormal bleeding vessel was identified (Figure 4. Digital subtraction angiography (DSA also did not reveal any abnormal or bleeding vessel. The patient was managed with blood transfusion and NCD was kept patent by intermittent flushing. The bleeding subsided and the effluent from NCD cleared in 48 hours. The NCD was replaced with 10 Fr pigtail stents and CT abdomen done 3 weeks later revealed resolution of WOPN (Figure 5. The patient has been asymptomatic over a follow up period of 13 months. Gastrointestinal bleeding is rare but potentially lethal complication of acute pancreatitis as well as of transmural drainage of pancreatic collections [1, 2, 3]. CTA is the most common procedure used to detect pseudoaneurysms but it can miss them if they are small or bleeding is intermittent and slow because of compression by collection [4, 5]. In these situations, EUS can help in detecting this potentially catastrophic complication of pancreatitis.

  2. Prediction value of the ratio of serum high-sensitivity C-reactive protein and prealbumin on acute myocardial infarction complicated with acute heart failure

    Su-Yun Zu; Shuang Wang; Feng-Lan Yang; Bao-Gui Chen; Ming-Zhe Ma

    2015-01-01

    Objective:To through counting serum high-sensitivity C-reactive protein (hs-CRP), prealbumin (PAB) and the ratio of the two to analyze its predictive value on acute myocardial infarction complicated with postoperative acute heart failure.Methods: 100 cases of acute myocardial infarction patients treated in our hospital from January 2013 to January 2015 were selected as research objects. Serum PAB and hs-CRP values on the next day of admission as well as after PCI surgery were recorded respectively. Then PAB data change before and after surgery, PAB and hs-CRP change with or without postoperative cardiovascular events (heart failure) as well as the value of the ratio of hs-CRP and PAB on prediction of acute myocardial infarction complicated with acute heart failure was compared.Results:Postoperative PAB in 100 cases of myocardial infarction patients increased from (0.19±0.05) to (0.24±0.06), and the differences had statistical significance; 40 cases had postoperative cardiovascular events (heart failure), incidence being 40%; PAB in patients without postoperative cardiovascular events (heart failure) increased significantly, hs-CRP decreased significantly, and the differences had statistical significance; Logistic regression univariate analysis showed that acute myocardial infarction complicated with heart failure was associated with diabetes, PAB, hs-CRP and In (hs-CRP/PAB), and multivariate analysis showed that it was associated with In (hs-CRP/PAB). Conclusion:hs-CRP in patients with acute myocardial infarction increases, PAB decreases, postoperative PAB increases relatively, hs-CRP and PAB data shows different degrees of change with or without postoperative cardiovascular (heart failure), and In (hs-CRP/PAB) is associated with acute myocardial infarction complicated with heart failure and can be used as its prediction index.

  3. Experience in Diagnosis and Treatment of Bleeding Complications in Severe Acute Pancreatitis by TAE

    2005-01-01

    The experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis (SAP) by transcatheter arterial embolization was summarized. The clinical data of 19 SAP patients complicated with intra-abdominal bleeding in our hospital from Jan. 2000 to Jan. 2003 were analyzed retrospectively and the therapeutic outcome of TAE was evaluated statistically. The results showed that the short-term successful rate of hemostasis by TAE was 89.5 % (17/19), the incidence of re-bleeding after TAE was 36.8 % (7/19) and the successful rate of hemostatis by second TAE was 71.4 % (5/7). It was concluded that the intra-abdominal bleeding in SAP was mainly caused by the rupture of erosive/infected pseudoaneurysm. Mostly, the broken vessels were splenic artery and gastroduodenal artery. In terms of emergence hemostatis, TAE is the most effective method. Surgical hemostasis is necessary if hemostasis by TAE is failed or re-bleeding occurs after TAE.

  4. Complicated Cholelithiasis: An Unusual Combination of Acute Pancreatitis and Bouveret Syndrome

    Ioannis Baloyiannis

    2012-07-01

    Full Text Available Bouveret syndrome is a rare form of gallstone ileus. The purpose of the present study was to present the unusual case of a female patient with complicated cholelithiasis manifested as a combination of acute pancreatitis and concomitant Bouveret syndrome. A 61-year-old female patient was admitted to the emergency department complaining of mid-epigastric and right upper quadrant abdominal pain radiating band-like in the thoracic region of the back as well as repeated episodes of vomiting over the last 24 h. The initial correct diagnosis of pancreatitis was subsequently combined with the diagnosis of Bouveret syndrome as a computed tomography scan revealed the presence of a gallstone within the duodenum causing luminal obstruction. After failure of endoscopic gallstone removal, a surgical approach was undertaken where gallstone removal was followed by cholecystectomy and restoration of the anatomy by eliminating the fistula. The concomitant pancreatitis complicated the postoperative period and prolonged the length of hospital stay. However, the patient was discharge on the 45th postoperative day. Attempts for endoscopic removal of the impacted stone should be the initial therapeutic step. Surgery should be reserved for cases refractory to endoscopic intervention and when definite treatment is the actual challenge.

  5. In-hospital medical complications associated with patient dependency after acute ischemic stroke: data from the China National Stroke Registry

    WANG Peng-lian; ZHAO Xing-quan; DU Wan-liang; WANG An-xin; JI Rui-jun; YANG Zhong-hua; WANG Chun-xue

    2013-01-01

    Background The mortality of stroke patients is strongly affected by medical complications.However,there are limited data investigating the effect of in-hospital medical complications on the dependency of stroke patients worldwide.We prospectively and systematically investigated the effect of medical complications on dependency of patients at 3,6 and 12 months after stroke using the China National Stroke Registry (CNSR).Methods This prospective cohort study collected data of patients age >18 years with acute ischemic stroke in 132 clinical centers distributed across 32 provinces and four municipalities (including Hong Kong region) of China,from September 2007 to August 2008.Data on medical complications,dependency and other information were obtained from paper-based registry forms.Medical complications associated with stroke outcomes were assessed using multivariable Logistic regression.Results Of 11 560 patients with acute ischemic stroke,1826 (15.80%) presented with in-hospital medical complications.In-hospital medical complications were independent risk factors for dependency of patients at 3 months (adjusted odds ratio (OR) 2.367,95% confidence interval (CI) 2.021-2.771),6 months (adjusted OR 2.257,95% CI 1.922-2.650),and 12 months (adjusted OR 1.820,95% CI 1.538-2.154) after acute ischemic stroke.Conclusion The results demonstrated that the short-term and long-term dependency of acute ischemic stroke patients is significantly associated with in-hospital medical complications in China.

  6. A case of Clostridium difficile infection complicated by acute respiratory distress syndrome treated with fecal microbiota transplantation.

    Kim, Ji Eun; Gweon, Tae-Geun; Yeo, Chang Dong; Cho, Young-Seok; Kim, Gi Jun; Kim, Jae Young; Kim, Jong Wook; Kim, Hyunho; Lee, Hye Won; Lim, Taeseok; Ham, Hyoju; Oh, Hyun Jin; Lee, Yeongbok; Byeon, Jaeho; Park, Sung Soo

    2014-09-21

    Acute respiratory distress syndrome is a life-threatening disorder caused mainly by pneumonia. Clostridium difficile infection (CDI) is a common nosocomial diarrheal disease. Disruption of normal intestinal flora by antibiotics is the main risk factor for CDI. The use of broad-spectrum antibiotics for serious medical conditions can make it difficult to treat CDI complicated by acute respiratory distress syndrome. Fecal microbiota transplantation is a highly effective treatment in patients with refractory CDI. Here we report on a patient with refractory CDI and acute respiratory distress syndrome caused by pneumonia who was treated with fecal microbiota transplantation.

  7. Viscosupplementation of the knee: Three cases of acute Pseudoseptic Arthritis with painful and irritating complications and a literature review

    Aydın, Murat; Arıkan, Murat; Toğral, Güray; Varış, Onur; Aydın, Güle

    2017-01-01

    Acute pseudoseptic arthritis is a very rare complication that is associated with intra-articular hyaluronic acid injections, which normally involve minimal risk. The most common adverse events that are caused by hyaluronic acid injections are inflammatory reactions or flares at the injection site. In this study, we described three cases of acute pseudoseptic arthritis that was caused by hyaluronic acid; the symptoms in these cases were reminiscent of acute septic arthritis. Moreover, we performed a literature review on pseudoseptic arthritis following hyaluronic acid injections to determine the manner in which this condition can be described, diagnosed, and treated. PMID:28293455

  8. Pleuropulmonary blastoma type I following resection of incidentally found congenital lobar emphysema.

    Walsh, S

    2009-07-01

    Pleuropulmonary blastoma (PPB) is an aggressive tumour accounting for less than 1% of all primary malignant lung tumours in the paediatric population. It can be associated with cystic pulmonary lesions, which may be evident at the time of diagnosis or predate the appearance of the tumour. There are contradictory reports about the value of prophylactic resection of pulmonary cysts in protecting patients from developing PPB. We report an individual case where asymptomatic congenital lobar emphysema was incidentally picked up on CXR. Following a period of surveillance the lesion was resected due to increasing size. The histology of the lesion revealed PPB Type I.

  9. Effect of Complications After Minimally Invasive Surgical Repair of Acute Achilles Tendon Ruptures Report on 211 Cases

    Metz, Roderik; van der Heijden, Geert J. M. G.; Verleisdonk, Egbert-Jan M. M.; Kolfschoten, Nicky; Verhofstad, Michiel H. J.; van der Werken, Christiaan

    2011-01-01

    Background: Complications of acute Achilles tendon rupture treatment are considered to negatively influence outcome, but the relevance of these effects is largely unknown. Purpose: The Achilles Tendon Total Rupture Score (ATRS) was used to determine level of disability in patients with minimally inv

  10. Clinical correlates of complicated grief among individuals with acute coronary syndromes

    Pini S

    2015-10-01

    Full Text Available Stefano Pini,1 Camilla Gesi,1 Marianna Abelli,1 Alessandra Cardini,1 Lisa Lari,1 Francesca Felice,2 Rossella Di Stefano,2 Gianfranco Mazzotta,3 Francesco Bovenzi,4 Daniele Bertoli,5 Lucia Borelli,4 Paola Michi,1 Claudia Oligeri,3 Alberto Balbarini,2 Vijaya Manicavasagar6 1Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, 2Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, 3Unit of Cardiology, Ospedale Sant’Andrea, La Spezia, 4Cardio-Respiratory Department, Ospedale Campo di Marte, Lucca, 5Unit of Cardiology, Ospedale San Bartolomeo, Sarzana (SP, Italy; 6Black Dog Institute, University of New South Wales, Sydney, NSW, Australia Objective: The study aimed at exploring bereavement and complicated grief (CG symptoms among subjects without a history of coronary heart disease (CHD at the time of a first acute coronary syndrome (ACS and to evaluate the relationship of CG symptoms and ACS. Method: Overall, 149 subjects with ACS (namely, acute myocardial infarct with or without ST-segment elevation or unstable angina, with no previous history of CHD, admitted to three cardiac intensive care units were included and evaluated by the Structured Clinical Interview for Complicated Grief (SCI-CG, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and the 36-item Short-Form Health Survey (MOS-SF-36. Results: Of the total sample of 149 subjects with ACS, 118 (79.2% met criteria for DSM-5 persistent complex bereavement disorder. Among these, subjects who lost a partner, child, or sibling were older (P=0.008, less likely to be working (P=0.032, and more likely to be suffering from hypertension (P=0.021, returned higher scores on the SCI-CG (P=0.001 and developed the index ACS more frequently between 12 and 48 months after the death than those who lost a parent or another relative (P≤0.0001. The occurrence of ACS 12–48 months (P=0.019 after the loss was

  11. CT Manifestations of Lung Changes and Complications in Patients with Severe Acute Respiratory Syndrome

    张雪哲; 王武; 卢延; 黄振国; 洪闻; 尚燕宁; 任安

    2003-01-01

    Objective:To investigate the role of CT scanning in diagnosing severe acute respiratory syndrome(SARS). Methods: One hundred and twelve times of spiral CT scanning, 106 times on the chest with standard pulmonary and mediastinal window, 5 on the brain and once on the abdomen, were performed in 82 patients (37 males and 45 females) of SARS. Results: Bilateral shadows showed in 66 patients (80.48%) and unilateral shadow in 16 (19.52%). The lung CT findings were sub-pleural focal consolidation in 26 patients (31.70%), flaky cloudy opacity in 53 (64.63%), large area consolidation in 9 (10.97%), ground-glass blurry shadow in 31 (37.80%), alveolar substantive shadow in 14 (17.07%) and interstitial changes in 16 (19.51%). The pulmonary CT signs of SARS were relatively characterized by: (1) The lesions tending to multiply occur, mostly to be bilaterally distributed and commonly involved in the lower lung field. (2) The lung shadows mostly showed as sub-pleural focal consolidation, flaky cloudy shadow, large area consolidation, ground-glass blurry shadow, and often accompanied with signs of broncho-inflation. (3) Having opacified nodular shadows in the alveolar cavities. (4) Rapid progressions or changes on the size, amount, and distribution of the lesions likely to be found in dynamic observation of chest X-ray and CT scanning, i.e., markedly dynamic changes found within 24 to 48 hrs. Lesions with these characteristics may be recognized as pulmonary changes possibly induced by SARS. Complications were found in 6 patients (7.31%), including tuberculosis of lung and brain accompanied with pneumomediastinum in one patient, secondary infection of lung in 2, pneumothorax in 1, pulmonary fungus in 1, and pyothorax in 1.Conclusion: CT scanning is a sensitive method for diagnosis of SARS, by which more accurate assessment of the abnormal changes of lung and occurrence of complications in SARS patients can be made.

  12. Effect of lung resection on pleuro-pulmonary mechanics and fluid balance.

    Salito, C; Bovio, D; Orsetti, G; Salati, M; Brunelli, A; Aliverti, A; Miserocchi, G

    2016-01-15

    The aim of the study was to determine in human patients the effect of lung resection on lung compliance and on pleuro-pulmonary fluid balance. Pre and post-operative values of compliance were measured in anesthetized patients undergoing resection for lung cancer (N=11) through double-lumen bronchial intubation. Lung compliance was measured for 10-12 cm H2O increase in alveolar pressure from 5 cm H2O PEEP in control and repeated after resection. No air leak was assessed and pleural fluid was collected during hospital stay. A significant negative correlation (r(2)=0.68) was found between compliance at 10 min and resected mass. Based on the pre-operative estimated lung weight, the decrease in compliance following lung resection exceeded by 10-15% that expected from resected mass. Significant negative relationships were found by relating pleural fluid drainage flow to the remaining lung mass and to post-operative lung compliance. Following lung re-expansion, data suggest a causative relationship between the decrease in compliance and the perturbation in pleuro-pulmonary fluid balance.

  13. The role of DNA amplification and cultural growth in complicated acute appendicitis

    Francesca Tocchioni

    2016-09-01

    Full Text Available Bacterial growth of peritoneal fluid specimens obtained during surgical procedures for acute appendicitis may be useful to optimize further antibiotic therapy in complicated cases. DNA amplification represents a fast technique to detect microbial sequences. We aimed to compare the potential of DNA amplification versus traditional bacterial growth culture highlighting advantages and drawbacks in a surgical setting. Peritoneal fluid specimens were collected during surgery from 36 children who underwent appendectomy between May and December 2012. Real-time polymerase chain reaction (RT-PCR and cultures were performed on each sample. RT-PCR showed an amplification of 16S in 18/36 samples, Escherichia coli (in 7 cases, Pseudomonas aeruginosa (3, Fusobacterium necrophorum (3, Adenovirus (2, E.coli (1, Klebsiella pneumoniae (1, Serratia marcescens/Enterobacter cloacae (1. Bacterial growth was instead observed only in four patients (3 E.coli and 1 P.aeruginosa and Bacteroides ovatus. Preoperative C-reactive protein and inflammation degree, the most reliable indicators of bacterial translocation, were elevated as expected. DNA amplification was a quick and useful method to detect pathogens and it was even more valuable in detecting aggressive pathogens such as anaerobes, difficult to preserve in biological cultures; its drawbacks were the lack of biological growths and of antibiograms. In our pilot study RT-PCR and cultures did not influence the way patients were treated.

  14. Total Hip Arthroplasty Complicated by a Gluteal Hematoma Resulting in Acute Foot Drop.

    Khattar, Nicolas K; Parry, Phillip V; Agarwal, Nitin; George, Hope K; Kretz, Eric S; Larkin, Timothy M; Gruen, Gary S; Abla, Adnan A

    2016-01-01

    Total hip arthroplasty is a prevalent orthopedic intervention in the United States. Massive postoperative hematomas are a rare albeit serious complication of the procedure. Sequelae of these hematomas can include lower extremity paralysis from compression of the sciatic nerve. A 66-year-old woman taking aspirin and clopidogrel for coronary stents presented with a complete foot drop, paresthesias, and lower extremity pain 10 days after a total hip arthroplasty. The patient was initially seen by a neurology service at another hospital and thought to have lateral recess stenosis. At the authors' center, magnetic resonance imaging of the lumbar spine failed to show lateral recess stenosis. Urgent pelvic computed tomography showed a large hematoma and raised suspicion of sciatic nerve compression. Hip magnetic resonance imaging showed a right gluteal hematoma compressing the sciatic nerve. The patient was then taken to the operating room for the clot to be evacuated and was later referred for rehabilitation. Massive hematomas after total hip arthroplasty are an important consideration in the differential diagnosis of nontraumatic acute foot drop. Prompt diagnosis may correlate with improved neurological outcome and help reduce overall morbidity.

  15. The Role of DNA Amplification and Cultural Growth in Complicated Acute Appendicitis

    Tocchioni, Francesca; Tani, Chiara; Bartolini, Laura; Moriondo, Maria; Nieddu, Francesco; Pecile, Patrizia; Azzari, Chiara; Messineo, Antonio; Ghionzoli, Marco

    2016-01-01

    Bacterial growth of peritoneal fluid specimens obtained during surgical procedures for acute appendicitis may be useful to optimize further antibiotic therapy in complicated cases. DNA amplification represents a fast technique to detect microbial sequences. We aimed to compare the potential of DNA amplification versus traditional bacterial growth culture highlighting advantages and drawbacks in a surgical setting. Peritoneal fluid specimens were collected during surgery from 36 children who underwent appendectomy between May and December 2012. Real-time polymerase chain reaction (RT-PCR) and cultures were performed on each sample. RT-PCR showed an amplification of 16S in 18/36 samples, Escherichia coli (in 7 cases), Pseudomonas aeruginosa (3), Fusobacterium necrophorum (3), Adenovirus (2), E.coli (1), Klebsiella pneumoniae (1), Serratia marcescens/Enterobacter cloacae (1). Bacterial growth was instead observed only in four patients (3 E.coli and 1 P.aeruginosa and Bacteroides ovatus). Preoperative C-reactive protein and inflammation degree, the most reliable indicators of bacterial translocation, were elevated as expected. DNA amplification was a quick and useful method to detect pathogens and it was even more valuable in detecting aggressive pathogens such as anaerobes, difficult to preserve in biological cultures; its drawbacks were the lack of biological growths and of antibiograms. In our pilot study RT-PCR and cultures did not influence the way patients were treated. PMID:27777701

  16. Postmortem changes in lungs in severe closed traumatic brain injury complicated by acute respiratory failure

    V. A. Tumanskiy

    2013-08-01

    Full Text Available V.А. Tumanskіy, S.І. Ternishniy, L.M. Tumanskaya Pathological changes in the lungs were studied in the work of 42 patiens who died from severe closed intracranial injury (SCII. It was complicated with acute respiratory insufficient (ARI. The most modified subpleural areas were selected from every lobe of the lungs for pathological studies. Prepared histological sections were stained by means of hemotoxylin and eosin and by Van Giеson for light microscopy. The results of the investigation have shown absence of the significant difference of pathological changes in the lungs of patients who died from ARI because of severe brain injury and traumatic intracranial hemorrhage. Pathognomic pathological changes in the lungs as a result of acute lung injury syndrome (ALIS were found in deceased patients on the third day since the SCII (n=8. There was a significant bilateral interstitial edema and mild alveolar edema with the presence of red and blood cells in the alveoli, vascular plethora of the septum interalveolar and stasis of blood in the capillaries, the slight pericapillary leukocyte infiltration, subpleural hemorrhage and laminar pulmonary atelectasis. In deceased patients on 4-6 days after SCII that was complicated with ARI (n=14, morphological changes had been detected in the lungs. It was pathognomic for acute respiratory distress syndrome (ARDS with local pneumonic to be layered. A significant interstitial pulmonary edema was observed in the respiratory part of the lungs. The edema has spread from the walls of the alveoli into the interstitial spaces of the bronchioles and blood vessels, and also less marked serous-hemorrhagic alveolar edema with presence of the fibrin in the alveoli and macrophages. The ways of intrapleural lymphatic drainage were dilatated. Histopathological changes in the lungs of those who died on the 7-15th days after severe closed craniocerebral injury with ARI to be complicated (n=12 have been indicative of two

  17. A Case of Acute Budd-Chiari Syndrome Complicating Primary Antiphospholipid Syndrome Presenting as Acute Abdomen and Responding to Tight Anticoagulant Therapy

    Naofumi Chinen

    2016-01-01

    Full Text Available A 34-year-old woman with primary antiphospholipid syndrome was admitted to the Gastroenterology Department of our hospital with fever, acute abdomen, watery diarrhea, and extremely high levels of inflammatory parameters. She had a history of left lower limb deep vein thrombosis and pulmonary embolism and was taking warfarin potassium. Acute gastroenteritis was suspected and an antibiotic was administered, but symptoms progressed. Abdominal ultrasonography showed occlusion of the left hepatic vein and the middle hepatic vein and her D-dimer level was high. Accordingly, Budd-Chiari syndrome was diagnosed and high-dose intravenous infusion of heparin was initiated. Her abdominal symptoms improved and the levels of inflammatory parameters and D-dimer decreased rapidly. It is known that antiphospholipid syndrome can be complicated by Budd-Chiari syndrome that usually occurs as subacute or chronic onset, but acute onset is rare. It is difficult to diagnose acute Budd-Chiari syndrome complicating antiphospholipid syndrome and this complication generally has a poor outcome. However, the present case can get early diagnosis and successful treatment with tight anticoagulant therapy.

  18. Lactoferrin acute-phase protein and proteinase inhibitors in blood of patients with Q-wave myocardial infraction complicated by acute heart failure

    K. P. Belokoneva

    2012-01-01

    Full Text Available 153 patients with Q-wave noncomplicated and complicated myocardial infraction have been examined. Blood serum was studied for acute-phase proteins (alfa-2-macroglobulin (MG, alfa-1-antitrypsin (ATr, and lactoferrin (LF in 97 patients ((57.9 ± 1.06 years old. Blood was sampled at the 1st, 7th, and 14th days after myocardial infraction. The decrease of MG in acute phase was observed in patients with cardiogenic shock. Increased concentrations of LF and unchanged MG level at the 1—7 days were observed at pulmonary edema.

  19. Pleuro-pulmonary abnormalities in patients with systemic lupus erythematosus assessment with high resolution computed tomography, chest radiography and pulmonary function tests

    Sant, S.M.; Doran, M.; Fenelon, H.M.; Breatnach, E.S. [University of Michigan (United States)

    1998-04-01

    The objective has to assess the nature of pleuro-pulmonary abnormalities, with particular reference to interstitial lung disease (ILD), in patients with systemic lupus erythematosus (SLE) In conclusion, HRCT is more sensitive than PFTs or CXR in the evaluation of pleuro-pulmonary disease in SLE. We report an unusually high prevalence of HRCT appearances suggestive of ILD in patients with SLE. subclinical lung disease is common in patients with SLE. (author)

  20. Logistic regression analysis of the risk factors of acute renal failure complicating limb war injuries

    Chang-zhi CHENG

    2011-06-01

    Full Text Available Objective To explore the risk factors of complication of acute renal failure(ARF in war injuries of limbs.Methods The clinical data of 352 patients with limb injuries admitted to 303 Hospital of PLA from 1968 to 2002 were retrospectively analyzed.The patients were divided into ARF group(n=9 and non-ARF group(n=343 according to the occurrence of ARF,and the case-control study was carried out.Ten factors which might lead to death were analyzed by logistic regression to screen the risk factors for ARF,including causes of trauma,shock after injury,time of admission to hospital after injury,injured sites,combined trauma,number of surgical procedures,presence of foreign matters,features of fractures,amputation,and tourniquet time.Results Fifteen of the 352 patients died(4.3%,among them 7 patients(46.7% died of ARF,3(20.0% of pulmonary embolism,3(20.0% of gas gangrene,and 2(13.3% of multiple organ failure.Univariate analysis revealed that the shock,time before admitted to hospital,amputation and tourniquet time were the risk factors for ARF in the wounded with limb injuries,while the logistic regression analysis showed only amputation was the risk factor for ARF(P < 0.05.Conclusion ARF is the primary cause-of-death in the wounded with limb injury.Prompt and accurate treatment and optimal time for amputation may be beneficial to decreasing the incidence and mortality of ARF in the wounded with severe limb injury and ischemic necrosis.

  1. Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report.

    Gollapalli, Rajesh Babu; Naiman, Ana Nusa; Merry, David

    2015-07-01

    Cervical necrotizing fasciitis secondary to epiglottitis is rare. The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy. We report the case of an immunocompetent 59-year-old man who developed cervical necrotizing fasciitis as a complication of acute epiglottitis. We were able to successfully manage this patient with conservative surgical treatment (incision and drainage, in addition to antibiotic therapy) that did not involve aggressive debridement.

  2. [Acute traumatic spinal cord injury and cardiovascular complications due to neurogenic shock: a possible threat for functional recovery].

    van de Meent, H; Vos, P E; Schreuder, H W; van der Hoeven, J G

    2004-05-29

    Three men aged 18, 18 and 24 years, developed hypotension and bradycardia following an acute traumatic cervical or thoracic spinal cord injury. After treatment in intensive care and 1-12 months of rehabilitation they still suffered from considerable neurological disorders. Hypotension and bradycardia are common phenomena following acute traumatic cervical and thoracic spinal cord injury. Awareness of cardiovascular complications as a possible threat for functional recovery and adequate insight in the neurological cause of hypotension and bradycardia are important issues in the acute treatment of patients with spinal cord injury. It seems sensible to admit these patients to a medium-care or intensive-care department where they can be monitored and treated by a specialised team in accordance with an adequate protocol.

  3. [Multiple organ failure complicating a severe acute necrotising pancreatitis secondary of a severe hypertriglyceridemia: a case report].

    Degardin, J; Pons, B; Ardisson, F; Gallego, J-P; Thiery, G

    2013-09-01

    We report the case of a 42-year-old man admitted for a multi-organ failure with a coma, a hemodynamic instability, a respiratory distress syndrome, an acute renal failure and a thrombocytopenia. The blood samples highlighted a milky serum and allowed to diagnose an acute pancreatitis associated with a major dyslipidemia: hypertriglyceridemia 11,800 mg/dL and hypercholesterolemia 1195 mg/dL. The CT-scans do not reveal any cerebral abnormalities but highlighted pancreatic lesions without biliary obstruction. A multi-organ failure complicating a severe acute pancreatitis secondary of a major hypertriglyceridemia was mentioned. Despite the absence of clear guidelines, a session of plasma exchange was started in emergency. Symptomatic treatment with protective ventilation, vasopressors, continuous heparin and insulin was continued. The clinical and biological course was good in parallel of the normalization of lipid abnormalities. The patient was discharged at day 17 with a lipid-lowering therapy. We discuss the various treatments available for the management of acute pancreatitis complicating a severe hypertriglyceridemia and their actual relevance in the absence of clear recommendations.

  4. National complicated acute diverticulitis (CADS) study: a protocol for a prospective observational scoping study for acute diverticulitis

    Shaikh, Shafaque

    2016-01-01

    Background Diverticular disease is a widely prevalent disease in western society, and acute diverticulitis is a common acute surgical presentation. However, there is a lack of level 1 evidence addressing the multifaceted presentations associated with acute diverticulitis. There is also a lack of robust epidemiological data that could be used to meaningfully inform randomised controlled trials. The National CADS project aims to generate baseline data for a cohort of patients managed for clinically suspected acute diverticulitis and evaluate the impact of variability in the management approach on patient outcomes in the short (3 months) and long (2 years) term. Method A Unit policy questionnaire will be completed by the principal investigator from all participating centres prior to study initiation. All patients aged above 18 years admitted with clinical suspicion of acute diverticulitis will be included from UK hospitals providing acute surgical care. Demographic, clinical, inpatient stay and outpatient follow-up data will be collected for index admissions between July and September 2014, 3 months follow-up and finally a 2-year follow-up. Results The study attracted participation from 108 centres nationally and has so far generated data on 2500 patients admitted between 1 July 2014 and 30 September 2014. Short-term follow-up data have been obtained for this cohort. Conclusions The National CADS study is currently ongoing with the long-term outcomes data anticipated to be submitted in autumn of 2016. PMID:27957337

  5. A one-year observational study of all hospitalized acute poisonings in Oslo: complications, treatment and sequelae

    Lund Cathrine

    2012-07-01

    Full Text Available Abstract Objectives Changes in poisoning trends may affect both complications and outcomes in patients with acute poisoning. This study reports the treatments given and the frequency of complications, also related to treatment, mortality and sequelae related to various toxic agents. Methods All acute poisonings in adults (≥16 years admitted to the five hospitals in Oslo were included consecutively during one year (2008 to 2009 in an observational cross-sectional multicenter study. A standardized form was completed by the treating physician, which covered the study aims. Results There were 1065 admissions in 912 patients. The median length of hospital stay was one day, and 49% were observed in an intensive care unit (ICU. Active treatment was given to 83%, and consisted of supportive therapy (70%, antidote(s (38%, activated charcoal (16% and gastric lavage (9%. The most commonly used antidotes were flumazenil (19%, naloxone (17% and N-acetylcysteine (11%. The rate of treatment-related complications was 2.4% (21/884. Neither flumazenil, naloxone, nor the combination, was associated with convulsions or other complications. Among those receiving N-acetylcysteine, 5% (6/120 developed allergic reactions, one of which mandated discontinuation of treatment. Nineteen percent presented in a coma. Complications developed in 30%, compared with 18% in a 2003 study, mainly respiratory depression (12%, prolonged QTc interval (6% and hypotension (5%. Eight patients died (0.8% and five (0.5% survived with permanent sequelae, mainly anoxic brain damage. Discussion Few patients stayed more than two days. The use of the ICU was liberal, considering that only one out of five presented in a coma. Antidotes were frequently given diagnostically. Although N-acetylcysteine induced allergic reactions, most were mild and treatment discontinuation was only necessary once. The frequency of complications had almost doubled in five years, although the poisoning pattern was

  6. An autopsy case of acute pancreatitis with a high serum IgG4 complicated by amyloidosis and rheumatoid arthritis

    Tatsuki Ichikawa; Kazuhiko Nakao; Keisuke Hamasaki; Kazuaki Ohkubo; Kan Toriyama; Katsumi Eguchi

    2005-01-01

    We report an autopsy case of acute pancreatitis with a high serum IgG4 concentration complicated by systemic amyloid A amyloidosis and rheumatoid arthritis (RA). The patient was a 42-year-old Japanese female with a 22-year history of rheumatoid arthritis. She was diagnosed with myasthenia gravis when she was 31-year old. At the onset of pancreatitis, the patient was anti-nuclear antibody-positive,and had high serum gamma globulin and IgG4 levels.Dexamethasone and conventional therapy induced clinical remission and significantly decreased the serum IgG4 and gamma globulin. However, despite the decreased disease parameters, the patient developed a bleeding pseudocyst and died of cardiac failure. In the autopsy examination, it was determined that pancreatitis was probably caused by ischemia due to vascular obstruction caused by amyloid deposition in the pancreas. Even though acute pancreatitis is a rare complication in RA patients, we speculate that an autoimmune pancreatitis-related mechanism and ischemia due to vascular obstruction by amyloid deposition might be attributable to a single source that leads to acute pancreatitis in our particular case.

  7. Influence of renal dysfunction on clinical outcomes in patients with congestive heart failure complicating acute myocardial infarction.

    Kim, Chang Seong; Kim, Min Jee; Kang, Yong Un; Choi, Joon Seok; Bae, Eun Hui; Ma, Seong Kwon; Ahn, Young-Keun; Jeong, Myung Ho; Kim, Young Jo; Cho, Myeong Chan; Kim, Chong Jin; Kim, Soo Wan

    2013-01-01

    The clinical course and medical treatment of patients with congestive heart failure (CHF) complicating acute myocardial infarction (AMI) are not well established, especially in patients with concomitant renal dysfunction. We performed a retrospective analysis of the prospective Korean Acute Myocardial Infarction Registry to assess the medical treatments and clinical outcomes of patients with CHF (Killip classes II or III) complicated by AMI, in the presence or absence of renal dysfunction. Of 13,498 patients with AMI, 2769 (20.5%) had CHF on admission. Compared to CHF patients with preserved renal function, in-hospital mortality and major adverse cardiac events were increased both at 1 month and at 1 year after discharge in patients with renal dysfunction (1154; 41.7%). Postdischarge use of aspirin, betablockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers and statins significantly reduced the 1-year mortality rate for CHF patients with renal dysfunction; such reduction was not observed for those without renal dysfunction, except in the case of aspirin. Patients with CHF complicating AMI, which is accompanied by renal dysfunction, are at higher risk for adverse cardiovascular outcomes than patients without renal dysfunction. However, they receive fewer medications proven to reduce mortality rates.

  8. Acute aortic occlusion as an unusual embolic complication of cardiac myxoma

    ZHANG Jian; DUAN Zhi-quan; WANG Chuan-jiang; SONG Qing-bin; LUO Ying-wei; XIN Shi-jie

    2006-01-01

    @@ Acute aortic occlusion is an infrequent but dangerous vascular emergency with a mortality rate of 50%,1 resulting from aortic saddle embolus, thrombosis of an atherosclerotic abdominal aorta, or sudden thrombosis of a small abdominal aortic aneurysm.

  9. How to reduce avoidable admissions due to acute diabetes complications?: Interrelation between primary and specialized attention in a diabetes unit

    N. V. García-Talavera Espín

    2012-12-01

    Full Text Available Introduction: Type 2 Diabetes Mellitus is a serious health problem. In the year 2030 it will affect 366 million people around the world. Objective: Evaluate the effectiveness of a mixed intervention and reducing the amount and seriousness of acute complications in diabetics from our Health Area. Materials and method: Protocols of action as well as information documents were produced. Diabetes Unit coordinated educational activities in the different support levels of the Area VII of Murcia. Information talks were provided for the people in charge of the Diabetes Unit in every Care Center and Service of the Health Area. Personalized training was provided for patients treated in the differet Care levels. The study comprised three stages. Information leaflets were spread and talks offered to the patient regarding in house handling of hypo and hyper glycemia. Results: A reduction of 39% of the emergencies due to acute non complicated diabetes was achieved, as well as a reduction of 47.6% of hospital admissions. There was a reduction of 67.8% of the amount of total hospital stays for the group of patients under 35 years who were admitted into the hospital due to type 1 or 2 diabetes mellitus that didn't show any complications (GRD295. Conclusions: There was a reduction of more than thirty percent in the emergencies due to acute decompensations in the disease and a significant reduction in the avoidable hospital stays in the young adult, thus improving the patients' life quality and reducing the social cost of the diabetic patient.

  10. Statin-associated rhabdomyolysis with acute renal failure complicated by intradialytic NSTEMI: a review of lipid management considerations.

    Kar, Subrata; Chockalingam, Anand

    2013-01-01

    Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are associated with myopathy, myalgias, myositis, and rhabdomyolysis. Rhabdoymyolysis is a rare complication and may cause acute renal failure, which may be fatal. In such cases, alternative therapies should be considered. In this review, we attempted to elucidate the lipid management options in patients with rhabdomyolysis and coronary artery disease. We also describe a case report of a patient who developed rhabdomyolysis from dual antilipid therapy followed by acute renal failure and non-ST elevation myocardial infarction. Such a complex case has not been reported in the literature, and lipid management options may include niacin, omega 3-fatty acids, or bile acid sequestrants. Once alternative therapies are initiated, monitoring a patient closely with evaluation for associated adverse events should be performed.

  11. Diagnosis and treatment of melamine-associated urinary calculus complicated with acute renal failure in infants and young children

    SUN Ning; JIANG Ye-ping; FENG Dong-chuan; ZHANG Rui-feng; ZHU Xiao-yu; XIAO Hong-zhan; SHEN Ying; SUN Qiang; LI Xu-ran; JIA Li-qun; ZHANG Gui-ju; ZHANG Wei-ping; CHEN Zhi; FAN Jian-feng

    2009-01-01

    Background Infants in some areas of China developed urinary lithiasis after being fed with powdered milk that was tainted with melamine in 2008 and very small proportion of the infants developed acute renal failure caused by urinary tract calculus obstruction. The aim of this article was to summarize clinical characteristics, diagnosis and treatment of infants with urinary calculus and acute renal failure developed after being fed with melamine tainted formula milk.Methods Data of infant patients with urinary calculus and acute renal failure due to melamine tainted formula milk admitted to the Beijing Children's Hospital Affiliated to the Capital Medical University and the Xuzhou Children's Hospital in 2008 were used to analyze the epidemiological characteristics, clinical manifestations, imaging features as well as effects of 4 types of therapies.Results All the 34 infants with urinary calculus were complicated with acute renal failure, their blood urea nitrogen (BUN) was (24.1±8.2) mmol/L and creatinine (CO was (384.2±901.2) μmol/L. The chemical analysis on the urinary calculus sampled from 15 of the infants showed that the calculus contained melamine and acidum uricum. The time needed for the four types of therapies for returning Cr to normal was (3.5±1.9) days for cystoscopy group, (2.7±1.1) days for lithotomy group, (3.8±2.3) days for dialysis group, and (2.7±1.6) days for medical treatment group, which had no statistically significant difference (P=0.508). Renal failure of all the 34 infants was relieved within 1 to 7 days, averaging (3.00±1.78) days.Conclusions Melamine tainted formula milk may cause urinary calculus and obstructive acute renal failure. It is suggested that firstly the patients with urinary calculus complicated with acute renal failure should be treated with dialysis or medication to correct electrolyte disturbance, in particular hyperkalemia, and then relieve the obstruction with available medical and surgical methods as soon as

  12. Apical ballooning syndrome complicated by acute severe mitral regurgitation with left ventricular outflow obstruction – Case report

    Celermajer David S

    2007-02-01

    Full Text Available Abstract Background Apical ballooning syndrome (or Takotsubo cardiomyopathy is a syndrome of transient left ventricular apical ballooning. Although first described in Japanese patients, it is now well reported in the Caucasian population. The syndrome mimicks an acute myocardial infarction but is characterised by the absence of obstructive coronary disease. We describe a serious and poorly understood complication of Takotsubo cardiomyopathy. Case Presentation We present the case of a 65 year-old lady referred to us from a rural hospital where she was treated with thrombolytic therapy for a presumed acute anterior myocardial infarction. Four hours after thrombolysis she developed acute pulmonary oedema and a new systolic murmur. It was presumed she had acute mitral regurgitation secondary to a ruptured papillary muscle, ischaemic dysfunction or an acute ventricular septal defect. Echocardiogram revealed severe mitral regurgitation, left ventricular apical ballooning, and systolic anterior motion of the mitral valve with significant left ventricular outflow tract gradient (60–70 mmHg. Coronary angiography revealed no obstructive coronary lesions. She had an intra-aortic balloon pump inserted with no improvement in her parlous haemodynamic state. We elected to replace her mitral valve to correct the outflow tract gradient and mitral regurgitation. Intra-operatively the mitral valve was mildly myxomatous but there were no structural abnormalities. She had a mechanical mitral valve replacement with a 29 mm St Jude valve. Post-operatively, her left ventricular outflow obstruction resolved and ventricular function returned to normal over the subsequent 10 days. She recovered well. Conclusion This case represents a serious and poorly understood association of Takotsubo cardiomyopathy with acute pulmonary oedema, severe mitral regurgitaton and systolic anterior motion of the mitral valve with significant left ventricular outflow tract obstruction. The

  13. Impaired microcirculation predicts poor outcome of patients with acute myocardial infarction complicated by cardiogenic shock

    C.A. den Uil; W.K. Lagrand; M. van der Ent; L.S.D. Jewbali; J.M. Cheng; P.E. Spronk; M.L. Simoons

    2010-01-01

    We investigated the relationship between sublingual perfused capillary density (PCD) as a measure of tissue perfusion and outcome (i.e. occurrence of organ failure and mortality) in patients with cardiogenic shock from acute myocardial infarction. We performed a prospective study in 68 patients. Usi

  14. Hyperglycemia during induction therapy is associated with increased infectious complications in childhood acute lymphocytic leukemia

    Children with acute lymphocytic leukemia (ALL) are at high risk for developing hyperglycemia. Hyperglycemic adult ALL patients have shorter remissions, more infections, and increased mortality. No corresponding data are available in children. We hypothesized that children with ALL who become hypergl...

  15. Boxing sparring complicated by an acute subdural haematoma and brainstem haemorrhage.

    Hart, Michael G; Trivedi, Rikin A; Hutchinson, Peter J

    2012-10-01

    A professional boxer developed an acute subdural haematoma after boxing sparring. Despite timely surgical decompression, he had a poor overall outcome predominantly from a delayed brainstem haematoma. Magnetic resonance imaging (MRI) was used to elucidate the pathophysiology of the patients' injury and clinical condition.

  16. A case of minimal change nephrotic syndrome with acute renal failure complicating Hashimotoâs disease.

    Iwazu, Y; Nemoto, J; Okuda, K; Nakazawa, E; Hashimoto, A; Fujio, Y; Sakamoto, M; Ando, Y; Muto, S; Kusano, E

    2008-01-01

    A 63-year-old man was admitted to our hospital for evaluation of generalized edema. Coexistence of severe hypothyroidism and nephrotic syndrome was detected by laboratory examination. High titer of both antimicrosomal antibody and antithyroid peroxidase antibody indicated Hashimotoâs disease. Renal biopsy showed minimal change glomerular abnormality, but no findings of membranous nephropathy. A series of medical treatments, including steroid therapy, thyroid hormone and human albumin replacement therapy, were administered. However, acute renal failure accompanied by hypotension, was not sufficiently prevented. After 9 sessions of plasmapheresis therapy, the severe proteinuria and low serum albumin levels were improved. Even after resting hypotension was normalized, neither renal function nor thyroid function were fully recovered. After discharge, renal function gradually returned to normal, and the blood pressure developed into a hypertensive state concomitant with the normalization of thyroid function. This report is a rare case of autoimmune thyroid disease complicated with minimal change nephrotic syndrome. In most cases of nephritic syndrome, acute renal failure (ARF) has been reported to coexist with hypertension. Although pseudohypothyroidism is well-known in nephrotic pathophysiology, complications of actual hypothyroidism are uncommon. It is suggested that the development of hypotension and ARF could be enhanced not only by hypoproteinemia, but also by severe hypothyroidism.

  17. [Hepatosplenic and kidneys candidasis complicating an acute myeloblastic leukemia. A case treated with voriconazole and caspofungin].

    Elouennass, M; Doghmi, K; Fagot, T; Soler, C; Mac Nab, C; Foissaud, V; De Revel, T; Hervé, V

    2005-01-01

    We report the observation of hepato-splenic and kidneys candidiasis complicating the chemotherapy of a myeloblastic leukemia (LAM5b). Following the lack of effectiveness of a first line treatement, using amphotericine B liposomale and 5-fluorocytosine, implementation of an association of new molecules, a triazole of second generation (voriconazole) and an echinocandine (caspofungine) has allowed a successful result.

  18. Complicated septic shock caused by Achromobacter xylosoxidans bacteremia in a patient with acute lymphoblastic leukemia

    Al-Jasser A M

    2007-01-01

    Full Text Available Infections caused by Achromobacter xylosoxidans cause significant morbidity and mortality in debilitated individuals. Eradication of these infections requires prolonged therapy with antimicrobial agents and removal of any infected central venous catheter. The outcome is usually poor in patients with high risk malignancy, septic complications, and/or multi-organ dysfunction

  19. Effect of in-hospital medical complications on case fatality post-acute ischemic stroke: data from the China National Stroke Registry

    WANG Peng-lian; CHEN Sheng-yun; CHEN Qi-dong; QU Hui; LU Jing-jing; ZHANG Jing; MA Rui-hua; ZHANG Yu-mei; WANG Yong-jun; ZHAO Xing-quan; YANG Zhong-hua; WANG An-xin; WANG Chun-xue; LIU Li-ping; WANG Yi-long; WANG Xin-gao; JU Yi

    2012-01-01

    Background In-hospital medical complications are associated with poorer clinical outcomes for stroke patients after disease onset.However,few studies from China have reported the effect of these complications on the mortality of patients with acute ischemic stroke.In this prospective work,the China National Stroke Registry Study,we investigated the effect of medical complications on the case fatality of patients with acute ischemic stroke.Methods From September 2007 to August 2008,we prospectively obtained the data of patients with acute stroke from 132 clinical centers in China.Medical complications,case fatality and other information recorded at baseline,during hospitalisation,and at 3,6,and 12 months after stroke onset.Multivariable Logistic regression was performed to analyze the effect of medical complications on the case fatality of patients with acute ischemic stroke.Results There were 39741 patients screened,14526 patients with acute ischemic stroke recruited,and 11560 ischemic stroke patients without missing data identified during the 12-month follow-up.Of the 11560 ischemic patients,15.8% (1826)had in-hospital medical complications.The most common complication was pneumonia (1373;11.9% of patients),followed by urinary tract infection and gastrointestinal bleeding.In comparison with patients without complications,stroke patients with complications had a significantly higher risk of death during their hospitalization,and at 3,6 and 12 months post-stroke.Having any one in-hospital medical complication was an independent risk factor for death in patients with acute ischemic stroke during hospital period (adjusted OR=6.946;95% CI 5.181 to 9.314),at 3 months (adjusted OR=3.843;95% Cl 3.221 to 4.584),6 months (adjusted OR=3.492;95% CI 2.970 to 4.106),and 12 months (adjusted OR=3.511;95% Cl 3.021 to 4.080).Having multiple complications strongly increased the death risk of patients.Conclusion Short-term and long-term outcomes of acute stroke patients

  20. Preventive central nervous system irradiation in children with acute nonlymphocytic leukemia. [Complications of. gamma. radiation

    Dahl, G.V.; Simone, J.V.; Hustu, H.O.; Mason, C.

    1978-11-01

    In this study of children with acute nonlymphocytic leukemia an attempt was made to prevent central nervous system relapse and to determine whether this therapy, coupled with multiagent chemotherapy, would be successful in prolonging durations of complete remission. Central nervous system relapses were prevented by irradiation, although patients who received this therapy did no better than those who did not receive irradiation. A small group of patients received irradiation to the liver and spleen, but this modality also failed to improve the duration of remission. Control of extramedullary leukemia, in this study, failed to improve remission duration because bone marrow relapse was not prevented or delayed. It is unlikely that focal therapy will have a significant impact in acute nonlymphocytic leukemia until longer marrow remissions are achieved.

  1. Cardiogenic shock complicating acute myocardial infarction; prognostic impact of early and late shock development

    Lindholm, M G; Køber, L; Boesgaard, S

    2003-01-01

    AIMS: Cardiogenic shock accounts for the majority of deaths following acute myocardial infarction. The majority of outcome data on this issue are, however, derived from single hospitals, referral centers or selected patients in randomized studies. The purpose of this study was to investigate...... incidence, outcome and prognostic significance of cardiogenic shock in 6676 consecutive patients with acute myocardial infarction. METHODS AND RESULTS: Demographic and clinical data including the presence of cardiogenic shock were prospectively collected in 6676 non-invasively managed patients...... with myocardial infarction consecutively admitted to 27 different hospitals during a 2-year period. Six-year mortality data were collected in 99.9% of the population. Cardiogenic shock developed in 444 patients (6.7%). In 59% of these patients cardiogenic shock developed within 48 h, 11% developed shock during...

  2. [Neuroimmunocorrection therapy for the prophylaxis of infectious complications in acute stroke patients].

    Kul'chikov, A E; Makarenko, A N

    2008-01-01

    Neuroimmunocorrection therapy with cerebrolysin has been used for the prophylaxis of clinical pneumonia development in the early stage of acute stroke in a group of 140 patients with heavy clinical course of acute ischemic stroke (AIS). All patients in the test and control groups received the basal anti-AIS therapy and antibacterial drugs (IV-generation cephalosporins) in case of pneumonia development. The efficacy of cerebrolysin administration was evaluated both on the clinical scale (NIH-NINDS, CPIS, SIRS immonograms) and using laboratory indices. It is established that the proposed neuroimmunocorrection therapy with cerebrolysin decreases the frequency of the clinical pneumonia development. A relationship between the pneumonia onset rate and the focus localization in limbico-diencephalic part of the brain is established. The use of cerebrolysin decreases lethality, normalizes the impaired immunity indices, accelerates the restoration of violated neural functions, suppresses pneumonia development, restores the level of albumin, and normalizes the laboratory indices of inflammatory syndrome.

  3. Treatment of patients with acute colonic diverticulitis complicated by abscess formation

    Gregersen, Rasmus; Mortensen, Laura Quitzau; Burcharth, Jakob

    2016-01-01

    . Two authors screened the records independently, initially on title and abstract and subsequently on full-text basis. Articles describing patients treated acutely for Hinchey Ib and II were included. Results were presented by treatment, classified as non-operative (percutaneous abscess drainage (PAD......PURPOSE: This study aimed to systematically review the literature and present the evidence on outcomes after treatment for acute diverticulitis with abscess formation. Secondly, the paper aimed to compare different treatment options. METHODS: PubMed, EMBASE and the Cochrane Library were searched...... were the only available evidence. Treatment generally failed for 20% of patients, regardless of non-operative treatment choice. Abscesses with diameters less than 3 cm were sufficiently treated with antibiotics alone, possibly as outpatient treatment. Of patients treated non-operatively, 25...

  4. Mechanism of acute pancreatitis complicated with injury of intestinal mucosa barrier

    2007-01-01

    Acute pancreatitis (AP) is a common acute abdomen in clinic with a rapid onset and dangerous pathogenetic condition.AP can cause an injury of intestinal mucosa barrier, leading to translocation of bacteria or endotoxin through multiple routes,bacterial translocation (BT), gutorigin endotoxaemia, and secondary infection of pancreatic tissue, and then cause systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS), which are important factors influencing AP's severity and mortality. Meanwhile, the injury of intestinal mucosa barrier plays a key role in AP's process. Therefore, it is clinically important to study the relationship between the injury of intestinal mucosa barrier and AP. In addition, many factors such as microcirculation disturbance, ischemical reperfusion injury, excessive release of inflammatory mediators and apoptosis may also play important roles in the damage of intestinal mucosa barrier. In this review, we summarize studies on mechanisms of AP.

  5. Cardiac and pleuropulmonary AL amyloid imaging with technetium-99m labelled aprotinin

    Aprile, C. [Dept. of Nuclear Medicine, Fondazione Clinica del Lavoro-IRCCS, Pavia (Italy); Marinone, G. [Inst. of Clinical Medicine II and Research Lab. Biotechnology, Policlinico S. Matteo-IRCCS, Pavia (Italy); Saponaro, R. [Dept. of Nuclear Medicine, Fondazione Clinica del Lavoro-IRCCS, Pavia (Italy); Bonino, C. [SORIN Biomedica, Saluggia VC (Italy); Merlini, G. [Inst. of Clinical Medicine II and Research Lab. Biotechnology, Policlinico S. Matteo-IRCCS, Pavia (Italy)

    1995-12-01

    Antiproteases are known to be present in amyloid deposits. We evaluated the possibility of using an anti-serine protease (aprotinin) labelled with technetium-99m (TcA), usually employed as a cortical renal tracer, for the imaging of amyloid deposits. Because of the known high uptake of TcA by the kidneys, we limited our analysis to extra-abdominal amyloid localizations. We report the scintigraphic findings observed in 24 patients with light chain amyloidosis (AL) and one with a hereditary form who were known or suspected to have extra-abdominal involvement. Planar scans obtained 100 min after i.v. TcA administration showed myocardial accumulation in 11 patients, pleuropulmonary accumulation in nine, pericardial accumulation in two and localization in the neck region (thyroid, salivary glands and tongue) in eight. TcA scintigraphy was negative in five patients without clinical or laboratory evidence of extra-abdominal involvement, as well as in 12 control group patients with cardiac and renal diseases. These preliminary results indicate TcA to be a low-cost, readily available radiopharmaceutical for imaging of extra-abdominal involvement in AL type amyloidosis. (orig.)

  6. Diagnosis and Management of Severe Acute Pancreatitis Complicated with Abdominal Compartment Syndrome

    陶京; 王春友; 陈立波; 杨智勇; 许逸卿; 熊炯炘; 周峰

    2003-01-01

    Presented in this paper is our experience in the diagnosis and management of abdominal compartment syndrome during severe acute pancreatitis. On the basis of the history of severe acute pancreatitis, after effective fluid resuscitation, if patients developed renal, pulmonary and cardiac insufficiency after abdominal expansion and abdominal wall tension, ACS should be considered.Cystometry could be performed to confirm the diagnosis. Emergency decompressive celiotomy and temporary abdominal closure with a 3 liter sterile plastic bag must be performed. It is also critical to prevent reperfusion syndrome. In 23 cases of ACS, 18 cases received emergency decompressive celiotomy and 5 cases did not. In the former, 3 patients died (16.7 %) while in the later, 4 (80%)died. Total mortality rate was 33.3% (7/21). In 7 death cases, 4 patients developed acute obstructive suppurative cholangitis (AOSC). All the patients who received emergency decompressive celiotomy 5 h after confirmation of ACS survived. The definitive abdominal closure took place mostly 3 to 5 days after emergency decompressive celiotomy, with longest time being 8 days. 6 cases of ACS at infection stage were all attributed to infected necrosis in abdominal cavity and retroperitoneum. ACS could occur in SIRS stage and infection stage during SAP, and has different pathophysiological basis. Early diagnosis, emergency decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag are the keys to the management of the condition.

  7. Acute pancreatitis and cholangitis: A complication caused by a migrated gastrostomy tube

    2007-01-01

    Percutaneous endoscopic gastrostomy (PEG) is generally considered safe with a low rate of serious complications. However, dislocation of the PEG-tube into the duodenum can lead to serious complications.An 86-year old Japanese woman with PEG-tube feeding sometimes vomited after her family doctor replaced the PEG-tube without radiologic confirmation. At her hospitalization, she complained of severe tenderness at the epigastric region and the PEG-tube was drawn into the stomach. Imaging studies showed that the tip of PEG-tube with the inflated balloon was migrated into the second portion of the duodenum, suggesting that it might have obstructed the bile and pancreatic ducts,inducing cholangitis and pancreatitis. After the PEG-tube was replaced at the appropriate position, vomiting and abdominal tenderness improved dramatically and laboratory studies became normal immediately. Our case suggests that it is important to secure PEG-tube at the level of skin, especially after replacement.

  8. Acute Abdominal Compartment Syndrome as a Complication of Percutaneous Nephrolithotomy: Two Cases Reports and Literature Review

    Jing Tao

    2016-09-01

    Full Text Available Percutaneous nephrolithotomy (PCNL is a technique commonly used to remove large or multiple kidney stones and stones in the inferior calyx, with the advantages of lower morbidity rates, decrease in post-operative pain with faster recovery. Intra-abdominal irrigation fluid extravasation which leads to abdominal hypertension is a rare complication of PCNL with little reports. Early detection of intra-abdominal extravagation is very important to prevent morbidity and mortality. We present two cases and review the literature.

  9. Acute Pancreatitis in the Postoperative Course after Esophagectomy: A Major Complication Described in 4 Patients

    R.L.G.M. Blom

    2009-11-01

    Full Text Available Background: Postoperative pancreatitis is a rare but devastating complication after esophageal surgery. It has been described in connection with abdominal surgery but the etiology in connection with esophageal surgery has never been evaluated. The present study describes 4 cases of postoperative pancreatitis, and a hypothesis about the etiology is formed. Methods: We performed a search for patients with postoperative pancreatitis after esophagectomy using our prospective database including all patients that underwent esophageal resection at our institution between 1993 and 2008. Pancreatitis was described as abdominal pain, hyperamylasemia, signs of pancreatitis on CT scan or findings during laparotomy or autopsy. Results: A total of 950 patients underwent esophagectomy at our institution, 4 patients developed postoperative pancreatitis (incidence 0.4%. Two out of four patients died. Discussion: Pancreatitis following esophageal surgery is a serious, potentially lethal complication. Diagnosis can be difficult as clear clinical or laboratory findings might be lacking. Peroperative manipulation of the pancreas, mobilization of the duodenum or compromized vascularization have been suggested as etiological factors; although in the described patients, none of these factors were identified as the cause of pancreatitis. In conclusion, pancreatitis following esophageal surgery is a serious but rare complication that should always be considered in patients who deteriorate postoperatively.

  10. Acute gastric dilatation complicating the use of mydriatics in a preterm newborn

    Sarici, S.Ue.; Yurdakoek, M.; Uenal, S. [Div. of Neonatology, Hacettepe University School of Medicine, Ankara (Turkey)

    2001-08-01

    A 2-month-old girl who had been born at 27-weeks' gestation was admitted for her screening examination for retinopathy of prematurity and given two drops each of cyclopentolate 0.5 % and phenylephrine 2.5 %. Approximately 2 h after completion of the examination, the infant had episodes of apnoea and vomiting. She was noted to be distended, and an abdominal radiograph demonstrated acute gastric dilatation. Apnoea, vomiting and distension resolved after 18 h and a repeat abdominal radiograph demonstrated resolution of the gastric dilatation. (orig.)

  11. Idiopathic cystic ar ter y aneur ysm complicated with hemobilia and acute pancreatitis

    Subhi J. Al'Aref; Husham Abdel-Rahman; Nasir Hussain

    2008-01-01

    BACKGROUND:  Aneurysm of the cystic artery is not common, and it is a rare cause of hemobilia. Most of reported cases are pseudoaneurysms resulting from either an inlfammatory process in the abdomen or abdominal trauma. METHOD: We report a healthy individual who developed hemobilia and acute pancreatitis associated with cystic artery aneurysm. RESULT: The patient was managed with angio-embolization with an uneventful post-embolization course. CONCLUSIONS: Visceral artery aneurysms are rare and can rupture with potentially grave outcome due to excessive bleeding. Angiographic embolization as a common method of treatment for visceral artery aneurysms was used in our patient with good outcome.

  12. Amyand's hernia complicated with acute appendicitis: A case report and literature review

    Mehmet Hanifi Okur

    2015-06-01

    Full Text Available Amyand's hernia is the presence of the appendix within an inguinal hernia sac. It is a rare condition, occurring in 1% of inguinal hernia patients. The clinical presentation varies depending on the extent of appendix inflammation. Amyand's hernia is difficult to diagnose clinically. However, imaging studies are valuable for both its diagnosis and detection of the associated complications. Here, we report a case of Amyand's hernia in a 3-year-old male child who presented with a history of right inguinal tenderness, pain, and swelling. An operation revealed a hernia sac containing the inflamed appendix; hence, an appendectomy was performed along with a right inguinal herniotomy.

  13. CT in nontraumatic acute thoracic aortic disease: typical and atypical features and complications.

    Castañer, Eva; Andreu, Marta; Gallardo, Xavier; Mata, Josep Maria; Cabezuelo, María Angeles; Pallardó, Yolanda

    2003-10-01

    Thoracic aortic dissection is the most frequent cause of aortic emergency, and unless it is rapidly diagnosed and treated, the result is death. Helical computed tomography (CT) permits the diagnosis of acute aortic dissection with a sensitivity and specificity of nearly 100%. This imaging modality also enables differentiation between proximal aortic dissection (type A in the Stanford classification) and distal aortic dissection (Stanford type B), which are treated differently and have different prognoses. In 70% of patients in whom nontraumatic acute thoracic aortic dissection is diagnosed after evaluation with helical CT, scans show the typical signs of aortic dissection, with rupture and displacement of the intima. CT also can depict other pathologic entities with similar clinical manifestations, such as intramural hematoma and penetrating atherosclerotic ulcer. Awareness of the different radiologic appearances of these disease entities is essential for differential diagnosis. More than one-third of patients with aortic dissection show signs and symptoms indicative of systemic involvement. Because branch-vessel involvement may increase morbidity and mortality, in this group of patients it is important to evaluate the entire aorta so as to determine the distal extent of the dissection and detect any systemic involvement.

  14. CYTOMORPHOLOGICAL EVALUATION AND PROGNOSIS OF BRONCHOPULMONARY COMPLICATIONS IN ACUTE AND EARLY PERIODS OF SPINAL CORD TRAUMA

    I.A. Norkin

    2009-09-01

    Full Text Available There were investigated 50 cytological preparations after fibro-optic bronchoscopy of 10 patients with cervical spinal cord injuries. The dynamics of broncho-pulmonary complications of spinal cord injuries was estimated on the basis of cytological broncho-alveolar lavage fluid investigations. In the work there were used clinico-neurologic methods, radiological (computer tomography and magnetic resonance imaging, endoscopic (fibro-optic bronchoscopy and cytomorphological investigations. Cytomorphological investigations of broncho-alveolar lavage fluid were carried out on the 3-4, 7, 14, 30th days. Cellular composition of the broncho-alveolar wash-out (endopulmonary cytogramme was estimated by calculation of more than 100 cells in 3 fields of the immersion microscope coverage. Quantitative changes of cellular elements were taken into account with respect to normal cell amount. The results were analyzed according to the average out method. Quantitative changes of inflammatory elements in endopulmonary cytogramme were determined by the degree of endobronchitic manifestations and were corresponding to clinico-radiological picture of development of broncho-pulmonary complications in different periods of spinal cord injury

  15. The clinical and imaging presentation of acute "non complicated" pyelonephritis: A new profile for an ancient disease

    Piccoli Giorgina

    2011-12-01

    Full Text Available Abstract Background Acute pyelonephritis (APN is differently defined according to imaging or clinical criteria. In adults information on the relationship between imaging and clinical data is lacking. Our study was aimed at analysing the relationship between the clinical and imaging presentation of APN, defined according to imaging criteria (parenchymal involvement at MR or CT scan. Methods All consecutive patients hospitalized for "non-complicated" APN were considered (June 2005-December 2009. Clinical, biochemical and imaging data at hospitalization were analyzed by univariate and logistic regression analysis. Results There were 119 patients, all females, median age 32 years (15-72. At hospitalization, inflammatory markers were elevated (CRP median: 12.1 mg/dL, normal Conclusions APN is a protean disease. In the absence of strict correlation with clinical or biochemical markers, imaging studies are required to assess the severity of kidney involvement.

  16. Acute exacerbation of Hashimoto thyroiditis mimicking anaplastic carcinoma of the thyroid: A complicated case.

    Kanaya, Hiroaki; Konno, Wataru; Fukami, Satoru; Hirabayashi, Hideki; Haruna, Shin-ichi

    2014-12-01

    The fibrous variant of Hashimoto thyroiditis is uncommon, accounting for approximately 10% of all cases of Hashimoto thyroiditis. We report a case of this variant that behaved like a malignant neoplasm. The patient was a 69-year-old man who presented with a right-sided anterior neck mass that had been rapidly growing for 2 weeks. Fine-needle aspiration cytology revealed clusters of large multinucleated cells suggestive of an anaplastic carcinoma. A week after presentation, we ruled out that possibility when the mass had shrunk slightly. Instead, we diagnosed the patient with an acute exacerbation of Hashimoto thyroiditis on the basis of laboratory findings. We performed a right thyroid lobectomy, including removal of the isthmus, to clarify the pathology and alleviate pressure symptoms. The final diagnosis was the fibrous variant of Hashimoto thyroiditis, with no evidence of malignant changes. Physicians should keep in mind that on rare occasions, Hashimoto thyroiditis mimics a malignant neoplasm.

  17. Partial remission of acute myeloid leukemia complicating multiple myeloma following COAP chemotherapy: A case report.

    Shen, Man; Sun, Wan-Jun; Huang, Zhong-Xia; Zhang, Jia-Jia; An, Na; Li, Xin

    2015-03-01

    A 77-year-old male was admitted to hospital after complaining of fever and a cough for three days. A diagnosis of multiple myeloma was confirmed following M protein identification and a bone marrow biopsy. The patient received chemotherapy regimens of bortezomib plus dexamethasone, cyclophosphamide, thalidomide and dexamethasone, and thalidomide and dexamethasone, and was prescribed thalidomide (100 mg/d) to be taken orally for maintenance therapy. After a further two years the patient was subsequently diagnosed with acute myeloid leukemia. Chemotherapy regimens of cytarabine, aclacinomycin and daunorubicin, homoharringtonine and etoposide, and mitoxantrone and cytarabine resulted in no remission. Partial remission was obtained with a course of ifosfamide, vindesine, cytarabine and prednisone chemotherapy. This therapy may be an alternative treatment for secondary leukemia, particularly in elderly patients.

  18. Acute pancreatitis as a postburn complication: report of two cases in children Pancreatitis aguda como complicación de quemadura en dos niños

    Jairo Alberto Patarroyo Serrano; José Ovidio Herrera Montoya; Marco Antonio Hoyos Franco

    2007-01-01

    Acute pancreatitis in burnt adults has been reported with some frequency; contrariwise, there has been only one report of this complication in a burnt child. We reviewed the medical records of two childrenwith acute pancreatitis as a postburn complication, who were treated at the Burns Unit of the San Vicente de Paúl Hospital, in Medellín, Colombia. As a result, we add two documented cases to the limited literature on this subject. La pancreatitis aguda ha sido reportada con alguna frecuencia...

  19. A complicated case of antepartum eclamptic fit with HELLP syndrome, acute renal failure and multiple intracranial hemorrhages: A mortality report

    Ahmed Samy El-agwany

    2016-04-01

    Full Text Available HELLP is an acronym for hemolysis, elevated liver enzymes and low platelets count, affecting 0.2–12% of all pregnancies or 4–12% of those with preeclampsia. The maternal mortality reported from the literature is up 4% due to disseminated intravascular coagulation, placental abruption, acute renal failure, eclampsia, and cerebral hemorrhage. A 20 year old, G2P1, at 36 weeks of gestation, was referred to our hospital because of postictal coma state with bilateral mydriasis and epistaxis due to repeated antepartum eclamptic fits. Elevated blood pressure level 170/110 mmHg was accompanied with massive proteinuria. Cesarean section was performed and female newborn were delivered. Laboratory findings were characteristic of preeclampsia, HELLP syndrome and renal failure. The patient developed an intraventricular hematoma and an intracerebral hemorrhage with subarachnoid one, which were not suitable to neurosurgical treatment. The patient died from refractory hemolytic anemia, spontaneous bleeding of multiple organs, renal failure and intracranial hemorrhage. Preeclampsia, HELLP syndrome, and acute fatty liver of pregnancy might overlap and be associated with potentially fatal complications, including intracranial hemorrhage, as in the present case. Early detection and diagnosis are crucial to ensure appropriate management and treatment success.

  20. Pleuropulmonary and Lymph Node Progression after Docetaxel - Benefits from Treatment with Cabazitaxel in Metastatic Prostate Cancer

    Angel Segura Huerta

    2013-07-01

    Full Text Available Introduction: To date, there are no guidelines for a rational and more favourable sequence of treatment after docetaxel. Two drugs (cabazitaxel and abiraterone have recently been approved as second-line treatment after docetaxel failure in metastatic castration-resistant prostate cancer (mCRPC, but there are no studies comparing abiraterone versus cabazitaxel. The most suitable drug is chosen based on the physician's opinion and the patient's characteristics. In patients with a good performance status who are able to receive either treatment, it would be convenient to begin with cabazitaxel and to reserve abiraterone in case there is a worsening of the general status, in consideration of abiraterone's more favourable toxicity profile. Case Report: We describe the case of a 74-year-old male with mCRPC who presented with an interesting and uncommon tumour dissemination (pleuropulmonary occurring after the first standard treatment with docetaxel. Intravenous treatment with cabazitaxel 25 mg/m2 and oral prednisone 10 mg continuously was initiated. The patient received a total of 8 cycles of chemotherapy. A reduction of mediastinal adenopathies and infrarenal para-aortic stable bone involvement and an absence of pleural effusion were observed. No relevant toxicity was noted. Since February 2012, a progressive PSA increase without clinical deterioration has been noted. Conclusions: The selection criteria for second- and third-line systemic treatment and the excellent response obtained with cabazitaxel in an unusual disease setting are described. The results confirm the long duration and quality of response of cabazitaxel treatment. Further therapeutic options in this group of patients are suggested.

  1. Anaphylaxis Complicated by Acute Respiratory Distress and Fatal Outcome in A Nigerian Family

    Agelebe, Efeturi; Musa, Tawakalit Lily; Ajayi, Idowu Adebowale

    2017-01-01

    Reports on hypersensitivity diseases in Nigerians are rare. We report the incidence of anaphylaxis in three siblings following fatal outcome in their mother. Urticarial rashes were noticed in three siblings’ resident in a South Western Nigerian town, one week before presentation at our facility. All the three siblings developed respiratory distress four days after the rash was noticed. Onset of respiratory distress made the family seek care at a private hospital, where they were admitted and treated with intravenous aminophylline and ceftriaxone. The mother of the children had experienced the same symptoms earlier also. She took treatment and died in the same private hospital, where her children received care. Death of the mother and worsening respiratory distress in the children made the father effect transfer of the children to the paediatric emergency unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo. The three children made a slow but uneventful recovery after instituting appropriate management for anaphylaxis and acute respiratory distress syndrome. The cases are discussed with a view to create awareness amongst health practitioners about the occurrence of anaphylaxis in our society. The need for prompt recognition and appropriate management, when confronted with this disease is also underscored.

  2. Acute Inflammatory Bowel Disease Complicating Chronic Alcoholism and Mimicking Carcinoid Syndrome

    Piercarlo Ballo

    2012-08-01

    Full Text Available We report the case of a woman with a history of chronic alcohol abuse who was hospitalized with diarrhea, severe hypokalemia refractory to potassium infusion, nausea, vomiting, abdominal pain, alternations of high blood pressure with phases of hypotension, irritability and increased urinary 5-hydroxyindoleacetic acid and cortisol. Although carcinoid syndrome was hypothesized, abdominal computed tomography and colonoscopy showed non-specific inflammatory bowel disease with severe colic wall thickening, and multiple colic biopsies confirmed non-specific inflammation with no evidence of carcinoid cells. During the following days diarrhea slowly decreased and the patient’s condition progressively improved. One year after stopping alcohol consumption, the patient was asymptomatic and serum potassium was normal. Chronic alcohol exposure is known to have several deleterious effects on the intestinal mucosa and can favor and sustain local inflammation. Chronic alcohol intake may also be associated with high blood pressure, behavior disorders, abnormalities in blood pressure regulation with episodes of hypotension during hospitalization due to impaired baroreflex sensitivity in the context of an alcohol withdrawal syndrome, increased urinary 5-hydroxyindoleacetic acid as a result of malabsorption syndrome, and increased urinary cortisol as a result of hypothalamic-pituitary-adrenal axis dysregulation. These considerations, together with the regression of symptoms and normalization of potassium levels after stopping alcohol consumption, suggest the intriguing possibility of a alcohol-related acute inflammatory bowel disease mimicking carcinoid syndrome.

  3. Acute inflammatory bowel disease complicating chronic alcoholism and mimicking carcinoid syndrome.

    Ballo, Piercarlo; Dattolo, Pietro; Mangialavori, Giuseppe; Ferro, Giuseppe; Fusco, Francesca; Consalvo, Matteo; Chiodi, Leandro; Pizzarelli, Francesco; Zuppiroli, Alfredo

    2012-05-01

    We report the case of a woman with a history of chronic alcohol abuse who was hospitalized with diarrhea, severe hypokalemia refractory to potassium infusion, nausea, vomiting, abdominal pain, alternations of high blood pressure with phases of hypotension, irritability and increased urinary 5-hydroxyindoleacetic acid and cortisol. Although carcinoid syndrome was hypothesized, abdominal computed tomography and colonoscopy showed non-specific inflammatory bowel disease with severe colic wall thickening, and multiple colic biopsies confirmed non-specific inflammation with no evidence of carcinoid cells. During the following days diarrhea slowly decreased and the patient's condition progressively improved. One year after stopping alcohol consumption, the patient was asymptomatic and serum potassium was normal. Chronic alcohol exposure is known to have several deleterious effects on the intestinal mucosa and can favor and sustain local inflammation. Chronic alcohol intake may also be associated with high blood pressure, behavior disorders, abnormalities in blood pressure regulation with episodes of hypotension during hospitalization due to impaired baroreflex sensitivity in the context of an alcohol withdrawal syndrome, increased urinary 5-hydroxyindoleacetic acid as a result of malabsorption syndrome, and increased urinary cortisol as a result of hypothalamic-pituitary-adrenal axis dysregulation. These considerations, together with the regression of symptoms and normalization of potassium levels after stopping alcohol consumption, suggest the intriguing possibility of a alcohol-related acute inflammatory bowel disease mimicking carcinoid syndrome.

  4. Acute Thyrotoxic Bulbar Myopathy with Encephalopathic Behaviour: An Uncommon Complication of Hyperthyroidism

    Neeraja J. Boddu

    2013-01-01

    Full Text Available Objective. Acute thyrotoxic bulbar palsy is rare, severe, and rapidly progressive. We describe a case of thyrotoxicosis with bulbar palsy, encephalopathy, and pyramidal tract dysfunction. Case Report. 64-year-old white male with toxic multinodular goiter presented with rapid atrial fibrillation. He had mild tremor, normal cranial nerve examination, 4/5 strength in all extremities, normal reflexes, and down going plantars. TSH was low at 0.09 (normal: 0.34–5.6 uIU/mL, and free T4 was high at 5.22 (normal: 0.47–1.41 ng/dL. Despite optimal AV nodal blockade, he had persistent rapid atrial fibrillation. He later developed cervical dystonia, rigidity, clonus, dysarthria, dysphagia, vocal cord palsy, and absent gag reflex. Thyroid storm was suspected. Neuroimaging and cerebrospinal fluid cultures were nondiagnostic. Acetylcholine receptor antibodies were negative. Swallow ability was impaired with heavy secretions. Remarkable improvement in symptoms was noted after initiation of treatment for thyroid storm. Conclusion. Pyramidal tract symptoms and bulbar palsy may occur with thyrotoxicosis. Cranial nerve involvement and encephalopathy raise a question of primary brain mechanism causing bulbar palsy. This is reversible with prompt treatment of thyroid storm.

  5. Acute venous thrombosis as complication and clue to diagnose a SAPHO syndrome case. A case report.

    Rosero, A; Ruano, R; Martin, M; Hidalgo, C; Garcia-Talavera, J

    2013-01-01

    This report concerns a male adult admitted for sternal and left arm pain, who was diagnosed and treated for acute deep venous thrombosis in the left subclavian and axillary veins. X-ray and a hybrid single photon emission tomography and computed tomography (SPECT-CT) scintigraphy scan revealed high intensity uptake in both sternoclavicular joints, which corresponded to hyperostosis, thereby suggesting a SAPHO syndrome. Upon reviewing the patient's medical history, we found dermatological pustulosis disease and an intermittent sternal chest pain untreated since 10 years ago. In the biochemical study we found erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) elevation, hyperglobulinemia, and mild anaemia. Initial treatment included nonsteroidal anti-inflammatory drugs (NSAIDs) with low response, which then changed to methotrexate, sulfasalazine, and prednisone. The patient's pain was controlled almost completely in 10 months. A control bone scan revealed a marked decrease in intensity of bone deposits according to clinical response. To our knowledge, there are only a few cases of SAPHO and thrombosis and none are followed up with a bone SPECT-CT scan.

  6. Nystagmus in patients with unilateral acute otitis media complicated by serous labyrinthitis.

    Kim, Chang-Hee; Yang, Young Soo; Im, Donghyuk; Shin, Jung Eun

    2016-06-01

    Conclusion The patients with serous labyrinthitis caused by acute otitis media (AOM) exhibited various patterns of nystagmus in which direction-fixed irritative-type nystagmus was the most common pattern. Differential effects on inner ear function by toxic or inflammatory mediators may be responsible for the various manifestation of nystagmus. Objective This study aimed to investigate nystagmus patterns in patients with serous labyrinthitis, and discuss possible mechanisms. Methods From October 2011 to March 2014, 13 consecutive patients with serous labyrinthitis were included. Eye movements of the patients were serially examined using video-nystagmography, and patterns of nystagmus were investigated. Results The most commonly observed pattern was direction-fixed nystagmus (nine of 13 patients). Of these, eight showed irritative-type, and one showed paretic-type. Direction of nystagmus, although the intensity gradually decreased, was not changed during the course of treatment. One patient showed direction-changing spontaneous nystagmus, which changed into paretic-type direction-fixed nystagmus 1 day after myringotomy. Three patients exhibited persistent direction-changing positional nystagmus in a supine head-roll test. Of them, two showed apogeotropic and one showed geotropic type. In all 13 patients, vertigo and hearing loss were improved after the treatment.

  7. Pulmonary alveolar proteinosis requiring "hybrid" extracorporeal life support, and complicated by acute necrotizing pneumonia.

    Moisan, M; Lafargue, M; Calderon, J; Oses, P; Ouattara, A

    2013-04-01

    Pulmonary alveolar proteinosis (PAP), which was first described by Rosen in 1958, is a rare disease characterized by impaired surfactant metabolism that provokes the accumulation of proteinaceous material in the alveoli. PAP is usually an auto-immune disease though, less commonly, may be congenital or secondary to another underlying disorder, such as infection, an immunodeficiency or a haematological disease. A positive diagnosis can be made with the appearance of "crazy-paving" on a computed tomography scan, with a milky fluid bronchial aspiration. A cytological examination will also show eosinophilic material and pink stained periodic acid-Schiff-positive material. A whole lung lavage is the most widely accepted therapy for hypoxemic PAP. Herein, we report the case of a 27-year-old woman admitted into our intensive care unit for hypoxemic PAP that was complicated by a pulmonary embolism. Because the patient presented with refractory hypoxemia associated with a brief cardiac arrest, femoral veno-arterial extracorporeal life support (ECLS) was rapidly inserted. Under ECLS, the patient subsequently developed "Harlequin syndrome", which was managed using an original and minimally invasive method. A whole lung lavage as well as prone positioning was effectively performed under ECLS, and resulted in substantial improvement in oxygenation. The patient could be discharged from the hospital 40 days later.

  8. Acute Headache at Emergency Department: Reversible Cerebral Vasoconstriction Syndrome Complicated by Subarachnoid Haemorrhage and Cerebral Infarction

    M. Yger

    2015-01-01

    Full Text Available Introduction. Reversible cerebral vasoconstriction syndrome is becoming widely accepted as a rare cause of both ischemic and haemorrhagic stroke and should be evocated in case of thunderclap headaches associated with stroke. We present the case of a patient with ischemic stroke associated with cortical subarachnoid haemorrhage (cSAH and reversible diffuse arteries narrowing, leading to the diagnosis of reversible vasoconstriction syndrome. Case Report. A 48-year-old woman came to the emergency department because of an unusual thunderclap headache. The computed tomography of the brain completed by CT-angiography was unremarkable. Eleven days later, she was readmitted because of a left hemianopsia. One day after her admission, she developed a sudden left hemiparesis. The brain MRI showed ischemic lesions in the right frontal and occipital lobe and diffuse cSAH. The angiography showed vasoconstriction of the right anterior cerebral artery and stenosis of both middle cerebral arteries. Nimodipine treatment was initiated and vasoconstriction completely regressed on day 16 after the first headache. Conclusion. Our case shows a severe reversible cerebral vasoconstriction syndrome where both haemorrhagic and ischemic complications were present at the same time. The history we reported shows that reversible cerebral vasoconstriction syndrome is still underrecognized, in particular in general emergency departments.

  9. The Role of Oxygen Free Radicals in Acute Renal Failure Complicating Obstructive Jaundice: An Experimental Study

    Serdar Yüceyar

    1998-01-01

    Full Text Available Oxydant injury is considered to be an important mechanism in the pathophysiology of acute renal failure. It has been thought that decrease in extracellular and intracellular fluid and endotoxemia seen in obstructive jaundice may cause an increase in production of oxygen free radicals and impairment in antioxydant defense mechanism. This study is designed to investigate the possible role of oxydant injury in renal failure seen in jaundiced patients. In this study, 28 rats were divided into four groups: Control(C (N=7; Renal ischemia (RI (N=7; Obstructive jaundice+renal ischemia (OJ+RI (N=7; Obstructive jaundice (OJ (N=7. All groups were compared with each other according to renal failure findings and enzyme activities, such as Xanthine oxidase (XOD, Superoxide Dismutase (SOD and Catalase in renal cortex and Glutathione Peroxidase (GSH-Px, in blood at 3rd day after ischemia and reperfusion. Renal failure findings monitored by blood urea and creatinine levels, seemed more evident in OJ+RI than RI group (p <0.05. When compared with RI, in OJ+RI group, increase in XOD activity at 3rd day was statistically significant [0.259 ±0.01 U/g (tissue and 0.362±0.03 U/g (tissue respectively] (p <0.05. SOD and GSH-Px activities of each ischemic group at 3rd day were decreased compared to non-ischemic groups. This fall was significant (p <0.05. But there was no statistical difference between jaundiced and non-jaundiced groups. Alterations in catalase activities also had no statistical significance.

  10. Environmental Air Pollution and Acute Cerebrovascular Complications: An Ecologic Study in Tehran, Iran

    Nabavi, Seyed Massood; Jafari, Batoul; Jalali, Mozhgan Sadat; Nedjat, Saharnaz; Ashrafi, Khosro; Salahesh, Alireza

    2012-01-01

    Background: In this study, we aimed to assess the association between air pollution and cerebrovascular complications in Tehran, one of the most air-polluted cities in the world, among different subgroups of patients with stroke in 2004. Methods: In this ecologic study, we calculated the daily average levels of different air pollutants including CO, NOX, SO2, O3, and PM10 and also humidity and temperature on the day of stroke and 48 hours prior to stroke in 1 491 patients admitted with the diagnosis of stroke in eight referral hospitals in different areas of Tehran. Then, we evaluated the association between the rate of stroke admissions and the level of the selected pollutants, humidity, and temperature on the day of stroke and 48 hours prior to stroke among different subgroups of patients. Results: There was no significant association between the same-day level of the pollutants and the rate of stroke admissions, but an association was seen for their level 48 hours before stroke. These associations differed among different subgroups of age, sex, history of underlying diseases, and type of stroke. Same-day temperature had a reverse association in patients with hemorrhagic stroke and in patients without a history of heart disease or previous stroke. A direct significant association was seen for humidity level 48 hours before stroke in patients with a history of heart disease. Conclusions: It is inferred that air pollution has a direct association with the incidence of stroke and these association differs among different subgroups of patients. The results of this study are not time-dependant and can be generalized to different times and regions. Moreover, these results may be useful for environmental health policy makers. PMID:23112900

  11. The lipid-regulating effect and safety of combined statin and bezafibrate therapy in acute coronary syndrome patients complicating with dyslipidemia

    李向平

    2014-01-01

    Objective To investigate the lipid-regulating effectand safety of combined statin and bezafibrate therapy in acute coronary syndrome(ACS)patients complicating with dyslipedemia.Methods One hundred and four hospitalized patients with established ACS and increased serum triglycerides(TG)levels and/or low serum levels of high density

  12. First aid treatment of critically acute epidural hematoma complicated by cerebral hernia using cranial trepanation and drainage decompression: a report of 16 cases

    陈宁

    2002-01-01

    @@From October 1997 to February 2000, 16 cases of critically acute epidural hematoma (CAEH) complicated by cranial hernia were treated with cranial trepanation and drainage decompression (CTDD), which was used as the first aid treatment before craniotomy and evacuation of hematoma. Satisfactory results were obtained.

  13. Activities of daily living as an additional predictor of complications and outcomes in elderly patients with acute myocardial infarction

    Nakajima H

    2016-08-01

    Full Text Available Hiroyuki Nakajima,1 Jiro Yoshioka,2 Nobuyuki Totsuka,2 Izumi Miyazawa,2 Tatsuya Usui,2 Nobuyuki Urasawa,2 Takahiro Kobayashi,3 Tomoaki Mochidome4 1Department of Cardiology, Nagano Matsushiro General Hospital, 2Department of Cardiology, Nagano Red Cross Hospital, 3Department of Cardiology, Nagano Municipal Hospital, Nagano, 4Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan Background: Age is an important determinant of outcome in acute myocardial infarction (AMI. However, in clinical settings, there is an occasional mismatch between chronological age and physical age. We evaluated whether activities of daily living (ADL, which reflect physical age, also predict complications and prognosis in elderly patients with AMI.Design: Single-center, observational, and retrospective cohort study.Methods: Preserved ADL and low ADL were defined according to the scale for independence degree of daily living for the disabled elderly by the Japanese Ministry of Health, Labour, and Welfare. We examined 82 consecutive patients aged ≥75 years with AMI who underwent primary percutaneous coronary intervention. Patients were divided into preserved ADL (n=52; mean age, 81.8±4.8 years; male, 59.6% and low ADL (n=30; mean age, 85.8±4.7 years; male, 40.0% groups according to prehospital ADL.Results: The prevalence of Killip class II–IV and in-hospital mortality rate were significantly higher with low ADL compared to that with preserved ADL (23.1% vs 60.0%, P=0.0019; 5.8% vs 30.0%, P=0.0068, respectively. Multivariate analysis showed that ADL was an independent predictor of Killip class II–IV and 1-year mortality after adjusting for age, sex, and other possible confounders (odds ratio 5.11, 95% confidence interval [CI] 1.52–17.2, P=0.0083; hazard ratio 4.32, 95% CI 1.31–14.3, P=0.017, respectively.Conclusion: Prehospital ADL is a significant predictor of heart failure complications and prognosis in elderly

  14. Analysis of the clinical symptoms of patients complicated with acute intestinal obstruction after the surgery of colon cancer

    Pei-Jun Ye

    2016-01-01

    Objective: To study the content of serum inflammatory medium of the patients complicated with acute intestinal obstruction after the surgery of colon cancer. Methods: A total of 150 patients with colon cancer received limited surgery treatment during the period of May 2012 to October 2015 were selected as the study objects. They were divided into postoperative ileus (POI) group and non-postoperative ileus (non-POI) group according to the presence or absence of intestinal obstruction. Then, the contents of serum procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-a) and interleukin-6 (IL-6) were detected at the 1st, 3rd, 5th and 7th days after the surgery. Results: The levels of serum PCT, CRP, TNF-a and IL-6 of two groups at the 1st day had no differences after the surgery. The level of serum PCT of POI group tended to increase and its levels of serum CRP, TNF-a and IL-6 tended to decrease at the 3rd, 5th and 7th days after the surgery, while the levels of serum PCT, CRP, TNF-a and IL-6 of non-POI group were decreased. The content of serum PCT of POI group and non-POI group at the 3rd day after the surgery had no differences (P > 0.05), and the level of serum PCT of POI group was higher than that of non-POI group at the 5th and 7th days after the surgery (P0.05). Conclusions: The raising of the content of serum PCT after the surgery can be used as the laboratory index to predict the incidence of acute intestinal obstruction after the surgery of colon cancer.

  15. Evaluation of some pulmonary functions and pleuropulmonary complications after endoscopic sclerotherapy of gastric fundal varices at Zagazig university hospitals

    Jihan A. Shawky

    2016-10-01

    Conclusions: NBCA injection of gastric fundal varices was associated with significant, reversible deterioration in some pulmonary functions, atelectasis and minimal pleural effusion with significant rapid improvement if incentive spirometry is used.

  16. Clinical effects of continuous high volume hemofiltration on severe acute pancreatitis complicated with multiple organ dysfunction syndrome

    Hao Wang; Wei-Qin Li; Wei Zhou; Ning Li; Jie-Shou Li

    2003-01-01

    AIM: To investigate the efficiency of continuous high volume hemofiltration (HVHF) in the treatment of severe acute pancreatitis (SAP) complicated with multiple organ dysfunction syndrome (MODS).METHODS: A total of 28 SAP patients with an average of 14.36±3.96 APACHE Ⅱ score were involved. Diagnostic criteria for SAP standardized by the Chinese Medical Association and diagnostic criteria for MODS standardized by American College of Chest Physicians (ACCP) and Society of Critical Care Medicine (SCCM) were applied for inclusion. HVHF was started 6.0±6.1 (1-30) days after onset of the disease and sustained for at least 72 hours, AN69 hemofilter (1.2 m2)was changed every 24 hours. The ultrafiltration rate during HVHF was 4 000 mi/h, blood flow rate was 250-300 mi/min,and the substitute fluid was infused with pre-dilution. Low molecular weight heparin was used for anticoagulation.RESULTS: HVHF was well tolerated in all the patients, and lasted for 4.04±3.99 (3-24) days. 20 of the patients survived,6 patients died and 2 of the patients quited for financial reason.The ICU mortality was 21.4%. Body temperature, heart rate and breath rate decreased significantly after HVHF.APACHE Ⅱ score was 14.4±3.9 before HVHF, and 9.9±4.3after HVHF, which decreased significantly (P<0.01). Partial pressure of oxygen in arterial blood before HVHF was 68.5±19.5 mmHg, and increased significantly after HVHF,which was 91.9±25 mmHg (P<0.01). During HVHF the hemodynamics was stable, and serum potassium, sodium,chlorine, glucose and pH were at normal level.CONCLUSION: HVHF is technically possible in SAP patients complicated with MODS. It does not appear to have detrimental effects and may have beneficial effects.Continuous HVHF, which seldom disturbs the hemodynamics and causes few side-effects, is expected to become a beneficial adjunct therapy for SAP complicated with MODS.

  17. Correlation of Body Mass Index and Waist-Hip Ratio with Severity and Complications of Hyperlipidemic Acute Pancreatitis in Chinese Patients

    Lixin Yang

    2017-01-01

    Full Text Available Hyperlipidemic acute pancreatitis (HLAP is characterized by critical condition and high recurrence rate compared with non-HLAP. We conducted this study to investigate the value of body mass index and waist-hip ratio in predicting severity and local complications in HLAP. 96 patients with HLAP were categorized by body mass index and waist-hip ratio, respectively. According to the body mass index, they were divided into 3 groups, including normal weight, overweight, and obesity. According to the waist-hip ratio, they were divided into central obesity group and no central obesity group. The body mass index and waist-hip ratio were compared in severity, local complications, and systematic complications of HLAP, using chi-square test and Monte Carlo simulations. The body mass index and waist-hip ratio were correlated with the severity of acute pancreatitis (MAP, MSAP, and SAP, respiratory failure, and circulatory failure in HLAP (p<0.05, but not correlated with the local complications (walled-off necrosis, pancreatic abscess, and pancreatic pseudocyst, renal failure, and gastrointestinal bleeding.The body mass index and waist-hip ratio are valuable in predicting severity and complication in HLAP. We demonstrated that obese patients had an increased risk of developing more serious condition and more complications in HLAP.

  18. Diagnosis and Management of Papillary Muscle Rupture Complicating Acute Myocardial Infarction: A Case Report and Review of the Literature

    Suarez

    2015-08-01

    Full Text Available Introduction The incidence of mechanical complications related to myocardial infarction has decreased over the last decades, and revascularization certainly plays a major role in this change. However, mortality still remains elevated. This is a case of acute papillary muscle rupture secondary to myocardial infarction leading to cardiogenic shock. Case Presentation A 71-year-old woman presented to an outside hospital complaining of chest pain and shortness of breath. An electrocardiogram was obtained and revealed depression of the ST segments from leads V1 to V4. Troponin I was elevated at 3.0 ng/mL. She was transferred to our facility for a higher level of care. She was found in cardiogenic shock at arrival. A bedside echocardiogram was ordered, which demonstrated papillary muscle rupture with severe mitral regurgitation. A coronary angiogram followed, which diagnosed severe three-vessel disease. After the insertion of an intra-aortic balloon pump, she was transferred emergently to the surgical suite for mitral valve replacement and revascularization. The operation was uneventful. She was discharged to a rehabilitation center after approximately 1 month of hospital stay. Conclusions Mortality from papillary muscle rupture remains elevated. Survival largely depends on the early surgical repair or the replacement of the mitral valve.

  19. Primary Pulmonary Amebiasis Complicated with Multicystic Empyema

    Ali Zakaria

    2016-01-01

    Full Text Available Amebiasis is a parasitic infection caused by the protozoan Entamoeba histolytica. While most infections are asymptomatic, the disease could manifest clinically as amebic dysentery and/or extraintestinal invasion in the form of amebic liver abscess or other more rare manifestations such as pulmonary, cardiac, or brain involvement. Herein we are reporting a case of a 24-year-old male with history of Down syndrome who presented with severe right side pneumonia complicated with multicystic empyema resistant to regular medical therapy. Further investigation revealed a positive pleural fluid for E. histolytica cysts and trophozoites. The patient was diagnosed with primary pleuropulmonary amebiasis and he responded promptly to surgical drainage and metronidazole therapy. In patients from endemic areas all physicians should keep a high index of suspicion of amebiasis as a cause of pulmonary disease.

  20. Primary Pulmonary Amebiasis Complicated with Multicystic Empyema

    Al-Share, Bayan; Al Asad, Khaled

    2016-01-01

    Amebiasis is a parasitic infection caused by the protozoan Entamoeba histolytica. While most infections are asymptomatic, the disease could manifest clinically as amebic dysentery and/or extraintestinal invasion in the form of amebic liver abscess or other more rare manifestations such as pulmonary, cardiac, or brain involvement. Herein we are reporting a case of a 24-year-old male with history of Down syndrome who presented with severe right side pneumonia complicated with multicystic empyema resistant to regular medical therapy. Further investigation revealed a positive pleural fluid for E. histolytica cysts and trophozoites. The patient was diagnosed with primary pleuropulmonary amebiasis and he responded promptly to surgical drainage and metronidazole therapy. In patients from endemic areas all physicians should keep a high index of suspicion of amebiasis as a cause of pulmonary disease. PMID:27478673

  1. Analysis of the clinical symptoms of patients complicated with acute intestinal obstr uction after the surger y of colon cancer

    Pei-Jun Ye

    2016-09-01

    Full Text Available Objective: To study the content of serum inflammatory medium of the patients complicated with acute intestinal obstruction after the surgery of colon cancer. Methods: A total of 150 patients with colon cancer received limited surgery treatment during the period of May 2012 to October 2015 were selected as the study objects. They were divided into postoperative ileus (POI group and non-postoperative ileus (non-POI group according to the presence or absence of intestinal obstruction. Then, the contents of serum procalcitonin (PCT, C-reactive protein (CRP, tumor necrosis factor-alpha (TNFa and interleukin-6 (IL-6 were detected at the 1st, 3rd, 5th and 7th days after the surgery. Results: The levels of serum PCT, CRP, TNF-a and IL-6 of two groups at the 1st day had no differences after the surgery. The level of serum PCT of POI group tended to increase and its levels of serum CRP, TNF-a and IL-6 tended to decrease at the 3rd, 5th and 7th days after the surgery, while the levels of serum PCT, CRP, TNF-a and IL-6 of non-POI group were decreased. The content of serum PCT of POI group and non-POI group at the 3rd day after the surgery had no differences (P > 0.05, and the level of serum PCT of POI group was higher than that of non-POI group at the 5th and 7th days after the surgery (P 0.05. Conclusions: The raising of the content of serum PCT after the surgery can be used as the laboratory index to predict the incidence of acute intestinal obstruction after the surgery of colon cancer. 1. Introduction Postoperative ileus (POI mainly happens after major abdominal surgeries causing the clinical symptoms such as abdominal pain, abdominal distension, no flatus and defecation, etc. Colorectal cancer is a common malignant tumor in the digestive system, and the incidence and death rates of the disease were all tending to in

  2. Contralateral acute epidural haematoma following evacuation of a chronic subdural haematoma with burr-hole craniostomy and continuous closed system drainage: a rare complication.

    Panourias, Ioannis G; Skandalakis, Panajiotis N

    2006-06-01

    Chronic subdural haematoma (CSDH) is one of the most frequent causes for neurosurgical intervention. Although the prognosis is generally good and treatment modalities are well established, some devastating intracranial haematomas can complicate its evacuation. The authors report here a case of an acute epidural haematoma occurring after evacuation of a contralateral chronic subdural haematoma (CSDH) with burr-hole craniostomy and continuous closed system drainage without irrigation. Since this is a rare, but potentially life-threatening, complication, clinicians should suspect its occurrence when an unexpected postoperative course is demonstrated.

  3. Acute intraventricular thrombosis of an impella LP 5.0 device in an ST-elevated myocardial infarction complicated by cardiogenic shock.

    Ranc, Sylvain; Sibellas, Franck; Green, Lisa

    2013-01-01

    A 58-year-old male patient, suffering from an acute anterior ST-elevated myocardial infarction, developed cardiogenic shock, despite an optimal revascularization and hemodynamic support through the use of an intra-aortic balloon pump and inotropic pharmacological agents. Additional support was provided by a left ventricular assistance device Impella LP 5.0 (Abiomed, Europe GmbH). Device failure occurred 27 hours after implantation due to an acute thrombosis of the Impella inflow portion. This major adverse event might have occurred due to an inflammatory status in the cardiogenic shock context, a pre-existing intraventricular thrombus that could have been sucked up inside the Impella, and/or a subtherapeutic anticoagulation. There are very few data regarding this type of complication. Further studies are therefore needed to assess the frequency of such a complication and the means to avoid it.

  4. Dual pancreas- and lung-targeting therapy for local and systemic complications of acute pancreatitis mediated by a phenolic propanediamine moiety.

    Li, Jianbo; Zhang, Jinjie; Fu, Yao; Sun, Xun; Gong, Tao; Jiang, Jinghui; Zhang, Zhirong

    2015-08-28

    To inhibit both the local and systemic complications with acute pancreatitis, an effective therapy requires a drug delivery system that can efficiently overcome the blood-pancreas barrier while achieving lung-specific accumulation. Here, we report the first dual pancreas- and lung-targeting therapeutic strategy mediated by a phenolic propanediamine moiety for the treatment of acute pancreatitis. Using the proposed dual-targeting ligand, an anti-inflammatory compound Rhein has been tailored to preferentially accumulate in the pancreas and lungs with rapid distribution kinetics, excellent tissue-penetrating properties and minimum toxicity. Accordingly, the drug-ligand conjugate remarkably downregulated the proinflammatory cytokines in the target organs thus effectively inhibiting local pancreatic and systemic inflammation in rats. The dual-specific targeting therapeutic strategy may help pave the way for targeted drug delivery to treat complicated inflammatory diseases.

  5. Acute cholecystitis is a common complication after allogeneic stem cell transplantation and is associated with the use of total parenteral nutrition.

    Bagley, Stephen J; Sehgal, Alison R; Gill, Saar; Frey, Noelle V; Hexner, Elizabeth O; Loren, Alison W; Mangan, James K; Porter, David L; Stadtmauer, Edward A; Reshef, Ran; Luger, Selina M

    2015-04-01

    The incidence and risk factors for acute cholecystitis after allogeneic hematopoietic stem cell transplantation (HSCT) are not well defined. Of 644 consecutive adult transplants performed at our institution between 2001 and 2011, acute cholecystitis occurred in the first year of transplant in 32 patients (5.0%). We conducted 2 retrospective case-control studies of this population to determine risk factors for cholecystitis after HSCT and to evaluate the performance of different methods of imaging to diagnosis cholecystitis in patients undergoing HSCT compared with non-HSCT patients. In the HSCT population, development of cholecystitis was associated with an increased 1-year overall mortality rate (62.5% versus 19.8%, P cholecystitis was higher in patients who received total parenteral nutrition (TPN) (adjusted odds ratio, 3.41; P = .009). There was a trend toward more equivocal abdominal ultrasound findings in HSCT recipients with acute cholecystitis compared with nontransplant patients (50.0% versus 30.6%, P = .06). However, hepatobiliary iminodiacetic acid (HIDA) scans were definitively positive for acute cholecystitis in most patients in both populations (80.0% of HSCT recipients versus 77.4% of control subjects, P = .82). In conclusion, acute cholecystitis is a common early complication of HSCT, the risk is increased in patients who receive TPN, and it is associated with high 1-year mortality. In HSCT recipients with findings suggestive of acute cholecystitis, especially those receiving TPN, early use of HIDA scan may be considered over ultrasound.

  6. Effect of levosimendan on heart function and hs-CRP, IL-6, TNF-α levels in elderly patients with acute myocardial infarction complicated heart failure

    Wei-Peng Song; Qiang-Hua Guo; Hong-Dan Jia; Ting-Ting Song; Li Liu

    2016-01-01

    Objective:To observe the effect of levosimendan on heart function and hs-CRP, IL-6, TNF-α levels in elderly patients with acute myocardial infarction complicated heart failure. Methods:A total of80 elderly patients with acute myocardial infarction complicated heart failure were randomly divided into control group (40 cases) and research group (40 cases), the control group was given the basic treatment, and the research group was given levosimendan on the basis of the control group, after 1 weeks’ treatment, to compare the clinical curative effect, LVESD, LVEDD, LVEF, hs-CRP, IL-6, TNF-α.Results:Comparing with the before treatment, the LVEDD, LVESD, hs-CRP, TNF-α, IL-6 in two groups after treatment decreased, and LVEF increased, the difference were statistically significant. Comparing with control group after treatment, the LVEDD, LVESD, hs-CRP, TNF-α, IL-6 in research group after treatment decreased obviously, and LVEF increased obviously, the difference were statistically significant.Conclusion:It has great clinical curative effect that levosimendan treat elderly patients with acute myocardial infarction complicated heart failure, it can ameliorate heart function and inflammation reaction, safe and reliable, and it is worthy of application.

  7. Impact of aspirin and statins on long-term survival in patients hospitalized with acute myocardial infarction complicated by heart failure

    Lewinter, Christian; Bland, John M; Crouch, Simon;

    2014-01-01

    AIMS: Aspirin and statins are established therapies for acute myocardial infarction (MI), but their benefits in patients with chronic heart failure (HF) remain elusive. We investigated the impact of aspirin and statins on long-term survival in patients hospitalized with acute MI complicated by HF....... METHODS AND RESULTS: Of 4251 patients in the Evaluation of Methods and Management of Acute Coronary Events (EMMACE)-1 and -2 observational studies, 1706 patients had HF. A propensity score-matching method estimated the average treatment effects (ATEs) of aspirin and statins on survival over 90 months....... ATEs were calculated as relative risk differences in all-cause mortality comparing patients receiving aspirin and statins with controls, respectively. Moreover, combined aspirin and statins vs. none (ATE I), aspirin or statins vs. none (ATE II), and aspirin and statins vs. aspirin or statins (ATE III...

  8. One-year clinical outcomes in invasive treatment strategies for acute ST-elevation myocardial infarction complicated by cardiogenic shock in eld-erly patients

    Yeon Pyo Yoo; Ki-Woon Kang; Hyeon Soo Yoon; Jin Cheol Myung; Yu Jeong Choi; Won Ho Kim; Sang Hyun Park; Kyung Tae Jung; Myung Ho Jeong

    2013-01-01

    Objective To investigate the clinical outcomes of an invasive strategy for elderly (aged≥75 years) patients with acute ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Methods Data on 366 of 409 elderly CS patients from a total of 6,132 acute STEMI cases enrolled in the Korea Acute Myocardial Infarction Registry between January 2008 and June 2011, were collected and analyzed. In-hospital deaths and the 1-month and 1-year survival rates free from major adverse cardiac events (MACE;defined as all cause death, myocardial infarction, and target vessel revascularization) were reported for the patients who had undergone invasive (n=310) and conservative (n=56) treatment strategies. Results The baseline clinical characteristics were not significantly different between the two groups. There were fewer in-hospital deaths in the invasive treatment strategy group (23.5%vs. 46.4%, P<0.001). In addition, the 1-year MACE-free survival rate after invasive treatment was significantly lower compared with the conservative treatment (51%vs. 66%, P=0.001). Conclusions In elderly patients with acute STEMI complicated by CS, the outcomes of invasive strategy are similar to those in younger patients at the 1-year follow-up.

  9. Mortality in children with complicated severe acute malnutrition is related to intestinal and systemic inflammation: an observational cohort study12

    van Vliet, Sara J; Di Giovanni, Valeria; Zhang, Ling; Richardson, Susan; van Rheenen, Patrick F

    2016-01-01

    Background: Diarrhea affects a large proportion of children with severe acute malnutrition (SAM). However, its etiology and clinical consequences remain unclear. Objective: We investigated diarrhea, enteropathogens, and systemic and intestinal inflammation for their interrelation and their associations with mortality in children with SAM. Design: Intestinal pathogens (n = 15), cytokines (n = 29), fecal calprotectin, and the short-chain fatty acids (SCFAs) butyrate and propionate were determined in children aged 6–59 mo (n = 79) hospitalized in Malawi for complicated SAM. The relation between variables, diarrhea, and death was assessed with partial least squares (PLS) path modeling. Results: Fatal subjects (n = 14; 18%) were younger (mean ± SD age: 17 ± 11 compared with 25 ± 11 mo; P = 0.01) with higher prevalence of diarrhea (46% compared with 18%, P = 0.03). Intestinal pathogens Shigella (36%), Giardia (33%), and Campylobacter (30%) predominated, but their presence was not associated with death or diarrhea. Calprotectin was significantly higher in children who died [median (IQR): 1360 mg/kg feces (2443–535 mg/kg feces) compared with 698 mg/kg feces (1438–244 mg/kg feces), P = 0.03]. Butyrate [median (IQR): 31 ng/mL (112–22 ng/mL) compared with 2036 ng/mL (5800–149 ng/mL), P = 0.02] and propionate [median (IQR): 167 ng/mL (831–131 ng/mL) compared with 3174 ng/mL (5819–357 ng/mL), P = 0.04] were lower in those who died. Mortality was directly related to high systemic inflammation (path coefficient = 0.49), whereas diarrhea, high calprotectin, and low SCFA production related to death indirectly via their more direct association with systemic inflammation. Conclusions: Diarrhea, high intestinal inflammation, low concentrations of fecal SCFAs, and high systemic inflammation are significantly related to mortality in SAM. However, these relations were not mediated by the presence of intestinal pathogens. These findings offer an important understanding of

  10. 糖尿病并发急性虹膜睫状体炎的临床观察%Clinical observation of diabetes complicated with acute iridocyclitis

    田蕊蕊; 张玲

    2012-01-01

    OBJECTIVE To discuss the clinical features and diagnosis and treatment of patient who suffered from type 2 diabetes complicated with acute iridocyclitis. METHODS The clinical diagnosis and treatment of 23 patients who suffered from type 2 diabetes complicated with acute iridocyclitis were analyzed retrospectively. RESULTS When patients with type 2 diabetes complicate with iridocyclitis, the local symptom and sign was acute and serious, the effect was ideal through the active control blood sugar and local comprehensive treatment. CON-CLUSIONS The resistance of patients with type 2 diabetes reduced easily so that they were sensitive to the acute iridocyclitis. We should pay more attention and take active reasonable treatment as early as possible.%目的 探讨2型糖尿病并发急性虹膜睫状体炎患者的发病特点及诊治.方法 对我院2005年1月-2010年12月收治的23例2型糖尿病并发急性虹膜睫状体炎患者的临床诊治进行回顾性分析.结果 2型糖尿病患者并发虹膜睫状体炎时发病急,局部症状、体征重,经积极控制血糖及局部综合治疗后效果理想.结论 2型糖尿病患者全身抵抗力下降,容易并发急性虹膜睫状体炎,应引起高度重视,并尽早给于积极、合理治疗.

  11. Acute dilated cardiomyopathy in a patient with beriberi and cryoglobulinaemic vasculitis: an unusual potential complication of two rare disorders.

    Tejedor, Ana; Solé, Manel; Prieto-González, Sergio; Alba, Marco Antonio; Grau, Josep Maria; Cid, Maria Cinta; Hernández-Rodríguez, José

    2014-01-01

    We report the case of a 45-year-old patient who presented with acute dilated cardiomyopathy. During admission the patient was consecutively diagnosed with cryoglobulinaemic vasculitis and beriberi. In both diseases, cardiac involvement may occur as dilated cardiomyopathy. Thiamin deficiency was the final cause for the severe cardiac manifestations (cardiac acute beriberi or Shoshin syndrome), which returned to normal after thiamin supplementation.

  12. Statin therapy and clinical outcomes in myocardial infarction patients complicated by acute heart failure : insights from the EPHESUS trial

    Dobre, Daniela; Rossignol, Patrick; Murin, Jan; Parkhomenko, Alexander; Lamiral, Zohra; Krum, Henry; van Veldhuisen, Dirk J.; Pitt, Bertram; Zannad, Faiez

    2013-01-01

    Several clinical trials have shown that in patients with acute myocardial infarction (MI), statin therapy improves cardiovascular (CV) outcomes, but in these trials patients with acute heart failure (HF) were excluded or only a few were included. In patients with chronic HF, statin therapy does not

  13. Rapidly fatal community-acquired pneumonia due to Klebsiella pneumoniae complicated with acute myocarditis and accelerated idioventricular rhythm.

    Chuang, Tzu-Yi; Lin, Chou-Jui; Lee, Shih-Wei; Chuang, Chun-Pin; Jong, Yuh-Shiun; Chen, Wen-Jone; Hsueh, Po-Ren

    2012-08-01

    We describe a previously healthy 52-year-old man with rapidly fatal community-acquired pneumonia caused by Klebsiella pneumoniae. The patient developed acute renal dysfunction, accelerated idioventricular rhythm (acute myocarditis), lactic acidosis and septic shock. He died within 15 hours after admission despite intravenous levofloxacin (750 mg daily) and aggressive medical treatment.

  14. 急性阑尾炎术后并发症的防治%Prevention and Treatment of Acute Appendicitis Postoperative Complications

    景玉萍

    2013-01-01

    Objective To observe the prevention and treatment of complications of acute appendicitis. Methods:a retrospective analysis of the clinical data of 800 patients with acute appendicitis patients in our hospital from 2007 January to 2012 December were analyzed. Results:suppurative appendicitis in 300 cases, incision infection in 10 cases, the complication rate was 3.3%;80 cases of appendiceal abscess, a total of 15 cases of complications, the incidence of complications was 18.8%. Conclusion:the early diagnosis of acute appendicitis, timely operation are the key to prevent operation incision infection.%目的:观察急性阑尾炎术后并发症的防治。方法回顾性分析我院自2007年1月~2012年12月收治的800例急性阑尾炎患者的临床资料。结果单纯性化脓性阑尾炎300例,并发切口感染10例,并发症发生率为3.3%;阑尾脓肿80例,并发症发生总数15例,并发症发生率为18.8%。结论对急性阑尾炎的早期诊断、及时手术是预防手术切口感染的关键。

  15. Treatment countermeasures of acute complication of maintenance hemodialysis%维持性血液透析急性并发症处理对策分析

    郭德跃

    2014-01-01

    目的:探讨维持性血液透析( MHD)急性并发症的相关因素及防治对策。方法回顾性分析MHD患者常见的急性并发症及处理措施。结果3881次MHD中发生急性并发症287次,发生率为7.40%(287/3881)。其中出现低血压21次(7.32%),高血压63次(21.95%),肌肉痛性痉挛112次(39.02%),心律失常8次(2.79%),失衡综合征4次(1.39%),首次使用综合征(或透析器反应)2次(0.70%),腹痛、胸痛、背痛39次(13.59%),低血糖、急性左心衰等其他并发症38次(13.24%)。全部病例给予及时有效的对症处理,287次均抢救成功。结论 MHD是尿毒症患者主要的肾脏替代治疗方法。虽然透析技术日益成熟,设备不断改进,但由于透析病例和高危患者的不断增多,发生多种并发症的可能性加大,应高度重视,勤巡视,细心观察,积极应对,及早发现,及时处理,保证透析质量,以提高患者的生活质量和生存率。%Objective To explore the related factors and prevention or treatment of acute complication of maintenance hemodialysis ( MHD) patients .Methods A retrospective study was performed of common acute compli-cations and treatment measures in MHD .Results In 3881 case-times of MHD,acute complications were found in 287 case-times(7.40%, 287/3881).Of all the acute complications , there were 21 case-times of hypotension(7.32%), 63 case-times of hypertension(21.95%), 112 case-times of muscle cramps(39.02%), 8 case-times of arrhythmia (2.79%), 4 case-times of disequilibrium syndrome (1.39%), 2 case-times of first-use syndrome or dialyzer reac-tion(0.70%), 39 case-times of abdominal, chest or back pain(13.59%), 38 case-times of hypoglycemia acute left heart failure or other complication (13.24%) .All of the complications were dealt with by giving symptomatic treat-ment.Conclusion MHD is a well-used renal replacement therapy of uremia .Although

  16. Effects of dialysis modality on blood loss, bleeding complications and transfusion requirements in critically ill patients with dialysis-dependent acute renal failure.

    Pschowski, R; Briegel, S; Von Haehling, S; Doehner, W; Bender, T O; Pape, U F; Hasper, D; Jörress, A; Schefold, J C

    2015-11-01

    Blood loss and bleeding complications may often be observed in critically ill patients on renal replacement therapies (RRT). Here we investigate procedural (i.e. RRT-related) and non-procedural blood loss as well as transfusion requirements in regard to the chosen mode of dialysis (i.e. intermittent haemodialysis [IHD] versus continuous veno-venous haemofiltration [CVVH]). Two hundred and fifty-two patients (122 CVVH, 159 male; aged 61.5±13.9 years) with dialysis-dependent acute renal failure were analysed in a sub-analysis of the prospective randomised controlled clinical trial-CONVINT-comparing IHD and CVVH. Bleeding complications including severity of bleeding and RRT-related blood loss were assessed. We observed that 3.6% of patients died related to severe bleeding episodes (between group P=0.94). Major all-cause bleeding complications were observed in 23% IHD versus 26% of CVVH group patients (P=0.95). Under CVVH, the rate of RRT-related blood loss events (57.4% versus 30.4%, P=0.01) and mean total blood volume lost was increased (222.3±291.9 versus 112.5±222.7 ml per patient, P dialysis-dependent acute renal failure in this regard.

  17. The treatment with patients of acute promyelocytic leukemia complicating pregnancy%急性早幼粒细胞白血病合并妊娠处理

    郁进

    2014-01-01

    aPl 是急性白血病中病情十分凶险的一种类型,除具有急性白血病的共同特点外,出血症状明显重于其他白血病。我们通过2例白血病合并妊娠患者的诊疗过程探讨白血病与妊娠的相互影响。白血病合并妊娠时孕妇及胎儿死亡率均增加。在治疗妊娠合并白血病的患者时,不仅要注意治疗母体,还有考虑对胎儿的影响。%aPl is a type of acute leukemia that is very dangerous, in addition to the common features of acute leukemia, bleeding symptoms were significantly heavier than other leukemia. We explored the interaction of leukemia and pregnancy through 2 cases of leukemia patients complicating pregnancy during their diagnosis and treatment of patients. the death incidence of patients with leukemia complicating pregnancy was increased. in the treatment of pregnancy complicated with leukemia patients, we should not only pay attention to treatment of the parent, but also consider the impact on the fetus.

  18. Mortality in children with complicated severe acute malnutrition is related to intestinal and systemic inflammation : an observational cohort study

    Attia, Suzanna; Versloot, Christian J.; Voskuijl, Wieger; van Vliet, Sara J.; Di Giovanni, Valeria; Zhang, Ling; Richardson, Susan; Bourdon, Celine; Netea, Mihai G.; Berkley, James A.; van Rheenen, Patrick F.; Bandsma, Robert H. J.

    2016-01-01

    Background: Diarrhea affects a large proportion of children with severe acute malnutrition (SAM). However, its etiology and clinical consequences remain unclear. Objective: We investigated diarrhea, enteropathogens, and systemic and intestinal inflammation for their interrelation and their associati

  19. 个性化护理干预对心肌梗死急性期并发症的影响%Infulence of personalized nursing intervention on complications of acute myocardial infarction patient in acute period

    彭锐; 廖容; 张雪兰; 刘莉

    2011-01-01

    目的:探讨个性化护理干预对心肌梗死急性期并发症的影响.方法:将86例急性心肌梗死患者按入院单双日随机分为实验组42例,对照组44例.两组均接受常规的治疗和护理,实验组还进行个性化护理干预.对两组患者急性期主要并发症心力衰竭、心律失常和心源性休克发生率,住院病死率及死亡原因进行对比分析.结果:对照组急性期主要并发症中心力衰竭的发生率明显高于实验组(P<0.05);对照组急性期住院病死率高于实验组(P<0.05);死亡的主要原因为心力衰竭,由于心力衰竭而导致对照组患者死亡情况明显多于实验组(P<0.05).结论:个性化护理干预可降低急性心肌梗死患者急性期并发症的发生率及住院病死率.%Objective:To explore the influence of nursing intervention individuation on acute myocardial infarction complications. Methods: Will 86 patients with acute myocardial infarction were randomly divided into experimental group 42 cases and control group 44 cases, both groups received routine therapy and nursing. For experimental group were given personalize nursing intervention, two groups of patients with acute heart failure, the main complications cardiac arrhythmia source sex shock incidence, hospital mortality and comparative analysis of the cause of death were analyzed. Results:The acute heart failure of control group was obviously higher than the experimental group( P <0.05 ). The incidence of acute hospitalization fatality rate was higher than experimental group( P <0.05 ),The leading cause of death was heart failure, heart failure and death due to the control group of patients than the experimental group ( P <0.05 ). Conclusion:Personalized nursing intervention can reduce of control group was the incidence of complications in the acute myocardial infarction patients with acute period and hospital mortality.

  20. [Purulent pericarditis and colonic infiltrating to Salmonella enteritidis complicated by acute intussusception in a case of IL-12Rβ1 deficiency].

    Ailal, F; Tazi, A; Bustamante, J; Picard, C; Najib, J; Casanova, J-L; Bousfiha, A A

    2014-12-01

    IL-12 receptor β1 deficiency (IL-12Rβ1) predisposes patients to mycobacteria and Salmonella infections. We report a case of IL-12Rβ1 deficiency with a fatal multi-resistant Salmonella enteritidis infection. This boy was born after from a consanguineous marriage, and diagnosed as having a IL-12Rβ1 deficiency since the age of 3 months. He presented with recurrent Salmonella enteritidis essentially digestive localization, complicated by purulent pericarditis at the same germ at the age of two and a half years. At the age of 3, a colonic infiltration due to a Salmonella enteritidis resistant to antibiotics, was complicated by acute intussusception, and the child died. The IL-12Rβ1 deficiency is considered as having a good prognosis, in contrast to what happened in our patient. We review therapeutic issues in these patients.

  1. 成人急性鼻-鼻窦炎眶并发症四例临床分析%Clinical analysis of orbital complications of acute rhinosinusitis in adults

    李娜; 于龙刚; 姜彦; 韩敏; 陈敏; 闫舒; 张晓雯

    2013-01-01

    目的 分析成人急性鼻-鼻窦炎眶并发症的临床特点及诊断与治疗.方法 回顾性分析2011年4月至2012年1月青岛大学医学院附属医院耳鼻咽喉头颈外科收治的4例保守治疗无效后行内镜手术或联合眉弓切口手术治疗的急性鼻-鼻窦炎眶并发症成年患者的临床资料.结果 4例急性鼻-鼻窦炎患者中并发眶内脓肿2例、眶骨膜下脓肿者2例.其中2例患有糖尿病.所有患者术后随访9~19个月,全身症状及眼部症状均消失.结论 成人急性鼻-鼻窦炎眶并发症临床上较少见,患者往往合并糖尿病等基础疾病,机体免疫力较低.在控制基础疾病的基础上,手术清除病灶同时联合药物治疗效果确切.%Objective To investigate the clinical features,diagnosis and surgical intervention for orbital complications of acute rhinosinusitis in adults.Methods Four adults patients with orbital complications of acute rhinosinusitis were restrospectively reviewed.After conservative managements failed,these patients were treated by transnasal endoscopic sinus surgery or combined with eyebrow incision.Results There were 2 cases with orbital abscess,2 cases with subperiosteal abscess.Among them,2 patients suffered from diabetes.After operation,constitutional symptoms and ocular symptoms disappeared in all 4 patients.CT was rechecked during the postoperative follow-up.The imaging showed that the orbital and nasal lesions were obviously relieved or disappeared.Conclusions The orbital complications of acute rhinosinusitis in adults are clinically rare.The patients are usually with lowered immunity or with underlying conditions,such as diabetes.On the basis of controlling basic diseases,the treatment outcome of orbital complications of acute rhinosinusitis in adults is affirmative by surgery and conservative managements.

  2. [Complications of acute lesions of the digestive tract as a direct cause of mortality in patients with advanced forms of neoplasms in palliative and symptomatic treatment].

    Iaremchuk, O Ia; Zotov, O S; Bielik, O O; Mil'hram, S S

    2001-09-01

    There were analyzed an autopsy protocols of 117 patients with oncological disease, in whom during performance of pathomorphological investigation an acute erosive-ulcerative affection (AEUA) of digestive channel (DCH) was revealed, of them in 69 patients palliative and/or symptomatic treatment for extended forms of cancer was conducted. Structure of principal complications as well as their significance in pathogenesis, localization of affection, influence of different methods of palliative treatment on AEUA DCH occurrence. The data obtained must be taken in account during planning of palliative therapy in such patients.

  3. Comparison of Ertapenem and Ceftriaxone Therapy for Acute Pyelonephritis and Other Complicated Urinary Tract Infections in Korean Adults: A Randomized, Double-Blind, Multicenter Trial

    PARK, DAE WON; Peck, Kyong Ran; Chung, Moon Hyun; Lee, Jin Seo; Park, Yoon Soo; Kim, Hyo Youl; Lee, Mi Suk; Kim, Jung Yeon; Yeom, Joon Sup; Kim, Min Ja

    2012-01-01

    The efficacy and safety of ertapenem, 1 g once daily, were compared with that of ceftriaxone, 2 g once daily, for the treatment of adults with acute pyelonephritis (APN) and complicated urinary tract infections (cUTIs) in a prospective, multicenter, double-blinded, randomized study. After ≥ 3 days of parenteral study therapy, patients could be switched to an oral agent. Of 271 patients who were initially stratified by APN (n = 210) or other cUTIs (n = 61), 66 (48.9%) in the ertapenem group an...

  4. Acute gouty arthritis complicated with acute ST elevation myocardial infarction is independently associated with short- and long-term adverse non-fatal cardiac events.

    Liu, Kuan-Liang; Lee, Hsin-Fu; Chou, Shing-Hsien; Lin, Yen-Chen; Lin, Chia-Pin; Wang, Chun-Li; Chang, Chi-Jen; Hsu, Lung-An

    2014-01-01

    Large epidemiologic studies have associated gouty arthritis with the risk of coronary heart disease. However, there has been a lack of information regarding the outcomes for patients who have gout attacks during hospitalization for acute myocardial infarction. We reviewed the data of 444 consecutive patients who were admitted to our hospital between 2005 and 2008 due to acute ST elevation myocardial infarction (STEMI). The clinical outcomes were compared between patients with gout attack and those without. Of the 444, 48 patients with acute STEMI developed acute gouty arthritis during hospitalization. The multivariate analysis identified prior history of gout and estimated glomerular filtration rate as independent risk factors of gout attack for patients with acute STEMI (odds ratio (OR) 21.02, 95 % CI 2.96-149.26, p = 0.002; OR 0.92, 95 % CI 0.86-0.99, p = 0.035, respectively). The in-hospital mortality and duration of hospital stay did not differ significantly between the gouty group and the non-gouty group (controls). During a mean follow-up of 49 ± 28 months, all-cause mortality and stroke were similar for both groups. Multivariate Cox regression showed that gout attack was independently associated with short- and long-term adverse non-fatal cardiac events (hazard ratio (HR) 1.88, 95 % CI 1.09-3.24, p = 0.024; HR 1.82, 95 % CI 1.09-3.03, p = 0.022, respectively). Gout attack among patients hospitalized due to acute STEMI was independently associated with short-term and long-term rates of adverse non-fatal cardiac events.

  5. Pleuropulmonary Blastoma (PPB in an infant: Is the timing of an elective resection of neonatal lung lesions challenged?

    Robert Simon

    2014-10-01

    Full Text Available Congenital Pulmonary Airway Malformations (CPAMs are abnormalities of lung parenchyma that are often diagnosed upon prenatal imaging as opposed to postnatal symptoms. With a clinical presentation identical to CPAMs, Pleuropulmonary Blastoma (PPB is a rare pulmonary neoplasm of highly malignant potential. We present a rare case of a female infant with a vague medical history of respiratory distress syndrome (RDS at birth, presenting with a tension pneumothorax at three months of age, thought initially to be secondary to CPAM, but found to be PPB upon surgical resection and histological analysis. PPB is a rare pulmonary neoplasm of childhood that originates from the primitive interstitium of the lung, resulting in lesions that can be highly malignant. It is classified as type I (cystic, type II (cystic/solid or type III (solid, with a progression of disease and worsening prognosis from type I to type III. Due to the cystic nature of CPAM and PPB it is difficult to differentiate on imaging alone; diagnosis must be made based on histological analysis. The highly malignant nature and potential for morbidity and mortality of PPB should make clinicians consider early resection of cystic lung lesions preferentially on an elective basis.

  6. [Acute traumatic spinal cord injury and cardiovascular complications due to neurogenic shock: a possible threat for functional recovery

    Meent, H. van de; Vos, P.E.; Schreuder, H.W.B.; Hoeven, J.G. van der

    2004-01-01

    Three men aged 18, 18 and 24 years, developed hypotension and bradycardia following an acute traumatic cervical or thoracic spinal cord injury. After treatment in intensive care and 1-12 months of rehabilitation they still suffered from considerable neurological disorders. Hypotension and bradycardi

  7. Practical use, effects and complications of prehospital treatment of acute cardiogenic pulmonary edema using the Boussignac CPAP system

    E.E. Spijker (Eva Eiske); M. De Bont (Maarten); M. Bax; M. Sandel (Maro)

    2013-01-01

    textabstractBackground: Early use of continuous positive airway pressure (CPAP) has been shown to be beneficial within the setting of acute cardiogenic pulmonary edema (ACPE). The Boussignac CPAP system (BCPAP) was therefore introduced into the protocols of emergency medical services (EMS) in a larg

  8. Acute pancreatitis as a postburn complication: report of two cases in children Pancreatitis aguda como complicación de quemadura en dos niños

    Jairo Alberto Patarroyo Serrano

    2007-04-01

    Full Text Available Acute pancreatitis in burnt adults has been reported with some frequency; contrariwise, there has been only one report of this complication in a burnt child. We reviewed the medical records of two childrenwith acute pancreatitis as a postburn complication, who were treated at the Burns Unit of the San Vicente de Paúl Hospital, in Medellín, Colombia. As a result, we add two documented cases to the limited literature on this subject. La pancreatitis aguda ha sido reportada con alguna frecuencia en adultos quemados pero sólo se ha publicado un caso de esta complicación en un niño quemado. Se revisan las historias clínicas de dos niños con pancreatitis aguda como complicación de quemaduras, atendidos en la Unidad de Quemados del Hospital Universitario San Vicente de Paúl (Medellín. Como resultado de la revisión se añaden dos casos bien documentados a la escasa literatura al respecto.

  9. 急性大面积放射线烧伤及其并发症的救治%Treatment of extensive acute radiation burn and its complications

    李叶扬; 汪锦伦; 李罡; 林伟华; 梁岷; 黄峻; 孙敬恩

    2013-01-01

    This article reports the treatment of a patient suffered from acute radiation burn covering 41% TBSA,with deep partial-thickness and full-thickness injury,produced by exposure to a large-scale industrial electron accelerator.An open wound began to appear and enlarged gradually 10 weeks after the exposure.Serious wound infection with methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa,pneumonia,respiratory failure,systemic inflammatory response syndrome,nephropathy and hypoproteinemia developed successively since 3 weeks after the wound formation.Skin grafts failed to survive,resulting in enlargement of the wound.After being treated with proper measures,including parenteral nutrition,respiratory support with a ventilator,appropriate antibiotics,steroid administration for nephropathy,deep debridement for wounds followed by skin grafting,the patient was cured and discharged after undergoing 15 operations in 500 days.The clinical condition of an extensive acute radiation burn is complicated.We should pay close attention to the changes in functions of organs,and strengthen the therapeutic strategies to support the function of organs to reduce the incidence of systemic complications.The control of the infection and the timely and effective repair of the wound are stiil the key points of the treatment of an extensive local radiation injury.

  10. Research Development of Acute Myocardial Infarction Complicating Cardiogenic Shock%急性心肌梗死合并心源性休克的研究进展

    冯灿

    2013-01-01

    Cardiogenic shock is one of the highest mortality complications after acute myocardial infarction . With the application of vascular revascularization technique , drugs and equipment, the treatment of cardiogenic shock has made progress and achievements . This article reviews the definition, etiology, pathophysiology and treatment of acute myocardial infarction complicating cardiogenic shock , and introduces new therapeutic guide as well as research development .%心源性休克是急性心肌梗死后病死率最高的并发症,随着近些年血管再通技术以及新药物和设备的使用,心源性休克的治疗有了较多的新进展和理念.文章综述了急性心肌梗死合并心源性休克的定义、病因、病理生理以及治疗方法,并对指南和新进展进行了介绍.

  11. A case of progressive hypertension preceding gemcitabine-associated thrombotic microangiopathy complicated by acute kidney injury and stroke.

    Phelan, Paul J

    2009-01-01

    Gemcitabine-associated thrombotic microangiopathy is being increasingly recognized as a serious complication of treatment. We report a normotensive patient who developed progressive hypertension after commencing gemcitabine therapy. She also developed subtle changes in her platelet count and serum creatinine months before her emergent presentation. Clinicians should be aware of new onset or worsening hypertension and \\'mild\\' biochemical changes in gemcitabine-treated patients.

  12. Clinical Evaluation of High-Volume Hemofiltration with Hemoperfusion Followed by Intermittent Hemodialysis in the Treatment of Acute Wasp Stings Complicated by Multiple Organ Dysfunction Syndrome.

    Xiaoyun Si

    Full Text Available Multiple organ dysfunction syndrome (MODS is a rare complication of wasp stings. Currently, there is no standardized treatment for MODS secondary to multiple wasp stings, although blood purification techniques are often used. This study aimed to analyze our experiences of using intermittent hemodialysis (IHD with or without high-volume hemofiltration (HVHF for treating acute wasp stings complicated by MODS. In this retrospective study, 36 patients with wasp stings complicated by MODS received either IHD combined with hemoperfusion, or HVHF (ultrafiltration flow rate, 70 mL/kg/h combined with hemoperfusion for 5 days followed by IHD. Clinical symptoms, blood biochemical parameters, duration of mechanical ventilation, use of vasoactive agents, duration of hospital stay and survival rate were recorded, and Acute Physiology and Chronic Health Evaluation II (APACHE II and multiple organ dysfunction (MOD scores estimated. Patients treated with HVHF followed by IHD appeared to exhibit a faster recovery than those receiving IHD alone, as evidenced by superior improvements in MOD (4.29±1.08 vs. 2.27±1.07 and APACHE II (7.09±2.62 vs. 4.20±1.69 scores (P < 0.05. Patients treated with HVHF had significantly lower myoglobin, creatine kinase-MB, lactate dehydrogenase, bilirubin and creatinine levels than patients treated with IHD alone. In addition, the durations of hospital stay (13.15±2.77 vs. 27.92±3.18 days, vasopressor use (1.76±0.24 vs. 3.43 ± 1.01 days, mechanical ventilation (3.02±1.63 vs. 5.94 ± 2.11 days and oliguria (6.57±2.45 vs. 15.29 ± 3.51 days were reduced, and renal function more often recovered (85.1% vs. 53.1%, in the HVHF group compared with the IHD group (P < 0.05. These results raise the possibility that HVHF plus IHD may be superior to IHD alone for the treatment of acute wasp stings complicated by MODS; additional prospective studies are merited to explore this further.

  13. Effect of recombinant human brain natriuretic peptide-assisted interventional treatment on prognosis of acute myocardial infarction patients complicated with cardiogenic shock

    Xi-Zhou Chen

    2016-01-01

    Objective:To analyze the effect of recombinant human brain natriuretic peptide-assisted interventional treatment on prognosis of acute myocardial infarction patients complicated with cardiogenic shock.Methods: A total of 112 cases of inpatients treated in Cardiology Department of our hospital from March 2013 to March 2015 were selected, all of whom had acute myocardial infarction within 12 hours of onset and received direct PCI treatment. They were divided into observation group and control group according to random number table, each group with 56 cases, control group received conventional interventional treatment and observation group received recombinant human brain natriuretic peptide-assisted interventional treatment. Then differences of regional myocardial deformability, myocardial enzyme spectrum indicators, brain natriuretic peptide and inflammatory factors, blood sugar and stress hormones as well as myocardial infarction prognosis-associated indexes, etc, between two groups after treatment were compared.Results:After treatment, LVEF, SRs, SRe and Sra levels of observation group were higher than those of control group, WMSI level was lower than that of control group; serum myocardial enzyme spectrum indicators CK, CK-MB, AST and LDH values were lower than those of control group; serum BNP, CRP, TNF-α and IL-6 levels were lower than those of control group; serum cortisol, growth hormone and glucagon levels were lower than those of control group, insulin level was higher than that of control group; FT3 and IGF-1 levels were higher than those of control group, sPLA2 and Hcy levels were lower than those of control group.Conclusion: Recombinant human brain natriuretic peptide-assisted interventional treatment for acute myocardial infarction patients complicated with cardiogenic shock can reduce myocardial function injury, protect normal myocardial function and optimize patients' long-term prognosis; it has active clinical significance.

  14. Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure

    Hu Sung-Yuan

    2011-03-01

    Full Text Available Abstract Background Scrub typhus, a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is an endemic disease in Taiwan and may be potentially fatal if diagnosis is delayed. Case presentations We encountered a 23-year-old previously healthy Taiwanese male soldier presenting with the right ear pain after training in the jungle and an eleven-day history of intermittent high fever up to 39°C. Amoxicillin/clavulanate was prescribed for otitis media at a local clinic. Skin rash over whole body and abdominal cramping pain with watery diarrhea appeared on the sixth day of fever. He was referred due to progressive dyspnea and cough for 4 days prior to admission in our institution. On physical examination, there were cardiopulmonary distress, icteric sclera, an eschar in the right external auditory canal and bilateral basal rales. Laboratory evaluation revealed thrombocytopenia, elevation of liver function and acute renal failure. Chest x-ray revealed bilateral diffuse infiltration. Doxycycline was prescribed for scrub typhus with acute respiratory distress syndrome and multiple organ failure. Fever subsided dramatically the next day and he was discharged on day 7 with oral tetracycline for 7 days. Conclusion Scrub typhus should be considered in acutely febrile patients with multiple organ involvement, particularly if there is an eschar or a history of environmental exposure in endemic areas. Rapid and accurate diagnosis, timely administration of antibiotics and intensive supportive care are necessary to decrease mortality of serious complications of scrub typhus.

  15. Angiotensin II induces apoptosis of human pulmonary microvascular endothelial cells in acute aortic dissection complicated with lung injury patients through modulating the expression of monocyte chemoattractant protein-1.

    Wu, Zhiyong; Dai, Feifeng; Ren, Wei; Liu, Huagang; Li, Bowen; Chang, Jinxing

    2016-01-01

    Patients with acute aortic dissection (AAD) usually showed acute lung injury (ALI). However, its pathogenesis is still not well defined. Apoptosis of pulmonary microvascular endothelial cells (PMVECs) is closely related to the alveolus-capillary barrier injury and the increased vascular permeability. In this study, we aim to investigate the human PMVECs (hPMVECs) apoptosis induced by angiotensin II (AngII) and monocyte chemoattractant protein-1 (MCP-1) and their potential interaction in the pathogenesis of AAD complicated with ALI. Fifty-eight newly diagnosed AAD, 12 matched healthy individuals were included. Pulmonary tissues of AAD complicated with lung injury were obtained from 2 cadavers to determine the levels of AngII type 1 receptor (AT1-R) and MCP-1. Serum AngII was measured using commercial ELISA kit. H&E staining and immunohistostaining were performed to determine the expression of AT1-R and MCP-1. For the in vitro experiment, hPMVECs were divided into control, AngII group, AngII+Bindarit group and Bindarit group, respectively. Flow cytometry was performed to analyze the apoptosis in each group. Reverse transcription-polymerase chain reaction was performed to determine the mRNA expression of MCP-1. Western blot analysis was performed to evaluate the expression of MCP-1 and apoptosis related protein. Apoptosis of hPMVECs was observed in the lung tissues in the cadavers with AAD complicated with ALI. Besides, the expression of AT1-R and MCP-1 was remarkably elevated. Compared with normal individuals and the non-lung injury AAD patients, the expression of serum AngII was remarkably elevated in AAD patients complicated with ALI. In vitro experiments showed AngII contributed to the apoptosis and elevation of MCP1 in hPMVECs. Besides, it involved in the down-regulation of Bcl-2 protein, and up-regulation of Bax and Caspase-3. Such phenomenon was completely reversed after administration of MCP-1 inhibitor (Bindarit). The production of MCP-1 and cellular

  16. Acute Liver Failure in an Adult, a Rare Complication of Alagille Syndrome: Case Report and Brief Review.

    Frongillo, F; Bianco, G; Silvestrini, N; Lirosi, M C; Sanchez, A M; Nure, E; Gaspari, R; Avolio, A W; Sganga, G; Agnes, S

    2015-09-01

    Alagille syndrome (AS) is an autosomal-dominant, multisystem disorder affecting the liver, heart, eyes, skeleton, and face. The manifestations are predominantly pediatric. Diagnosis is based on findings of a paucity of bile ducts on liver biopsy combined with ≥3 of 5 major clinical criteria. Orthotopic liver transplantation (OLT) is the only option for treating patients who developed liver failure, portal hypertension, severe itching, and xanthomatosis. It is difficult to establish clear criteria for OLT; indications are controversial because of the wide variety of clinical symptoms and the multisystem involvement. Generally, AS-associated liver disease is never an acute illness. We report the case of a 28-year-old woman with AS who underwent urgent OLT for acute liver failure. At 24 months posttransplant, the patient is in good clinical condition and with normal hepatic and renal function.

  17. [Effect of complications in the acute period of myocardial infarction on physical exertion tolerance at the hospital stage of rehabilitation].

    Al'khimovich, V M; Golubev, V G; Rudina, M D; Rusetskaia, V G

    1988-11-01

    Physical stress tolerance and its hemodynamic support were examined in 95 patients with early myocardial infarction, 50 normal subjects and 25 coronary patients. It is suggested that the stress tolerance test is advisable at an early stage of complicated macrofocal myocardial infarction. The safety of the test improves considerably where it is performed under continuous electrocardiographic and chest-rheographic control. An abnormal diastolic impedance wave, emerging during exercise, may serve an additional diagnostic indicator of stress intolerance.

  18. Acute Portal Vein Thrombosis and Massive Necrosis of the Liver. An Unusual Complication After Stenting for Chronic Pancreatitis

    Velayutham Vimalraj

    2006-11-01

    Full Text Available Context ERCP can provide information which is invaluable in managing chronic pancreatitis but it is associated withinfrequent, although significant, complications and rare mortality. The complications uniquely associated withdiagnostic ERCP include pancreatitis and sepsis (primary cholangitis. Case report A 32-year-old man presented with severe upper abdominal pain radiating to the back, associated with vomiting and abdominal distension. The patient was diagnosed as having had chronic calcific pancreatitis recently and had undergone ERCP with pancreatic duct stenting elsewhere. Two days after the procedure, the patient developed severe abdominal pain, vomiting and abdominal distention, and patient was referred to our hospital 7 days after the procedure. Investigation revealed massive liver necrosis and portal vein thrombosis. This patient had a life-threatening complication following pancreatic duct stenting for chronic pancreatitis and was managed medically.Conclusion Therapeutic pancreatic endoscopy procedures are technically demanding and should be restricted to highvolume centers. There is a continuing need for evaluation and comparison with alternative strategies. In a good surgical candidate, it is better to avoid stenting.

  19. INCIDENCE, RISK FACTORS AND COMPLICATIONS OF ACUTE PERFORATED AND NON - PERFORATED APPENDICITIS IN A RURAL SETUP OF ANDHRA PRADESH

    Anil Kumar

    2015-05-01

    Full Text Available Appendicitis is one of the most common surgical emergencies. The incidence of appendicitis and chances of complication in the form of perforation are dependent on both the patients and non - patient factors . There are various studies conducted to address this problem, but there are no studies conducted to look in to the incidence of appendicitis in east Godavari district of Andhra Pradesh. Our study was aimed to bridge thi s gap. METHOD S AND MATERIALS: this was a retrospective study, patient data from 2009 - 2014 was analyzed and the age, distance from hospital, educational and socioeconomic background of the patients was collected. The duration between first appearance of sy mptoms and hospitalization was recorded. The incidence of post - op complication was also recorded. RESULTS: T he incidence of perforation was 15% in our study population, most of the patients were from low socioeconomic group and having income less than 5000 /month. The middle age group between 30 - 40 years was commonly affected by the appendicitis. The time laps between appearance of symptoms and hospitalization was found to be a predominant factor in the perforation. Surgical site infection was most common co mplication in the patients treated. CONCLUSION: T he incidence of perforation is still high and the time laps between first appearance of symptoms and hospitalization is a major determinant of perforation or complication in the appendicitis.

  20. Shrinking lung syndrome complicating pediatric systemic lupus erythematosus

    Burns, Natalie S. [University of Washington Medical Center, Department of Radiology, Seattle, WA (United States); Stevens, Anne M. [Seattle Children' s Hospital, Division of Rheumatology, Department of Pediatrics, Seattle, WA (United States); Iyer, Ramesh S. [University of Washington School of Medicine, Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States)

    2014-10-15

    Systemic lupus erythematosis (SLE) can affect the lungs and pleura, usually manifesting with pleural effusions or diffuse parenchymal disease. A rare manifestation of SLE is shrinking lung syndrome, a severe restrictive respiratory disorder. While pleuropulmonary complications of pediatric SLE are common, shrinking lung syndrome is exceedingly rare in children. We present a case of a 13-year-old girl previously diagnosed with lupus, who developed severe dyspnea on exertion and restrictive pulmonary physiology. Her chest radiographs on presentation demonstrated low lung volumes, and CT showed neither pleural nor parenchymal disease. Fluoroscopy demonstrated poor diaphragmatic excursion. While shrinking lung syndrome is described and studied in adults, there is only sparse reference to shrinking lung syndrome in children. (orig.)

  1. Effects of gentamicin monotherapy for the initial treatment of community-onset complicated non-obstructive acute pyelonephritis due to Enterobacteriaceae in elderly and non-elderly women.

    Wie, S-H; Kim, H W; Chang, U-I

    2014-11-01

    Aminoglycosides may serve as fluoroquinolone-sparing or cephalosporin-sparing agents if the clinical effectiveness of aminoglycoside monotherapy is demonstrated. The purposes of this study were to investigate the clinical efficacy of gentamicin as an initial empirical antimicrobial agent and to evaluate the effects of gentamicin resistance on clinical outcomes in women with complicated non-obstructive acute pyelonephritis (APN). Medical records of 1066 women with a diagnosis of APN were reviewed retrospectively. We enrolled 275 women with community-onset complicated non-obstructive APN due to Enterobacteriaceae who received gentamicin as their initial antibiotic. Of these 275 patients, 43 had gentamicin-resistant (GM-R) Enterobacteriaceae APN, and 232 had gentamicin-susceptible (GM-S) Enterobacteriaceae APN. The early clinical success rates were 67.4% (29/43) versus 89.7% (208/232) at 72 h in the GM-R versus the GM-S groups (p 0.001). The overall clinical cure rate was 100% (43/43) and 98.7% (229/232) in the GM-R and GM-S groups, respectively. The duration of hospital stay was significantly longer in the elderly, although there were no significant differences in the rates of early clinical success, final clinical cure, mortality, and time to fever clearance between the elderly and non-elderly groups. Resistance of Enterobacteriaceae to gentamicin, haematuria and serum C-reactive protein level≥20 mg/dL were independently associated with early clinical failure. Gentamicin can be an effective initial antibiotic option for empirical therapy in women with community-onset complicated APN who do not need urological interventional procedures. The use of gentamicin may contribute to a reduction of fluoroquinolone or broad-spectrum cephalosporin use in the treatment of complicated APN.

  2. Clinical research on eye complications of acute chlorine poisoning%急性氯气中毒眼部并发症的临床研究

    季玉玲; 张迎秋; 王涛; 陈晨; 苗娟; 王猛; 张娟美

    2015-01-01

    •AlM:To observe the eye complications in the cases of acute chlorine gas poisoning. •METHODS:A retrospective review of 121 cases of acute chlorine gas poising with eye irritation, dry eye and other eye complications in Linyi People’s Hospital from February 2009 to February 2013 was performed. •RESULTS: Among 121 patients, 117 cases ( about 96. 7%) had complications of eye irritation and conjunctival and corneal epithelial damage, and the ocular surface damage was aggravated with the increasing level of chlorine gas poisoning. After 3, 6mo being discharged, 32 and 7 patients respectively occurred dry eye among 115 patients followed up. One mild chlorine poisoning patient, during the hormonotherapy of pulmonary complication, complicated with bullous retinal detachment, of which symptoms and physical signs had been improved after stopping hormonotherapy and adding drugs facilitating fluid absorption. One severe chlorine poisoning patient with loss of consciousness during the treatment, had corneal ulcer and after ulcer being healed with drug and conjunctival flap covering surgery, was left permanent leukoma cornea. •CONCLUSlON: Acute chlorine poisoning can cause corneal and conjunctival epithelial damage and dry eye. Ocular complications like bullous retinal detachment associated with hormone application should be paid more attention to in the hormonotherapy. For some patients with severe poisoning, the therapy of corneal and conjunctival epitheliums should be taken seriously in case of irreparable damage in rescuing patient’s life.%目的:观察急性氯气中毒患者眼部并发症的发生情况。  方法:回顾性分析2009-02/2013-02就诊于临沂市人民医院的急性氯气中毒患者121例,其发生眼部刺激症状、干眼及其它一些眼部并发症的情况。  结果:在121例患者中,有117例(96.7%)并发有眼部刺激症状及角结膜上皮的损伤,随着氯气中毒程度的加重,眼表损伤也加重。在115

  3. Clinical analysis of orbital complications of acute pediatric sinusitis%儿童急性鼻窦炎眶并发症五例临床分析

    于龙刚; 李娜; 姜彦; 韩敏

    2012-01-01

    Objective To investigate the treatment outcome of surgical intervention for orbital complications of acute pediatric sinusitis. Methods Five children with orbital complications of acute sinusitis were retrospectively reviewed.The patients underwent pediatric endoscopic sinus surgery (PESS) after conservative treatment failed. Results There were 1 case with orbital cellulitis,3 cases with subperiosteal abscess and 1 case with orbital abscess.After operation,the body temperature in all 5 patients returned to normal and ocular symptoms disappeared.CT or MRI was rechecked after PESS.The imaging showed that the orbital and nasal lesions disappeared.Conclusions If conservative treatment fails,it is important to perform PESS for children with orbital complications of acute sinusitis to clean the focus of infection as soon as possible.The surgery is safe and effective.%目的 探讨手术治疗儿童急性鼻窦炎合并严重眶并发症的疗效.方法 回顾性分析2010年11月至2011年7月连续收治的5例保守治疗无效后行鼻内镜手术治疗的儿童急性鼻窦炎眶并发症患儿的临床资料.结果 5例患儿中合并眶蜂窝织炎1例,眶骨膜下脓肿3例,眶内脓肿1例,患儿术后体温均恢复正常,眼部症状消失.复查CT或MRI见眶部及鼻部病变基本消失.结论 对于保守治疗无效的儿童急性鼻窦炎眶并发症病例应尽早行内镜鼻窦手术清除病灶,手术安全且疗效确切.

  4. Cell- and developmental stage-specific Dicer1 ablation in the lung epithelium models cystic pleuropulmonary blastoma.

    Wagh, Purnima K; Gardner, Margaret A; Ma, Xiaolan; Callahan, Melissa; Shannon, John M; Wert, Susan E; Messinger, Yoav H; Dehner, Louis P; Hill, D Ashley; Wikenheiser-Brokamp, Kathryn A

    2015-05-01

    Inherited syndromes provide unique opportunities to identify key regulatory mechanisms governing human disease. We previously identified germline loss-of-function DICER1 mutations in a human syndrome defined by the childhood lung neoplasm pleuropulmonary blastoma (PPB), which arises during lung development. DICER1 regulates many biological processes critical in development and disease pathogenesis. Significant challenges in defining the role of DICER1 in human disease are identifying cause-effect relationships and generating manipulatable systems that model the complexity of organ development and disease pathogenesis. Here we report the generation of a murine model for PPB and demonstrate that precise temporal and cell type-specific Dicer1 ablation is necessary and sufficient for the development of cystic lungs that histologically and phenotypically model PPB. Dicer1 ablation in the distal airway epithelium during early stages of lung development resulted in a cystic lung phenotype indistinguishable from PPB, whereas DICER1 function was not required for development of the proximal airway epithelium or during later stages of organogenesis. Mechanistic studies demonstrate that Dicer1 loss results in epithelial cell death, followed by cystic airway dilatation accompanied by epithelial and mesenchymal proliferation. These studies define precise temporal and epithelial cell type-specific DICER1 functions in the developing lung and demonstrate that loss of these DICER1 functions is sufficient for the development of cystic PPB. These results also provide evidence that PPB arise through a novel mechanism of non-cell-autonomous tumour initiation, in which the genetic abnormality initiating the neoplasm does not occur in the cells that ultimately transform, but rather occurs in a benign-appearing epithelial cell component that predisposes underlying mesenchymal cells to malignant transformation.

  5. Acute Cor Pulmonale and Right Heat Failure Complicating Ethanol Ablative Therapy: Anesthetic and Radiologic Considerations and Management

    Naik, Bhiken, E-mail: bin4n@virginia.edu [University of Virginia, Department of Anesthesiology (United States); Matsumoto, Alan H. [University of Virginia, Department of Radiology and Medical Imaging (United States)

    2013-10-15

    Ethanol is an effective ablative agent used for the treatment of certain solid organ tumors and vascular malformations (VMs). The egress of ethanol beyond the target tissue can be associated with significant changes to the cardiopulmonary system that can lead to cardiac arrest. This article reviews the contemporary role of ethanol in tumor and VM treatment and discusses the physiological mechanisms of acute pulmonary hypertension and cardiovascular collapse. The importance of periprocedural recognition of the hemodynamic changes that can occur with the use of ethanol and the treatment of this condition are discussed.

  6. Acute cor pulmonale and right heat failure complicating ethanol ablative therapy: anesthetic and radiologic considerations and management.

    Naik, Bhiken; Matsumoto, Alan H

    2013-10-01

    Ethanol is an effective ablative agent used for the treatment of certain solid organ tumors and vascular malformations (VMs). The egress of ethanol beyond the target tissue can be associated with significant changes to the cardiopulmonary system that can lead to cardiac arrest. This article reviews the contemporary role of ethanol in tumor and VM treatment and discusses the physiological mechanisms of acute pulmonary hypertension and cardiovascular collapse. The importance of periprocedural recognition of the hemodynamic changes that can occur with the use of ethanol and the treatment of this condition are discussed.

  7. The clinical analysis of 11 cases of acute myocardial infarction complicated with cardiac rupture%急性心肌梗死后心脏破裂11例临床分析

    覃秀川

    2012-01-01

    心脏破裂(CR)是急性心肌梗死(AMI)后最严重的并发症,一旦出现,患者可在数分钟内死亡.本文回顾性分析了2008~2011年间我科收治的AMI后11例并发CR的临床资料,对AMI并发CR的危险因素、临床表现、早期诊断进行探讨.%Cardiac rupture is one of the most severe complications of acute myocardial infarction. The retrospective analysis of 11 cases between 2008 and 2011 were admitted from acute myocardial infarction complicated with cardiac rupture to investigate the risk factors, clinical manifestation and early diagnosis in patients acute myocardial infarction complicated with cardiac rupture.

  8. Point-of-Care Ultrasound in Necrotizing Acute Pancreatitis Complicated by Perforated Ileum Due to Nonocclusive Mesenteric Ischemia

    Sonia López-Cuenca

    2016-09-01

    Full Text Available Necrotizing acute pancreatitis is the most severe form of pancreatitis, and it is a potentially life-threatening condition. Its diagnosis and severity are based on radiological signs. Although computed tomography is the most used imaging tool, ultrasound can be a quick and useful technique in emergency and intensive care scenarios. The use of abdominal ultrasound is generally limited to ruling out cholecystitis. Bowel gas can limit the accuracy of pancreatic imaging. When the pancreas is visualized, ultrasound can reveal pancreatic enlargement, echotextural changes, and peripancreatic fluid. We present a patient with necrotizing pancreatitis who developed peritonitis due to ileal perforation, where the use of ultrasound as a bedside imaging technique was very useful.

  9. Urinary retention and acute kidney injury in a tetraplegic patient using condom catheter after partying: a preventable complication

    Vaidyanathan S

    2015-10-01

    Full Text Available Subramanian Vaidyanathan,1 Fahed Selmi,1 Peter L Hughes,2 Gurpreet Singh,3 Bakul M Soni11Regional Spinal Injuries Centre, 2Department of Radiology, 3Department of Urology, Southport and Formby District General Hospital, Town Lane, Southport, UKBackground: Spinal cord injury patients, who manage their bladder using a condom catheter, are at risk of developing urine retention when they consume large volumes of alcoholic drinks within a short period of time.Case presentation: A male tetraplegic patient had been managing satisfactorily penile sheath drainage for 8 years. He went out socializing during which he consumed large volumes of alcohol but did not take any recreational drugs. The following morning, he noticed distension of the lower abdomen and passed urine in dribbles. He then developed a temperature and became unwell. He was seen by district nurses and a doctor, who prescribed antibiotics. He continued to feel unwell. After 8 days, he referred himself to a spinal unit at Regional Spinal Injuries Centre, Southport. The blood test results showed the following: blood urea: 19.8 mmol/L; creatinine: 172 µmol/L; and C-reactive protein: 336.4 mg/L. Urethral catheterization led to immediate drainage of 1,400 mL of urine. A computed tomography scan revealed an enlarged, swollen left kidney, indicating acute bacterial nephritis. He was prescribed intravenous fluids and Meropenem. Creatinine decreased to 46 µmol/L.Conclusion: Spinal cord injury patients using condom catheters should be made aware of the risk of urine retention when they consume large amounts of alcoholic drinks in a short period of time. Patients and caregivers should be informed to consider intermittent catheterizations for 24–48 hours or insert indwelling urethral catheter when planning for an evening out.Keywords: spinal cord injury, tetraplegia, neuropathic urinary bladder, acute kidney injury 

  10. [Acute damage to the myocardium and left lung is a complication of high-frequency percutaneous thermoablation of solitary metastasis of renal cancer into the liver (a clinical observation)].

    Tipisev, D A; Gorobets, E S; Agapov, A A; Zotov, A V; Kosyrev, V Iu

    2005-01-01

    The paper describes a case of severe complication of radio-frequency percutaneous thermoablation of renal metastasis into the liver, which occurred in a young woman with the intact cardiovascular system and manifested itself in the development of alveolar edema of the lung and acute dilation of the stomach. Pulmonary edema resulted from left ventricular myocardial and pulmonary parenchymal lesions and acute mitral valvular insufficiency. The authors' considerations as to the possible cause and mechanisms of development of this life-threatening complication first described in the literature are also given.

  11. An open multicenter study of the use of gatifloxacin for the treatment of non-complicated acute bacterial rhinosinusitis in adults

    L.L.M. Weckx

    2005-04-01

    Full Text Available The bacteriological and clinical efficacy and the safety of gatifloxacin for the treatment of non-complicated acute rhinosinusitis was evaluated in 49 adult patients in an open-label multicenter study in Brazil. Patients under age 18, or with associated systemic diseases, were excluded. Diagnosis was based on symptoms, otorhinolaryngological examination, and X-rays of the sinus. At the first visit, all patients were treated with a single daily dose of 400 mg gatifloxacin for 10 days. Middle nasal meatus secretion was collected and sent for culture before and after treatment. Patients were all reevaluated at days 3 to 5; days + 1 to + 5 and 18 to 25 days + 7 to + 14 . Ninety three percent of the patients were considered clinically cured at the end of the treatment. The most frequent bacteria isolated were Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis, and at the end of the treatment, presumed bacteriological eradication was observed in almost all patients. Adverse effects were observed in 19 of the cases, mostly mild and self limiting, including diarrhea, abdominal pain, nausea and vomiting. Treatment had to be interrupted in two cases. Gatifloxacin was found to be efficacious and safe for the treatment of acute rhinosinusitis in adults.

  12. Femur chondrosarcoma misdiagnosed as acute knee arthritis and osteomyelitis--further developing a hitherto unreported complication of tumor embolic ischemic ileal perforation after arthroscopic lavage.

    Chow, Louis Tsun Cheung

    2014-12-01

    The differentiation between osteomyelitis and bone tumor may be difficult due to their overlapping clinical and radiological features. A 25-year-old lady presented with left knee pain and joint effusion associated with redness and hotness. A sub-optimally taken plain radiograph showed mixed osteolytic and osteoblastic lesion in the left lower femur with surrounding soft tissue swelling. Since the clinical diagnosis was acute osteomyelitis and arthritis, arthroscopic lavage was performed as a diagnostic and therapeutic procedure. The removed loose bodies and fibrinous tissue showed pathological features suspicious of chondrosarcoma. Subsequent MRI revealed an infiltrative tumor eroding through the cortex and joint cartilage. En bloc excision of the left lower femur, upper tibia including the knee joint and patella was performed, and the final diagnosis was grade 2 chondrosarcoma. The patient developed bilateral pulmonary metastasis 33 months after operation. Five months later, she suffered from a hitherto undescribed complication of ischemic perforation of the terminal ileum secondary to tumor embolic arterial obstruction with no macroscopic intestinal or peritoneal tumor deposit. The patient developed multiple brain metastases and died 43 months after initial presentation. Our case illustrates that malignant bone tumor as a differential diagnosis of acute osteomyelitis and arthritis merits recognition and exclusion before arthroscopic lavage, which may enhance tumor dissemination and in our patient results in embolic ischemic ileal perforation.

  13. THE EFFECT OF INTENSIVE GLYCEMIC CONTROL ON THE FACTORS DETERMINING PREDICTION COMPLICATIONS OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH TYPE 2 DIABETES

    A. I. Fedotova

    2015-01-01

    Full Text Available Objective. To determine predictors of complications of myocardial infarction (MI in patients with type 2 diabetes (2TDM and it’s value of intensive glycemic control during insulin infusion.Methods. The study included 112 patients with MI and 2TDM at first day of hospital admission with blood glucose level above 7.8 mmol/l. Prognosis of combined study endpoint included the death and ma-jor complications of MI for the hospital and long-term (6-month stages. The statistical analysis was per-formed (Statistica 6.0 for Windows. The predictive value was assessed with ROC-curves analysis meth-od.Results. Intensive glycemic control with insulin infusion reduced the activity of lipid peroxidation and improve prediction of study endpoint. Predictors of adverse hospital prognosis of MI in association with type 2 diabetes were hyperglycemia on admission above 10 mmol/l, and increase of C-peptide. The in-crease of C-peptide in the 1st and 7th day, hs-CRP on day 1, diene conjugates on the 7th day and glucose level on admission above 8.9 mmol/l (patients without 2TDM and 14.3 mmol/l (patients with 2TDM had the 6-month predictive value.Conclusion. The strict achievement of the target level of glucose in acute MI improves it’s prognosis at the hospital and at a 6-month prospective study.

  14. Relationship of glycaemic level of mother in last two hours before delivery and occurrence of acute neonatal complications

    Georgy Joy Eralil

    2014-06-01

    Full Text Available Background: Diabetes is the most common pre-existing medical disorder seen in pregnancy. Between 2-5% of pregnancies are complicated by diabetes. 87.5% of these women have gestational diabetes, 7.5% have type 1 and 5% have type 2. The study was designed to know the relation of control of diabetes to neonatal outcome in terms of metabolic complications. Methods: Study was conducted in laboring women in government medical college hospital Kottayam. Selection criteria was based on oral GTT. Patients with multiple gestations, other medical disorders were excluded. All the patients were monitored with hourly RBS in active phase of labor. It was compared with cord levels of RBS, calcium, haematocrit and admission to SCNU. For data measured at normal level Chi square test was used to study the significance of difference between the groups. For statistically significant differences odds ratios were computed and 95% confidence limits are calculated. Whenever necessary for quantitative data t- test was used to study the difference in mean values. Results: All normal RBS had live births and all the intrauterine deaths were associated with maternal hyperglycaemia. Among the SCNU admission 87.5% had hyperglycaemia in mother. 33.3 % of abnormal RBS had admission to SCNU whereas only 3.4% of the normal RBS group had admission. The risk of SCNU admission is 14 times more among babies of mothers with abnormal maternal RBS. X2 = 16.188 P = 0.000. The correlation coefficient between maternal RBS and cord RBS is 0.35 indicating a negative relationship between maternal RBS and Cord RBS. The coefficient of determination (r2 is 12 indicates 12% of variation of RBS is explained by maternal RBS. The average RBs cord among mothers with abnormal maternal RBS is 58.4 and among mothers with normal RBS is 72.4 and the observed difference is statistically significant. Conclusions: Heart The study shows that tight regulation of maternal glucose levels during labor can reduce

  15. Treatment of Metformin Intoxication Complicated by Lactic Acidosis and Acute Kidney Injury: The Role of Prolonged Intermittent Hemodialysis.

    Regolisti, Giuseppe; Antoniotti, Riccardo; Fani, Filippo; Greco, Paolo; Fiaccadori, Enrico

    2017-02-17

    Metformin intoxication with lactic acidosis, a potentially lethal condition, may develop in diabetic patients when the drug dose is inappropriate and/or its clearance is reduced. Diagnosis and therapy may be delayed due to nonspecific symptoms at presentation, with severe anion gap metabolic acidosis and elevated serum creatinine values being the most prominent laboratory findings. Confirmation requires measurement of serum metformin by high-performance liquid chromatography-tandem mass spectrometry, but this technique is available only at specialized institutions and cannot be relied on as a guide to immediate treatment. Thus, based on strong clinical suspicion, renal replacement therapy must be started promptly to achieve efficient drug clearance and correct the metabolic acidosis. However, because metformin accumulates in the intracellular compartment with prolonged treatment, a rebound in serum concentrations due to redistribution is expected at the end of dialysis. We report a case of metformin intoxication, severe lactic acidosis, and acute kidney injury in a diabetic patient with pre-existing chronic kidney disease stage 3, treated effectively with sustained low-efficiency dialysis. We discuss the pathophysiology, differential diagnosis, and treatment options and highlight specific pharmacokinetic issues that should be considered in selecting the appropriate modality of renal replacement therapy.

  16. Acute Abdomen in the 17th Week of Twin Pregnancy due to Ovarian Torsion – A Late Complication of IVF

    Habek, D.; Bauman, R.; Rukavina Kralj, L.; Hafner, T.; Turudic, T.; Vujisic, S.

    2016-01-01

    Background: A 32-year-old woman with tubal factor infertility due to bilateral laparoscopic salpingectomy conceived twins with in vitro fertilization (IVF). She developed moderate ovarian hyperstimulation syndrome which was treated with anticoagulant therapy. The subsequent course of the twin pregnancy was normal until the 17th week of gestation when she presented to hospital because of a sharp pain in the right lower abdomen which ceased after admission. Case: Except for a single incident of vomiting, patient had no other subjective symptoms. The clinical examination showed tenderness of the lower right abdominal segment on palpation. The surgeon and the urologist found no signs of an acute surgical or urologic condition, and laboratory findings were within normal reference ranges for pregnant women. Two days after admission the pain reappeared; it was now much stronger and colic-like. The pain was initially located supraumbilically but subsequently spread diffusely across the lower abdomen. Abdominal guarding was present and laboratory findings showed an increase in inflammatory parameters. An enlarged and edematous right ovary was found on transvaginal ultrasound. Conclusion: Exploratory laparotomy via a vertical midline abdominal transection revealed a torqued necrotic right ovary with elements of inflammation and inflammatory adhesions involving the entire pelvis. The patient underwent right-sided ovariectomy and adhesiolysis. Recovered was normal and the patient was delivered of healthy twins in the 37th week of gestation. PMID:28017976

  17. Study of the relative factors of Acute Cerebrovascular Disease complicated by acute kidney injury%急性脑血管疾病并发急性肾损伤相关因素的分析

    颜伟健; 胡杨青; 卢琳; 张驰; 袁银芳

    2013-01-01

    Objective To discuss and analyse the relative factors of acute cerebrovascular disease (ACVD) compli-cated by acute kidney injury (AKI),in order to provide referrence on early detection and proper treatment of the patient of ACVD complicated by AKI in clinical. Methods The patients of ACVD complicated by AKI in Affiliated Hospital of Shaoyang Medical College,during October 2009 to February 2012 were screened by Lab Administration Network. The incidence, Complications and related indexes of the patients of ACVD complicated by AKI were retrospectively ana-lyzed.Logistic regression analysis was used to investigate the etiology and relative factors in the patients of ACVD com-plicated by AKI. Results Forty-seven patients suffering from ACVD complicated by AKI were enrolled. The morbility of the ACVD complicated by AKI group was 10.28%, ACVD and AKI patients were merged or at least one disease, Logistic regression analysis showed that the most common reason of AKI was infection. Univariate analysis showed that age, the Serum creatinine(Scr) underlaying level, the blood urea anitrogen(BUN) underlaying level, the plasm carbon dioxide com-bining power (CO2CP) underlaying level, Scr peak level,BUN peak level,Serum uric acid peak level,Serum albumin were independent risk factors for ACVD complicated by AKI.Multivariate logistic regression analysis showed Scr peak level was the most important factor of ACVD complicated by AKI. Conclusion Patients with ACVD were prone to complicated by AKI, especially in the cases of intracerebral hemorrhage. infection was the most common reason of the ACVD compli-cated by AKI. The occurrence of ACVD complicated by AKI were closely related to age, the Scr underlaying level,the BUN underlaying level, the Serum CO2CP underlaying level, Scr peak level,BUN peak level,Serum uric acid peak level, Serum albumin. It's necessary to attach importance to the above-mentioned factors in clinical ralated to ACVD compli-cated by AKI.%目的:探讨急性

  18. Expression and significance of SOCS3 in liver tissue of rats with severe acute pancreatitis complicated by liver injury

    Bin WANG

    2012-11-01

    Full Text Available Objective  To investigate the expression and mechanism of action of suppressor of cytokine signaling 3 (SOCS3 in liver tissue of rats with experimental severe acute pancreatitis (SAP concurring with liver injury. Methods  The rat model of SAP was reproduced by retrograde injection of 4% sodium taurocholate into the biliopancreatic duct. Thirty-two male SD rats were randomly assigned into 4 groups (8 each: normal control group (NC, SAP 6h, 12h, and 18h groups. The levels of serum amylase (AMY, alanine aminotransferase (ALT and aspartate aminotransferase (AST were measured dynamically. The concentrations of IL -6 and IL -18 were determined by ELISA. The localization and expression of SOCS3 protein in liver were determined by immunohistochemical staining and Western blotting. Results  Compared with NC group, the serum levels of AMY, ALT and AST increased significantly in SAP groups (P < 0.05, and there was significant difference among SAP groups. The serum concentrations of IL-6 and IL-18 increased significantly in the SAP groups than in NC group (P < 0.05, and there was significant difference among SAP groups. Compared with NC group, the concentration of SOCS3 protein increased significantly in SAP groups, and increased gradually along with the increased duration of pancreatitis (P < 0.05. A minor expression of SOCS3 protein was found in NC group. The change in SOCS3 protein concentration was consistent with the severity of liver injury as well as the serum concentrations of IL-6 and IL-18. Conclusions  The inflammatory action induced by SAP concurring with liver injury may induce the expression of SOCS3 in liver tissue, and it may increase in intensity along with the severity of liver injury and inflammatory reaction. The mechanism may be attributed to a negative feedback regulation of the inflammatory action mediated by JAK/STAT pathway.

  19. Expression levels of induced sputum IL-8 and IL-10 and drug intervention effects in patients with acute exacerbated COPD complicated with chronic cor pulmonale at high altitude.

    Feng, Enzhi; Wan, Ronghua; Yang, Shengyue; Yan, Ziqiang; Wang, Shaolin; He, Wei; Zhang, Ying; Yin, He; Chen, Zongru; Liu, Ruinian

    2013-09-01

    The aim of this study was to assess the expression levels of induced sputum interleukin (IL)-8 and IL-10 levels in patients with acute exacerbated chronic obstructive pulmonary disease (AECOPD) complicated with chronic cor pulmonale (CCP) at high altitude, and to evaluate the intervention effects of an inhaled corticosteroid (ICS) and a β2-adrenoceptor agonist in this disease. A total of 186 patients with AECOPD complicated with CCP were randomly divided into three groups, with 62 cases in each. With regard to the two treatment groups, group A was treated with salmeterol/fluticasone (50 μg/250 μg, respectively) by airway inhalation twice daily, while group B received budesonide (1 mg) as a spray inhalation, twice daily. The routine treatment group (group C) received only routine treatment. The levels of IL-8 and IL-10 in the induced sputum and the predicted percentage of forced expiratory volume in one second (FEV1%pred), partial pressure of oxygen in arterial blood (PaO2) and partial pressure of carbon dioxide in arterial blood (PaCO2) were examined on admission and at a stable stage two weeks following treatment. Forty healthy volunteers served as a control group (group D). Compared with group D values, the IL-8 induced sputum level and the PaCO2 were significantly increased, while the level of IL-10, FEV1%pred and the PaO2 were markedly decreased in the three COPD groups prior to treatment. Following treatment, the induced sputum IL-8 level and the PaCO2 were significantly decreased, while the induced sputum IL-10 level, FEV1%pred and the PaO2 were markedly increased in the three treatment groups compared with the values pre-therapy (all P<0.01). The post-treatment parameters were significantly different among the three groups (P<0.01). The results indicate that IL-8 and IL-10 are involved in the airway inflammation of AECOPD complicated by CCP. Treatment with an ICS was demonstrated to be a successful method of reducing the local expression of IL-8 and

  20. Acute-phase serum amyloid A: an inflammatory adipokine and potential link between obesity and its metabolic complications.

    Rong-Ze Yang

    2006-06-01

    Full Text Available BACKGROUND: Obesity is associated with low-grade chronic inflammation, and serum markers of inflammation are independent risk factors for cardiovascular disease (CVD. However, the molecular and cellular mechanisms that link obesity to chronic inflammation and CVD are poorly understood. METHODS AND FINDINGS: Acute-phase serum amyloid A (A-SAA mRNA levels, and A-SAA adipose secretion and serum levels were measured in obese and nonobese individuals, obese participants who underwent weight-loss, and persons treated with the insulin sensitizer rosiglitazone. Inflammation-eliciting activity of A-SAA was investigated in human adipose stromal vascular cells, coronary vascular endothelial cells and a murine monocyte cell line. We demonstrate that A-SAA was highly and selectively expressed in human adipocytes. Moreover, A-SAA mRNA levels and A-SAA secretion from adipose tissue were significantly correlated with body mass index (r = 0.47; p = 0.028 and r = 0.80; p = 0.0002, respectively. Serum A-SAA levels decreased significantly after weight loss in obese participants (p = 0.006, as well as in those treated with rosiglitazone (p = 0.033. The magnitude of the improvement in insulin sensitivity after weight loss was significantly correlated with decreases in serum A-SAA (r = -0.74; p = 0.034. SAA treatment of vascular endothelial cells and monocytes markedly increased the production of inflammatory cytokines, e.g., interleukin (IL-6, IL-8, tumor necrosis factor alpha, and monocyte chemoattractant protein-1. In addition, SAA increased basal lipolysis in adipose tissue culture by 47%. CONCLUSIONS: A-SAA is a proinflammatory and lipolytic adipokine in humans. The increased expression of A-SAA by adipocytes in obesity suggests that it may play a critical role in local and systemic inflammation and free fatty acid production and could be a direct link between obesity and its comorbidities, such as insulin resistance and atherosclerosis. Accordingly, improvements

  1. Complicações orbitárias da rinossinusite aguda: uma nova classificação Orbital complications of acute rhinosinusitis: a new classification

    Antonio Augusto Velasco e Cruz

    2007-10-01

    Full Text Available A rinossinusite é uma doença potencialmente grave, e pode apresentar sérias complicações. As orbitárias são as mais freqüentes, graças às peculiaridades anatômicas desta região, podendo levar à morte em 5% dos casos. Os sintomas variam desde sinais flogísticos periorbitários até proptose do globo ocular, oftalmoplegia e amaurose. OBJETIVOS: Proposição de uma nova classificação para as complicações orbitárias das rinossinusites agudas. MATERIAL E MÉTODO: Revisão de TC e prontuários de 83 pacientes atendidos no Hospital das Clínicas da FMRP-USP, entre os anos de 1995 a 2005, com rinossinusites agudas complicadas. RESULTADOS: Após a revisão das TC e história clínica, foram identificadas em sessenta e seis pacientes, três tipos de complicações orbitárias: celulite orbitária (46,9%, abscesso subperiosteal (40,9% e abscesso orbitário (12,1%. Dezessete foram considerados como infecções palpebrais, ficando excluídos da nova classificação. CONCLUSÃO: As classificações das complicações orbitárias existentes na atualidade, como a de Chandler, não levam em conta os parâmetros anatômicos da órbita e tornaram-se obsoletas com o advento da TC. Este estudo propõe uma classificação mais concisa e objetiva que ajude a guiar a conduta terapêutica de forma mais linear.Rhinosinusitis is a severe sickness and may have serious complications. Orbital complications happen more often, due to anatomical particularities and are lethal in 5% of patients. They vary from inflammatory signs to proptosis, loss of ocular motility and blindness. AIM: We propose a new classification of acute rhinosinusitis complications. METHODS: A review of 83 patients with CT scan and clinical reports. Patients were evaluated at HCFMRP-USP between 1995 and 2005 and were diagnosed with complicated rhinosinusitis. RESULTS: In sixty-six patients, were identified three types of orbital complications: orbital cellulitis (46. 9%, subperiosteal

  2. Normal Tissue Complication Probability Analysis of Acute Gastrointestinal Toxicity in Cervical Cancer Patients Undergoing Intensity Modulated Radiation Therapy and Concurrent Cisplatin

    Simpson, Daniel R.; Song, William Y. [Center for Advanced Radiotherapy Technologies, Department of Radiation Oncology, University of California San Diego, La Jolla, CA (United States); Moiseenko, Vitali [Department of Medical Physics, Vancouver Cancer Centre, BC (Canada); Rose, Brent S.; Yashar, Catheryn M.; Mundt, Arno J. [Center for Advanced Radiotherapy Technologies, Department of Radiation Oncology, University of California San Diego, La Jolla, CA (United States); Mell, Loren K., E-mail: lmell@ucsd.edu [Center for Advanced Radiotherapy Technologies, Department of Radiation Oncology, University of California San Diego, La Jolla, CA (United States)

    2012-05-01

    Purpose: To test the hypothesis that increased bowel radiation dose is associated with acute gastrointestinal (GI) toxicity in cervical cancer patients undergoing concurrent chemotherapy and intensity-modulated radiation therapy (IMRT), using a previously derived normal tissue complication probability (NTCP) model. Methods: Fifty patients with Stage I-III cervical cancer undergoing IMRT and concurrent weekly cisplatin were analyzed. Acute GI toxicity was graded using the Radiation Therapy Oncology Group scale, excluding upper GI events. A logistic model was used to test correlations between acute GI toxicity and bowel dosimetric parameters. The primary objective was to test the association between Grade {>=}2 GI toxicity and the volume of bowel receiving {>=}45 Gy (V{sub 45}) using the logistic model. Results: Twenty-three patients (46%) had Grade {>=}2 GI toxicity. The mean (SD) V{sub 45} was 143 mL (99). The mean V{sub 45} values for patients with and without Grade {>=}2 GI toxicity were 176 vs. 115 mL, respectively. Twenty patients (40%) had V{sub 45} >150 mL. The proportion of patients with Grade {>=}2 GI toxicity with and without V{sub 45} >150 mL was 65% vs. 33% (p = 0.03). Logistic model parameter estimates V50 and {gamma} were 161 mL (95% confidence interval [CI] 60-399) and 0.31 (95% CI 0.04-0.63), respectively. On multivariable logistic regression, increased V{sub 45} was associated with an increased odds of Grade {>=}2 GI toxicity (odds ratio 2.19 per 100 mL, 95% CI 1.04-4.63, p = 0.04). Conclusions: Our results support the hypothesis that increasing bowel V{sub 45} is correlated with increased GI toxicity in cervical cancer patients undergoing IMRT and concurrent cisplatin. Reducing bowel V{sub 45} could reduce the risk of Grade {>=}2 GI toxicity by approximately 50% per 100 mL of bowel spared.

  3. Retrospective Analysis of 14 Cases with Pregnancy Complicating Acute Pancreatitis%14例妊娠期急性胰腺炎回顾性分析

    郭艳巍; 朱艳菊

    2014-01-01

    Objective:To explore risk factors of acute pancreatitis during pregnancy, providing the basis for large sample research. Methods:A retrospective analysis of 14 cases of pregnancy with the clinical data of patients with acute pancreatitis, studying the risk factors. Results:14 cases of patients with acute pancreatitis during pregnancy (12 patients for farmers, 2 cases as urban residents), 1 case of mid-term pregnancy, the rest are in third trimester;9 cases are of light pancreatitis, 5 cases are of heavy pancreatitis;2 cases for cholecystitis or with a history of cholelith disease, 10 cases were associated with hyperlipidemia;3 cases were complicated with pregnancy hypertension disease;1 case for pregnancy with diabetes ketoacidosis. 13 cases recovered, 1 case death, including fetal death in 2 cases. Conclusions:The late pregnancy period is high incidence of acute pancreatitis and hyperlipidemia is one of the most important risk factor for pregnancy with acute pancreatitis. Normative antenatal examination to pregnant women and grass-roots system training to obstetricians are the keys to reduce adverse pregnancy .%目的:探讨妊娠期急性胰腺炎的发病特点,为大样本研究提供依据。方法:回顾性分析14例妊娠合并急性胰腺炎患者的临床资料,研究其危险因素。结果:14例妊娠期急性胰腺炎患者中(12例为农民,2例为城镇居民),1例为中期妊娠,其余均为晚期妊娠;轻型胰腺炎9例,重型胰腺炎5例;患胆囊炎或有胆石症病史的患者2例,伴有高脂血症10例;并发妊娠期高血压疾病者3例;妊娠合并糖尿病酮症酸中毒1例;13例痊愈,1例死亡,其中宫内死胎2例。结论:妊娠晚期是急性胰腺炎高发时期,高脂血症是妊娠合并急性胰腺炎可能的危险因素。对妊娠妇女规范的产前检查和对基层妇产科医生的系统培训是降低不良妊娠结局发生的关键。

  4. Comparison of ertapenem and ceftriaxone therapy for acute pyelonephritis and other complicated urinary tract infections in Korean adults: a randomized, double-blind, multicenter trial.

    Park, Dae Won; Peck, Kyong Ran; Chung, Moon Hyun; Lee, Jin Seo; Park, Yoon Soo; Kim, Hyo Youl; Lee, Mi Suk; Kim, Jung Yeon; Yeom, Joon Sup; Kim, Min Ja

    2012-05-01

    The efficacy and safety of ertapenem, 1 g once daily, were compared with that of ceftriaxone, 2 g once daily, for the treatment of adults with acute pyelonephritis (APN) and complicated urinary tract infections (cUTIs) in a prospective, multicenter, double-blinded, randomized study. After ≥ 3 days of parenteral study therapy, patients could be switched to an oral agent. Of 271 patients who were initially stratified by APN (n = 210) or other cUTIs (n = 61), 66 (48.9%) in the ertapenem group and 71 (52.2%) in the ceftriaxone group were microbiologically evaluable. The mean duration of parenteral and total therapy, respectively, was 5.6 and 13.8 days for ertapenem and 5.8 and 13.8 days for ceftriaxone. The most common pathogen was Escherichia coli. At the primary efficacy endpoint 5-9 days after treatment, 58 (87.9%) patients in the ertapenem group and 63 (88.7%) in the ceftriaxone had a favorable microbiological response. When compared by stratum and severity, the outcomes in the two groups were equivalent. The frequency and severity of drug-related adverse events were generally similar in both treatment groups. The results indicate that ertapenem is highly effective and safe for the treatment of APN and cUTIs.

  5. Clinical characteristics of acute pancreatitis complicated with hyperlipidemia%急性胰腺炎合并高脂血症的临床特点

    谭韡; 严君; 罗和生

    2009-01-01

    Objective To investigate the etiology and clinical characteristics of acute pancreatitis complicated with hyperlipidemia.Methods 497 patients admitted from Jan.2002 to Dec.2007 were screened,60 patients who fulfiHed the inclusion criteria were enrolled,and these patients were divided into two groups according to the level of serum triglyeeride and disease severity respectively.Patients whose serum level of triglyeeride>11.3 mmoVL were defined as severe hyperlipidemia group.while those patients whose serum level of triglyceride between 5.65~11.3 mmol/L with milky serliiH were defined as mild hyperlipidemia group.Patients were classified into mild acute pancreatitis(MAP) and Severe acute pancreatitis(SAP) groups according to the disease severity.The etiology and clinical characteristics in all patients were investigated. Results There were 13 patients in severe hyperlipidemia group,47 patients in mild hyperlipidemia group.5 patients(38.5%)in Severe hyperlipidemia group had history of acute pancreatitis,which wag significantly higher than that of mild hyperlipidemia group(10.6%,P11.3 mmol/L或者TG在5.65~11.3 mmol/L之间,但血清呈乳状者为标准分为重度高脂血症组和轻度高脂血症组,另按病情严重程度分为轻症急性胰腺炎组(MAP)和重症急性胰腺炎组(SAP),分别观察其病因及临床特点.结果 重度高脂血症组13例,轻度高脂血症组47例.重度组5例(38.5%)有AP发作史,显著高于轻度组的10.6%(P<0.05);重度组病因以高脂血症为主,轻度组以胆源性为主.重度组血清总胆固醇(TC)为(8.17±2.76)mmol/L,TG为(13.47±4.12)mmol/L,显著高于轻度组的(4.97±1.67)mmol/L和(4.09±2.18)mmol/L(P<0.01).另一方面,SAP组血淀粉酶、血糖、TG、TC及腹痛缓解时间分别为(1396±2233)U/L、(14.17±8.37)mmol/L、(7.69 ±6.56)mmol/L、(5.39±3.58)mmol/L和(6.30±3.27)d,MAP组分别为(831±1348)U/L、(8.28±3.89)mmol/L、(5.55±3.92)mmol/L、(5.64±1.79)mmol/L和(4.29±2.62)d,两组比

  6. Impact of Chemotherapy on Normal Tissue Complication Probability Models of Acute Hematologic Toxicity in Patients Receiving Pelvic Intensity Modulated Radiation Therapy

    Bazan, Jose G.; Luxton, Gary; Kozak, Margaret M.; Anderson, Eric M.; Hancock, Steven L.; Kapp, Daniel S.; Kidd, Elizabeth A.; Koong, Albert C.; Chang, Daniel T., E-mail: dtchang@stanford.edu

    2013-12-01

    Purpose: To determine how chemotherapy agents affect radiation dose parameters that correlate with acute hematologic toxicity (HT) in patients treated with pelvic intensity modulated radiation therapy (P-IMRT) and concurrent chemotherapy. Methods and Materials: We assessed HT in 141 patients who received P-IMRT for anal, gynecologic, rectal, or prostate cancers, 95 of whom received concurrent chemotherapy. Patients were separated into 4 groups: mitomycin (MMC) + 5-fluorouracil (5FU, 37 of 141), platinum ± 5FU (Cis, 32 of 141), 5FU (26 of 141), and P-IMRT alone (46 of 141). The pelvic bone was contoured as a surrogate for pelvic bone marrow (PBM) and divided into subsites: ilium, lower pelvis, and lumbosacral spine (LSS). The volumes of each region receiving 5-40 Gy were calculated. The endpoint for HT was grade ≥3 (HT3+) leukopenia, neutropenia or thrombocytopenia. Normal tissue complication probability was calculated using the Lyman-Kutcher-Burman model. Logistic regression was used to analyze association between HT3+ and dosimetric parameters. Results: Twenty-six patients experienced HT3+: 10 of 37 (27%) MMC, 14 of 32 (44%) Cis, 2 of 26 (8%) 5FU, and 0 of 46 P-IMRT. PBM dosimetric parameters were correlated with HT3+ in the MMC group but not in the Cis group. LSS dosimetric parameters were well correlated with HT3+ in both the MMC and Cis groups. Constrained optimization (0complication probability curve compared with treatment with Cis. Dose tolerance of PBM and the LSS subsite may be lower for

  7. Paraplegia aguda. Uma complicação rara da dissecção aórtica Acute paraplegia. A rare complication of aortic dissection

    Renato Côrtes de Lacerda

    1998-04-01

    Full Text Available Mulher normotensa de 67 anos desenvolveu síncope, seguida de choque, e, mesmo após estabilização hemodinâmica, permaneceu anúrica. Observaram-se paraplegia e paresia do membro superior direito, além de isquemia das extremidades distais dos membros inferiores. A hipótese de dissecção aórtica aguda foi considerada e confirmada através de tomografia computadorizada, tendo sido a paraplegia atribuída a infarto isquêmico da medula espinhal. Óbito ocorreu no 4º dia de evolução, conseqüente a tamponamento pericárdico. São revistas as dificuldades diagnósticas relacionadas a manifestações pouco conhecidas da dissecção aórtica, enfatizando-se, como complicação rara, a paraplegia aguda.A 67 year-old normotensive woman had a syncope followed by shock and remained anuric after hemodynamic stabilization. Paraplegia and paresis of the right upper limb, as well as signs of ischemia of the distal lower limbs were noted. The possibility of acute aortic dissection was raised and confirmed by computed tomography. The paraplegia was attributed to an ischemic infarction of the spinal cord. The patient died on the fourth hospital day due to a pericardial tamponade. This rare and not well recognized complication of aortic dissection is briefly reviewed.

  8. Inflammatory cascades driven by tumor necrosis factor-alpha play a major role in the progression of acute liver failure and its neurological complications.

    Anne Chastre

    Full Text Available BACKGROUND/AIMS: Acute liver failure (ALF due to ischemic or toxic liver injury is a clinical condition that results from massive loss of hepatocytes and may lead to hepatic encephalopathy (HE, a serious neuropsychiatric complication. Although increased expression of tumor necrosis factor-alpha (TNF-α in liver, plasma and brain has been observed, conflicting results exist concerning its roles in drug-induced liver injury and on the progression of HE. The present study aimed to investigate the therapeutic value of etanercept, a TNF-α neutralizing molecule, on the progression of liver injury and HE in mice with ALF resulting from azoxymethane (AOM hepatotoxicity. METHODS/PRINCIPAL FINDINGS: Mice were administered saline or etanercept (10 mg/kg; i.p. 30 minutes prior to, or up to 6 h after AOM. Etanercept-treated ALF mice were sacrificed in parallel with vehicle-treated comatose ALF mice and controls. AOM induced severe hepatic necrosis, leading to HE, and etanercept administered prior or up to 3 h after AOM significantly delayed the onset of coma stages of HE. Etanercept pretreatment attenuated AOM-induced liver injury, as assessed by histological examination, plasma ammonia and transaminase levels, and by hepatic glutathione content. Peripheral inflammation was significantly reduced by etanercept as shown by decreased plasma IL-6 (4.1-fold; p<0.001 and CD40L levels (3.7-fold; p<0.001 compared to saline-treated ALF mice. Etanercept also decreased IL-6 levels in brain (1.2-fold; p<0.05, attenuated microglial activation (assessed by OX-42 immunoreactivity, and increased brain glutathione concentrations. CONCLUSIONS: These results indicate that systemic sequestration of TNF-α attenuates both peripheral and cerebral inflammation leading to delayed progression of liver disease and HE in mice with ALF due to toxic liver injury. These results suggest that etanercept may provide a novel therapeutic approach for the management of ALF patients awaiting

  9. Hypopituitarism in patients with vasculotoxic snake bite envenomation related acute kidney injury: a prospective study on the prevalence and outcomes of this complication.

    Golay, Vishal; Roychowdhary, Arpita; Dasgupta, Sanjay; Pandey, Rajendra

    2014-04-01

    Acute kidney injury (AKI) is common in patients with vasculotoxic snake bite (SB) envenomation but hypopituitarism (HP) is an uncommonly reported complication. We conducted a prospective observational study on survivors of SB-AKI who were evaluated and followed up from September 2010 till September 2012. Pituitary function tests were done if they developed any symptoms of HP. MRI of the hypothalamo-pituitary axis was done in those with documented HP. Response to therapy in the form of improvement in the quality of life (QoL) was evaluated by asking patients to mark on a visual analogue scale marked over 0-100 mm which was reported as percentage improvement. 126 patients were included for this study (30 were lost to follow up and were excluded). 25 cases were clinically suspected to have pituitary dysfunction and underwent evaluation with 9 (9.37%, n = 96) found to have evidence of HP. One child had partial empty sella on MRI with anterior as well as posterior pituitary abnormality and stunting; imaging was normal in others. Higher number of patients with HP had hypotension (p = 0.005, n = 7), coagulation abnormalities (p = 0.005, n = 9), severe clinical snake bite envenomation (p = 0.024, n = 9) and progression to chronic kidney disease (CKD) (p = 0.001, n = 5) as compared to those who did not. Dialysis dependence at presentation was not significantly different (p = 0.348, n = 9). Only development of CKD on follow up predicted the development of HP. Patients had an improvement in the QoL after treatment with mean score on the visual analogue scale of 66.67 ± 14.14%. HP is not very uncommon in patients with severe vasculotoxic SB-AKI. Threshold of clinical suspicion and evaluation should be low as it causes significant morbidity.

  10. 急性心肌梗死合并心源性休克的诊断及治疗进展%Diagnosis and Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction

    杨震

    2012-01-01

    Cardiogenic shock complicating acute myocardial infarction is one of the biggest challenges in clinics. With understanding of the pathogenic mechanisms of cardiogenic shock, and with the advent of new therapies like revascularization, it s clinical prognosis has been improved. This review examines recent developments in the diagnosis and treatment of cardiogenic shock complicating acute myocardial infarction.%伴发心源性休克的急性心肌梗死依然是心血管内科临床常见的重大挑战.随着人们对其发病机制认识的逐步深入和新的治疗方法的涌现,尤其是再血管化治疗的进展,其临床预后有所改善.现就急性心肌梗死合并心源性休克的诊断和治疗进展进行综述.

  11. 重症急性胰腺炎合并急性呼吸窘迫综合征的临床分析%Clinical analysis of severe acute pancreatitis complicated with acute respiratory distress syndrome

    宋扬; 刘全达; 沈洪

    2012-01-01

    目的 探讨重症急性胰腺炎(SAP)合并急性呼吸窘迫综合征(ARDS)患者的临床特点和治疗经验.方法 回顾分析2004年至2007年诊治的93例SAP及合并ARDS患者的临床特点和预后.结果 SAP合并ARDS患者在入院时的Ranson评分、APACHEⅡ评分、胰腺CT严重度指数、发病72h时脏器功能障碍数目和未合并ARDS的患者有显著差异(P<0.01).SAP患者的死亡率为21.5%(20/93),其中合并ARDS患者死亡率为35.0%(14/40);而未合并ARDS患者的死亡率为11.3%(6/53)(P<0.01).SAP发病72 h以内发生ARDS的患者的死亡率为55.6%(10/18),于SAP发病72 h后发生ARDS的患者的死亡率为18.2%(4/22)(P<0.05),两者从SAP发病至死亡的时间分别为(7.3±5.0)和(15.3±8.4),有显著性差异(P<0.05).合并ARDS的SAP患者在死亡时平均累计有3.5个脏器功能障碍.结论 SAP合并的ARDS发生越早,死亡率越高.密切监测ARDS的高危患者,并在ARDS早期即给予保护性的呼吸机辅助通气,有助于ARDS的救治和降低SAP的死亡率.%Objective To investigate the clinical characteristics and treating experiences for patients of severe acute pancreatitis ( SAP ) complicated with acute respiratory distress syndrome ( ARDS ). Methods The clinical characteristics and outcomes of 40 patients of SAP complicated with ARDS between 2004 and 2007 were analyzed retrospectively. Results The Ranson score, APACHE II score, pancreatic CT severity index at admission and the number of dysfunctional organ at 72 hour after the onset of SAP were much higher for patients with ARDS than for those without ARDS ( P < 0. 01 ). The overall mortality was 21.5% ( 20/93 ) for patients with SAP, 35. 0% ( 14/40 ) for those combined with ARDS and 11.3% ( 6/53 ) for those without ARDS ( P <0. 01 ). Among SAP patients complicated with ARDS, the mortality was 55. 6% ( 10/18 ) for those occurring ARDS following the onset of ASP within 72 hours while it was 18. 2% ( 4/22 ) for those occurring ARDS following the

  12. Acute pancreatitis

    Bo-Guang Fan

    2010-01-01

    Full Text Available Background : Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims : The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods : We reviewed the English-language literature (Medline addressing pancreatitis. Results : Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions : Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  13. Acute pancreatitis

    Bo-Guang Fan

    2010-05-01

    Full Text Available Background: Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims: The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods: We reviewed the English-language literature (Medline addressing pancreatitis. Results: Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions: Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  14. Nursing of Patients with Rhabdomyolosis Complicated with Acute Renal Failure%横纹肌溶解症并发急性肾功能衰竭患者的护理

    陆云晖; 陈静

    2013-01-01

    Objective To investigate the nursing method of patients with rhabdomyolysis syndrome complicated acute renal failure. Methods The clinical data of 7 cases of rhabdomyolysis syndrome complicated acute renal failure since 2010 were analyzed retrospectively. The corresponding nursing interventions were summarized accordingly. Results All the patients accepted blood purification in the 48-72 hours after the onset of rhabdomyolysis syndrome complicated acute renal failure. The patients were discharged when all the indicators of renal function were back to normal and the urine output increased after the timely hemodialysis treatment and nursing care. Conclusion The late-night nursing hemodialysis has the necessity and positive significance for the treatment of patients with acute renal failure.%目的 探讨横纹肌溶解症(rhabdomyolysis,RM)合并急性肾功能衰竭(acute renal failure,ARF)患者的护理方法.方法 回顾性分析2010年以来第二军医大学长征医院收治的7例RM致ARF患者的临床资料,并总结其护理方法.结果 所有患者均于发病48~72 h内接受透析治疗.通过治疗与护理,所有患者各项肾功能指标均恢复正常,尿量增多,痊愈出院.结论 加强晚夜间血液透析(hemodialysis,HD)的护理,对ARF患者的治疗具有一定的必要性与积极意义.

  15. The Clinical Observation of 26 Cases Old Age Hypertension Diabetes Complicating Acute Myocardial Infarction%老年高血压糖尿病合并急性心肌梗死26例临床观察

    陈源; 董亚辉

    2015-01-01

    Objective To observe the elderly hypertension diabetes complicating acute myocardial infarction (mi) of clinical manifestations, complications and prognosis. Methods 26 patients with senile hypertension diabetes complicating acute myocardial infarction (observation group) and the other at the same time, with the department of hypertension diabetes complicating acute myocardial infarction treated 30 cases as control (control group), two groups of patients with clinical data were retrospectively analyzed, compare two groups of fasting blood glucose (FBG), glycosylated hemoglobin (HbAlc), complications. Results Observation group of arrhythmiaFBG, HbAlc, myocardial enzymes were higher than control group, signiifcant difference (P<0.05). Conclusion Old age hypertension diabetes complicating acute myocardial infarction, painless type, more complications, mortality is higher, should strictly control the patients' blood sugar, blood lipid levels.%目的:观察老年高血压糖尿病合并急性心肌梗死的临床表现、并发症及预后情况。方法老年高血压糖尿病合并急性心肌梗死患者26例(观察组),另选取同期、同科室收治的非高血压糖尿病合并急性心肌梗死30例作对照(对照组),回顾性分析两组患者临床资料,观察比较两组空腹血糖(FBG)、糖化血红蛋白(HbAlc)、血清酶学情况。结果观察组FBG、HbAlc、心肌酶谱均高于对照组,差异显著(P<0.05)。结论老年高血压糖尿病合并急性心肌梗死无痛型多见,应严格控制患者血糖、血脂水平。

  16. Complications of mechanical ventilation

    Drašković Biljana

    2011-01-01

    Full Text Available Mechanical ventilation of the lungs, as an important therapeutic measure, cannot be avoided in critically ill patients. However, when machines take over some of vital functions there is always a risk of complications and accidents. Complications associated with mechanical ventilation can be divided into: 1 airway-associated complications; 2 complications in the response of patients to mechanical ventilation; and 3 complications related to the patient’s response to the device for mechanical ventilation. Complications of artificial airway may be related to intubation and extubation or the endotracheal tube. Complications of mechanical ventilation, which arise because of the patient’s response to mechanical ventilation, may primarily cause significant side effects to the lungs. During the last two decades it was concluded that mechanical ventilation can worsen or cause acute lung injury. Mechanical ventilation may increase the alveolar/capillary permeability by overdistension of the lungs (volutrauma, it can exacerbate lung damage due to the recruitment/derecruitment of collapsed alveoli (atelectrauma and may cause subtle damages due to the activation of inflammatory processes (biotrauma. Complications caused by mechanical ventilation, beside those involving the lungs, can also have significant effects on other organs and organic systems, and can be a significant factor contributing to the increase of morbidity and mortality in critically ill of mechanically ventilated patients. Complications are fortunately rare and do not occur in every patient, but due to their seriousness and severity they require extensive knowledge, experience and responsibility by health-care workers.

  17. Complications of nephrotic syndrome

    Se Jin Park

    2011-08-01

    Full Text Available Nephrotic syndrome (NS is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox, thromboembolism (e.g., venous thromboembolism and pulmonary embolism, hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension, cardiovascular problems (e.g., hyperlipidemia, acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception. The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS.

  18. Pregnancy Complications

    ... To receive Pregnancy email updates Enter email Submit Pregnancy complications Complications of pregnancy are health problems that ... pregnancy. Expand all | Collapse all Health problems before pregnancy Before pregnancy, make sure to talk to your ...

  19. Complications - National

    U.S. Department of Health & Human Services — Complications - national data. This data set includes national-level data the hip/knee complication measure, and the Agency for Healthcare Research and Quality...

  20. Complications - State

    U.S. Department of Health & Human Services — The Complications measures - state data. This data set includes state-level data for the hip/knee complication measure, and the Agency for Healthcare Research and...

  1. Complications - Hospital

    U.S. Department of Health & Human Services — Complications - provider data. This data set includes provider data for the hip/knee complication measure, and the Agency for Healthcare Research and Quality (AHRQ)...

  2. Dialysis complications in acute kidney injury patients treated with prolonged intermittent renal replacement therapy sessions lasting 10 versus 6 hours: results of a randomized clinical trial.

    Albino, Bianca Ballarin; Balbi, André Luis; Abrão, Juliana Maria Gera; Ponce, Daniela

    2015-05-01

    Prolonged intermittent renal replacement therapy (PIRRT) has emerged as an alternative to continuous renal replacement therapy in the management of acute kidney injury (AKI) patients. This trial aimed to compare the dialysis complications occurring during different durations of PIRRT sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline doses ranging from 0.3 to 0.7 µg/kg/min. Patients were divided into two groups randomly: in G1, 6-h sessions were performed, and in G2, 10-h sessions were performed. Seventy-five patients were treated with 195 PIRRT sessions for 18 consecutive months. The prevalence of hypotension, filter clotting, hypokalemia, and hypophosphatemia was 82.6, 25.3, 20, and 10.6%, respectively. G1 was composed of 38 patients treated with 100 sessions, whereas G2 consisted of 37 patients treated with 95 sessions. G1 and G2 were similar in male predominance (65.7 vs. 75.6%, P = 0.34), age (63.6 ± 14 vs. 59.9 ± 15.5 years, P = 0.28) and Sequential Organ Failure Assessment score (SOFA; 13.1 ± 2.4 vs. 14.2 ± 3.0, P = 0.2). There was no significant difference between the two groups in hypotension (81.5 vs. 83.7%, P = 0.8), filter clotting (23.6 vs. 27%, P = 0.73), hypokalemia (13.1 vs. 8.1%, P = 0.71), and hypophosphatemia (18.4 vs. 21.6%, P = 0.72). However, the group treated with sessions of 10 h were refractory to clinical measures for hypotension, and dialysis sessions were interrupted more often (9.5 vs. 30.1%, P = 0.03). Metabolic control and fluid balance were similar between G1 and G2 (blood urea nitrogen [BUN]: 81 ± 30 vs. 73 ± 33 mg/dL, P = 1.0; delivered Kt/V: 1.09 ± 0.24 vs. 1.26 ± 0.26, P = 0.09; actual ultrafiltration: 1731 ± 818 vs. 2332 ± 947 mL, P = 0.13) and fluid balance (-731 ± 125 vs. -652 ± 141

  3. Use and outcomes of multivessel percutaneous coronary intervention in patients with acute myocardial infarction complicated by cardiogenic shock (from the EHS-PCI Registry).

    Bauer, Timm; Zeymer, Uwe; Hochadel, Matthias; Möllmann, Helge; Weidinger, Franz; Zahn, Ralf; Nef, Holger M; Hamm, Christian W; Marco, Jean; Gitt, Anselm K

    2012-04-01

    The value of multivessel percutaneous coronary intervention (MV-PCI) in patients with cardiogenic shock (CS) and multivessel disease (MVD) is still unclear because randomized controlled trials are missing. Therefore, we sought to evaluate the impact of MV-PCI on in-hospital outcomes of patients with MVD presenting with CS: 336 patients with acute myocardial infarction complicated by CS and ≥70% stenoses in ≥2 major epicardial vessels were included in this analysis of the Euro Heart Survey PCI registry. Patients undergoing MV-PCI (n = 82, 24%) were compared to those with single-vessel PCI (n = 254, 76%). The rate of 3-vessel disease (60% vs 57%, p = 0.63) was similar in the 2 cohorts. Presentation with resuscitation (48 vs 46%, p = 0.76) and ST-segment elevation myocardial infarction (83 vs 87%, p = 0.31) was frequent in patients with MV-PCI and single-vessel PCI. Patients with ventilation were more likely to receive MV-PCI (30% vs 19%, p = 0.05). There was a tendency toward a higher hospital mortality in patients with MV-PCI (48.8% vs 37.4%, p = 0.07). After adjustment for confounding variables, no significant difference for in-hospital mortality (odd ratio [OR] 1.28, 95% confidence interval [CI] 0.72 to 2.28) could be observed between the 2 groups. Age (OR 1.41, 95% CI 1.13 to 1.77), 3-vessel disease (OR 1.78, 95% CI 1.04 to 3.03), ventilation (OR 3.01, 95% CI 1.59 to 5.68), and previous resuscitation (OR 2.55, 95% CI 1.48 to 4.39) were independent predictors of hospital death. In conclusion, MV-PCI is currently used in only 1/4 of patients with CS and MVD. An additional nonculprit PCI was not associated with a survival benefit in these high risk patients.

  4. 急性重症脑卒中患者并发上消化道出血临床分析%Clinical characteristics of severe acute stroke complicated with upper gastrointestinal bleeding:analysis of 180 cases

    李丽霞; 李建国

    2012-01-01

    Objective To investigate the clinical characters of severe acute stroke complicated with upper gastrointestinal bleeding. Methods The clinical data of 180 patients with severe acute hemorrhagic or cerebral infarction were retrospectively analyzed. Results The incidence of severe acute stroke complicated with upper gastrointestinal bleeding was 28.3% (51/180). The upper gastrointestinal bleeding often occurred 2 to 7 days after acute stroke. The incidence of upper gastrointestinal bleeding in the patients with severe acute cerebral infarction was 31.3%, a little higher than that of the patients with severe cerebral hemorrhage (27.3%), but not significantly. Multivariate logistic regression analysis showed that senility, low GCS score and previous history of aspirin use were the important risk factors of upper gastrointestinal bleeding. The vast majority of patients with severe acute stroke complicated with upper gastrointestinal hemorrhage were treated with fasting and proton pump inhibitor. The mortality within 90 days of the patients complicated with upper gastrointestinal bleeding was 62.7% (32/52), significantly higher than that of the patients not complicated with upper gastrointestinal bleeding [32 45.7% (59/129), P<0.05]. Conclusion The patients with severe acute stroke are susceptible to upper gastrointestinal bleeding. The prognosis of acute stroke complicated with upper gastrointestinal bleeding is poor.%目的 探讨急性重症脑卒中患者并发上消化道出血的临床特点.方法 对180例符合入选标准 的急性重症脑出血或脑梗死患者的临床资料进行回顾性分析.结果 急性重症脑卒中患者上消化道出血 发生率为28.3%,上消化道出血多发生于卒中2~7 d之内.急性重症脑梗死患者上消化道出血的发生率 为31.3%,略高于重症脑出血患者(27.3%),但二者比较无显著差异.高龄、入院GCS评分低、发病前服用 小剂量阿司匹林是重症脑卒中患者并发上消化道

  5. Acute mastoiditis in children

    Anthonsen, Kristian; Høstmark, Karianne; Hansen, Søren;

    2013-01-01

    Conservative treatment of acute otitis media may lead to more complications. This study evaluates changes in incidence, the clinical and microbiological findings, the complications and the outcome of acute mastoiditis in children in a country employing conservative guidelines in treating acute...... otitis media....

  6. Acute leukemia complicating deep venous thrombosis:5 cases report and literature review%急性白血病合并深静脉血栓5例报道并文献复习

    胡成琳; 曾翰庆; 罗云; 娄世锋

    2015-01-01

    Objective To analyze the clinical characteristics ,diagnosis and treatment of acute leukemia complicating deep ve‐nous thrombosis(DVT) to deepen the cognition on this complication .Methods The clinical data of consecutive patients with acute leukemia were performed the retrospective analysis .The occurrence situation of deep venous thrombosis was investigated and the a‐broad related literatures were reviewed .Results A total of 116 cases of acute leukemia in our department from July 2011 to March 2014 were treated ,in which 85 cases were acute myeloid leukemia and 31 cases were acute lymphoblastic leukemia;5 cases devel‐oped DVT with the proportion of 4 .31% (5/116) .Of these cases ,3 cases were acute promyelocytic leukemia and 2 cases were acute lymphoblastic leukemia .Conclusion The occurrence rate of DVT in the patients with acute promyelocytic leukemia is relatively higher ,if the patients have the corresponding symptom ,timely diagnosis and treatment should be conducted .%目的:分析急性白血病合并深静脉血栓患者的临床特点,加深对此合并症的认识。方法回顾分析重庆医科大学附属第二医院血液科连续收治急性白血病患者的临床资料,调查深静脉血栓发生情况,并复习国外相关文献。结果该科于2011年7月至2014年3月间共收治急性白血病患者116例,其中急性髓细胞白血病85例,急性淋巴细胞白血病31例;共有5例患者发生深静脉血栓,占4.31%(5/116)。5例患者中急性早幼粒细胞白血病3例,急性淋巴细胞白血病2例。结论急性早幼粒细胞白血病患者深静脉血栓发生率相对较高,如有相应症状应及时诊治。

  7. 脑梗死急性期合并抑郁障碍的康复与功能预后%Rehabilitation and functional prognosis of acute brain infarct complicated with depression

    戴慧寒; 张纯

    2001-01-01

    Objective To observe rehabilitation and functional prognosis of patients suffered from brain infarction of acute phase complicated by depression. Method We selected 38 cases of acute brain infarct complicated with depression disorder as depression group, 40 cases of non- depression patient admitted at the same period were selected as non depression group.Antidepressants drugs administration and rehabilitation therapy were performed.We evaluated patients according to functional independence measure(FIM)of Chinese edition. HAMD grading comparison was carried out in depression group. Result Before treatment,two groups score nearly the same,compared with pretreatment. After treatment,patients in depression group and non depression group showed significant improvement esp non- depression group (P<0.01).11 cases with severe depression in the depression showed no changes in FIM score before and after treatment. Conclusion Compared with non- depression patients,functional recovery of patients with depression following brain infarction of acute stage is much slower,especially for patients with severe depression.

  8. [The local complications of appendicitis].

    Ortega León, L H; Vargas Domínguez, A; Miranda Fraga, P

    1994-01-01

    In order to find out the predisposing factors of local complications after appendectomy in two general hospitals, 268 charts of patients with acute appendicitis confirmed by surgery were reviewed. There were 142 males and 126 females. All wounds were closed and prophylactic antibiotics were not used. Sixty patients (22 per cent) developed local complications; 49 (81.7 per cent) surgical wound infection and 11 (18.3 per cent) with intra-abdominal abscess. In the wound infection group 25 per cent had complicated acute appendicitis and only one per cent non-complicated acute appendicitis. The correlation between the preoperative period and wound sepsis showed, the longer period the higher incidence of wound infection, 1.7 per cent with less than 24 hr. 11 per cent with less than 72 hr. and 78.9 per cent with more than 96 hr.

  9. Clinical observation of investigating senile diabetes complicated with acute myocardial infarction%探讨老年糖尿病合并急性心肌梗死的临床观察

    吴瑕; 孙丹; 孙俐俐

    2016-01-01

    ObjectiveTo investigate clinical characteristics of senile diabetes complicated with acute myocardial infarction patients.MethodsThere were 20 senile diabetes complicated with acute myocardial infarction patients as experimental group, and another 15 senile patients without diabetes and acute myocardial infarction as control group. Comparative research was made on clinical symptoms, complications and mortality in both groups.ResultsThe experimental group had higher incidence of painless myocardial infarction as 45.0% than 13.3% of the control group. It also had incidence of nausea and vomiting as 85.0% and incidence of dyspnea as 65.0% than 53.3% and 26.7% of the control group (P<0.05). The experimental group had higher incidence of complications as 45.0% than 13.3% of the control group (P<0.05). Within 1 month of attack, the experimental group had higher mortality rate as 35.0% than 6.7% of the control group (P<0.05).ConclusionComplications are common in senile diabetes complicated with acute myocardial infarction patients, along with high mortality rate. Therefore, early treatment and symptom research are necessary for senile diabetes complicated with acute myocardial infarction patients to decrease their mortality rate.%目的:探讨老年糖尿病合并急性心肌梗死患者的临床特征。方法20例老年糖尿病合并急性心肌梗死患者作为实验组,15例老年非糖尿病急性心肌梗死患者作为对照组,对两组患者的临床症状、并发症、死亡情况进行对比研究。结果实验组无痛型心肌梗死发生率45.0%高于对照组13.3%、恶心呕吐发生率85.0%高于对照组53.3%、呼吸困难发生率65.0%高于对照组26.7%(P<0.05)。实验组并发症发生率45.0%高于对照组13.3%(P<0.05)。发病1个月内,实验组死亡率35.0%高于对照组6.7%(P<0.05)。结论老年糖尿病合并急性心肌梗死患者比较容易发生并发症,死亡率高,因此糖尿病合并急性心肌梗

  10. Acute presentation of gestational diabetes insipidus with pre-eclampsia complicated by cerebral vasoconstriction: a case report and review of the published work.

    Mor, Amir; Fuchs, Yael; Zafra, Kathleen; Haberman, Shoshana; Tal, Reshef

    2015-08-01

    Gestational diabetes insipidus (GDI) is a rare, self-limited complication of pregnancy. As it is related to excess placental vasopressinase enzyme activity, which is metabolized in the liver, GDI is more common in pregnancies complicated by conditions associated with liver dysfunction. We present a case of a 41-year-old woman at 38 weeks' gestation who presented with pre-eclampsia with severe features, including impaired liver function and renal insufficiency. Following cesarean section she was diagnosed with GDI, which was further complicated by cerebral vasoconstriction as demonstrated by magnetic resonance angiography. This case raises the possibility that cerebral vasoconstriction may be related to the cause of GDI. A high index of suspicion of GDI should be maintained in patients who present with typical signs and symptoms, especially in the setting of pregnancy complications associated with liver dysfunction.

  11. 心房颤动射频导管消融术并发急性心脏压塞九例临床分析%Atrial Fibrillation Complicated by Acute Cardiac Tamponade in Radiofrequency Catheter Ablation

    宁尚秋; 刘文娴; 陈立颖; 康铁朵; 李江; 董建增; 任学军; 马长生; 吕树铮

    2011-01-01

    Objective To summarize the manifestations and results of atrial fibrillation ( AF ) complicated by acute cardiac tamponade in radiofrequency catheter ablation. Methods A total of 2 094 AF patients received radiofrequency catheter ablation in our hospital from January 2006 to June 2010, 9 of whom were complicated by acute cardiac tamponade. The clinical manifestations and treatment outcomes of 9 patients were analyzed retrospectively. Results The incidence of acute cardiac tamponade was 0. 43% ( 9/2 094 ). The patients presented with chest distress and hypotension in early stage and remitted completely after drainage by pericardiocentesis without bleeding. Conclusion Cardiac tamponade is a severe complication of atrial fibrillation during radiofrequency catheter ablation. Timely detection and effective treatment are very important.%目的 探讨心房颤动射频消融术发生急性心脏压塞的临床特点和治疗结果.方法 2006年1月-2010年6月我院2 094例心房颤动患者接受射频消融治疗,其中9例并发急性心脏压塞,回顾性分析9例患者的临床表现和治疗结果.结果 急性心脏压塞发生率为0.43%(9/2 094).9例患者早期均表现为胸闷、血压下降.9例患者经心包穿刺引流后症状均完全缓解,无继续出血.结论 急性心脏压塞是心房颤动射频消融术的严重并发症,及时发现和有效救治是十分重要的.

  12. Hemorrhagic intra splenic pseudocyst as a complication of chronic pancreatitis in acute phase - a case report; Pseudocisto intra-esplenico hemorragico como complicacao de pancreatite cronica agudizada - relato de um caso

    Almeida, Fabiola Assuncao de; Marchiori, Edson; Mello, Walter de Assis; Nogueira, Aline Silva; Sales, Anderson Ribeiro; Martins, Renata Romano; Santos, Tereza Cristina C.R.S. dos [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia

    1999-03-01

    The authors report a case of hemorrhagic intra splenic pseudocyst as a complication of chronic pancreatitis in acute phase. A 43-year-old woman, chronic alcoholic, who had pancreatitis 5 years ago, with symptoms of strong abdominal pain in the epigastrium, nausea and fever. Abdominal sonography showed a lesion contiguous to the spleen and computed tomography demonstrated an heterogeneous lesion of not well defined limits, in the lateral and posterior parts of the spleen. The patient was submitted to Roux-Y cystojejunostomy, he does not present any symptoms at the moment, and is undergoing clinical control. (author)

  13. Acute renal failure complicated with myocardial infarction and anemia: a difficult and complicated case report%第1例:突发急性肾衰竭-心肌梗死-贫血

    杨定位; 林珊; 李栋

    2012-01-01

    病历摘要 患者女性,75岁.因双下肢水肿2个月,血肌酐升高1d入院.患者入院前2个月无明显诱因出现双下肢水肿,在当地医院查血白蛋白21g/L,尿蛋白定量7.45g/d,血肌酐95 mmol/L,诊断为肾病综合征,给予雷公藤总甙、辛伐他汀、西洛他唑治疗.入院前1d患者突发心前区疼痛伴一过性意识丧失(约30min),急查血肌酐220μmol/L,心电图异常,收入院.%This report presented a case of 75-year-old woman who had received drug treatments two months earlier for nephrotic syndrome and was admitted to our hospital for inferior wall myocardial infarction with elevated creatinine and anemia.Kidney pathology after myocardial infarction showed allergic acute interstitial nephritis which induced acute renal failure.We stopped tripterygium glycosides and used cortical hormone,consequently.Thereafter,the symptoms of renal failure and anemia were improved and we considered tripterygium glycosides resulted in above allergic acute interstitial nephritis and anemia.Therefore,we had to carry out renal needle biopsy in the patient with the elderly nephrotic syndrome before confirmatory treatment to avoid blind use of tripterygium glycosides.

  14. Cataract complications

    David Yorston

    2008-03-01

    Full Text Available Any eye surgeon, no matter how experienced, will occasionally encounter a serious cataract complication. Although complications may be devastating for the patient and are always distressing for the surgeon, are they really a major issue for VISION 2020? The evidence says that they are.

  15. Dengue hemorrhagic fever complicated by pancreatitis

    Guido Ricardo Gonzalez Fontal

    2011-10-01

    Full Text Available Acute pancreatitis is an atypical complication of dengue fever and is rarely described. We are reporting a case of dengue hemorrhagic fever complicated by acute pancreatitis in a patient with history of diabetes mellitus type 1 and end stage renal disease on hemodialysis.

  16. 艾滋病合并外科急腹症患者的快速康复护理%Fast track nursing of patients with AIDS complicated with acute abdomen during perioperative period

    李丹丹; 肖艳玲

    2016-01-01

    目的:探讨艾滋病合并外科急腹症患者的快速康复护理方法。方法:回顾性分析2012年7月至2015年7月42例艾滋病合并外科急腹症的患者的临床特点及护理对策。结果:38例患者围手术期经快速康复外科(fast track surgery,FTS)护理治疗(术前患者心理干预;避免胃管、尿管的置入;减少术中引流管留置、术中液体控制、体温控制;术后胃肠功能、肺功能的加速康复、疼痛的管理、切口的管理、管道的早期拔除),未出现院内感染及其他重大并发症,护理治疗效果满意,康复出院。4例因重度的免疫功能缺陷,术后出现难以控制的腹腔感染后继而多器官功能衰竭死亡。结论:快速康复护理治疗可减少艾滋病合并急腹症患者的术后并发症,降低围手术期病死率,促进患者术后早期康复。%Objective: To investigate the perioperative nursing methods on AIDS complicated with acute abdomen diseases. Methods: 42 cases of AIDS complicated with acute abdomen diseases from July 2012 to July 2015 were studied, the clinical features of patients and nursing treatment were analyzed.Results: 38 cases were healed without nosocomial infection and other serious complications by fast track nursing treatment (preoperative psychological intervention; avoid gastric tube, urine tube placement; reduce intraoperative drainage tube indwelling, intraoperative lfuid control, temperature control, accelerate postoperative gastrointestinal function, rehabilitate pulmonary function, pain management, postoperative incision management, early removal of pipeline). Four cases with severe immune function defects suffered uncontrollable abdominal postoperative infection and multiple organ failure which led to death.Conclusion: Fast track nursing can prevent postoperative complications, reduce perioperative mortality and promote the fast-tract recovery on patients with AIDS complicated with acute abdomen

  17. [Impact of renal dysfunction on clinical course of myocardial infarction complicated by acute heart failure in patients with preserved systolic function].

    Parkhomenko, O M; Hur"ieva, O S; Kornatskyĭ, Iu V; Kozhukhov, S M; Sopko, O O

    2013-01-01

    Aiming to assess the relationships between renal function and ST-segment elevation myocardial infarction (MI) clinical course and remote outcomes in patients with preserved systolic left ventricular (LV) function (LV ejection fraction > 40%) estimated glomerular filtration rates (eGFR) were evaluated on 1st and 3rd -10th MI day (n = 491). On 3rd-10th day of MI in patients with acute heart failure (HF) symptoms on admission day (1st group, n = 153) eGFR infarction (Hazzard Ratio (HR) with 95% confidence intervals (95% CI) = 4,08 [1,72 -11,73], P acute HF (2nd group, n = 338) eGFR renal dysfucntion in patients with and without acute HF and preserved LV function.

  18. Bereavement and complicated grief.

    Shear, M Katherine; Ghesquiere, Angela; Glickman, Kim

    2013-11-01

    Bereavement is a common experience in adults aged 60 and older. Loss of a loved one usually leads to acute grief characterized by yearning and longing, decreased interest in ongoing activities, and frequent thoughts of the deceased. For most, acute grief naturally evolves into a state of integrated grief, where the bereaved is able to reengage with everyday activities and find interest or pleasure. About 7 % of bereaved older adults, however, will develop the mental health condition of Complicated Grief (CG). In CG, the movement from acute to integrated grief is derailed, and grief symptoms remain severe and impairing. This article reviews recent publications on the diagnosis of CG, risk factors for the condition and evidenced-based treatments for CG. Greater attention to CG detection and treatment in older adults is needed.

  19. Amiodarone use after acute myocardial infarction complicated by heart failure and/or left ventricular dysfunction may be associated with excess mortality

    Thomas, Kevin L; Al-Khatib, Sana M; Lokhnygina, Yuliya;

    2008-01-01

    BACKGROUND: We sought to assess the association of amiodarone use with mortality during consecutive periods in patients with post-acute myocardial infarction with left ventricular systolic dysfunction and/or HF treated with a contemporary medical regimen. METHODS: This study used data from VALIAN...

  20. 重症急性胰腺炎并发胃肠瘘的处理方式与评价%Evaluation and treatment of severe acute pancreatitis complicated with gastro intestinal fistulae

    赵允召

    2012-01-01

    在机体度过早期循环障碍、多脏器损伤阶段,防治感染与消化液腐蚀所造成的大出血、消化道瘘、营养不良以及由此导致的多器官功能障碍和迟发性腹腔间隔室综合征等并发症就成为胰腺炎治疗的关键.其中消化道瘘的防治重点在于感染、坏死组织处理,肠瘘部位的充分引流,尽可能早期恢复肠内营养,防止或减轻腹腔感染的发生或发展.%Despite advances in management of circulation dysfunction and MOD, Intestinal fistula, necrosis and sepsis are potentially lethal complications of severe acute pancreatitis that represents bleeding, sepsis, intestinal fistula, ACS and malnutrition. Intestinal fistulas are complications principal of severe acute pancreatitis and they present either as ongoing abdominal sepsis or abdominal bleeding. The main point of fistula treatment is dominating sepsis, evacuation of pus and surgical necrosectomy, external drainage of intestinal fluid and nutrition support (feeding jejunostomy).

  1. Complicated Pancreatitis

    Bakker, O.J.

    2015-01-01

    Research questions addressed in this thesis: What is the accuracy of serum blood urea nitrogen as early predictor of complicated pancreatitis? ; What is difference in clinical outcome between patients with pancreatic parenchymal necrosis and patients with extrapancreatic necrosis without necrosis

  2. 有创呼吸机辅助治疗急性心肌梗死并发心源性休克%Ventilator aided rescue of acute myocardial infarction complicated with cardiogenic shock

    单艳华

    2012-01-01

    Objective To observe the rescue experience of invasive mechanical ventilation in the treatment of patients with acute myocardial infarction (AMI) complicated with cardiogenic shock in order to improve the successful rescue rate.Methods The clinical data of 32 cases of acute myocardial infarction complicated with cardiogenic shock patients in the ICU were retrospectively analysed.They were given the general treatment and invasive mechanical ventilation.Results Thirty-two patients with AMI complicated with cardiogenic shock were actively rescued,24 patients were cured,8 patients died,including 6 cases over 70 years old,2 cases below 70 years old,the successful rescue rate was 75%.Conclusions Cardiogenic shock is a serious complication of acute myocardial infarction,mortality is high,the clinical diagnosis,ventilator-assisted therapy and the management of the respiratory tract,can effectively improve the successful resue rate.%目的 总结呼吸机辅助治疗急性心肌梗死(AMI)并发心源性休克患者的治疗抢救经验,提高抢救成功率.方法 回顾性分析32例急性心肌梗死并发心源性休克患者在ICU给予一般治疗配合呼吸机辅助呼吸的效果.结果 32例AMI并发心源性休克患者经积极抢救24例治愈出院,8例抢救无效死亡,其中≥70岁6例,<70岁2例,抢救成功率为75%.结论 心源性休克是急性心肌梗死的严重并发症,痛死率高,临床上早期诊断、及时行呼吸机辅助治疗并加强呼吸道的管理能有效提高抢救成功率.

  3. Differentiating Acute Otitis Media and Acute Mastoiditis in Hospitalized Children.

    Laulajainen-Hongisto, Anu; Aarnisalo, Antti A; Jero, Jussi

    2016-10-01

    Acute otitis media is a common infection in children. Most acute otitis media episodes can be treated at an outpatient setting with antimicrobials, or only expectant observation. Hospital treatment with parenteral medication, and myringotomy or tympanostomy, may be needed to treat those with severe, prolonged symptoms, or with complications. The most common intratemporal complication of acute otitis media is acute mastoiditis. If a child with acute mastoiditis does not respond to this treatment, or if complications develop, further examinations and other surgical procedures, including mastoidectomy, are considered. Since the treatment of complicated acute otitis media and complicated acute mastoiditis differs, it is important to differentiate these two conditions. This article focuses on the differential diagnostics of acute otitis media and acute mastoiditis in children.

  4. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome

    Soldati Gino

    2008-04-01

    Full Text Available Abstract Background Differential diagnosis between acute cardiogenic pulmonary edema (APE and acute lung injury/acute respiratory distress syndrome (ALI/ARDS may often be difficult. We evaluated the ability of chest sonography in the identification of characteristic pleuropulmonary signs useful in the diagnosis of ALI/ARDS and APE. Methods Chest sonography was performed on admission to the intensive care unit in 58 consecutive patients affected by ALI/ARDS or by acute pulmonary edema (APE. Results Ultrasound examination was focalised on finding in the two groups the presence of: 1 alveolar-interstitial syndrome (AIS 2 pleural lines abnormalities 3 absence or reduction of "gliding" sign 4 "spared areas" 5 consolidations 6 pleural effusion 7 "lung pulse". AIS was found in 100% of patients with ALI/ARDS and in 100% of patients with APE (p = ns. Pleural line abnormalities were observed in 100% of patients with ALI/ARDS and in 25% of patients with APE (p All signs, except the presence of AIS, presented a statistically significant difference in presentation between the two syndromes resulting specific for the ultrasonographic characterization of ALI/ARDS. Conclusion Pleuroparenchimal patterns in ALI/ARDS do find a characterization through ultrasonographic lung scan. In the critically ill the ultrasound demonstration of a dyshomogeneous AIS with spared areas, pleural line modifications and lung consolidations is strongly predictive, in an early phase, of non-cardiogenic pulmonary edema.

  5. Rescue and nursing of complicated acute pericardial tamponade with cardiac interventional therapy%心脏介入治疗并发急性心包填塞的抢救与护理

    李晓彤

    2012-01-01

    目的 总结心脏介入治疗并发12例急性心包填塞的护理经验.方法 回顾分析心脏介入治疗并发12例急性心包填塞患者的临床资料,总结护理要点.结果 急性心包填塞发生在冠状动脉介入治疗3例,射频消融术6例,永久起搏术1例,临时起搏术2例,无1例死亡.结论 严密观察病情,积极护理施救,加强心理护理,提高风险意识,各项护理环环相扣,从而保障患者的生命安全.%Objective To summarize the nursing experience of 12 cases of complicated acute pericardial tamponade with cardiac interventional therapy. Methods The clinical data of 12 complicated acute pericardial tamponade patients treated with cardiac interventional therapy were analyzed retrospectively,and nursing strategies were summarized as well. Results There were 3 cases of a-cute pericardial tamponade in coronary interventional therapy,6 cases of radiofrequency ablation,1 case of permanent pacing,and 2 cases of temporary pacing with no case of death. Conclusion The close observation of the disease,active care and rescue,enhancement of psychological nursing and risk awareness are interrelated. They can ensure the safety of patients.

  6. Nursing care of patients with severe pneumonia complicated with acute heart failure%重症肺炎合并急性心力衰竭的护理措施研究

    沙莹

    2015-01-01

    目的:重症肺炎合并急性心力衰竭的护理措施。方法对我院从2012年3月至2015年1月收治的31例重症肺炎合并心衰患儿的护理资料进行分析。结果31例患儿经过积极治疗及护理以后,均痊愈。住院时间6至21d,平均(13.01±2.54)d。经对患儿家长进行问卷调查,护理满意度为97%。结论对重症肺炎合并急性心力衰竭患儿合理有效的护理可以明显改善病情,提高治疗效果。%Objective:the nursing measures of severe pneumonia complicated with acute heart failure.Methods:the nursing data of 31 cases of severe pneumonia complicated with heart failure in our hospital from january 2015 to March 2012 were analyzed. Results:31 cases were cured by active treatment and nursing.Hospitalization time of 6 to 21d,average(13.01+2.54)d.The parents of the children with the questionnaire survey,nursing satisfaction was 97%.Conclusion:the severe pneumonia complicated with acute heart failure in childrenreasonable and effective nursing can improve the condition and improve the treatment effect.

  7. Decompressive laparotomy in the treatment of severe acute pancreatitis complicated with abdominal compartment syndrome%开腹减压治疗重症急性胰腺炎并发腹腔间室综合征

    朱维铭; 龚剑峰

    2008-01-01

    Abdominal compartment syndrome(ACS)is an important factor contributing to the multiple organ dysfunction syndrome which is commonly seen in patients with severe acute pancreatitis(SAP).As a life-saving procedure,decompressive laparotomy is widely applied to patients with SAP complicated with ACS,especially to patients with edema of the visceral tissues caused by massive fluid resuscitation at the early stage of the disease.However,decompressive laparotomy should be adopted with caution since it is associated with enteroatmospherie fistula,intraabdominal infection,postoperative ileus,third space losses,hypothermia and hemia.Therefore,decompressive laparotomy should only be considered after conservative management had failed.The indications for decompressive laparotomy are as follows:(1)intraabdominal pressure>25 nnn Hg;(2)adequate ventilation of the patient is difficult;(3)pereutaneous drainage of ascites is not helpful.Timely temporal abdominal closure is helpful in preventing complications.Infected peripanereatie necrosis is the indication for peripancreatic exploration or necroseetomy.A thorough knowledge of decompressive laparotomy is essential for individualized management of patients with SAP complicated with ACS.

  8. Effectiveness of anti-inflammatory treatment versus antibiotic therapy and placebo for patients with non-complicated acute bronchitis with purulent sputum. The BAAP Study protocol

    Fernández Yvonne; Cots Josep M; Pera Helena; Morros Rosa; Bayona Carolina; Moragas Ana; Llor Carl; Miravitlles Marc; Boada Albert

    2011-01-01

    Abstract Background Acute bronchitis is one of the most prevalent respiratory infections in primary care, and in more than 90% of the cases antibiotics are prescribed, mainly when purulent expectoration is present. However, this process is usually viral in origin and the benefits of antibiotic treatment are marginal. On the other hand, in recent years bronchitis has been considered more as an inflammatory than an infectious process. Thus, the aim of this study is to evaluate the clinical effe...

  9. Effect of folate status and methylenetetrahydrofolate reductase genotypes on the complications and outcome of high dose methotrexate chemotherapy in north Indian children with acute lymphoblastic leukemia

    Nirmalya Roy Moulik

    2016-01-01

    Full Text Available Purpose: The genes of the folate metabolic pathway have been associated with toxicities during high dose methotrexate therapy for childhood ALL, however, the importance of intrinsic folate status in this regard is unclear. Methods: In the present study the effect of precourse folate levels and MTHFR genotypes on the complications during high dose methotrexate chemotherapy in children with ALL were examined. Results: Twenty-one children were studied. Folate deficiency was associated with higher incidence of neutropenia (P = 0.03 and longer duration of chemotherapy interruption (P = 0.009. Children with MTHFR1298 mutations needed more red cell transfusion (P = 0.03. All 3 deaths encountered were seen in folate deficient children. Conclusions: Folate deficiency was associated with higher complications during high dose methotrexate therapy, the implications of which are important especially in resource poor settings with high prevalence of folate deficiency.

  10. Analysis of clinical features and risk factors of children with acute leukemia complicated with central nervous system complications%急性白血病患儿伴中枢神经系统并发症临床特点及危险因素分析

    王毅捷; 马亚震; 孙和顺

    2016-01-01

    Objective To analyze the clinical features and risk factors of children with acute leukemia (AL) complicated with central nervous system (CNS) complications .Methods Seventy children with acute leukemia admitted into our hospital from March 2010 to March 2015 were selected as the research objects .The clinical data of all children were retrospectively an-alyzed ,including the occurrence rate of CNS complications and their clinical features and the risk factors of CNS complications were analyzed at the same time .Results There were 12 cases (17 .14% ) of CNS in 70 cases ,including 8 cases of AML com-plicated with CNS ,3 cases of ALL complicated with CNS and 1 case of acute granular lymphocyte leukemia and the complica-tions of CNS mainly were intracranial hemorrhage .The occurrence rates of CNS complications with platelet counts less than 50 × 109 L - 1 (whether or not) were 50 .00% and 2 .08% .The rates of white blood cell counts more than 100 × 109 L - 1 (whether or not) respectively were 50 .00% and 2 .08% .The rate of lymphadenectasis(whether or not) respectively was 47 .62% and 4 . 08% and there was significant difference between the two groups(P < 0 .01) .Logistic regression analysis showed that less than 50 × 109 L - 1 of the platelet counts ,more than 100 × 109 L - 1 of white blood cell counts and lymphadenectasis were the risk factors of AL with CNS complications .Conclusion Intracranial hemorrhage is common in children with acute leukemia com-plicated with central nervous system complications .And the risk factors affecting the occurrence of CNS complications include low platelet count ,high white blood cell count and lymphadenectasis .%目的:分析急性白血病(AL)患儿伴中枢神经系统(CNS)并发症的临床特点及危险因素。方法以我院2010-03—2015-03收治的70例急性白血病患儿为研究对象,回顾性分析 CNS 并发症发生率、CNS 并发症临床特点等,同时分析CNS 并发

  11. 2型糖尿病合并急性脑梗死的临床研究%Clinical study of type-2 diabetes mellitus complicated with acute cerebral infarction

    关颖; 张茁

    2011-01-01

    Objective To investigate the clinical characteristics of type-2 diabetes mellitus complicated with acute cerebral infarction. Methods 150 patients with type-2 diabetes mellitus complicated with acute cerebral infarction in Anzhen Hospital from 2008 to 2009 were investigated as the diabetes group. 150 cases with acute cerebral infarction without type-2 diabetes mellitus were enrolled as the control group. Age, sex, fasting blood glucose ( FBG), glycosylated hemoglobin (HbAlc) ,TG,TC, HDL-C,LDL-C, clinical manifestation, position of cerebral infarction, complications, efficacy of treatment and prognosis were compared between the two groups. Results Compared with the control group,age and proportion of male patients were significantly lower, hemianopia,vertigo,diplopia,ataxia,FBG,HbAlc,TG,TC,LDL-C were significantly higher in diabetes group (P ll. 1 mmol/L were 5. 12±1. 21,7. 94±2. 13 and 11. 90±2. 35 (P < 0. 01). Conclusion Diabetes mellitus and stroke were correlated with age and sex. Severity of clinical symptoms was correlated with the blood glucose level on admission in type-2 diabetes mellitus complicated with acute cerebral infarction. Main type of cerebral infarction was posterior circulation infarction in diabetes group. Incidence of complications in the diabetes group was significantly higher than that in the control group. Therapeutic efficacy and prognosis were worse in diabetes group.%摘要:目的 探讨2型糖尿病合并急性脑梗死的临床特点.方法 选择住院的糖尿病合并急性脑梗死患者(糖尿病组)150例,另随机选择同期的非糖尿病合并急性脑梗死患者(对照组)150例.对2组患者年龄、性别、空腹血糖、糖化血红蛋白、血脂、临床表现、脑梗死部位、病情轻重程度、并发症、临床疗效及预后进行比较.结果 与对照组比较,糖尿病组患者年龄、男性比例明显降低,空腹血糖、糖化血红蛋白、TC、TG、LDL-C、偏盲、眩晕、复视

  12. 恶性肿瘤并发急性肺栓塞的诊疗探讨%Diagnosis and treatment of the malignant tumor complicated with acute pulmonary embolism.

    史菲; 张向霞

    2011-01-01

    目的 探讨恶性肿瘤并发急性肺栓塞患者的诊断及治疗特点.方法 回顾性分析我院26例恶性肿瘤并发急性肺栓塞患者的临床表现、诊断方法及治疗转归.结果 恶性肿瘤并发急性肺栓塞的临床表现不典型,CTPA和核素肺灌注-通气扫描检查是首选的确诊方法,积极的溶栓和/或抗凝治疗可降低病死率.结论 恶性肿瘤并发急性肺栓塞病死率高,易发生误诊.临床医生需加强警惕以预防肺栓塞发生,对于疑似病例应尽早进行积极的诊断与治疗.%Objective To discuss thc characteristics of diagnosis and treatment in malignant tumor complicated with acute pulmonary embolism(APE). Methods TTo analyze retrospectively the clinical features,diagnostic approach and treatment outcomes of 26 cases with malignant tumor complicated with APE. Results The clinical features of the patients with malignant tumor complicated with APE were nonspecific. CTPA and the ventilation/perfusion scan were the first choice of its final diagnosis. Active thrombolytic and/or anticoagulant therapy was effective to decrease the mortality. Conclusion The fatality rate of malignant tumor complicated with APE has very high mortality and tends to be misdiagnosed. Clinicians should be extra alert to prevent APE, and the suspect cases should be given correct diagnosis and aggressive treatment as early as possible.

  13. A case of complicated otomastoiditis

    Mario Atzeni

    2015-12-01

    Full Text Available We describe the case of a child who, at her first episode of clinically evident acute otitis media, has developed a bilateral mastoiditis, though with unilateral simptomatology. The mastoiditis was complicated by the spontaneous drainage of the postauricular abscess in the subcutaneous tissue. According to the literature, we believe that the temporal bone computed tomography scan is the fundamental examination to properly define an anusual case of mastoiditis, plan adequate therapy (medical o surgical, and rule out other possible complications.

  14. The clinical experience in diagnosis and treatment of acute pancreatitis in pregnancy(APIP) complicated with renal function injury%妊娠期急性胰腺炎并发肾功能损害的诊治体会

    李钢; 万祎; 王彦铭; 张雨佳; 罗智

    2011-01-01

    Objective To discuss the clinical features, diagnosis and treatment in APIP complicated with renal function injury (RFI). Methods Thirteen cases of APIP complicated with RFI from Jan. 2002 to Apr. 2010 were collected. Results There were 7 cases of mild acute pancreatitis (MAP), of whom 6 cases cured, one patient died of acute renal failure (ARF). There were 4 patients complicated with ARF in 6 cases of severe acute pancreatitis (SAP). Two patients died after CVVH, two patients cured. In total, 3 pregnant women and 6 fetuses died. Conclusion APIP patients are prone to damage the kidney function even result in ARF. At last make the pregnant woman and fetus both died. Obstetricians and surgeons ought to be vigilant, find a properly comprehensive treatment as soon as possible. The termination of pregnancy is needed when necessary.%目的 探讨妊娠期急性胰腺灸并发肾功能损害的临床特点及诊治方法.方法 回顾性分析我院2002年1月~2010年4月收治的妊娠期急性胰腺炎患者并发肾功能损害的患者13例的临床资料.结果 7例轻型患者中6例治愈,1例进展成为重症后并发急性肾衰竭死亡;6例重症患者中4例并发急性肾衰竭,经连续性静脉-静脉血液滤过(CVVH)治疗后,2例死亡,2例治愈出院.孕妇死亡3例,胎儿死亡6例.结论 妊娠期急性胰腺炎易并发肾功能损害,引起急性肾衰竭,导致母婴双亡.接诊医师应当提高警惕,及时发现并尽早进行综合治疗,必要时可终止妊娠.

  15. 急性心肌梗死并发心源性休克50例的诊断与治疗效果%Diagnosis and treatment effect of 50 cases of acute myocardial infarction complicated with cardiogenic shock

    朱国安

    2015-01-01

    目的:探讨急性心肌梗死并发心源性休克的早期诊断及治疗效果。方法:严密观察病情,高浓度吸氧,绝对卧床休息,止痛,及时采取再灌注治疗,结合药物及机械辅助装置。结果:50例患者中,经再灌注并结合药物及机械辅助装置等治疗,抢救成功率>90%。结论:心源性休克是急性心肌梗死严重的并发症,是心肌梗死早期死亡的主要原因。早发现,早确诊,早治疗,对抢救心肌梗死并发心源性休克具有非常重要的价值,可提高患者的生存率。%Objective:To explore the early diagnosis and treatment effect of 50 cases of acute myocardial infarction complicated with cardiogenic shock.Methods:The patients were given the strict observation of condition,the high concentration of oxygen, absolute bed rest,relieving pain,timely reperfusion therapy,combined with drugs and mechanical auxiliary device.Results:In 50 patients,after reperfusion and the combination of drugs and mechanical auxiliary device and other treatment,the rescue success rate was more than 90%.Conclusion:Cardiogenic shock was a severe complication in patients with acute myocardial infarction.It was the main cause of early death in acute myocardial infarction.Early discovery,early diagnosis,early treatment had very important value to the rescue of myocardial infarction complicated with cardiogenic shock.It could improve the survival rate of patients.

  16. The beneficial effects of inhaled nitric oxide in patients with severe traumatic brain injury complicated by acute respiratory distress syndrome: a hypothesis

    Papadimos Thomas J

    2008-01-01

    Full Text Available Abstract Background The Iraq war has vividly brought the problem of traumatic brain injury to the foreground. The costs of death and morbidity in lost wages, lost taxes, and rehabilitative costs, let alone the emotional costs, are enormous. Military personnel with traumatic brain injury and acute respiratory distress syndrome may represent a substantial problem. Each of these entities, in and of itself, may cause a massive inflammatory response. Both presenting in one patient can precipitate an overwhelming physiological scenario. Inhaled nitric oxide has recently been demonstrated to have anti-inflammatory effects beyond the pulmonary system, in addition to its ability to improve arterial oxygenation. Furthermore, it is virtually without side effects, and can easily be applied to combat casualties or to civilian casualties. Presentation of hypothesis Use of inhaled nitric oxide in patients with severe traumatic brain injury and acute respiratory distress syndrome will show a benefit through improved physiological parameters, a decrease in biochemical markers of inflammation and brain injury, thus leading to better outcomes. Testing of hypothesis A prospective, randomized, non-blinded clinical trial may be performed in which patients meeting the case definition could be entered into the study. The hypothesis may be confirmed by: (1 demonstrating an improvement in physiologic parameters, intracranial pressure, and brain oxygenation with inhaled nitric oxide use in severely head injured patients, and (2 demonstrating a decrease in biochemical serum markers in such patients; specifically, glial fibrillary acidic protein, inflammatory cytokines, and biomarkers of the hypothalamic-pituitary-adrenal axis, and (3 documentation of outcomes. Implications of hypothesis Inhaled nitric oxide therapy in traumatic brain injury patients with acute respiratory distress syndrome could result in increased numbers of lives saved, decreased patient morbidity

  17. Juxtarenal Mycotic Aneurysm as a Complication of Acute Exacerbation of Chronic Cholecystitis Treated by Resection and Replacement by a Fresh Allograft.

    Grus, Tomáš; Lambert, Lukáš; Rohn, Vilém; Klika, Tomáš; Grusová, Gabriela; Michálek, Pavel

    2016-01-01

    We present a case of a female patient with infectious (mycotic) juxtarenal abdominal aneurysm with atypical symptoms beginning as acute exacerbation of chronic cholecystitis. Apart from common antibiotic treatment, the patient successfully underwent resection of the diseased segment and replacement by a fresh allograft in order to reduce the risk of infection of the graft, but with the need of subsequent life-long immunosuppressive therapy. Perioperative monitoring of the spinal cord by near infrared spectroscopy was used to identify possible spinal ischemia. The choice of the fresh allograft was based on our experience supported by review of the literature.

  18. A Complicated Case of Acute Promyelocytic Leukemia in the Second Trimester of Pregnancy Successfully Treated with All-trans-Retinoic Acid.

    Agarwal, Kanika; Patel, Megha; Agarwal, Vandana

    2015-01-01

    A 40-year-old female at 26-week gestation was diagnosed with acute promyelocytic leukemia (APL) after an abnormal prenatal lab workup showed pancytopenia. She was treated with all-trans-retinoic acid (ATRA), idarubicin, and dexamethasone. After day one of treatment, she developed differentiation syndrome, which was treated with dexamethasone. At 30-week gestation, she had preterm premature rupture of membranes and delivered by cesarean section because of the fetus' breech presentation. Despite ATRA's potential for teratogenicity, a viable infant was born without apparent anomalies. Postpartum, she underwent consolidation treatment with ATRA and arsenic trioxide (ATO). The patient continued ATRA therapy after delivery and is currently in remission.

  19. The HAS-BLED Score Identifies Patients with Acute Venous Thromboembolism at High Risk of Major Bleeding Complications during the First Six Months of Anticoagulant Treatment.

    Judith Kooiman

    Full Text Available The HAS-BLED score enables a risk estimate of major bleeds in patients with atrial fibrillation on vitamin K-antagonists (VKA treatment, but has not been validated for patients with venous thromboembolism (VTE. We analyzed whether the HAS-BLED score accurately identifies patients at high risk of major bleeds during VKA treatment for acute VTE.Medical records of 537 patients with acute VTE (primary diagnosis pulmonary embolism in 223, deep vein thrombosis in 314 starting VKA treatment between 2006-2007 were searched for items on the HAS-BLED score and the occurrence of major bleeds during the first 180 days of follow-up. The hazard ratio (HR for the occurrence of major bleeds comparing non-high with high-risk patients as defined by a HAS-BLED score ≥ 3 points was calculated using Cox-regression analysis.Major bleeds occurred in 11/537 patients (2.0%, 5.2/100 person years, 95% CI 2.8-9.2. Cumulative incidences of major bleeds were 1.3% (95% CI 0.1-2.5 in the non-high (HAS-BLED < 3 and 9.6% (95%CI 2.2-17.0 in the high-risk group (HAS-BLED ≥ 3, (p <0.0001 by Log-Rank test, with a HR of 8.7 (95% CI 2.7-28.4. Of the items in the HAS-BLED score, abnormal renal function (HR 10.8, 95% CI 1.9-61.7 and a history of bleeding events (HR 10.4, 95% CI 2.5-42.5 were independent predictors of major bleeds during follow-up.Acute VTE patients with a HAS-BLED score ≥ 3 points are at increased risk of major bleeding. These results warrant for correction of the potentially reversible risk factors for major bleeding and careful International Normalized Ratio monitoring in acute VTE patients with a high HAS-BLED score.

  20. Complicated rhinosinusitis

    Hansen, F.S.

    2016-01-01

    Complicated rhinosinusitis: a title chosen for its multi-interpretable nature. In the Oxford dictionary ‘complicated’ is defined as ‘consisting of many interconnecting parts or elements’ and ‘involving many different and confusing aspects’ as well as ‘involving complications’ in medicine. It is the

  1. 糖尿病合并脑血管病急性期中医证候演变规律研究%Evolution laws of TCM syndromes of diabetes complicating cerebrovascular disease at acute stage

    占戈; 袁玉娇; 田园; 陈志刚; 谢颖桢

    2012-01-01

    Objective To discuss the evolution laws of TCM syndromes of diabetes complicating cerebrovascular disease at acute stage. Methods The patients with diabetes complicating cerebrovascular disease (re = 137, complicating group) and those without diabetes complicating cerebrovascular disease (re = 158, other disease group) were selected. The TCM syndrome factors included wind, fire, phlegm, blood stasis, qi deficiency and yin deficiency with yang hyperactivity, and they were collected, reviewed and compared at four time points (hospitalized day, 7th day, 14* day and 28* day). Results The evolution laws of TCM syndromes in complicating group were from syndrome of wind stirring due to yin deficiency to phlegm-fire syndrome to phlegm-stasis syndrome to qi deficiency and blood stasis syndrome, and that in other disease group, from wind-phlegm syndrome to phlegm-fire syndrome to phlegm-stasis syndrome to phlegm-stasis syndrome. Conclusion The different evolution laws in diabetes complicating cerebrovascular disease and other diseases provide theoretical basis for treating stroke with TCM at different stages.%目的 探讨糖尿病合并脑血管病急性期中医证候演变规律.方法 选择糖尿病合并脑血管病患者137例,非糖尿病合并脑血管患者158例作为研究对象,中医证候要素分为风、火、痰、瘀、气虚、阴虚阳亢,分别于入院时、发病第7天、14天、28天,4个时点进行证候采集和评价,进行两组比较.结果 糖尿病合并脑血管病组证候演变规律为阴虚风动证→痰火证→痰瘀证→气虚血瘀证.非糖尿病合并脑血管病组证候演变规律为风痰证→痰火证→痰瘀证→痰瘀证.结论 糖尿病合并脑血管病组与非糖尿病合并脑血管病组存在不同的证候演变规律,为中风不同时期的中医临床辨证施治提供了理论依据.

  2. Metastatic Complications and Multiple Organ Failure in Children with Acute Osteomyelitis%小儿急性骨髓炎的迁徙性并发症与多器官功能衰竭

    任德胜; 洪云; 刘方俊; 王保利; 熊斌

    1991-01-01

    本文报告24例有迁徙性并发症的小儿急性骨髓炎,其中8例继发多器官功能衰竭.积极治疗原发病、控制感染、及时发现和处理呼吸与循环系统的并发症是防治的关键.%Twenty four cases of metastatic complications in children with acute osteomyelitis were presented.Among them,multiple organ failure(MSOF)occurred in 8 cases.The clinical diagnosis,treatment and pathogenesis of those cases were discussed.The authors emphasized that supervission and protection of respiratory and circulatory system and the effective treatment of the primary diseases would be of critical importance to a successful salvage.

  3. Clinical analysis of acute abdomen patients complicated with septic shock and distribution of pathogens%急腹症患者感染性休克的临床分析及病原菌分布

    田霞; 亓剑凤; 高伟

    2014-01-01

    OBJECTIVE To explore the clinical characteristics of the acute abdomen patients complicated with septic shock ,analyze the distribution of pathogens ,and formulate the intervention measures so as to improve the level of clinical treatment .METHODS A total of 65 acute abdomen patients complicated with septic shock ,who were trea-ted from Jan 2010 to Jan 2013 ,were randomly recruited in the study ,then the clinical manifestations of the partic-ipants were retrospectively analyzed ,the conventional blood collection or abdominal puncture was performed before surgery ,the specimens were sampled intraperitoneally or intestinally for the bacterial culture during surgery ,and the distribution of the pathogens was observed .RESULTS The major clinical manifestations of the acute abdomen patients with septic shock included the apathy ,dysphoria ,pale and clammy extremities ,and mucocutaneous cya-nosis ;the major physical signs included the hypotension ,low pulse ,slow heart rate ,and oliguria .Totally 73 strains of pathogens have been isolated ,including 53 (72 .60% ) strains of gram-negative bacteria ,17 (23 .29% ) strains of gram-positive bacteria ,and 3 (4 .11% ) strains of fungi .The multivariate logistic regression analysis in-dicated that the age ,disease course ,types of disease ,and timing of treatment were the risk factors for the septic shock in the acute abdomen patients (P<0 .05) .The total cure rate was 93 .85% .CONCLUSIONS The acute abdo-men patients complicated with septic shock have typical clinical manifestations ;the symptomatic treatments such as active anti-shock and anti-infection ,in combination with surgery ,may achieve good prognosis .%目的:探讨急腹症患者合并感染性休克的临床分析及病原菌分布,制定干预对策,以期提高临床治疗水平。方法随机选取2010年1月-2013年1月65例急腹症合并感染性休克患者为研究对象,对其临床表现等进行回顾性分析,术前进行常规的采血或腹

  4. Biliary Ascariasis Complicated with Acute Pancreatitis in 69 Cases of Clinical Research%胆道蛔虫病并发急性胰腺炎69例临床探究

    赵洁

    2013-01-01

    目的对胆道蛔虫病并发急性胰腺炎的治疗方法以及注意事项等进行分析与探讨。方法对本医院在2008年2月~2012年9月之间收治的胆道蛔虫合并急性胰腺炎患者的临床资料进行回顾性分析与总结。结果患者出现了不同的症状,经过驱虫治疗效果较好,有的患者由于延误治疗时机转移至外科治疗。结论纤维胃镜检查系胆道蛔虫并发胰腺炎是较为有效的治疗方法,此病的治疗应该本着镇痛、解痉、驱虫和控制感染的基本原则。%Objective treatment of biliary ascariasis complicated with acute pancreatitis and mat ers needing at ention are analyzed and discussed. Methods the biliary ascariasis in this hospital between 2008 February to 2012 September were combined with clinical data of patients with acute pancreatitis were retrospectively analyzed and summarized. Results the patients had dif erent symptoms, after anthelmintic treatment ef ect is good, some patients delayed treatment to surgical treatment because of. Conclusion Gastroscopy of biliary ascariasis complicated with pancreatitis is more ef ective treatment, the treatment should be in line with the basic principles of analgesic, antispasmodic, antihelminthic and infection control.

  5. 小儿肱骨远端骨折严重合并症——骨筋膜室综合征%A Serious Complication of Fracture of Distal Humerus in Children-Acute Osteofaseial Compartment Syndrome

    刘兴炎; 葛宝丰; 文益民; 甄平; 石骥

    1995-01-01

    32例小儿前臂严重骨筋膜室综合征中,除4例为骨折直接合并肱动脉程度不同损伤继发外,余下之28例均为医源性处理不当所致.基于儿童上肢功能重建的特点,有必要选择外科综合治疗.早期采用骨筋膜室彻底减压,尤其强调早期恢复神经干的血运.对5例晚期缺血性挛缩处理,采用游离吻合血管神经的腓肠肌内侧头肌皮瓣重建手及前臂功能,随访1年以上结果满意.%Thirty-two cases of acute osteofascial compartment syndrome complicated to the distal humerus fracture in chileren were treated.Of them,28 were iatrogenic lesion,others were resulted from fracture of distal humerus complicated by brachial artery injury.The reasons of iatrogenic lesion were discussed in the paper.To protect the residual function of the upper extremity,surgery is essential,In acute stage,early decompression is necessary,including release of the fibrous adhesions around blood vessels,nerves and muscles,in order to improve the blood supply of the nerves.For late sequelae,e.g.ischemic constracture of the forearm,free vascularized medial gastrocnemius muscular flap with neurovascular microsurgical anastomosis was performed.Cases follow up for more than one year showed satisfactory result.

  6. A Complicated Case of Acute Promyelocytic Leukemia in the Second Trimester of Pregnancy Successfully Treated with All-trans-Retinoic Acid

    Kanika Agarwal

    2015-01-01

    Full Text Available A 40-year-old female at 26-week gestation was diagnosed with acute promyelocytic leukemia (APL after an abnormal prenatal lab workup showed pancytopenia. She was treated with all-trans-retinoic acid (ATRA, idarubicin, and dexamethasone. After day one of treatment, she developed differentiation syndrome, which was treated with dexamethasone. At 30-week gestation, she had preterm premature rupture of membranes and delivered by cesarean section because of the fetus’ breech presentation. Despite ATRA’s potential for teratogenicity, a viable infant was born without apparent anomalies. Postpartum, she underwent consolidation treatment with ATRA and arsenic trioxide (ATO. The patient continued ATRA therapy after delivery and is currently in remission.

  7. Effectiveness of anti-inflammatory treatment versus antibiotic therapy and placebo for patients with non-complicated acute bronchitis with purulent sputum. The BAAP Study protocol

    Fernández Yvonne

    2011-06-01

    Full Text Available Abstract Background Acute bronchitis is one of the most prevalent respiratory infections in primary care, and in more than 90% of the cases antibiotics are prescribed, mainly when purulent expectoration is present. However, this process is usually viral in origin and the benefits of antibiotic treatment are marginal. On the other hand, in recent years bronchitis has been considered more as an inflammatory than an infectious process. Thus, the aim of this study is to evaluate the clinical effectiveness of a schedule of an oral anti-inflammatory compared with an antibiotic regimen and another group assigned to receive a placebo. Methods and design A total of 420 patients from 15 to 70 years of age with no associated comorbidity, presenting respiratory tract infection of at least one week of evolution, with cough as the predominant symptom, the presence of purulent expectoration and at least one other symptom of the respiratory tract (dyspnoea, wheezing, chest discomfort or pain, with no alternative explanation such as pneumonia, will be included in a prospective, randomised and controlled, clinical trial with placebo. The patients will be randomised to receive one of three treatments: ibuprofen, amoxycillin and clavulanic acid or placebo for 10 days. The main outcome measure is the number of days with frequent cough defined by the symptom diary with a score of 1 or more. Discussion This trial is designed to evaluate the number of days with frequent cough with anti-inflammatory treatment compared with antimicrobial treatment and placebo in previously healthy patients with a clinical picture of acute bronchitis and purulent expectoration. It is hypothesized that anti-inflammatory treatment is more effective than antibiotic treatment to reduce cough, which is the most disturbing symptom for patients with this infection. Trial registration ISRCTN07852892

  8. Pulmonary complications in neurosurgical patients

    Randeep Guleria

    2012-01-01

    Full Text Available Pulmonary complications are a major cause of morbidity and mortality in neurosurgical patients. The common pulmonary complications in neurosurgical patients include pneumonia, postoperative atelectasis, respiratory failure, pulmonary embolism, and neurogenic pulmonary edema. Postoperative lung expansion strategies have been shown to be useful in prevention of the postoperative complications in surgical patients. Low tidal volume ventilation should be used in patients who develop acute respiratory distress syndrome. An antibiotic use policy should be put in practice depending on the local patterns of antimicrobial resistance in the hospital. Thromboprophylactic strategies should be used in nonambulatory patients. Meticulous attention should be paid to infection control with a special emphasis on hand-washing practices. Prevention and timely management of these complications can help to decrease the morbidity and mortality associated with pulmonary complications.

  9. Quality of Life and Long-term Complications of Patients After Severe Acute Pancreatitis%重症急性胰腺炎患者预后生存质量与远期并发症

    邱毓祯

    2012-01-01

    重症急性胰腺炎(SAP)患者预后生存质量常用SF-36量表来评价,发现患者心理、生理健康均有不同程度受损.在SAP的远期并发症中,胰腺炎的复发及慢性胰腺炎的发生与病因密切相关,胰腺内、外分泌功能不全应予以替代治疗,假性囊肿、胰瘘等局部并发症主要以观察为主,必要时外科干预.现就SAP患者预后生存质量和远期并发症等方面予以综述.%The Rand 36-item Health Survey was applied to evaluate the quality of life of patients after severe acute pancreatitis, and it was found that physical and mental health were affected. The recurrence of AP and the evolvement of chronic pancreatitis were related with the etiologies. Replacement therapy should be taken in case of impairment of pancreatic endocrine and exocrine function. Pseudocysts and pancreatic fistules should be followed regularly, when complications appeared, surgical intervation should be taken. Here is to make a review on the quality of life and long-term complications of SAP patients after treatment.

  10. 血清降钙素原对急性重度脑卒中患者并感染的预测价值研究%The predictive value of procalcitonin in severe acute cerebral apoplexy complicated infection

    马晓红

    2013-01-01

    Objective To evaluation the predictive value of serum procalcitonin (PCT) in severe acute cerebral apoplexy complicated infection. Methods Severe brain damage due to acute stroke, need access to ICU care of 48 patients, Detect when admitted to ICU, 3rd-, 5th-day PCT, and serum c-reactive protein (CRP) levels and occurrence of infections. Results Compared with non-infected group, Infected patients into icu and 3 days, 5 days serum PCT level significantly higher, The difference has statistics significance (P 0.05). Conclusion PCT determination contributed to early prediction of occurrence of severe infection in patients with acute cerebral apoplexy.%目的评估严重急性脑卒中患者的血清降钙素原(PCT)预测感染的临床价值。方法对急性脑卒中导致的严重脑损伤,需要进入ICU监护的患者48例,检测其入住ICU时第3天、第5天血清PCT和C反应蛋白(CRP)水平及感染发生情况。结果与非感染组相比,感染组患者入ICU时及第3天、第5天时血清PCT水平明显升高,差异有统计学意义(P0.05)。结论PCT测定有助于早期预测严重急性脑卒中患者感染的发生。

  11. Effect of amino acid powder on infants with acute diarrhea complicated with lactose intolerance%氨基酸奶粉对急性腹泻并发乳糖不耐受患儿的疗效

    王仁丰; 项秀荷

    2013-01-01

    目的:观察氨基酸奶粉在婴儿急性腹泻并发乳糖不耐受治疗中的效果。方法选取大便检测还原糖阳性的急性腹泻患儿130例作为研究对象,随机分为治疗组62例和对照组68例。两组均给予常规药物治疗的基础上,治疗组给予氨基酸特殊配方奶粉喂养,对照组给予无乳糖婴儿配方奶粉喂养,观察5天后两组的治疗效果。结果氨基酸奶粉喂养组腹泻的总有效率为95.16%,无乳糖奶粉喂养组的总有效率为82.35%,治疗组的总有效率高于对照组,差异有统计学意义(χ2=5.212,P<0.05)。结论氨基酸奶粉在婴儿急性腹泻并发乳糖不耐受的治疗中效果显著,能减轻腹泻症状,疗效优于无乳糖奶粉。%Objective To observe the efficacy of amino acid powder on infants with acute diarrhea complicated with lactose intolerance . Methods Totally 130 infants with acute diarrhea whose stool examination was positive for reducing sugar were selected in the study , and they were randomly divided into treatment group ( n =62 ) and control group ( n =68 ) .Based on conventional drug treatment , the treatment group was given special amino acid powder feeding , while the control group was given lactose-free infant powder feeding .The curative effect of two groups was observed after 5 days.Results The total effective rate was 95.16% and 82.35% in the treatment group and the control group, respectively, and the difference was statistically significant (χ2 =5.212, P<0.05).Conclusion The effect of amino acid powder on infants with acute diarrhea complicated with lactose intolerance is remarkable .Amino acid powder can alleviate the symptoms of diarrhea , and its efficacy is better than that of lactose-free powder .

  12. Meningencefalites bacterianas agudas em crianças: complicações e sequelas neurológicas Acute bacterial meningoencephalitis in children: complications and neurologic sequelae

    WLADIMIR NATALINO

    1999-06-01

    Full Text Available Foram estudadas 271 crianças com idade inferior a 15 anos, com diagnóstico de meningencefalite bacteriana aguda (MBA, no período 1980 -- 1990. Os pacientes foram divididos em dois grupos, conforme não tivessem recebido tratamento prévio (STP, 153 casos, e os que receberam tratamento prévio (CTP, 118 casos. Ocorreram diferenças significativas em relação a identificação do agente etiológico, que foi maior no grupo STP, e em relação a ocorrência de ventriculite, maior no grupo CTP. Ocorreu óbito em 19,5% dos 271 casos, com predomínio em crianças de idade abaixo de 12 meses (29,7% e nos pacientes com MBA por Streptococcus pneumoniae. As manifestações epilépticas e as paresias na fase aguda da MBA predominaram em crianças de idade abaixo de 1 ano. Foram identificados e tratados do ponto de vista neurocirúrgico as ventriculites, higroma subdural, hidrocefalia, empiema subdural e abscesso cerebral.We studied 271 children under age of 15 with diagnosis of acute bacterial meningencephalitis treated at Medical School in Ribeirão Preto, University of São Paulo, between 1980 and 1990. The patients were divided in two groups: 1 those who had not received previous antibiotics treatment (NTP, with 153 cases; and 2, those who had received previous antibiotics treatment (PT, with 118 cases. The etiological agent was more frequently identified in NPT group, while ventriculitis was more frequent in PT group. Mortality rate accounted for 19,5% of all cases, and 29.7% of children under 12 months of age. Acute meningitis caused by Streptococcus pneumoniae was frequently followed by increased mortality. Convulsive disorders and hemiparesis predominante among children under 12 months of age. On the neurosurgical point of view, ventriculitis, subdural hygroma, hydrocephalus, subdural empyema and brain abscess were identified and treated

  13. Clinical analysis of seven cases with acute myocardial infarction complicated psychiatric symptoms%急性心肌梗死患者并发精神症状临床分析(附7例报告)

    任澎; 王勇; 古孜丽; 李国庆; 涂良珍

    2012-01-01

    目的:探讨急性心肌梗死(AMI)并发精神症状的原因和治疗方法.方法:回顾分析7例AMI并发精神症状患者的临床资料、诊断和治疗方法.结果:所有患者均给以规范的冠心病二级预防治疗.病例1、3给以心境稳定剂,心理疏导、亲人安慰关怀,症状很快缓解;病例4转脑外科治疗;病例5予以小剂量镇静剂联合心理辅导;病例2、6、7给以小剂量抗精神病药物治疗.所有患者出院前均恢复正常.出院后1,3,6月随访患者无精神症状发生.结论:急性心肌梗死并发精神症状在常规冠心病治疗基础上给予心理治疗及抗精神病药物治疗预后良好.%Objective: To study causes and therapeutic methods of acute myocardial infarction (AMI) complicated psychiatric symptoms. Methods: Clinical data, diagnosis and therapeutic methods of seven AMI patients complicated psychiatric symptoms were retrospectively analyzed. Results: All patients received uniform secondary prevention and therapy for coronary heart disease. First case and third case received mood stabilizers, psychological counseling and comforts from family, and symptoms relieved soon; fourth case was transferred to brain surgery; fifth case received amall dose of sedative combined psycholgical counseling; second, sixth and seventh cases received small dose of antipsychotics. All patients recovered before discharge. No psychiatric symptoms occurred on first, third and sixth month after discharge. Conclusion: Psychological therapy and antipsychotic drug treatment based on routine treatment of coronary heart disease can achieve good prognosis in patients with acute myocardial infarction complicated psychiatric symptoms.

  14. [Orbital complications of sinusitis].

    Šuchaň, M; Horňák, M; Kaliarik, L; Krempaská, S; Koštialová, T; Kovaľ, J

    2014-12-01

    Orbital complications categorised by Chandler are emergency. They need early diagnosis and agresive treatment. Stage and origin of orbital complications are identified by rhinoendoscopy, ophtalmologic examination and CT of orbite and paranasal sinuses. Periorbital cellulitis and early stage of orbital cellulitis can be treated conservatively with i. v. antibiotics. Monitoring of laboratory parameters and ophtalmologic symptoms is mandatory. Lack of improvement or worsening of symptoms within 24-48 hours and advanced stages of orbital complications are indicated for surgery. The purpose of the study is to evaluate epidemiology, clinical features and management of sinogenic orbital complications. Retrospective data of 8 patients with suspicion of orbital complication admited to hospital from 2008 to 2013 were evaluated. Patients were analyzed in terms of gender, age, CT findings, microbiology, clinical features, stage and treatment. Male and female were afected in rate 1,66:1. Most of patients were young adult in 3rd. and 4th. decade of life (62,5 %). Acute and chronic sinusitis were cause of orbital complication in the same rate. The most common origin of orbital complication was ethmoiditis (62,5 %), than maxillary (25 %) and frontal (12,5 %) sinusitis. Polysinusitis with affection of ethmoidal, maxillary and frontal sinuses (75 %) was usual CT finding. Staphylococcus epidermidis and Staphylococcus aureus were etiological agens in half of cases. Periorbital oedema (100 %), proptosis, chemosis (50 %), diplopia and glaucoma (12,5 %) were observed. Based on examinations, diagnosis of periorbital oedema/preseptal cellulitis was made in 3 (37,5 %), orbital cellulitis in 3 (37,5 %) and subperiosteal abscess in 2 cases (25 %). All patients underwent combined therapy - i. v. antibiotics and surgery within 24 hours. Eradication of disease from ostiomeatal complex (OMC), drainage of affected sinuses and drainage of subperiosteal abscess were done via fuctional endonasal

  15. Therapeutic effect of early rehabilitation on aged patients with acute myocardial infarction complicated heart failure%早期康复对老年急性心肌梗死合并心衰患者的疗效

    卜庆锋; 刘杰; 李法祥; 唐娟

    2014-01-01

    目的:探讨早期康复对老年急性心肌梗死(AMI)合并心衰患者的疗效。方法:选择 AMI 患者168例,按数字表法随机分为早期康复组(84例,实施早期康复方案)和常规治疗组(84例,实施常规治疗)。比较康复程序结束时两组并发症发生率,踏车试验及步行试验完成情况。结果:两组梗塞后心绞痛、再梗塞、住院期间死亡例数、左室射血分数等对比无显著性差异(P >0.05)。与常规治疗组比较,早期康复组程序结束时踏车试验(77.6%比95.0%),步行试验(65.4%比95.8%)完成率显著提高(P 均<0.01)。早期康复组因长期卧床后易出现的并发症的发生率均显著低于常规护理组(P <0.05或 P <0.01)。结论在严密监护下对老年急性心肌梗死合并心衰(35%<左室射血分数<50%)患者实施早期康复方案是安全、有益的,可减少长期卧床所致并发症的发生,改善病人的运动功能,提高生活质量。%Objective:To explore the therapeutic effect of early rehabilitation on aged patients with acute myocardial infarction (AMI)complicated heart failure (HF).Methods:According to number table method,a total of 168 AMI cases were divided into early rehabilitation group (n=84,received early rehabilitation protocol)and routine treat-ment group (n=84,received traditional treatment).Incidence rate of complication,bicycling test and walking test result were compared between two groups at the end of rehabilitation program.Results:There were no significant difference in angina pectoris after myocardial infarction,re-infarction,dead cases during hospitalization and left ventricular ejection fraction (LVEF)etc.between two groups (P > 0.05 all).Compared with routine treatment group,there were significant rise in completion rates of bicycling test (77.6% vs.95.0%)and walking test (65.4%vs.95.8%)at the end of program in early rehabilitation group

  16. Acute kidney injury during pregnancy.

    Van Hook, James W

    2014-12-01

    Acute kidney injury complicates the care of a relatively small number of pregnant and postpartum women. Several pregnancy-related disorders such as preeclampsia and thrombotic microangiopathies may produce acute kidney injury. Prerenal azotemia is another common cause of acute kidney injury in pregnancy. This manuscript will review pregnancy-associated acute kidney injury from a renal functional perspective. Pathophysiology of acute kidney injury will be reviewed. Specific conditions causing acute kidney injury and treatments will be compared.

  17. 快速康复外科护理应用于急腹症并发抑郁症患者的临床成效%Clinical effect of fast track surgery nursing for acute abdomen complicated with depression

    古金花; 邹艳花; 陈小银

    2015-01-01

    目的:探究急腹症并发抑郁症患者实施快速康复外科护理对其术后病情康复及情绪状况的影响,并为这类人群的优质护理服务积累经验。方法选取我院普外科于2010年8月~2012年7月收治的39例急腹症并发抑郁症患者,设为对照组,实施常规普外科护理干预;选取我院普外科于2012年8月~2014年7月收治的43例急腹症并发抑郁症患者,设为研究组,实施快速康复外科护理干预。两组患者均于住院当天及干预后第5天末均接受简明抑郁症评定量表(BPRS)测评,同时记录两组患者术后进食时间、下床活动时间、医疗费用、住院时间、并发症发生率。结果研究组下次活动时间、术后进食时间、住院时间短于对照组(P<0.05),并发症发生率及医疗费用低于对照组(P<0.05)。两组干预前BPRS评分差异无统计学意义(P>0.05);干预后,研究组焦虑忧郁因子、缺乏活力因子、思维障碍因子及敌对猜疑因子均低于对照组(P<0.05),激活性因子高于对照组(P<0.05)。结论对于并发抑郁症的急腹症患者,快速康复外科理念能促进患者病情预后康复,降低并发症发生率,且有助于改善患者情感状态,促进社会功能的早日回归,取得较为满意的临床成效。%Objective To explore the effect of implementing fast rehabilitation surgery nursing on the postoperative condition and mood of acute abdomen complicated with depressive disorder,and accumulate experience for the high quality of nursing service in this group. Methods 39 cases of acute abdomen complicated with depression patients were selected in our hospital in 2010 August to 2012year in July in Department of general surgery were set as the control group,routine nursing intervention,the implementation of the department of general surgery;43 cases of acute abdomen complicated with depression patients were selected in

  18. [Respiratory complications after transfusion].

    Bernasinski, M; Mertes, P-M; Carlier, M; Dupont, H; Girard, M; Gette, S; Just, B; Malinovsky, J-M

    2014-05-01

    Respiratory complications of blood transfusion have several possible causes. Transfusion-Associated Circulatory Overload (TACO) is often the first mentioned. Transfusion-Related Acute Lung Injury (TRALI), better defined since the consensus conference of Toronto in 2004, is rarely mentioned. French incidence is low. Non-hemolytic febrile reactions, allergies, infections and pulmonary embolism are also reported. The objective of this work was to determine the statistical importance of the different respiratory complications of blood transfusion. This work was conducted retrospectively on transfusion accidents in six health centers in Champagne-Ardenne, reported to Hemovigilance between 2000 and 2009 and having respiratory symptoms. The analysis of data was conducted by an expert committee. Eighty-three cases of respiratory complications are found (316,864 blood products). We have counted 26 TACO, 12 TRALI (only 6 cases were identified in the original investigation of Hemovigilance), 18 non-hemolytic febrile reactions, 16 cases of allergies, 5 transfusions transmitted bacterial infections and 2 pulmonary embolisms. Six new TRALI were diagnosed previously labeled TACO for 2 of them, allergy and infection in 2 other cases and diagnosis considered unknown for the last 2. Our study found an incidence of TRALI 2 times higher than that reported previously. Interpretation of the data by a multidisciplinary committee amended 20% of diagnoses. This study shows the imperfections of our system for reporting accidents of blood transfusion when a single observer analyses the medical records.

  19. Risk factor analysis and prevention of acute cerebral infarction complicated with pulmonary infection%急性脑梗死合并肺部感染的危险因素分析及防治

    茆华武

    2012-01-01

    目的 探讨急性脑梗死合并肺部感染的相关危险因素以及防治措施,为该病的治疗提供参考依据.方法 回顾性分析2010年5月~2012年4月本院收治的90例急性脑梗死患者,分为肺部感染组28例和对照组62例,分析相关危险因素及防治措施.结果 与对照组比较,肺部感染组合并吞咽困难、意识障碍以及大面积脑梗死、肺部疾病等基础疾病明显增多;肺部感染组NIHSS、临床神经功能缺损评分较对照组明显升高;肺部感染组血清的pH、氧分压(PaO2)、CO2分压(PaCO2)、全血高切黏度均与对照组差异显著,且血清肿瘤坏死因子-α和白细胞介素-6明显高于对照组.结论 COPD病史、入院时NIHSS 评分高、吞咽困难、意识障碍、大面积脑梗死以及基础疾病是急性脑梗死合并肺部感染的危险因素,一旦诊断,应当给予积极有效的治疗,包括保持呼吸道通畅,及时改善肺功能,纠正脑缺氧,降低脑梗死面积,协助患者经常改变体位,合理选用抗生素,加强营养支持等.%Objective To study the associated risk factors and prevention of acute cerebral infarction complicated with pulmonary infection, so as to provide the references for treatment. Methods Ninety patients with acute cerebral infarction complicated with pulmonary infection from 2010 May to 2012 April in our hospital were divided into pulmonary infection group (n =28) and control group (n =62). The associated risk factors and prevention were analyzed. Results Compared with the control group, the dysphagia, disturbance of consciousness, large area cerebral infarction, and pulmonary disease increased significantly in pulmonary infection group. The NIHSS score, neural function defect score of pulmonary infection group were significantly higher than that in the control group. The scrum pH, PaC>2, PaCO2, whole blood viscosity in the two groups had significant difference, and the serum TNF-a and IL 6 of pulmonary infection

  20. 急性脊髓损伤患者并发低钠血症的危险因素分析及护理%Risk Factors of Acute Spinal Cord Injury Patients Complicated with Hyponatremia and Nursing Strategy

    鲍娟; 章泾萍; 罗琨; 何爱兄; 徐智华

    2013-01-01

      目的探讨急性脊髓损伤患者并发低钠血症的危险因素,以提供针对性的护理干预措施,提高护理质量,改善患者预后.方法回顾性分析121例确诊为急性脊髓损伤患者,根据有无并发低钠血症将患者分为两组,分析年龄、性别、损伤平面、完全截瘫、损伤严重程度、精神状态、甘露醇使用、激素使用、高热、腹泻、合并感染、合并颅脑损伤及血糖、血钾值等指标对其发生的影响,采用单因素分析和Logistic多元回归分析.结果脊髓损伤患者低钠血症发生率为43.8%,多因素Logistic回归模型分析显示:高热、合并颅脑损伤是低钠血症发生的独立危险因素(P<0.05).结论高热和合并颅脑损伤是急性脊髓损伤患者并发低钠血症的独立危险因素.应针对危险因素早期加强护理评估和护理干预,降低急性脊髓损伤后低钠血症的发生率.%Objective To investigate the risk factors and nursing measures of acute spinal cord injury with hyponatremia. Methods One hundred and twenty-one patients diagnosed as acute spinal cord injury were analyzed retrospectively. And the patients were divided into two groups according to whether complicated with hyponatremia. Multiple possible influence factors including age, gender, injury level, complete paraplegia or not, Frankel classification, mental status, use of mannitol, use of glucocorticoid, hyperthermia or not, diarrhea or not, whether combined with infection, whether combined with brain injury, blood glucose and serum potassium were studied by univariate analysis and multivariate Logistic regression analysis. Results Hyponatremia occurred in 43.8%of the patients with spinal cord injury. Multivariate Logistic regression analysis showed that hyperthermia (OR=1.927, P=0.048) and combined with brain injury were independent risk factors of hyponatremia (OR=3.132, P=0.042). Conclusion Hyperthermia and combined with brain injury are

  1. 急性脑血管病并发脑心综合征55例临床分析%Analysis of acute cerebrovascular disease complicated by brain- heart syndrome 55 cases

    杨彦; 滕军放

    2012-01-01

    目的 探讨急性脑血管病并发脑心综合征的发病机制和防治措施.方法 选择郑州大学第一附属医院2008年9月至2011年8月收治的急性脑血管病患者90例,回顾性分析其临床资料,观察并发脑心综合征的发生率,并分析发病机制和防治效果.结果 全部患者并发脑心综合征55例,发生率为61.11%.其中出血性脑血管病48例,占87.27%;缺血性脑血管病7例,占12.73%.经综合治疗后,好转53例,好转率为96.36%.结论 脑心综合征的发生可能与急性脑血管病的类型有关,出血性脑血管病高于缺血性脑血管病.其发生机制可能与脑受损后对心脏神经支配紊乱、神经和体液调节障碍、血管病变及血流动力学变化有关.应注意加强对急性脑血管病尤其是出血性脑血管病患者的心功能监护,积极防治脑心综合征.%Objective To investigate the pathogenesis and prevention measures of acute cerebrovascular disease complicated by brain - heart syndrome,and provide a reference for clinical work. Methods Totally 90 patients with acute ce-rebrovascular disease were treated in our hospital from September 2008 - August 2011,a retrospective analysis of clinical data,observation of brain - heart syndrome,complicated by incidence,pathogenesis and control. Results All patients with brain - heart syndrome in 55 cases,the rate was 61. 11%. One of hemorrhagic cerebrovascular disease in 48 cases,accounting for 87. 27% ; Ischemic cerebrovascular disease in 7 cases,accounting for 12. 73%. Comprehensive treatment ,improved in 53 cases,improvement rate was 96. 36%. Conclusions Brain - heart syndrome may occur with the type of acute cerebrovascular disease,hemorrhagic cerebrovascular disease was more than ischemic cerebrovascular disease. In future clinical work,should be paid attention to acute hemorrhagic cerebrovascular disease,especially heart function in patients with cerebrovascular disease monitoring,to prevent and treat

  2. Clinicopathologic features of infant pleuropulmonary blastoma%婴儿胸膜肺母细胞瘤临床病理观察

    徐升; 刘光; 王瑾; 李琳

    2012-01-01

    Objective To explore the significance of clinicopathological features and differential diagnosis of pleuropulmonary blastoma. Methods We observed 1 case of pleuralpulmonary blastoma on the histopathological and immunohistochemical features, with review of the literature. Results The patient was a 4-month-old boy with cough and cyanosis for 3 days. Gross examination showed that the size of the right lung and tumor tissue was 9 cm x 6 cm x 4 cm with gray and soft solid of cutting surface. Tumor and its boundaries were clear and occupied most of the lung. Microscopically tumors mainly composed of embryonal primitive round or oval cells. These cells were medium in size with less cytoplasm, clear nucleolus, and mitosis was easily seen. Some areas had characteristics of spindle cell sarcoma or malignant fibrous histiocytoma that was mainly composed of spindle and short spindle cells. Immunohistochemical studies showed that tumor cells were positive for vimentin and local positive for SMA, the nodule of cartilage were positive for S-100. The tumor cells were negative for CK ( AE1/AE3) , EMA, CD99, desmin, calretinin, calponin, FLI and Myo-D1. Conclusion Pleuralpulmonary blastoma is a relatively rare but highly malignant tumor. The most typical manifestation of pathology is the original malignant small cell aggregates. For early diagnosis and treatment, pleuralpulmonary blastoma needs to be differentiated from pulmonary blastoma, sarcomatoid mesothelioma, embryonal rhabdomyosarcoma, synovial fibroids, and primitive neuroectodermal tumor and so on.%目的 探讨胸膜肺母细胞瘤临床病理学特点及鉴别诊断.方法 对1例胸膜肺母细胞瘤进行组织病理学观察并行免疫组化标记,同时复习相关文献.结果 患儿男性,4个月.咳喘伴紫绀3天.巨检:右肺肿物,组织大小9 cm×6 cm×4 cm,切面灰白色,实性、质软;肿物与肺界限尚清,并占据大部分肺.镜检:肿瘤主要由原始胚胎性的圆形或卵圆形细胞组成,

  3. Neurologic Complications of Pre-eclampsia

    Zeeman, Gerda G.

    2009-01-01

    Pre-eclampsia is mainly responsible for the world's large maternal mortality rates, mostly due to acute cerebral complications. This review provides insight into the pathogenesis of the neurologic complications of hypertensive disease in pregnancy. In addition, practical relevance for clinical care

  4. 重组人脑利钠肽在应激性心肌病并急性泵衰竭中的应用%Application of recombinant human brain natriuretic peptide in stress cardiomyopathy complicated acute left heart failure

    余浩; 胡晓军; 李姣; 孙玉真

    2016-01-01

    Objective:To observe therapeutic effect of lyophilized recombinant human brain natriuretic peptide (Lrh-BNP)on stress cardiomyopathy (SCM)complicated acute bump failure.Methods:A total of 23 patients with SCM complicated acute bump failure were randomly divided into routine treatment group (n=10,received routine treatment)and Lrh-BNP group (n=13,received Lrh-BNP based on routine treatment).Clinical symptoms and signs,cardiac function :left ventricular ejection fraction (LVEF),stroke volume (SV),cardiac index (CI),peak early diastolic velocity/peak late diastolic velocity (E/A)assessed by echocardiography before and after treatment, and total effective rate were compared between two group.Results:Total effective rate of Lrh-BNP group was sig- nificantly higher than that of routine treatment group (92.3% vs.80.0% ,P0.05 all);after treatment,com- pared with routine treatment group,there were significant rise in LVEF [(50.2±16.3)% vs.(59.4±14.1)%],SV [(39.5±10.4)ml vs.(48.3±12.5)ml],CI [(3.7±1.1)L min-1 m-2 vs.(4.6±1.4)L min-1 m-2 ]and E/A [(1.0±0.5)vs.(1.3±0.7)]in Lrh-BNP group,P0.05);治疗后,与常规治疗组比较,Lrh-BNP组LVEF[(50.2±16.3)%比(59.4±14.1)%]、SV[(39.5±10.4)ml比(48.3±12.5)ml]、CI[(3.7±1.1)L·min-1·m-2比(4.6±1.4)L·min-1·m-2]、E/A[(1.0±0.5)比(1.3±0.7)]显著升高(P均<0.05).结论:Lrh-BNP治疗应激性心肌病合并急性泵衰竭有明显疗效.

  5. Clinical analysis of patients with acute cardiac tamponade complicating percutaneous coronary intervention%经皮冠状动脉介入治疗并发急性心脏压塞的临床分析

    宁尚秋; 刘文娴; 陈立颖; 康铁朵; 李江; 杨鲲; 马长生; 吕树铮

    2011-01-01

    Objective: To report eight cases of acute cardiac tamponade complicationg percutaneous coronary intervention( PCI) , and summarize the causes, manifestation and results of management Methods:From Jan 2005 to Dec. 2008, a total of 5 241 patients with coronary artery disease were treated with PCI in cardiology department of Beijing Anzhen hospital. Among them, 8 patients were complicated with cardiac tamponade. Pencardiocentesis was managed, and surgical procedure was done when pericardiocentesis failed.Results :Total incidence of acute cardiac tamponade was 0. 15% . The early clinical presentation of 8 patients was chest distress and hypotension. Pericardiocentesis was carried out in 7 patients. In 2 of them, surgical management was needed because of active bleeding. 1 patient was dead due to not doing pericardiocentesis.Conclusion:Cardiac tamponade is a severe complication of PCI. It is very important to recognize and treat the cardiac tamponade as soon as possible.%目的:分析8例经皮冠状动脉介入治疗(PCI)并发的急性心脏压塞原因、临床表现和治疗结果.方法:2005年1月至2008年12月对5 241例冠心病患者进行了PCI术,8例患者并发急性心脏压塞.采用心包穿刺引流术处理,无效时采用外科手术.结果:急性心脏压塞的发生率为0.15%.8例患者早期均表现为胸闷、血压下降.7例患者行紧急心包穿刺引流,其中2例因引流后仍继续出血而行外科修补手术.1例患者未行心包穿刺引流死亡.结论:急性心脏压塞是PCI术的严重并发症,及时发现和有效救治是十分重要的.

  6. Effect of Beam Orientation on Acute Complications in Intensity-modulated Radiation Therapy of Nasopharyngeal Carcinoma%鼻咽癌调强放疗射野方向对急性放疗反应的影响

    张昊; 胡彩容; 林少俊; 潘建基; 韩露; 林锦; 张秀春

    2012-01-01

    目的:比较两种不同射野方案的鼻咽癌调强计划及其导致的急性放疗反应,确定出一种合理的射野方案.方法:随机选20例鼻咽癌患者,应用飞利浦Pinnacle 8.0计划系统进行设计.其中10例患者采用IMRT-7P方案进行治疗,即调强放疗(IMRT)7野后半平面的均分布野方案;另10例患者采用IMRT-7A方案,即IMRT7野均分的布野方案.再分别模拟出对应的后半平面野和均分野计划,进行剂量学比较.比较参数为计划靶区的覆盖、均匀指数(HI)和适形指数(Cl)以及危及器官(OARs).观察并比较两组患者急性放疗反应.结果:两组计划具有相似的靶区覆盖、HI和CI,IMRT-7P对保护脑干、脊髓、腮腺和颌下腺,具有一定的优势(P<0.05),特别是保护了口腔.口腔的DMFAN:(29.3±1.3)Gy,(35.7±2.3)Gy,P<0.01;V30:(36.2±5.4)%,(73.1±10.9)%,P<0.01;V40:(13.3±3.8)%,(29.0±9.7)%,P<0.01.IMRT-7P所治疗的患者在口干、口腔黏膜炎、皮肤损伤和体质量下降上急性放疗反应更轻(P<0.05).结论:鼻咽癌IMRT-7P治疗方案能一定程度上减少危及器官的剂量,更好的保护危及器官,减轻了急性放疗反应.%Objective: The aim of this study was to compare two different beam arrangements in the treatment plan of intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) and its acute complications to find a reasonable beam arrangement. Methods: Twenty NPC patients were randomly selected in the study. Philips Pinnacle Planning System 8.0 was chosen to design the IMRT plan. Ten of the 20 patients were treated by the IMRT-7P plan, which was planned by the hind half-planes of seven fields of the IMRT plan. The remaining 10 patients were treated by the IMRT-7A plan, which was planned by seven equi-spaced fields of the IMRT plan. Then, the plans of homologous hind half-plane and equi-spaced fields were re-planned. Dosimetric comparisons between IMRT-7P and IMRT-7 A were conducted

  7. 急性心肌梗死并发心源性休克的干预进展%Progress on intervention for acute myocardial infarction complicated with cardiogenic shock

    张文芳; 胡桃红; 丁力平

    2013-01-01

    Cardiogenic shock is one of the most serious complications of acute myocardial infarction with an incidence rate of 7% to 10%. In recent years, with the development of revascularization techniques, such as percutanous coronary intervention (PCI) and coronary artery bypass grafting (CABG), the effective cooperation of dopamine and intraaortic balloon pumping (IABP), and the application of new drug-levosimendan, and mechanical circulatory assist devices, ventricular assist device (VAD) and extracorporeal membrane oxygenation (ECMO), the mortality rate has declined from 70%-80% in 1970s to 50% now. In this paper, we summarized the diagnostic criteria, pathophysiology and interventional measures for cardiogenic shock secondary to acute myocardial infarction.%心源性休克是急性心肌梗死(AMI)最严重的并发症之一,其发病率为7%~10%.近些年,随着经皮冠状动脉介入术(PCI)、冠状动脉旁路移植术(CABG)等血运重建技术的熟练应用和多巴胺、主动脉球囊反搏技术(IABP)的有效配合,以及新型药物左西孟坦和心室辅助装置(VAD)、体外膜氧合(ECMO)的应用,其病死率由70年代的70%~80%下降到50%.本文综述了急性心肌梗死并发的心源性休克的诊断标准、病理生理机制、尤其是干预手段的应用进展.

  8. Propensity-matched analysis to compare the therapeutic efficacies of cefuroxime versus cefotaxime as initial antimicrobial therapy for community-onset complicated nonobstructive acute pyelonephritis due to Enterobacteriaceae infection in women.

    Chang, U-Im; Kim, Hyung Wook; Wie, Seong-Heon

    2015-05-01

    This study was performed to compare the therapeutic efficacy of cefuroxime with that of cefotaxime as initial antimicrobial therapies in women with complicated nonobstructive acute pyelonephritis (APN) caused by Enterobacteriaceae infections. The clinical characteristics and outcomes of a cefuroxime-treated group (n = 156) were compared with those of a cefotaxime-treated group (n = 166). Of these 322 women, 90 from each group were matched by propensity scores. The defervescence rates were not significantly different in the cefuroxime and cefotaxime groups at 72 h after the start of antimicrobial therapy (81.1% versus 78.9%, P = 0.709). The clinical and microbiological cure rates during the follow-up visits that were 4 to 14 days after the end of the antimicrobial therapies were not significantly different in the cefuroxime versus cefotaxime groups, which were 97.8% (87/89) versus 97.8% (87/89) (P > 0.999) and 89.5% (68/76) versus 90.7% (68/75) (P = 0.807), respectively. The median hospital stay duration and the median times to defervescence in the cefuroxime versus cefotaxime groups were 8 days (interquartile range [IQR], 7 to 10 days) versus 9 days (IQR, 7 to 11 days), respectively, and 55 h (IQR, 37 to 70 h) versus 55 h (IQR, 35 to 69 h), respectively. Bacteremia, extended-spectrum-β-lactamase-producing Enterobacteriaceae, C-reactive protein levels of ≥ 15 mg/dl, and white blood cell counts of ≥ 15,000/mm(3) of blood had independent effects on the rates of early clinical failure. Our data suggest that the effects of cefuroxime are not different from those of cefotaxime when they are used as an initial antimicrobial treatments for community-onset complicated nonobstructive APN in women.

  9. Analysis of acute organophosphate poisoning complicated with plmonary edema: 52 cases%52例有机磷农药急性中毒并发急性肺水肿分析

    石峰

    2001-01-01

    Objective To discuss the clinical features and treatment of pulmonary edema caused by acute organophosphate poisoning. Methods The symptoms and therapeutic results of 52 cases (1994.1~ 1998.12) of organophosphate poisoning complicated with pulmonary edema were summrized. Results The clinical features of pulmonary edema caused by acute organophosphate poisoning were atypical during early stage. 8 of 52 patients died (15.4% ), and among this eight patients, 3 died of respiratory failure caused by pulmonary edema(5.8% ). Conclusion The physician should pay more attention to pulmonary edema and diagnose it early in acute organophosphate paisoning.%目的探讨有机磷农药急性中毒并发急性肺水肿的机理、临床特点、影像学特征及治疗方法。方法分析 1994年 1月~ 1998年 12月间,经抢救和治疗的 52例有机磷农药急性中毒并发急性肺水肿患者的症状、胸部 X线摄片、诊断及治疗结果的临床资料。结果 52例患者中 44例( 84.6%)治愈好转出院,死亡 8例( 15.4%)。其中死于肺水肿致呼吸衰竭 3例 (5.8% ).结论急性有机磷农药中毒并发急性肺水肿临床特点和 X线表现早期表现不明显,易被中毒的其它全身表现所掩盖。在治疗措施上 ,既要针对肺水肿的临床表现 ,又要考虑到原发疾病的病因治疗。

  10. Risk factors for complicated bronchial asthma in children with acute lower respiratory tract infections%急性下呼吸道感染患儿合并支气管哮喘的危险因素分析

    赵红玲; 程学文; 程首超; 王立琼

    2015-01-01

    OBJECTIVE To explore the risk factors for asthma in children with acute lower respiratory tract infec‐tions so as to provide guidance for clinical prevention of asthma .METHODS The clinical data of 2 410 children with acute lower respiratory tract infections who were treated in the hospital from Jun 2011 to Jan 2014 were ret‐rospectively analyzed .The univariate analysis and multivariate logistic regression analysis were performed to sta‐tistically analyze the risk factors for the asthma with the use of SPSS17 .0 software .RESULTS Of the 2 410 chil‐dren ,totally 112 cases were complicated with bronchial asthma ,with the incidence rate of 4 .6% .A total of 112 strains of pathogens have been isolated ,among which rhinovirus (RHV ) was dominant ,accounting for 37 .5%(23 strains) .The emergence of asthma in the children with acute lower respiratory tract infections was positively correlated with the young age ,family history of asthma ,allergic constitution ,respiratory syncytial virus (RSV) infection ,RHV infection ,and Mycoplasma pneumoniae (MP) infection ,which were the high risk factors for the asthma in the children with acute lower respiratory tract infections (P<0 .05) .CONCLUSION The children with acute lower respiratory tract infections ,who have the family history of asthma ,allergic constitution ,RSV infec‐tion ,or RHV infection ,or are male ,or young ,are at higher risk of asthma .It is necessary for the hospital to take targeted prevention and control measures according to the high risk factors for the asthma .%目的:探讨急性下呼吸道感染患儿发生哮喘的危险因素,为临床哮喘防治提供参考。方法回顾性分析2011年6月-2014年1月医院收治2410例急性下呼吸道感染患儿的临床资料,采用单因素及多因素logistic回归方法对患儿可能发生哮喘的危险因素进行统计分析,采用SPSS17.0软件进行统计处理。结果2410例患儿中共有112例合并支

  11. Interventional radiological treatment in complications of pancreatitis

    Memis, Ahmet E-mail: ahmemis@yahoo.com; Parildar, Mustafa

    2002-09-01

    Percutaneous interventional therapy plays an important role in treating complications of acute and chronic pancreatitis. With the development of cross-sectional imaging and advanced interventional techniques, percutaneous drainage has become the preferred treatment for pancreatic fluid collections such as acute collections, pseudocysts and abscesses. Abscess and pancreatic hemorrhage are the most life threatening complications of pancreatitis. Massive hemorrhage is rare but frequently lethal. As a rule, bleeding complications of pancreatitis require prompt diagnosis and an aggressive surgical approach. In unstable patients with a severely bleeding pseudoaneurysm, hemostasis can be obtained by occlusion with mechanical devices.

  12. Sigmoid Volvulus Complicating Postpartum Period

    Blake, Erin; Gonzalez, Eduardo; Pieracci, Frederic

    2017-01-01

    Background. Sigmoid volvulus is a rare complication of pregnancy and the puerperium. Case. A 19-year-old patient, gravida 1 para 0 at 41 0/7 weeks of gestation, admitted for late-term induction of labor underwent an uncomplicated primary low transverse cesarean delivery for arrest of descent. Her postoperative period was complicated by sudden onset of abdominal pain and the ultimate diagnosis of sigmoid volvulus. Conclusion. Prompt surgical evaluation of an acute abdomen in the postpartum period is essential; delayed diagnosis and treatment can lead to significant maternal morbidity and mortality.

  13. 重症急性胰腺炎并发胰腺脑病的发病机制研究进展%Advanced on the pathogenesis of severe acute pancreatitis complicated with pancreatic encephalopathy

    刘补报; 李得溪

    2015-01-01

    胰腺脑病是重症急性胰腺炎的严重并发症,病死率高,预后差。目前关于胰腺脑病的发病机制主要有胰酶学说、细胞因子学说、营养缺乏学说、细菌和真菌感染学说、低氧血症与微循环障碍和组织代谢紊乱学说等,但尚未有哪一种学说能独立阐明其发病机制。笔者主要综述近几年来发展的各种学说。%Pancreatic encephalopathy (PE) is a severe complication of severe acute pancreatitis, and has the characteristics of the high mortality and poor prognosis. Although about the pathogenesis of pancreatic encephalopathy mainly include theory of pancreatic enzyme, the theory of cytokines, the theory of alimentary deficiency, the theory of bacterial and fungal infection, the theory of hypoxemia and microcirculation dysfunction, the theory of tissue metabolism disorder and so on, the pathogenesis of pancreatic encephalopathy still unclear at present. The author mainly reviews the development of the pathogenesis of pancreatic encephalopathy in recent years.

  14. Management and outcome of 47 patients with acute myocardial infarction complicating cardiogenic shock%急性心肌梗死合并心原性休克47例治疗和死亡原因分析

    莫安胜; 林辉; 王风; 林英忠; 温绍科; 周一凡

    2008-01-01

    Objective To evaluate the clinical outcomes of patients with acute myocardial infarction(AMI)complicating cardiogenic shock underwent various treatments.Methods From January,2002 to May,2007,47 AMI patients with cardiogenic shock were treated in our department by optimal medication (dopamine,epinephrine,norepinephrine,etc.),intrar-aortic balloon pump(IABP),mechanical ventilation when indicated,percutaneous coronary intervention(PCI)or coronary artery bypass graft (CABG).Outcome and factors related to mortality for these patients were analyzed in this retrospective study.Results Besides optimal medication and IABP in all patients,31 patients underwent PCI(66.0%),6 patients received emergency CABG(12.8%).The overall in-hospital mortality rate was 36.2%(17/47),6 patients(14.9%)died before coronary revascularization and 11 patients(21.3%)died after revascularization.Nine patients died of pump failure and 8 patients died of renal and(or)respiratory failure.Regression analysis showed that acute renal failure(r=0.734,P=0.000),acute respiratory failure (r=0.606,P=0.000)and diabetes(r=0.372,P=0.012)were positively related to in-hospital mortality.Conclusion Despite improvements in treatment options for AMI patients complicating cardiogenic shock,in-hospital mortality remained high,especially for patients complicating further with acute renal failure and acute respiratory failure.%目的 评价急性心肌梗死合并心原性休克47例患者的临床疗效,寻求降低病死率、改善预后的措施.方法 回顾性分析2002年1月至2007年5月共47例心肌梗死合并心原性休克患者,运用心血管活性药物、主动脉内球囊反搏(IABP)、介入手术或冠状动脉旁路移植术的治疗效果.结果 IABP治疗47例(100%),再血管化治疗41例(87.3%),死亡17例(36.2%).经药物和IABP治疗,在接受再血管化前死亡的患者占死亡数的35.3%(6/17),再血管化后死亡的患者占死亡数的64.7%(11/17).死于心功能衰竭者9

  15. The analysis of bacteriology and antibiotic susceptibility in 493 patients with bronchiectasis complicated with acute infection%493例支气管扩张急性感染的细菌学特点及药敏分析

    宋杰; 刘保清; 王金祥; 胥振阳; 李晓辉

    2012-01-01

    目的 分析支气管扩张症患者急性感染的细菌学特点及药敏情况.方法 对本院呼吸科收治的493例支气管扩张急性感染患者痰标本的细菌培养及药敏试验进行分析.结果 493例痰标本分离出细菌200株,其中革兰阴性杆菌178株,占89.0%,革兰阳性球菌22株,占11.0%.根据五年统计结果,总数排在前6位的分别是铜绿假单胞菌(21.5%)、洛菲不动杆菌(15.5%)、肺炎克雷伯菌(8.5%),肠杆菌属(包括阴沟肠杆菌、产气肠杆菌、中间型肠杆菌及聚团肠杆菌)(8%)、鲍曼溶血不动杆菌(5.5%)和金黄色葡萄球菌(5%).结论 支气管扩张急性感染患者的细菌分布以革兰氏阴性菌为主,铜绿假单胞菌排在首位,提示合理选用抗菌药物对减少耐药菌的产生有重要作用.%Objective To investigate the bacteriology and antibiotic susceptibility in patients with bronchiectasis complicated with acute infection. Methods Data of sputum culture and antibiotic susceptibility of 493 patients with bronchiectasis complicated with acute infection from Jul 2006 to Aug 2011 were retrospectively analyzed. Results In the test of sputum culture, 200 strains of bacteria were ob-tained. Among them, there were 178 strains of gram negative bacilli ( 89. 0% ), and 22 strains of gram positive coccus ( 11. 0% ) . According to the statistical results of five years, the bacteria ranked the top six were Pseudomonas aeruginosa ( 21. 5% ), Acinetobacter lwoffii (11. 5% ), Klebsiella pneumonia( 8. 5% ), Enterobacter ( Enterobacter cloacae, Enterobacter aerogenes, Enterobacter intermedi-us and Enterobacter agglomerans) ( 8% ). Acinetobacter baumannii ( 5. 5% ), Staphylococcus aureus rosenbach( 5% ). Conclusions The most common pathogenic bacteria that induce acute infection in patients with bronchiectasis are Gram-negative bacteria, especially pseudomonas aeruginosa. It is suggested that reasonable use of antibiotics to reduce drug resistance is very important.

  16. Acute cervical spinal cord injury complicated with hyponatremia analysis of 16 cases%急性颈髓损伤并发低钠血症临床分析

    刘云龙; 汪勇

    2012-01-01

    Objective To investigate the clinical characteristics, pathogenesis, and treatment of acute cervical spinal cord injury complicated with hyponatremia. Methods The clinical data of 16 patients of acute cervical spinal cord injury complicated with hyponatremia, 15 males and 1 female, aged 35.6 (17 ~ 46), 4 with the injury at C4 and above, and 12 with the injuries below C4, were retrospectively analyzed. Results With a duration of (18.9+5.1) days, hyponatremia occurred (5.3 + 1.6) days after the injury on average, and the peak time of occurrence of hyponatremia was (7.9 ±2.1) days following the injury. The lowest serum sodium level was (112.7 ±3.8) mmol/L. Central venous pressure was monitored in all patients by cannulation of the deep vein. After appropriate salt supplement and restriction of water intake, hyponatremia were improved in 14 patients and 2 patients were discharged against medical advise. Conclusion hyponatremia is one of the common severe complications of cervical spinal cord injury. Close monitoring and maintenance of sodiu m metabolism help correct this disorder.%目的 探讨急性颈髓损伤后低钠血症的临床特点和有效的治疗方法.方法 回顾性分析急性颈髓损伤后低钠血症患者16例,男15例,女1例,年龄35.6(17~46)岁,高位颈髓(C4及C4以上)损伤4例,低位颈髓(C4以下)损伤12例,的临床资料.结果 平均出现低钠血症时间为伤后(5.3±1.6)d,出现低钠高峰时间为伤后(7.9±2.1)d,低钠持续时间(18.7±5.1)d,最低血清钠浓度为(112.7±3.8)mmol/L.所有患者均给予深静脉插管以补液及行中心静脉压监测,经限水、补钠等治疗后14例患者低钠血症纠正,2例患者自动出院.结论 低钠血症原因是颈髓损伤发常见的严重并发症.通过严密监测患者血钠并维持钠代谢正平衡可纠正患者的低钠血症.

  17. 老年急性心肌梗死合并脑梗死患者临床特点分析%Clinical analysis of elderly patients with acute myocardial infarction complicated with cerebral infarction

    张雅婷; 王丽

    2014-01-01

    目的:探讨老年急性心肌梗死合并脑梗死患者的临床特点。方法选取该院2008年6月至2013年6月收治的79例老年急性心肌梗死合并脑梗死患者,按预后分为死亡组和存活组,对两组患者的患病危险因素、临床表现、心肌梗死部位、脑梗死部位及确诊脑梗死时间进行临床观察。结果两组患者患病危险因素比较,差异无统计学意义(P>0.05),死亡组患者意识障碍、低血压、脑梗死确诊时间与存活组比较,差异均有统计学意义(P<0.05)。死亡组患者心前壁和脑干梗死比例高于存活组,差异有统计学意义(P<0.05)。结论老年急性心肌梗死合并脑梗死临床表现复杂,急性前壁心肌梗死患者应及早预防脑梗死的发生,早期确诊能明显改善患者预后。%Objective To investigate the clinical characteristics of elderly patients with acute myocardial infarction (A-MI) complicated with cerebral infarction. Methods A total of 79 elderly patients with AMI complicated with cerebral infarction , who were received in the hospital from June 2008 to June 2013,were divided into the death group(n=49) and survival group(n=30) according to prognosis. The risk factors,clinical manifestations,the site of myocardial infarction,the site of cerebral infarction site and confirmed infarction time of the two groups were observed clinically. Results There was no statistically significant dif-ference on risk factors between the two groups ,but the difference on disturbance of consciousness ,hypotension and confirmed in-farction time had statistical significance(P<0.05). The portion of anterior wall of heart and brainstem infarction in the death group was higher than that in the survival group(P<0.05). Conclusion The clinical manifestations of elderly patients with AMI compli-cated with cerebral infarction are complex ,it is necessary for the patients with acute anterior myocardial infarction to prevent the

  18. [COMPLICATED AMOEBIC APENDICITIS.REPORT OF A CASE

    Casavilca Zambrano, Sandro; Gomez Anchante, Victor; Cisneros Gallegos, Eduardo

    2000-01-01

    We report a case of acute abdomen that is operated with the presumptive diagnosis of complicated acute appendicitis. In the histologic examination we make the diagnosis of complicated amoebic appendicitis. We discuss clinical manifestations and histopathologic findings of this unusual presentation of amoebic infection.

  19. 74例血液透析病人常见急性并发症发生的相关因素分析及护理对策%74 cases of hemodialysis patients with common acute complications related factors and nursing strategy

    付珍; 付爱凤

    2011-01-01

    目的:针对血液透析病人常见急性并发症的相关因素,采取相应的护理对策,以降低常见并发症的发生.方法:应用护理程序在血液透析前和过程中认真评估并发症发生的相关因素并采取相应护理措施.结果:常见3种并发症,即低血压、心律失常和肌肉痉挛,其缓解率分别为92.7%,80%和92.2%.结论:只要认真采取预防对策,血液透析病人常见的急性并发症就能得到缓解,并能顺利完成透析过程.%Objective:To reduce the occur of common acute complications of hemodialysis patient, we adapt responding nursing measures according to related factors of common acute complications of hemodialysis patient. Methods: To evaluate and analyze related factors of common acute complications of hemodialysis patient carefully before the application of nursing process, and adapt suitable nursing measures regarding the analysis result. Results: Complications of hemodialysis patient, hypotension, arrhythmia and muscle cramps can be relieved with the following probabilities:92.7% ,80% and 92. 2%. Conclusion: As long as carefully selected preventive measures is adapted, most hemodialysis patient with acute complications can be relieved and complete the hemodialysis treatment without problems.

  20. CT Findings of Colonic Complications Associated with Colon Cancer

    Kim, Sang Won; Shin, Hyeong Cheol; Kim, Il Young; Kim, Young Tong; Kim, Chang-Jin

    2010-01-01

    A broad spectrum of colonic complications can occur in patients with colon cancer. Clinically, some of these complications can obscure the presence of underlying malignancies in the colon and these complications may require emergency surgical management. The complications of the colon that can be associated with colon cancer include obstruction, perforation, abscess formation, acute appendicitis, ischemic colitis and intussusception. Although the majority of these complications only rarely oc...

  1. 急性白血病患者感染性休克的临床特点分析%Clinical characteristics of acute leukemia patients complicated wi th septic shock

    李超; 杨如玉; 马海龙; 杜朝阳

    2014-01-01

    OBJECTIVE To explore the clinical characteristics of the acute leukemia complicated with septic shock and put forward prevention countermeasures so as to improve the survival rate of the patients with septic shock . METHODS The clinical data of 45 acute leukemia patients complicated with septic shock who were treated in the hospital from Mar 2006 to Apr 2013 were retrospectively analyzed ,then the clinical characteristics of the acute leukemia complicated with septic shock were analyzed ,the treatment programs were put forward ,the statistical analysis was performed with the use of SPSS 17 .0 software ,the rate was compared between the groups by using the chi-square test ,and the measurement data were analyzed by means of the t-test .RESULTS All the 45 patients suffered from the septic shock during the neutropenia stage .During the treatment stage ,the patients with refracto-ry or recurrent septic shock accounted for 60 .00% ,significantly higher than the proportion of the patients with in-itial induction of remission and consolidated enhancement ,the difference was significant (P< 0 .05) .After the treatment with active dilatation ,anti-infection ,and vasoactive drugs ,34 patients had the shock mitigated ,ac-counting for 75 .56% ,and 11 cases died ,accounting for 24 .44% .The patients with irritability or apathy occupied the largest proportion (71 .11% ) ,followed by the patients with decreased blood pressure (51 .11% ) ,besides ,the clinical manifestations and signs included the mild cyanosis of lips and nail beds as well as the rapid shallow breath-ing .A total of 87 strains of pathogens have been isolated from blood culture ,including 68 ( 78 .16% ) strains of bacteria ,7 ( 8 .05% ) strains of viruses ,and 12 (13 .79% ) strains of fungi .The gram-negative bacteria were high-ly susceptible to imipenem and meropenem ,with the drug resistance rates less than 12 .00% ,and the strains had certain drug resistance to other commonly used antibiotics .CONCLUSION The

  2. Complicação infecciosa indica mau prognóstico no infarto agudo do miocárdio Infection complication portends poor prognosis in acute myocardial infarction

    Leandro Carlos Grandini Júnior

    2006-09-01

    Full Text Available OBJETIVO: Determinar a incidência e o impacto das complicações infecciosas do infarto agudo do miocárdio (IAM no tempo de permanência e na letalidade. MÉTODOS: Trata-se de um estudo clínico e retrospectivo, tipo caso-controle, realizado por meio de análise de prontuários. A população do estudo foi constituída por pacientes internados na Unidade Coronariana do InCor do Hospital das Clínicas da FMUSP com diagnóstico de IAM, entre janeiro de 1996 e dezembro de 1999. RESULTADOS: Foram analisados 1.227 pacientes, e sessenta (5% preenchiam os critérios diagnósticos de complicação infecciosa do IAM (grupo infectados. Os demais 1.167 pacientes constituíram o grupo controle. A média das idades (67,5 versus 62,6 anos, o tempo de permanência hospitalar (26,6 versus 12,0 dias e a mortalidade hospitalar (45% versus 12% foram maiores no grupo infectados. Pacientes submetidos a mais de três procedimentos invasivos apresentaram índice de mortalidade mais elevado (68% e 32%, p = 0,006. As infecções mais freqüentes foram as pulmonares (63%, do trato urinário (37% e hemoculturas positivas sem sítio identificado (8%. CONCLUSÃO: Na população estudada, a incidência de complicação infecciosa foi de 5%. O tempo de internação prolongado e a taxa de mortalidade elevada sugerem que a complicação infecciosa tem um grande impacto sobre os pacientes internados com o diagnóstico de IAM em unidade coronariana.OBJECTIVE: To determine both the incidence and impact of infectious complications of acute myocardial infarction (AMI on length of hospital stay and mortality. METHODS: This is a retrospective, case-control clinical trial involving medical records review. The study population consisted of patients admitted to the Coronary Care Unit (CCU of the Hospital das Clínicas Heart Institute of the University of São Paulo Medical School - FMUSP - with AMI between January 1996 and December 1999. RESULTS: One thousand two hundred and twenty

  3. Acute liver failure

    Larsen, Fin Stolze; Bjerring, Peter Nissen

    2011-01-01

    Acute liver failure (ALF) results in a multitude of serious complications that often lead to multi-organ failure. This brief review focuses on the pathophysiological processes in ALF and how to manage these.......Acute liver failure (ALF) results in a multitude of serious complications that often lead to multi-organ failure. This brief review focuses on the pathophysiological processes in ALF and how to manage these....

  4. 急性白血病并肺部真菌感染57例早期诊断与防治策略%Early Diagnosis,Treatment and Prevention of Childhood Acute Leukemia Complicated with Pulmonary Fungal Infection

    邵静波; 蒋慧; 李红; 陆正华; 杨静薇; 杨为群

    2011-01-01

    Objective To analyze the clinical features and investigate the early diagnosis and treatment of childhood acute leukemia complicated with pulmonary fungal infection (PFI). Methods The clinical data of 132 cases of childhood acute leukemia were retrospectively analyzed. Fifty -seven patients, who had the PFI,including 5 times with confirmed diagnosis,30 times with clinical diagnosis,and 25 times with recommended diagnosis were diagnosed according to European Organization for Research and Treatment of Cancer. Results 1. The incidence rate of PFI in the childhood acute leukemia was 43.18% (57/132 cases). The median time from occurring PFI to confirmed leukemia was 7.2 months,among which 70% (42/60 cases) were within 12 months while 30% ( 18/60 cases) more than 12 months. 2. The representation of chest CT was multiform,mainly for inflammatory exudate,interstitial changes,and cloud flocculeut nodules. The severe patients were accompanied by pleural effusion or acute respiratory distress syndrome(ARDS). 3. Seventy -one point seven percent(43/60 cases)of PFI were neutropenia ( < 1.5 × 109 L-1 ) ,in which 40.0% were ngranulocytosis ( < 0. 5 × 109L-1 ). 4. The positive rate of fungal G test was 70.5% ( 31/44 cases) wille negative was 29.5% ( 13/44 cases). Totally 7 candida strains and 2 mierozyme strains were obtained from 57 cases of PFI. 5. The total cure rate was 95.0%. Cure rates of single drug and combined anti fungal were 53.3% and 41.7%. Conclusions 1. Fungal infection is one of the main pathogens in childhood acute leukemia complicated by severe infection. 2. Chest CT shows important value in the diagnosis of PFI. The positive rate of microorganism culture is low in children. 3. Early diagnosis and treatment are the key to improve curative effect. Better prognosis can be gained if those patients with early respiratory failure or ARDS get oxygen or mechanical ventilation in time.%目的 分析急性白血病并肺部真菌感染(PFI)患儿的

  5. Acute pituitary apoplexy complicating a pituitary macroadenoma

    Febin Joseph

    2010-12-01

    Full Text Available Pituitary apoplexy is a rare but potentially life-threatening condition caused by either haemorrhage or infarction of the pituitary gland. In most cases, a pre-existing pituitary macroadenoma is present. Patients present with the clinical syndrome of headache, visual defects or ophthalmoplegia, altered state of consciousness and variable endocrine deficits.

  6. 骨髓增生异常综合征并发急性发热性嗜中性皮病一例%Myelodysplastic syndrome complicated with acute febrile neutrophilic dermatosis:one case report

    曾芸馨; 李旭东; 张競文; 林东军

    2014-01-01

    骨髓增生异常综合征(MDS)是一种异质性克隆性造血干细胞疾病,少部分MDS患者可并发急性发热性嗜中性皮病(SWEET综合征,SS),其皮肤改变主要为不对称性疼痛性红色丘疹、结节和斑块,后期可进展为脓疱,同时伴发热、白细胞升高及ESR增快,皮肤病理活组织检查(活检)以弥漫分布于真皮浅层的成熟中性粒细胞浸润为特征,糖皮质激素治疗有效而抗感染治疗无效,合并SS的MDS容易进展为急性髓系白血病,预后不佳。该文报道1例接受皮下输液港植入化学治疗后继发SS的MDS患者,患者化学治疗过程顺利,但其皮下输液港植入部位发生胸壁皮肤感染,伴有持续高热,胸壁皮肤切口部位上方有疼痛性红色丘疹,经抗感染治疗无效,皮肤活检结果示真皮浅层中性粒细胞浸润,诊断为MDS并发SS,予糖皮质激素治疗后体温降至正常,皮损愈合,随访示MDS处于完全缓解状态。因此,临床上对于存在发热、痛性红色丘疹且抗感染治疗无效的MDS患者需警惕SS的可能,应及早完善皮肤活检以便早诊断、早治疗。%Myelodysplastic syndrome (MDS )is a type of heterogeneous clonal hematopoiefic stem cell disease. A minority of MDS patients could be complicated with acute febrile neutrophilic dermatosis (Sweet's syndrome,SS),mainly characterized by asymmetric painful red papula,node and plaque,andpro-gresses into pustule during the advanced stage. Meanwhile,signs of fever,leukocytosis and accelerated eryth-rocyte sedimentation could occur. Skin pathological biopsy revealed infiltrated matureneutrophilic leukocytes scattering across superficial dermal layer. Glucocorticoid treatment was effective whereas anti-infectious therapy yielded no efficacy. MDS complicated with SS is likely to progress into acute myeloid leukemia with poor prog-nosis. In this article,we reported one MDS case complicated with SS after

  7. Pneumonia por varicela associada com síndrome da angústia respiratória aguda: relato de dois casos Varicella pneumonia complicated with acute respiratory distress syndrome: two cases report

    Marcelo Moreno

    2007-03-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A varicela é uma doença exantemática causada pela infecção primária do vírus varicela zoster (VVZ. A pneumonia pelo VVZ complicada com a síndrome da angústia respiratória aguda (SARA é rara e associa-se a altas taxas de morbimortalidade. O objetivo deste estudo foi apresentar dois casos de pneumonia por varicela que evoluíram com SARA e outras disfunções orgânicas. RELATO DOS CASOS: Paciente de 15 anos, imunocomprometido com a síndrome da imunodeficiência adquirida (SIDA e uma paciente do sexo feminino imunocompetente, foram admitidos na UTI com quadro clínico de varicela, SARA, trombocitopenia e acidose graves. Além disso, disfunção cardiovascular e falência renal ocorreram no primeiro e segundo casos, respectivamente. Foram tratados com aciclovir além de ventilação mecânica protetora. CONCLUSÕES: Os dois casos de pneumonia por varicela, que apresentaram SARA e disfunções de múltiplos órgãos, obtiveram boa evolução clínica.BACKGROUNG AND OBJECTIVES: Varicella is an exantematic disease caused by varicella-zoster virus. Varicella pneumonia complicated with acute respiratory distress syndrome (ARDS is very rare in adults and is associated with high morbimortality. We report two cases of ARDS secondary to varicella-zoster virus pneumonia. CASES REPORT: We report two cases of ARDS and multiple organ dysfunction syndrome (MODS secondary to varicella-zoster virus pneumonia. A 15-year-old man with human immunodeficiency virus (HIV infection and a 29-year-old immunocompetent female were admitted in the ICU with primary varicella infection and pneumonia. Both cases progressed towards ARDS, severe thrombocytopenia and acidosis. In addition cardiovascular and renal failure occurred in the first and second patients, respectively. Treatment consisted of immediate administration of intravenous acyclovir and a lung-protective ventilation strategy. CONCLUSIONS: Both cases of varicella

  8. The use of echocardiography in acute cardiovascular care

    Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor

    2014-01-01

    of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described....

  9. The use of echocardiography in acute cardiovascular care

    Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor

    2015-01-01

    of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described....

  10. The use of echocardiography in acute cardiovascular care

    Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor

    2015-01-01

    of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiac care scenarios are also described....

  11. Surgical management of complications of multimodal therapy.

    Chui, Chan-Hon

    2012-08-01

    Multimodality therapies that include surgery, chemotherapy, radiotherapy, and various newer forms of targeted therapies have been commonly applied in childhood cancers. Such modalities are associated with complications that may adversely affect the outcome of cancer treatment. Acute complications that require surgical management form the focus of our discussion. These patients are often compromised by immunosuppression, thrombocytopenia, and malnutrition. The complications discussed include typhlitis, invasive aspergillosis (IA), pancreatitis, hemorrhagic cystitis, gastrointestinal hemorrhage, necrotizing skin and soft-tissue infections, and perianal infection. Familiarity with the spectrum of complications and their appropriate management approaches will minimize the patients' morbidity.

  12. Clinical Trial of Sertraline in Elderly Patients with Acute Coronary Syndrome Complicating Depression%老年急性冠状动脉综合征并抑郁患者舍曲林治疗研究

    方飞; 赵进和; 史佳

    2015-01-01

    Objective To investigate the clinical effects of sertraline in elderly patients with acute coronary syndrome complicating de-pression. Methods 57 patients were randomly divided into two groups :control group and observation group. The control group re-ceived regular therapy ;the observation group received oral sertraline and regular therapy . The cardiovascular events (angina pectoris , myocardial infarction ,congestive heart failure and death ) were carefully observed in one year. Results There were no significant dif-ferences between baseline values ,Hamilton’s depression scale (HAMD scale) ,the level of Amino terminal pro brain natriuretic pep-tide (NT Pro BNP) ,Plasma cortisol ,left ventriculear ejection fraction (LVEF) ,left ventricular end diastolic diameter (LVEDD) , plasma homocysteine levels among the two groups before research ( P>0.05). After the treatment ,LVEF in observation group was statistically significant higher than that in the control group ,HAMD scale ,the level of NT Pro BNP ,Plasma cortiso ,plasma homocys-teine were significantly decreased ( P0.05). The total incident rates of cardiovascular events were significantly lower in observation group than in control group ( P<0.05). Con-clusions Sertraline can restrain the hypothalamic pituitary adrenal axis and decrease the serum homocysteine ,that maybe the reason for sertraline could improve the prognosis of elderly patients with acute coronary syndrome complicating depression .%目的:观察舍曲林干预急性冠状动脉综合征合并抑郁患者的疗效。方法57例急性冠状动脉综合征合并抑郁患者随机分成两组,对照组给予基础治疗,观察组在基础治疗上加用舍曲林干预。观察两组患者1年的心血管事件发生率及其相关指标变化的情况。结果两组治疗前汉密尔顿抑郁量表评分(HAMD评分)、左心室射血分数(LVEF )、左心室舒张末期内径(LVEDD )、外周血氨基末端脑钠肽前体(NT Pro

  13. 100例急性心肌梗死合并糖尿病病患者的临床护理分析%Clinical Nursing Analysis on 100 Cases of Patients with Acute Myocardial Infarction Complicated with Diabetes Melitus

    吕连双; 韩静

    2013-01-01

    Objective: To study the nursing intervention in patients with acute myocardial infarction complicated with diabetes care effect, to find the best nursing method.Method:100 cases of myocardial infarction in patients with diabetes from 2011 March to 2011 December in our hospital were selected .They were randomly divided into experimental group and control group, routine nursing method using the group of 50 patients, and 50 cases in the experimental group, on the basis of conventional care, using overal nursing, comparative analysis of two groups of patients the effect of clinical nursing and the satisfaction.Result: the clinical nursing satisfaction is 100%, while the control group, patients satisfaction was 85.3%, the experimental group nursing satisfaction was significantly higher than the control group, two groups of contrast, the difference had statistical significance (P < 0.05).Conclusion: Taking the holistic nursing care of acute myocardial infarction complicated with diabetes melitus, not only can improve the treatment of patients with attitude and enthusiasm, ensure the clinical treatment effect, also can improve nursing satisfaction and quality of life of patients, is of great significance to improve the level of clinical nursing%  目的:研究护理干预在急性心肌梗死合并糖尿病护理中的效果,寻找最佳护理方法。方法:选择2011年3月至2011年12月在我院收治的100例性心肌梗死合并糖尿病患者,随即分为实验组和对照组,对照组50例患者采用常规护理方法,而实验组50例患者则在常规护理基础上,采用整体护理,对比分析两组患者的临床护理效果和满意度。结果:实验组临床护理满意度为100%,而对照组患者护理满意度为85.3%,实验组护理满意度明显高于对照组,两组对比,差异存在统计学意义(P <0.05)。结论:对急性心肌梗死合并糖尿病采取整体护理,不仅可以改善患者治疗心态和

  14. Clinical analysis of 128 patients with acute cerebral vascular complicated with multiple organ failure%128例急性脑血管并发多脏器功能衰竭的临床分析

    周永军

    2015-01-01

    目的:探讨急性脑血管并发多脏器功能衰竭的临床特点和治疗对策。方法选取2014年5月~2015年5月我院收治的急性脑血管并发多脏器功能衰竭患者共128例,按照出血、梗死及不同年龄、既往合并慢性疾病情况及是否存在肺部感染分析MOF数目、MOFS评分及MOFS存活时间。结果脑梗死组与脑出血组 MOF数目、MOFS存活时间比较,差异均无统计学意义(P>0.05)。脑梗死组MOFS评分明显低于脑出血组,两组比较差异有统计学意义(P<0.05)。年龄<60岁组的 MOF 数量明显少于60~70岁组及≥70岁组,比较差异有统计学意义(P<0.05)。三组MOFS评分及存活时间情况比较,差异无统计学意义(P>0.05)。有肺部感染组患者的 MOF数目、MOFS评分高于无肺部感染组, MOFS存活时间明显低于无肺部感染组,两组比较差异有统计学意义(P<0.05)。结论肺部感染及发病年龄是急性脑血管并发多脏器衰竭发生的重要因素。%Objective To investigate the clinical characteristics and treatment strategy of acute cerebral vessel complicated with multiple organ failure.Methods 128 patients with acute cerebrovascular disease complicated with multiple organ failure were selected from May 2014 to May 2015. The number of MOF, MOFS score and MOFS survival time were analyzed by bleeding, infarction, and different age, previous chronic diseases and the presence of pulmonary infection.Results There was no significant difference in the number of MOF and MOFS in cerebral infarction group and cerebral hemorrhage group (P>0.05). The score of MOFS in cerebral infarction group was significantly lower than that in cerebral hemorrhage group, and the difference between the two groups was statistically significant (P0.05). The MOF number and MOFS score of patients with pulmonary infection were significantly higher than those without pulmonary infection, and the survival time of

  15. 特重度烧伤并发急性肾功能衰竭的因素分析%Analysis of the factors of severe burn complicated with acute renal failure

    王野; 朱志军; 边曦

    2014-01-01

    目的:探讨特重度烧伤并发急性肾功能衰竭(acute renal failure,ARF)的相关因素,为临床早期防治ARF提供依据。方法分析我科2003年1月至2012年12月收治的特重度烧伤362例烧伤后开始接受液体复苏治疗的时间和方法,并结合测定的生化指标,分析特重度烧伤与ARF的相关性。结果362例特重度烧伤中有27例并发ARF,烧伤面积>90%组ARF发生比例明显高于其他各组(P<0.05)。烧伤面积>70%组,伤后2 h以后开始接受液体复苏治疗组发生ARF明显高于伤后2 h以内开始治疗组(P<0.05)。发生ARF者,血尿素氮(BUN)在伤后14 d明显高于无ARF者(P<0.05),血肌酐(Scr)在伤后7 d明显高于无ARF者(P<0.05),胱抑素C(CysC)在伤后2 d明显高于无ARF者(P<0.05)。结论烧伤面积和伤后液体复苏开始治疗时间均与烧伤并发ARF呈正相关,发生ARF时患者BUN、Scr、CysC均明显升高,CysC测定可能成为早期检测ARF的敏感指标。%Objective Through investigation the related factors of acute renal failure(ARF) with severely thermal burn, and provide evidence for clinical early prevention and treatment of ARF. Methods 362 cases data with ARF admitted into our department during January 2003 to December 2012 with severely thermal burn were enrolled to analyze the time and method began to receive fluid resuscitation therapy, combined with their biochemical index determination, to analyze the correlation of severely thermal burn with ARF. Results In 362 cases of severely thermal burn patients were 27 cases complicated with ARF, and the ARF incidence of burn area more than 90%was significantly higher than the other groups (P<0.05). In burn area more than 70%group, the ARF incidence of 2 hours after injury began to accept fluid resuscitation group was significantly higher than within 2 hours after injury to the treatment group (P<0.05). In 27 cases of ARF, blood urea

  16. VASCULAR COMPLICATIONS AFTER KIDNEY TRANSPLANTATION

    M. Sh. Khubutia

    2013-01-01

    Full Text Available Aim: evaluation of the incidence and the pattern of vessel complications, efficacy of the prophylactic anticoagulation therapy after kidney transplantation. Materials and methods. From March 2007 till January 2013 421 patients: 230 men (54,6% and 191 women (45,4%; mean age 43,07 ± 11,62 undergone 429 kidney transplantations in the department of pancreas and kidney transplantation of the Scientific-Research Institute of Emergency Care named after N.V. Sklifosovsky. In order to evaluate the condition and the function of the kidney transplant ultrasound investigation (daily andacquisition(weekly wereused. In cases of kidney dysfunction and assumption of vessel complications we used computerized tomography. Besides, we used daily analysis of biochemical and clinical parameters of blood and urine. Results. The most common vessel complication was the thrombosis of the microvasculature of the kidney transplant due to acute humoral and combined rejection resistant to antirejection therapy (n = 9; 2,1%; in 4 cases there was a breakage of the transplant due to the acute rejection and the urgent transplantatectomy in an effort to save the patient; thrombosis of the transplantat artery occurred in 1 case (0,23%; we observed 2 cases (0,46% of the artery stenosis and 2 cases (0,46% of venous thrombosis. Conclusion. Summary frequency of vessel complications in our clinic, including thrombosis due to rejection, was 3,49%. It fully corresponds with data obtained from the global medical community. The incidence of great vessel thrombosis was less than 1% which indicates the adequate prophylactic anticoagulation therapy. For the benefit of early diacrisis of complications Doppler sonography is needed. In case of assumption of vessel complications urgent acquisition, computerized tomography and/ or angiography are to be held. 

  17. 肝硬化患者并发上消化道出血和急性脑梗塞临床分析%Clinical characteristics of patients with liver cirrhosis complicated by upper gastrointestinal hemorrhage and acute cerebral infarction

    郭秀丽; 徐有青

    2011-01-01

    Objective To investigate the clinical characteristics of patients with liver cirrhosis complicated by upper gastrointestinal hemorrhage (UGH)and acute cerebral infarction (ACI).Methods The patients with UGH and ACI were compared with those without.Results The risk factors included the amount of gastrointestinal bleeding(x2=24.238, P<0.01), lienectomy(x2=37.10, P<0.01) , Child- Pugh scores and ascites (x2=29.002,P<0.01),arteriosclerosis and use of antifibrinolytic agent.Conclusions For the patients with liver cirrhosis, the risk factors for ACI should be taken into consideration to prevent its occurrence.%目的 探讨肝硬化并发上消化道出血和急性脑梗死的临床特点.方法 比较肝硬化上消化道出血并发急性脑梗死与同期肝硬化消化道出血未合并脑梗塞患者的临床特点.结果 消化道出血量(x2=24.238,P<0.01)、脾切除手术(x2=37.10,P<0.01)、Child-Pugh分级、腹水量(x2=29.002,P<0.01)、动脉硬化因素和应用强力抗纤溶药物在梗塞组与非梗塞组之间差别明显.结论 肝硬化患者在上消化道出血后,应尽早评估并发脑梗塞的危险因素,以预防急性脑梗塞的发生.

  18. 急性心肌梗死并发心源性休克的临床治疗分析%Analysis of clinical treatment of acute myocardial infarction complicated by cardiogenic shock

    吴镜

    2012-01-01

      目的探究急性心肌梗死并发心源性休克的临床治疗分析.方法选择2008年3月~2011年3月期间笔者所在医院收治的80例急性心肌梗死并发心源性休克患者,随机平均分为观察组和对照组各40例.对照组6 h 内给予溶栓治疗,观察组给予经皮冠状动脉介入术治疗.结果两组在肌钙蛋白 I、LVEF 得分差异无统计学意义(P >0.05).观察组有效25例,占62.5%,明显高于对照组有效19例,占47.5%,两组比较差异有统计学意义(P 0.05).25 cases of observation group,accounting for 62.5%,significantly higher than the effective 19 cases,accounting for 47.5% compared the two groups were comparable(P <0.05).In the observation group,15 cases died,accounting for 37.5%,significantly lower than the control group of 21 cases of death,accounting for 52.5% compared two groups were comparable(P <0.05). Conclusion The clinical occurrence of acute myocardial infarction complicated by cardiogenic shock dangerous disease,the prognosis is poor,despite the use of thrombolysis and PCI treatment,but mortality is still high,and treated with PCI efficiency compared with thrombolytic therapy have higher efficiency, it is worth clinical application and promotion.

  19. 心脏介入术中并发急性心脏压塞的抢救与护理%Rescue and nursing of complicated acute cardiac tamponade cardiac in patients with cardiac interventional operation

    杨福梅

    2015-01-01

    Objective To explore the rescue and nursing of complicated acute cardiac tam-ponade (ACT)in patients with cardiac interventional operation (CIO).Methods A total of 64 CIO patients with complicated ACT were randomly divided into observation group and control group,32 cases in each group.Both groups were conducted with emergency treatment for ACT, and on this basis the control group was treated with routine nursing,while the observation group was treated with comprehensive nursing.Discovery rate of ACT,success rate of rescue as well as satisfactory degree toward nursing and HDL score were compared between two groups.Results In the observation group,the discovery rate of ACT and success rate of rescue were significantly higher than those in the control group (P <0.05).Satisfactory degree toward nursing in the ob-servation group was significantly better than that in the control group (P <0.05).After nursing, scores of anxiety and depression as well as total score of HDL in the observation group were signifi-cantly lower than those before treatment and the control group (P <0.05).Conclusion For CIO patients with complicated ACT,rescue measures and comprehensive nursing can significantly im-prove the success rate of rescue and satisfactory degree toward nursing,reduce the HDL score and reduce medical disputes.%目的:研究心脏介入术(CIO)中并发急性心脏压塞(ACT)的抢救与护理。方法将64例患者实施 CIO 时并发ACT,以数字法随机分成观察组及对照组各32例,2组均实施 ACT 抢救措施,对照组在此基础上另实施常规护理,而观察组则实施综合护理。对比 2组 ACT 发现率及抢救成功率,2组护理满意情况以及 HDL 评分情况。结果观察组 ACT 发现率及抢救成功率均显著高于对照组,差异均有统计学意义(P <0.05);观察组的护理满意情况显著优于对照组,差异有统计学意义(P <0.05);观察组护理后的焦虑、抑郁评分及总

  20. 重症急性胰腺炎并发腹腔间室综合征的CT表现%Computed tomographic features of abdominal compartment syndrome complicated by severe acute pancreatitis

    吴晶涛; 朱庆强; 朱文荣; 陈文新; 王守安

    2014-01-01

    目的 探讨重症急性胰腺炎(SAP)并发腹腔间室综合征(ACS)患者的CT特征.方法 回顾性对比分析2005年3月至2013年3月江苏省苏北人民医院36例SAP并发ACS患者(观察组)和61例非ACS(NACS)的SAP患者(对照组)的CT资料,探讨有意义的CT特征.结果 本组36例ACS患者和61例NACS患者,CT扫描,ACS血管并发症包括腹腔及消化道出血的发生率高于NACS(P<0.05).ACS并发纹窄性肠梗阻及肠系膜炎的发生率高于NACS(P <0.05).ACS下腔静脉受压、狭窄(<3 mm),膈肌上抬、圆腹征阳性及大量腹腔积液的发生率高于NACS(P<0.05).ACSBalthazar CT评分(CT SI)高于NACS(P<0.05).与ACS有关的CT征象,出现≥4项有关ACS的CT特征,诊断敏感度96.5% (28/29),特异度100% (7/7),阳性预测值100% (28/28),阴性预测值87.5%(7/8),手术存活率远高于非手术存活率(P<0.05).结论 SAP合并ACS患者有一定的CT特征,充分认识此类征象,可为患者早期诊断及治疗起到积极地指导作用.%Objective To explore the computed tomographic (CT) imaging features of abdominal compartment syndrome (ACS) complicated by severe acute pancreatitis (SAP) to improve the diagnosis of disease.Methods Thirty-six cases of ACS and 61 cases of non-ACS (NACS) complicated by SAP were studied retrospectively.And the meaningful CT features were studied.Results Among them,the ACS vascular complications of abdominal cavity and gastrointestinal bleeding were found significantly more in ACS than in NACS (P < 0.05).The ACS intestinal obstruction occurred significantly more often in ACS than in NACS (P < 0.05).The ACS inferior vena cava pressure,diaphragm elevation,round belly sign and marked seroperitoneum occurred significantly more often in ACS than in NACS (P < 0.05).The score of ACS with Balthazar was higher than that of NACS (P < 0.05).For CT signs associated with ACS,four or more associated with ACS CT characteristics,the diagnostic sensitivity was 96.5

  1. Cardiovascular devices; reclassification of intra-aortic balloon and control systems for acute coronary syndrome, cardiac and non-cardiac surgery, or complications of heart failure; effective date of requirement for premarket approval for intra-aortic balloon and control systems for septic shock or pulsatile flow generation. Final order.

    2013-12-30

    The Food and Drug Administration (FDA) is issuing a final order to reclassify intra-aortic balloon and control system (IABP) devices when indicated for acute coronary syndrome, cardiac and non-cardiac surgery, or complications of heart failure, a preamendments class III device, into class II (special controls), and to require the filing of a premarket approval application (PMA) or a notice of completion of a product development protocol (PDP) for IABPs when indicated for septic shock or pulsatile flow generation.

  2. CT findings of colonic complications associated with colon cancer.

    Kim, Sang Won; Shin, Hyeong Cheol; Kim, Il Young; Kim, Young Tong; Kim, Chang-Jin

    2010-01-01

    A broad spectrum of colonic complications can occur in patients with colon cancer. Clinically, some of these complications can obscure the presence of underlying malignancies in the colon and these complications may require emergency surgical management. The complications of the colon that can be associated with colon cancer include obstruction, perforation, abscess formation, acute appendicitis, ischemic colitis and intussusception. Although the majority of these complications only rarely occur, familiarity with the various manifestations of colon cancer complications will facilitate making an accurate diagnosis and administering prompt management in these situations. The purpose of this pictorial essay is to review the CT appearance of the colonic complications associated with colon cancer.

  3. CT Findings of Colonic Complications Associated with Colon Cancer

    Kim, Sang Won; Shin, Hyeong Cheol; Kim, Il Young; Kim, Young Tong; Kim, Chang Jin [Cheonan Hospital, Soonchunhyang University, Cheonan (Korea, Republic of)

    2010-04-15

    A broad spectrum of colonic complications can occur in patients with colon cancer. Clinically, some of these complications can obscure the presence of underlying malignancies in the colon and these complications may require emergency surgical management. The complications of the colon that can be associated with colon cancer include obstruction, perforation, abscess formation, acute appendicitis, ischemic colitis and intussusception. Although the majority of these complications only rarely occur, familiarity with the various manifestations of colon cancer complications will facilitate making an accurate diagnosis and administering prompt management in these situations. The purpose of this pictorial essay is to review the CT appearance of the colonic complications associated with colon cancer.

  4. Clinical characteristics and complications of acute coronarv svndrome in women%女性急性冠状动脉综合征患者的临床特点分析

    王曦之; 陈韵岱; 米树华; 贾淑杰; 周芸; 杨红霞; 关杨

    2012-01-01

    目的 探讨女性急性冠状动脉综合征(ACS)患者的临床特点.方法 整理明确诊断为ACS的住院患者的病历资料,比较472例住院女性ACS患者与1277例男性ACS患者的临床诊治及并发症特点.结果 女性ACS的发病年龄较男性大,60岁以后发病比例女性明显比男性高[83.6% (395/472)比70.2%( 896/1277)];女性患者发病到就诊的时间长[(131±35)h比(114±36)h],住院时间长[(13±3)d比(12±4)d],2组比较差异均有统计学意义(P<0.05).女性ACS患者危险因素较多,较男性合并糖尿病[36.7%( 173/472)比22.1% (283/1277)]、高血压[72.5% (342/472)比60.9% (778/1277)]多,2组比较差异有统计学意义(P<0.05).诊断不稳定型心绞痛的女性患者明显多于男性患者[50.0%(236/472)比37.4%( 478/1277)],而诊断急性心肌梗死的女性少于男性[42.4%(200/472.比58.1% (742/1277)],2组比较差异有统计学意义(P<0.05).女性选择经皮冠状动脉介入治疗术[50.2%(237/472)比63.8% (825/1277)]及冠状动脉搭桥术[1.3%(6/472)比3.9%(49/1277)]治疗者少于男性,2组比较差异有统计学意义(P<0.05).结论 女性ACS患者并发症多,预后较男性差.%Objective To analyze the clinical characteristics and complications of acute coronary syndrome (ACS) in women.Methods Clinical characteristics and complications of 313 women and 857 men diagnosed of ACS in GRACE Study were observed.Results Women with ACS were older than men.The women's morbidity was significantly higher than that of men older than sixty[ 83.6% (395/472) vs 70.2% (896/1277) ].It takes longer time from onset to see a doctor in female patient with ACS than in male patient with ACS[ (131 ± 35 )h vs (114 ± 36) h ],and the duration of hospital stay in female patient with ACS is longer than that in male patient with ACS [ ( 13 ±3)d vs ( 12 ±4)d] (P <0.05).Women with ACS had more risk factors than men.Diabetes[ 36.7% ( 173/ 472)vs 22.1%(283/1277)] and

  5. Complications of endovascular treatment of cerebral aneurysms.

    Orrù, Emanuele; Roccatagliata, Luca; Cester, Giacomo; Causin, Francesco; Castellan, Lucio

    2013-10-01

    The number of neuroendovascular treatments of both ruptured and unruptured aneurysms has increased substantially in the last two decades. Complications of endovascular treatments of cerebral aneurysms are rare but can potentially lead to acute worsening of the neurological status, to new neurological deficits or death. Some of the possible complications, such as vascular access site complications or systemic side effects associated with contrast medium (e.g. contrast medium allergy, contrast induced nephropathy) can also be encountered in diagnostic angiography. The most common complications of endovascular treatment of cerebral aneurysms are related to acute thromboembolic events and perforation of the aneurysm. Overall, the reported rate of thromboembolic complications ranges between 4.7% and 12.5% while the rate of intraprocedural rupture of cerebral aneurysms is about 0.7% in patients with unruptured aneurysms and about 4.1% in patients with previously ruptured aneurysms. Thromboembolic and hemorrhagic complications may occur during different phases of endovascular procedures and are related to different technical, clinical and anatomic reasons. A thorough knowledge of the different aspects of these complications can reduce the risk of their occurrence and minimize their clinical sequelae. A deep understanding of complications and of their management is thus part of the best standard of care.

  6. Complications of endovascular treatment of cerebral aneurysms

    Orrù, Emanuele, E-mail: surgeon.ema@gmail.com [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Roccatagliata, Luca, E-mail: lroccatagliata@neurologia.unige.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy); Department of Health Sciences (DISSAL), University of Genoa (Italy); Cester, Giacomo, E-mail: giacomo.cester@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Causin, Francesco, E-mail: francesco.causin@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Castellan, Lucio, E-mail: lucio.castellan@hsanmartino.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy)

    2013-10-01

    The number of neuroendovascular treatments of both ruptured and unruptured aneurysms has increased substantially in the last two decades. Complications of endovascular treatments of cerebral aneurysms are rare but can potentially lead to acute worsening of the neurological status, to new neurological deficits or death. Some of the possible complications, such as vascular access site complications or systemic side effects associated with contrast medium (e.g. contrast medium allergy, contrast induced nephropathy) can also be encountered in diagnostic angiography. The most common complications of endovascular treatment of cerebral aneurysms are related to acute thromboembolic events and perforation of the aneurysm. Overall, the reported rate of thromboembolic complications ranges between 4.7% and 12.5% while the rate of intraprocedural rupture of cerebral aneurysms is about 0.7% in patients with unruptured aneurysms and about 4.1% in patients with previously ruptured aneurysms. Thromboembolic and hemorrhagic complications may occur during different phases of endovascular procedures and are related to different technical, clinical and anatomic reasons. A thorough knowledge of the different aspects of these complications can reduce the risk of their occurrence and minimize their clinical sequelae. A deep understanding of complications and of their management is thus part of the best standard of care.

  7. Interventianal therapy of acute myocardial infarction complicated with ventricular septal rapture%急性心肌梗死并发室间隔穿孔六例介入治疗

    唐学杰; 韩贞普; 李仕华; 夏碧华; 刘贤铭

    2009-01-01

    septal rupture with Amplatzer ventricular septal occluder, coordinated with PCI and PTCA for patients with acute myocardial infarction complicated with ventricular septal rupture.

  8. Diffusion Tensor Imaging of Cerebral Peduncle in Patients with Acute Striatocapsular Infarction Complicated by Upper Limb Motor Functional Damage%急性纹状体内囊梗死上肢运动功能损害的DTI研究

    王润榕; 张帅; 周龙江; 谭政帅; 何玲; 李澄

    2014-01-01

    Objective Using diffusion tensor imaging (DTI) to study the diffusion changes in cerebral peduncle in patients with acute striatocapsular infarction complicated by upper limb motor functional damage,and to discuss the relationship between the striatocapsular infarction and the upper limb motor functional damage.Methods A total of 18 patients with unilateral upper limb motor functional damage after the first onset of acute striatocapsular infarction were enrolled in this study.DTI scanning was performed in all patients within two weeks after the onset of the disease.The fractional anisotropy (FA) and the mean diffusivity (MD) of bilateral cerebral peduncles were measured,and the asymmetry index (AI) of bilateral FA was calculated.The correlation between AI and the involved upper limb motor function scores was evaluated.Results Two weeks after the onset of the disease,the FA value of cerebral peduncle at affected side was significantly lower than that at the unaffected side,and no significant difference in the MD values existed between the two side.AI carried a statistically significant negative relationship with the involved upper limb motor function scores (r =-0.91,P < 0.01).Conclusion DTI can detect the early diffusion changes in cerebral peduncle after striatocapsular infarction.The integrity of pyramidal tract in cerebral peduncle is closely correlated with the motor function of involved upper limb.DTI can provide quantitative imaging reference for clinical assessment of striatocapsular infarction.%目的 应用扩散张量成像(DTI)技术研究纹状体内囊梗死(SCI)患者急性期大脑脚扩散改变情况,分析其与上肢运动功能损害的关系.方法 选择首次急性起病,有单侧上肢运动功能损害的SCI患者18例,于发病后2周行DTI扫描,测量两侧大脑脚的各向异性分数(FA)、平均扩散率(MD)值,计算两侧FA的不对称指数(AI),对AI和受累上肢的FM功能评分进行相关分析.结果 发病后2周时患

  9. 急性早幼粒细胞白血病合并DIC行造血干细胞移植的护理%Nursing of acute promyelocytic leukemia complicated with disseminated intravascular coagulation after hematopoietic stem cell transplantation

    徐晓东; 张蓓蓓; 颜霞; 侯悦; 刘国艳; 张京

    2013-01-01

    目的 1例急性早幼粒细胞白血病合并弥漫性血管内凝血行造血干细胞移植的护理体会,探索造血干细胞移植弥漫性血管内凝血的护理方法.方法 针对此病例的疾病特点,改革造血干细胞移植患者锁骨下双腔静脉插管的静脉输注途径,使用留置针穿刺外周静脉.通过对出凝血指标的监测与评估,采取行之有效的护理方法.结果 通过对患者出凝血指标异常的严密监测,出血部位得到控制.同时,给予全环境保护隔离,患者成功走出层流室.结论 弥漫性血管内凝血,不是一个独立的疾病.该例患者原发病合并DIC,随时有生命危险,因此护理是一个系统工程,只有制订有针对性的护理计划,给予准确的实施,才能保证患者移植成功.%Objective To analyze the procedure of nursing care in one patient with acute promyelocytic leukemia (APL)who developed disseminated intravascular coagulation (DIC)after hematopoietic stem cell transplantation (HSCT).Methods Peripheral venous indwelling needle was used as a pathway of intravenous infusion instead of subclavian central venous catheterization.And coagulation test was monitored and evaluated during HSCT.Results Through the monitoring of coagulation test and environment protective isolation,bleeding was controlled and the patient left laminar flow room successfully.Conclusions DIC is a complicated coagulation disorder.This patient developed life-threatening DIC during HSCT,therefore,for this patient,nursing care is a systematic work.So,only the specified targeted nursing care plans and accurate implementation could ensure the success of HSCT.

  10. Sickle cell disease complications

    Ersi Voskaridou

    2014-12-01

    Full Text Available Sickle cell disease (SCD is an inherited, lifelong condition. The sickle mutation consists a single nucleotide change (GAT->GTT in the sixth codon of exon 1 of the β-globin gene coding for the β-globin polypeptide of hemoglobin (Hb (a2β2. This change results in replacement of the wild type glutamic acid residue by a valine residue in β-globin chain and the formation of the sickle Hb (HbS in homozygotes for this mutation. Heterozygotes live a normal life. In SCD patients, sickle erythrocytes are rigid with decreased deformability and reduced life span resulting in hemolysis, vaso-occlusive disease, vasculopathy and subsequent inflammation and end organ damage. Sickle cell disease affects millions of people worldwide. Today, with proper health care, many SCD patients have a good quality of life (QoL and are in fairly good health most of the time. These people can live up to their forties or fifties, or longer. Despite the ‘common’ underlying genetic basis and a similar pathophysiology, patients with SCD present a highly variable clinical phenotype due to Single Nucleotide Polymorphisms (SNPs variability throughout the genome. Patients with SCD are at high risk for developing multisystem acute and chronic complications associated with significant morbidity and mortality.

  11. Fatal complications of Plasmodium vivax malaria: A series of three case reports

    Deepak Sundriyal

    2013-01-01

    Full Text Available Plasmodium vivax malaria once thought to be benign, is now being seen increasingly as complicated disease in various manifestations. These complications include cerebral malaria, acute respiratory distress syndrome, acute pancreatitis, hepatic dysfunction, coagulopathy-associated hemorrhages, and others. Even if at the onset, disease appears benign, clinicians should be careful to watch for the complications and timely management.

  12. [Complications in null-diet].

    Oster, P; Mordasini, R; Raetzer, H; Schellenberg, B; Schlierf, G

    1977-09-24

    Total starvation is effective for acute weight reduction in obesity. However, in 200 patients, most of whom also had internal diseases, 8% exhibited sometimes severe complications, i.e. reversible cerebral ischemia in 3 hypertensive patients when the blood pressure was lowered to the normal range by natriuresis of fasting; breakdown of water and electrolyte homeostasis with circulatory collapse, vomiting and vertigo; acute crises of paroxysmal nocturnal hemoglobinuria and porphyria respectively and increase of transaminases up to 200 mu/ml, or cardiac arrhythmias. Relative (?) contraindications for total fasting appear to be clinical sings of arteriosclerosis such as vascular bruits, angina pectoris and intermittent claudication. In case of doubt, the method should only be used in hospital.

  13. [Cardiovascular complications of hypertensive crisis].

    Rosas-Peralta, Martín; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Ramírez-Arias, Erick; Pérez-Rodríguez, Gilberto

    2016-01-01

    It is inexorable that a proportion of patients with systemic arterial hypertension will develop a hypertensive crisis at some point in their lives. The hypertensive crises can be divided in hypertensive patients with emergency or hypertensive emergency, according to the presence or absence of acute end-organ damage. In this review, we discuss the cardiovascular hypertensive emergencies, including acute coronary syndrome, congestive heart failure, aortic dissection and sympathomimetic hypertensive crises (those caused by cocaine use included). Each is presented in a unique way, although some patients with hypertensive emergency report non-specific symptoms. Treatment includes multiple medications for quick and effective action with security to reduce blood pressure, protect the function of organs remaining, relieve symptoms, minimize the risk of complications and improve patient outcomes.

  14. Predictors of short term mortality in patients with acute ST-elevation myocardial infarction complicated by cardiogenic shock%急性心肌梗死合并心原性休克死亡危险因素分析

    刘尧; 杨艳敏; 朱俊; 谭慧琼; 梁岩; 刘力生; 丽英

    2010-01-01

    目的 探讨ST段抬高的急性心肌梗死合并心原性休克(cardiogenic shock,CS)患者的近期预后和影响病死率的独立危险因素,为CS患者的死亡风险评估提供参考.方法 采用国际多中心CREATE研究的中国ST段抬高急性心肌梗死患者517例资料,平均年龄(68.5±10.3)岁,男性患者占57.6%.用单变量和多变量logistic回归分析合并CS患者的基线特征因素和治疗因素与30 d病死率的相关性.结果 517例CS患者30 d的病死率为62.3%(322例).将全部变量进行多因素logistic回归分析显示年龄(OR=1.46,95%GI:1.18~1.81)、前壁梗死(OR=2.01,95%CI:1.29~3.11)、入院基线血糖>7.8 mmol/L(OR=2.17,95%CI:1.26~3.73)、血钠<130 mmoL/L(OR=2.21,95%CI:1.21~4.04)、左心室射血分数(LVEF)<40%或重度左心功能障碍(LVD)(OR=3.78,95%CI:2.28~6.27)、未紧急血运重建(OR=3.53,95%CI:1.20~10.41)和使用利尿剂(OR=1.90,95%CI:1.21~2.97)是30 d病死率增加的独立危险因素.仅包含基线特征变量的logistic回归分析显示,上述前5项基线变量是死亡的独立基线危险因素.受试者工作特征曲线(ROC)分析两个回归模型均有较高的判别死亡高危患者的能力,ROC下面积分别为0.81(95%CI:0.77~0.86)和0.80(95%CI:0.75~0.84).结论 STEMI并发CS的患者30 d病死率超过60%,年龄等基线因素和未紧急血运重建等治疗因素是影响30 d病死率的独立危险因素.%Objective To explore the indepedent risk factors associated with short term mortality in patients with ST-segment elevation acute myocardial infarction(STEMI)complicated by cardiogenic shock (CS). Methods We analyzed data from Chinese patients with ST-segment elevation myocardial infarction (STEMI)and cardiogenic shock enrolled in the CREATE trial. Predictors of 30-day mortality were identified by univariate and multivariate logistic regression analysis using baseline and procedural variables. Results The overall 30-day mortality of STEMI

  15. Central nervous system complications after liver transplantation.

    Kim, Jeong-Min; Jung, Keun-Hwa; Lee, Soon-Tae; Chu, Kon; Roh, Jae-Kyu

    2015-08-01

    We investigated the diversity of central nervous system complications after liver transplantation in terms of clinical manifestations and temporal course. Liver transplantation is a lifesaving option for end stage liver disease patients but post-transplantation neurologic complications can hamper recovery. Between 1 January 2001 and 31 December 2010, patients who had undergone liver transplantation at a single tertiary university hospital were included. We reviewed their medical records and brain imaging data and classified central nervous system complications into four categories including vascular, metabolic, infectious and neoplastic. The onset of central nervous system complications was grouped into five post-transplantation intervals including acute (within 1 month), early subacute (1-3 months), late subacute (3-12 months), chronic (1-3 years), and long-term (after 3 years). During follow-up, 65 of 791 patients (8.2%) experienced central nervous system complications, with 30 occurring within 1 month after transplantation. Vascular etiology was the most common (27 patients; 41.5%), followed by metabolic (23; 35.4%), infectious (nine patients; 13.8%), and neoplastic (six patients). Metabolic encephalopathy with altered consciousness was the most common etiology during the acute period, followed by vascular disorders. An initial focal neurologic deficit was detected in vascular and neoplastic complications, whereas metabolic and infectious etiologies presented with non-focal symptoms. Our study shows that the etiology of central nervous system complications after liver transplantation changes over time, and initial symptoms can help to predict etiology.

  16. Early management of acute pancreatitis.

    Schepers, Nicolien J; Besselink, Marc G H; van Santvoort, Hjalmar C; Bakker, Olaf J; Bruno, Marco J

    2013-10-01

    Acute pancreatitis is the most common gastro-intestinal indication for acute hospitalization and its incidence continues to rise. In severe pancreatitis, morbidity and mortality remains high and is mainly driven by organ failure and infectious complications. Early management strategies should aim to prevent or treat organ failure and to reduce infectious complications. This review addresses the management of acute pancreatitis in the first hours to days after onset of symptoms, including fluid therapy, nutrition and endoscopic retrograde cholangiography. This review also discusses the recently revised Atlanta classification which provides new uniform terminology, thereby facilitating communication regarding severity and complications of pancreatitis.

  17. Atypical respiratory complications of dengue fever

    Naveen Kumar; AK Gadpayle; Deepshikha Trisal

    2013-01-01

    In last decade, dengue has emerged as one of the most important vector born disease.With increasing cases, uncommon presentations and complications are now commonly recognized. Here, we report two cases of rare pattern of respiratory involvement in dengue: acute respiratory distress syndrome and bronchiolitis with respiratory failure.

  18. ERCP in acute pancreatitis

    Jijo V Cherian; Joye Varghese Selvaraj; Rajesh Natrayan; Jayanthi Venkataraman

    2007-01-01

    BACKGROUND:The role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute pancreatitis has evolved over years since its introduction in 1968. Its importance in diagnosing the etiology of pancreatitis has steadily declined with the advent of less invasive diagnostic tools. The therapeutic implications of ERCP in acute pancreatitis are many fold and are directed towards management of known etiological factors or its related complications. This article highlights the current status of ERCP in acute pancreatitis. DATA SOURCES:An English literature search using PubMed database was conducted on ERCP in acute pancreatitis, the etiologies and complications of pancreatitis amenable to endotherapy and other related subjects, which were reviewed. RESULTS: ERCP serves as a primary therapeutic modality for management of biliary pancreatitis in speciifc situations, pancreatitis due to microlithiasis, speciifc types of sphincter of Oddi dysfunction, pancreas divisum, ascariasis and malignancy. In recurrent acute pancreatitis and smoldering pancreatitis it has a deifnite therapeutic utility. Complications of acute pancreatitis including pancreatic-duct disruptions or leaks, benign pancreatic-lfuid collections and pancreatic necrosis can be beneifcially dealt with. Intraductal ultrasound and pancreatoscopy during ERCP are useful in detecting pancreatic malignancy. CONCLUSIONS:The role of ERCP in acute pancreatitis is predominantly therapeutic and occasionally diagnostic. Its role in the management continues to evolve and advanced invasive procedures should be undertaken only in centers dedicated to pancreatic care.

  19. Acute Pancreatitis Associated with Brucellosis

    Demetrios Papaioannides

    2006-01-01

    Full Text Available Context :Acute pancreatitis can be caused by a variety of infectious agents but it is regarded as an extremely rare complication of brucellosis. Case report: We briefly describe a 56-yearold man who presented with acute pancreatitis, fever, myalgia, and other clinical symptoms. Brucella melitensis was cultured from his blood. All clinical manifestations gradually resolved with the institution of intramuscular streptomycin and oral doxycycline therapy. Conclusion :Acute pancreatitis may rarely be a complication of infection with B. melitensis. In areas where brucellosis is endemic, it should be kept in mind that acute pancreatitis may result from infection with brucella organisms..

  20. Acute Paraplegia After General Anesthesia

    Gholam Hossein Ghaedi

    2011-08-01

    Full Text Available Acute paraplegia is a rare but catastrophic complication of surgeries performed on aorta and corrective operations of vertebral column. Trauma to spinal cord after spinal anesthesia and ischemia of spinal cord also may lead to acute paraplegia. Acute paraplegia as a complication of general anesthesia in surgeries performed on sites other than aorta and vertebral column is very rare. Here we present a 56 year old woman with acute paraplegia due to spinal cord infarction after laparoscopic cholecystectomy under general anesthesia probably caused by atherosclerosis of feeding spinal arteries and ischemia of spinal cord after reduction of blood flow possibly due to hypotension during general anesthesia.

  1. 四肢战创伤并发急性肾衰竭危险因素的logistic回归分析%Logistic regression analysis of the risk factors of acute renal failure complicating limb war injuries

    程昌志; 赵东海; 李全岳; 曲海燕; 陈伯成; 林舟丹

    2011-01-01

    Objective To explore the risk factors of complication of acute renal failure (ARF) in war injuries of limbs. Methods The clinical data of 352 patients with limb injuries admitted to 303 Hospital of PLA from 1968 to 2002 were retrospectively analyzed. The patients were divided into ARF group (n=9) and non-ARF group ( n=343) according to the occurrence of ARF, and the case-control study was carried out. Ten factors which might lead to death were analyzed by logistic regression to screen the risk factors for ARF,including causes of trauma, shock after injury, time of admission to hospital after injury, injured sites, combined trauma, number of surgical procedures, presence of foreign matters, features of fractures, amputation, and tourniquet time. Results Fifteen of the 352 patients died (4.3%) , among them 7 patients (46.7%) died of ARF, 3 (20.0%) of pulmonary embolism, 3 (20.0 %) of gas gangrene,and 2 (13.3%) of multiple organ failure. Univariate analysis revealed that the shock, time before admitted to hospital, amputation and tourniquet time were the risk factors for ARF in the wounded with limb injuries, while the logistic regression analysis showed only amputation was the risk factor for ARF ( P<0.05). Conclusion ARF is the primary cause-of-death in the wounded with limb injury.Prompt and accurate treatment and optimal time for amputation may be beneficial to decreasing the incidence and mortality of ARF in the wounded with severe limb injury and ischemic necrosis.%目的 探讨四肢战创伤并发急性肾衰竭(ARF)的危险因素.方法 回顾性分析1968-2002年收治的352例四肢战创伤患者,根据是否发生ARF将患者分为ARF组(9例)和非ARF组(343例)并进行病例对照研究,选择可能影响患者死亡的10个因素(致伤物、伤后是否休克、伤后入院时间、受伤部位、有无合并伤、手术次数、有否异物存留、骨折性质、是否截肢、止血带时间)进行logistic回归分析,筛

  2. Pregnancy Complications: Shoulder Dystocia

    ... Home > Complications & Loss > Pregnancy complications > Shoulder dystocia Shoulder dystocia Now playing: E-mail to a friend Please ... women more likely than others to have shoulder dystocia? A pregnant woman may be at risk for ...

  3. Pregnancy Complications: Bacterial Vaginosis

    ... Complications & Loss > Pregnancy complications > Bacterial vaginosis and pregnancy Bacterial vaginosis and pregnancy E-mail to a friend Please ... this page It's been added to your dashboard . Bacterial vaginosis (also called BV or vaginitis) is an infection ...

  4. Pregnancy Complications: Anemia

    ... Close X Home > Complications & Loss > Pregnancy complications > Anemia Anemia E-mail to a friend Please fill in ... anemia at a prenatal care visit . What causes anemia? Usually, a woman becomes anemic (has anemia) because ...

  5. Pregnancy Complications: Preeclampsia

    ... Close X Home > Complications & Loss > Pregnancy complications > Preeclampsia Preeclampsia E-mail to a friend Please fill in ... even if you’re feeling fine. What is preeclampsia? Preeclampsia is a condition that can happen after ...

  6. The nursing of use breathing machine adjuvant therapy acute myocardial infarction complicated by cardiogenic shock after intra-aortic balloon counterpulsation.%主动脉球囊反搏术后应用呼吸机辅助治疗急性心肌梗死合并心源性休克患者的护理

    李坚

    2012-01-01

    目的:探讨主动脉球囊反搏术后应用呼吸机辅助治疗急性心肌梗死合并心源性休克患者的效果及护理方法.方法:回顾分析我院21例急性心肌梗死合并心源性休克患者主动脉球囊反搏术后应用呼吸机辅助治疗的护理措施.结果:急性心肌梗死合并心源性休克患者经过积极的抢救治疗,16例患者好转出院,3例患者抢救无效死亡,2例患者家属签字放弃抢救,自动出院.救治成功率为76.19%.结论:急性心肌梗死患者应用主动脉球囊反搏治疗具有良好的近期疗效,及时使用呼吸机辅助治疗,给予积极有效的预防治疗护理措施,能降低死亡率,提高救治成功率,促进患者康复.%Objective: To investigate the effect and nursing method of use breathing machine adjuvant therapy acute myocardial infarction( AMI) complicated by cardiogenic shock after intra - aortic balloon counterpulsation( IABP ) . Methods: Retrospective analyzed the nursing measures of 21 cases of myocardial infarction( AMI ) complicated by cardiogenic shock patients use intra - aortic balloon counterpulsation and breathing machine adjuvant therapy. Results:The patient of acute myocardial infarction( AMI) complicated by cardiogenic shock after the emergency treatment, 16 cases were cured, 3 cases were dead. , 2cases were amel iorated. The successful rate of rescue was 76.19%. Conclusion:IABP therapy for acute myocardial infarction patients have a good short -term curative effect, cardigenic shock is the severe complications of acute myocardial infarction( AMI), there was high morbidity, timely treatment by breathing machine and actively adopted effective measures can reduced mortality rate and improve the success rate, and will promote the patient soon to be restored to health.

  7. Complications of blepharoplasty.

    Morax, Serge; Touitou, Valerie

    2006-12-01

    The complications of blepharoplasty are infrequent, most often minor and transient, and rarely major and permanent with functional or aesthetic consequences. Treatment is above all preventive with screening of "at risk" patients in whom blepharoplasty would be contra-indicated. Patients must be informed of possible risks through informative booklets stressing the most important points. The complications may affect vision. Partial or complete visual loss due to ischemic optic neuropathy, or rarely to compression of the ocular globe by intraorbital hemorrhage, is the most serious complication. Other visual complications include oculomotor disorders, keratoconjunctivitis sicca, epiphora, and chemosis of lymphatic origin. Eyelid complications are more frequent: ptosis of the upper eyelid or lagophthalmia caused by incorrect resection of the skin, scarring, and eyelid fold anomalies. The most severe aesthetic complication is the malposition of the lower eyelid resulting in retraction, lagophthalmia, ectropion, deformation of the external canthus, or lower eyelid tissue relaxation. These malpositions are often minor, sometimes reversible, but they can be major, with psychological, aesthetic, and functional consequences. Other local complications include enophthalmia and hypo- or hypercorrection. General complications may include pigmentation anomalies or infections extending as far as the orbital fat tissue. Finally, complications observed after the newer procedures of laser surgery include ectropion, burns and residual redness. Complications related to periocular injections of filling material are also mentioned. The discussion of these complications is followed by a comprehensive review of the prevention, diagnosis and management of the complications after blepharoplasty.

  8. 肾穿刺活检术后出血合并急性精神障碍患者的原因分析及护理%Postoperative hemorrhage complicating acute renal biopsy analysis of the causes of mental disorders and nursing

    赵丽芳

    2015-01-01

    Objective Explore postoperative hemorrhage complicating acute renal biopsy disorder causes and nursing measures to reduce the occurrence of postoperative complications and improve quality of care. Methods In May 2013 to October 2014 of 4 cases of renal biopsy admitted in our department an analysis of the causes of postoperative hemorrhage complicating acute mental disorders, and effective nursing intervention, the drug therapy. Results Carefully, treatment and nursing care of patients were cured in 4 patients. Conclusions Renal biopsy is not only focus on common postoperative complication of nursing, and should pay attention to patients' mental nursing, preventing the psychological problems affect the progress of the disease.%目的:探讨肾穿刺活检术后出血合并急性精神障碍发生的原因及护理措施,减少术后并发症的发生,提升护理质量。方法:对2013年5月至2014年10月我科收治的4例肾穿刺活检术后出血合并急性精神障碍患者进行原因分析,并进行有效的护理干预,药物治疗。结果:经过精心的治疗护理,4例患者均治愈。结论:肾穿刺活检术后不仅关注常见的并发症的护理,而且要注重患者心理精神的护理,防止因心理问题影响疾病的发展。

  9. Complications of strabismus surgery

    Scott E Olitsky

    2015-01-01

    Full Text Available All surgeries carry risks of complications, and there is no way to avoid ever having a complication. Strabismus surgery is no different in this regard. There are methods to reduce the risk of a complication during or after surgery, and these steps should always be taken. When a complication occurs, it is important to first recognize it and then manage it appropriately to allow for the best outcome possible. This article will discuss some of the more common and/or most devastating complications that can occur during or after strabismus surgery as well as thoughts on how to avoid them and manage them should they happen.

  10. [Complications of urinary calculi].

    Joual, A; Fekak, H; Rabii, R; el Moussasoui, A; Benjelloun, S

    1996-01-01

    Urinary stones is a frequent disease whose renal complications can engage both functional and vital prognosis. We report 769 complicated cases observed 10 years. The diagnosis was made by intravenous urography and ultrasonography. 607 cases were mechanical complications, 582 hydronephrosis, 25 anuria, 262 were infectious complications, 82 chronic pyelonephritis, 60 pyonephrosis, 10 perinephric abscess. Treatment included adapted antibiotic therapy, ureteral catheter in case of anuria ; surgical extraction of the stone nephrectomy was performed in 100 patients. Results were generally good. 9 patients had endstage chronic renal failure. The high frequency of urinary stone complications is due to the fact that most patients consult late. The diagnosis must obviously be made.

  11. Complications of mandibular fractures.

    Zweig, Barry E

    2009-03-01

    Before any definitive treatment of mandibular fractures, the patient needs to be evaluated for more potentially life-threatening injuries. Complications can and do occur with treatment of mandibular fractures and can occur during any of the phases of treatment. The development of an accurate diagnosis and appropriate treatment plan is vital in achieving optimal success and decreasing complications. Knowledge of the anatomy and the principles of bone healing is also an important factor in preventing complications. To limit long-term untoward effects, complications should be recognized early and the appropriate treatment should be started before a minor complication becomes a complex one that is more difficult to manage.

  12. COMPLICATIONS OF THROMBOLYTIC THERAPY IN ACTUAL CLINICAL PRACTICE

    A. F. Sharafutdinova

    2014-07-01

    Full Text Available Reperfusion therapy, in particular, thrombolysis in acute myocardial infarction involves development of serious complications. This clinical situation demonstrates the complexity of treatment of patients with hemorrhagic complications after thrombolysis and makes questions on the application of antiplatelet agents and anticoagulants in such cases.

  13. COMPLICATIONS OF THROMBOLYTIC THERAPY IN ACTUAL CLINICAL PRACTICE

    A. F. Sharafutdinova

    2011-01-01

    Full Text Available Reperfusion therapy, in particular, thrombolysis in acute myocardial infarction involves development of serious complications. This clinical situation demonstrates the complexity of treatment of patients with hemorrhagic complications after thrombolysis and makes questions on the application of antiplatelet agents and anticoagulants in such cases.

  14. Complications of flow-directed balloon-tipped catheters.

    Smart, F W; Husserl, F E

    1990-01-01

    Acute or short-term complications following the use of flow-directed balloon-tipped catheters are well recognized. Long-term sequelae are rarely reported. We report herein an early complication of pulmonary arterial rupture with infarction followed by the delayed development of a pulmonary arterial aneurysm.

  15. Complicated cholecystitis: the complementary roles of sonography and computed tomography.

    Charalel, Resmi A; Jeffrey, R Brooke; Shin, Lewis K

    2011-09-01

    Acute cholecystitis is a common cause of abdominal pain in the Western world. Unless treated promptly, patients with acute cholecystitis may develop complications such as gangrenous, perforated, or emphysematous cholecystitis. Because of the increased morbidity and mortality of complicated cholecystitis, early diagnosis and treatment are essential for optimal patient care. Nevertheless, complicated cholecystitis may pose significant challenges with cross-sectional imaging, including sonography and computed tomography (CT). Interpreting radiologists should be familiar with the spectrum of sonographic findings seen with complicated cholecystitis and as well as understand the complementary role of CT. Worrisome imaging findings for complicated cholecystitis include intraluminal findings (sloughed mucosa, hemorrhage, abnormal gas), gallbladder wall abnormalities (striations, asymmetric wall thickening, abnormal gas, loss of sonoreflectivity and contrast enhancement), and pericholecystic changes (echogenic fat, pericholecystic fluid, abscess formation). Finally, diagnosis of complicated cholecystitis by sonography and CT can guide alternative treatments including minimally invasive percutaneous and endoscopic options.

  16. Increased serum levels of fibrinogen degradation products due to treatment with recombinant tissue-type plasminogen activator for acute myocardial infarction are related to bleeding complications, but not to coronary patency

    R.W. Brower (Ronald); D. Collen; G.A. van Es (Gerrit Anne); J. Lubsen (Jacob); P.W.J.C. Serruys (Patrick); M.L. Simoons (Maarten); M. Verstraete (Marc); A.E.R. Arnold (Alfred)

    1989-01-01

    textabstractThe association of increasing serum levels of fibrinogen degradation products after recombinant tissue-type plasminogen activator (rt-PA) therapy with bleeding and early coronary patency was assessed in 242 patients with acute myocardial infarction. After administration of 5,000 IU hepar

  17. Extended complications of urethroplasty

    Hosam S. Al-Qudah

    2005-08-01

    Full Text Available INTRODUCTION: An extensive study of complications following urethroplasty has never been published. We present 60 urethroplasty patients who were specifically questioned to determine every possible early and late complication. MATERIALS AND METHODS: Retrospective chart review of urethroplasty patients between August 2000 and March 2004. An "open format" questioning style allowed maximal patient reporting of all complications, no matter how minor. RESULTS: 60 patients underwent 62 urethroplasties (24 anterior anastomotic, 19 buccal mucosal and 10 fasciocutaneous, 9 posterior anastomotic with mean follow-up of 29 months. Early complications occurred in 40%, but only 3% were major (rectal injury and urosepsis. Early minor complications included scrotal swelling, scrotal ecchymosis and urinary urgency. Late complications occurred in 48%, but only 18% were significant (erectile dysfunction, chordee and fistula. Late minor complications included a feeling of wound tightness, scrotal numbness and urine spraying. Fasciocutaneous urethroplasty caused the most significant complications, and buccal mucus urethroplasty the least, while also resulting in the lowest recurrence rate (0%. CONCLUSIONS: Serious complications after urethroplasty (3% early and 18% late appear similar to those reported elsewhere, but minor bothersome complications appear to occur in much higher numbers than previously published (39% early and 40% late. While all the early complications were resolved and most (97% were minor, less than half of the late complications were resolved, although most (82% were minor. These complication rates should be considered when counseling urethroplasty patients, and generally tend to support the use of buccal mucosal onlay urethroplasty as it had the lowest rate of serious side effects.

  18. Acute brain hemorrhage in dengue

    Somsri Wiwanitkit; Viroj Wiwanitkit

    2014-01-01

    Dengue is a tropical arboviral infection that can have severe hemorrhagic complication.Acute brain hemorrhage in dengue is rare and is a big challenge in neurosurgery.To perform surgery for management of acute brain hemorrhage in dengue is a controversial issue.Here, the authors try to summarize the previous reports on this topic and compare neurosurgery versus conservative management.

  19. Acute arsenic poisoning diagnosed late.

    Shumy, Farzana; Anam, Ahmad Mursel; Kamruzzaman, A K M; Amin, Md Robed; Chowdhury, M A Jalil

    2016-04-01

    Acute arsenicosis, although having a 'historical' background, is not common in our times. This report describes a case of acute arsenic poisoning, missed initially due to its gastroenteritis-like presentation, but suspected and confirmed much later, when the patient sought medical help for delayed complications after about 2 months.

  20. Early Small-incision High-ligation and Stripping for Great Saphenous Varicose Vein Complicated with Acute Superficial Thrombophlebitis%早期小切口大隐静脉高位结扎剥脱术治疗伴急性血栓性浅静脉炎的大隐静脉曲张

    袁链; 尹立伟; 张小明

    2013-01-01

    目的 探讨早期小切口大隐静脉高位结扎剥脱术治疗伴急性血栓性浅静脉炎的大隐静脉曲张的疗效. 方法 同顾性分析我院2008年10月~2011年5月32例大隐静脉曲张并发急性血栓性浅静脉炎的临床资料.发病2周内行小切口大隐静脉高位结扎剥脱术. 结果 全部患者术后局部红肿疼痛于3天内消退,切口全部甲级愈合,住院时间10~ 16 d,平均12.6 d 全部患者随访5~32个月,平均13.6月,其中11例>12个月,未见复发. 结论 早期小切口大隐静脉高位结扎剥脱术治疗伴急性血栓性浅静脉炎的大隐静脉曲张是安全的,术后疗效满意.%Objective To explore the efficacy of high ligation and stripping of the varicose veins through a small incision in early slage for patients with great saphenous varicose vein complicated with acute superficial thrombophlebitis. Methods The clinical data of 32 patients with great saphenous varicose vein complicated with acute superficial thrombophlebitis, who received operation in our hospital from October 2008 to May 2011 , were analyzed retrospectively. All of the patients underwent high ligation and stripping of the varicose veins through a small incision in two weeks since the onset of acute superficial thrombophlebitis. Results All the patients recovered well with grade A wound healing. Local swelling and pain disappeared in 3 days in all the cases. The mean hospital stay was 12. 6 days ( ranged from 10 to 16 days). All the patients were followed up for 5 to 32 months with a mean of 13. 6 months ( > 12 months in 11 cases). No patient had recurrence. Conclusions High ligation and stripping of the varicose veins through a small incision in an early stage is safe and effective for the treatment of great saphenous varicose vein complicated with acute superficial thrombophlebitis. We recommend it to be used in more hospitals.

  1. Hemorrhagic Fever with Renal Syndrome Complicated by Orchitis

    Edmond Puca; Arben Pilaca; Pellumb Pipero; Silva Bino; Majlinda Kote; Elton Rogozi; Entela Puca; Dhimiter Kraja

    2011-01-01

    Hemorrhagic fever with renal syndrome (HFRS) is a disease caused by viruses of the family Bunyaviridae,genus Hantavirus.HFRS from Dobrava virus (DOBV) is a seldom reported disease in Albania.Clinically HFRS is manifested as mild,moderate,or severe.Therefore,the number of cases of Hantavirus'infection may be underestimated,and should be included in the differential diagnosis of many acute infections,hematologic diseases,acute abdominal diseases and renal diseases complicated by acute renal failure.We report here an atypical presentation of HFRS from Dobrava virus complicated by orchitis with a positive outcome.

  2. A rare disease in the differential diagnosis of acute pancreatitis: acute brucellosis.

    Berber, Ilhami; Erkurt, Mehmet Ali; Yetkin, Funda; Unlu, Serkan; Yilmaz, Sami; Bentli, Recep; Bazna, Sezai

    2014-01-01

    Some infectious organisms may give rise to acute pancreatitis; brucellosis, however, extremely rarely leads to acute pancreatitis. A 40-year-old man was diagnosed with acute pancreatitis, the etiology of which was determined to be acute brucellosis. The patient was discharged without complications approximately 15 days after the initiation of trimethoprim-sulfamethoxazole and doxycycline treatment. Brucella infections may rarely be complicated by acute pancreatitis. Thus, brucellosis should be remembered in the etiology of acute pancreatitis in regions such as Turkey, where Brucella infections are endemic.

  3. Pancreatic pseudocyst after acute organophosphate poisoning.

    Kawabe, Ken; Ito, Tetsuhide; Arita, Yoshiyuki; Sadamoto, Yojiro; Harada, Naohiko; Yamaguchi, Koji; Tanaka, Masao; Nakano, Itsuro; Nawata, Hajime; Takayanagi, Ryoichi

    2006-04-01

    Acute organophosphate poisoning (OP) shows several severe clinical symptoms due to its strong blocking effect on cholinesterase. Acute pancreatitis is one of the complications associated with acute OP, but this association still may not be widely recognized. We report here the case of a 73-year-old man who had repeated abdominal pain during and after the treatment of acute OP. Hyperamylasemia and a 7-cm pseudocyst in the pancreatic tail were noted on investigations. We diagnosed pancreatic pseudocyst that likely was secondary to an episode of acute pancreatitis following acute OP. He was initially treated with a long-term intravenous hyperalimentation, protease inhibitors and octerotide, but eventually required surgical intervention, a cystgastrostomy. Acute pancreatitis and hyperamylasemia are known to be possible complications of acute OP. It is necessary to examine and assess pancreatic damage in patients with acute OP.

  4. Lower Limb Ischaemia Complicating Total Hip Arthroplasty

    Shiu-Wai Chan

    2012-06-01

    Full Text Available This article is about two patients having vascular injuries complicating total hip arthroplasty because of intraoperative indirect injuries. One patient had a delayed presentation of acute lower limb ischaemia, in which he required amputation of his left second toe because of ischaemic gangrene. The other patient had acute lower limb ischaemia leading to permanent muscle and nerve damage because of delayed recognition. Both patients had vascular interventions for the indirect vascular injuries. Preoperative workup for suspicious underlying peripheral vascular disease, intraoperative precautions, and perioperative period of vascular status monitoring are essential for prevention and early detection of such sinister events.

  5. Postoperative abdominal complications after cardiopulmonary bypass

    Dong Guohua

    2012-10-01

    Full Text Available Abstract Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB. Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4% developed abdominal complications postoperatively, including 11(33.3% cases of paralytic ileus, 9(27.3% of gastrointestinal haemorrhage, 2(6.1% of gastroduodenal ulcer perforation, 2(6.1% of acute calculus cholecystitis, 3(9.1% of acute acalculus cholecystitis, 4(12.1% of hepatic dysfunction and 2(6.1% of ischemia bowel diseases. Of the 33 patients, 26 (78.8% accepted medical treatment and 7 (21.2% underwent subsequent surgical intervention. There were 5(15.2% deaths in this series, which was significantly higher than the overall mortality (2.7%. Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients.

  6. Sigmoid volvulus complicating pregnancy

    De Utpal

    2005-07-01

    Full Text Available Sigmoid volvulus complicating pregnancy is an extremely rare complication with fewer than 76 cases reported in literature. We report a case of sigmoid volvulus complicating pregnancy. The sigmoid colon was resected and Hartman′s colostomy was performed. The patient had a successful recovery. Aggressive resuscitation followed by early surgical intervention should be undertaken to reduce maternal and fetal morbidity and mortality.

  7. An application trial with oriental medicine against radiation complication

    Aoki, Yukimasa; Nakagawa, Keiichi; Sasaki, Yasuhito (Tokyo Univ. (Japan). Faculty of Medicine)

    1991-11-01

    Late radiation complications have been the inevitable obstacles for radio-therapy, since the normal tissue damage restricts the maximum tumor dose. Recently, this limitation has been alleviated owing to the technological development in the field of radiation treatment devices. However, the treatment dose in case of radical and prophylactic irradiation cannot be adequately reduced, and acute radiation complications present another hurdle. Results of our preliminary trials with an oriental medicine to overcome the specified acute complication were favorable. We started a new trial with combined oriental medicines against various features of acute complications. Sixty-five cases were registered as the group administered oriental medicine (O group), thirty-two cases as conventionally treated group (C group) and forty-one cases as control group without medication (N group). They were analyzed according to the kind of symptoms. The improvement of sore throat, diarrhea and irritable bowel syndrome was more significant in the O group than in the C group. The effect on nausea was roughly equal between O and C groups. The effects of oriental medicines for the passage disturbance and the stomatitis were the same. The results of O group and C group were better than those of N group in every symptom. Acute radiation complication can be interpreted as unbalanced local liquid distribution from the oriental medical point of view, which is considered as a good indication of intermediate type in oriental medicines. Precise individualization will be required to control acute radiation complications more efficiently. (author).

  8. The postanesthetic period. Complications.

    Malamed, S F

    1987-01-01

    Postanesthetic complications can occur even in the best of circumstances. Proper preparation of the staff, aggressive monitoring of the recovering patient, and early recognition and management of the complications are essential if the outcome is to be successful. In reviewing postanesthetic complications, two factors are present in the overwhelming majority of situations--hypoxia and hypercarbia--often the direct result of inadequate monitoring during the postanesthetic period. The anesthetic procedure is not over once the anesthetic agents are discontinued. The skillful anesthetist is aware of the possibilities of postoperative complications and prevents problems by employing enhanced monitoring techniques during the recovery phase.

  9. The Heimlich maneuver: breaking down the complications.

    Chillag, Shawn; Krieg, Jake; Bhargava, Ranjana

    2010-02-01

    The very young and the very old are vulnerable to choking, and there are over 4000 choking-related deaths annually in the United States. Complications from the Heimlich maneuver (HM), as reported in infrequent case reports, predominantly relate to the elderly. It is doubtful that the denominator, numerator, appropriateness, expertise, and problems of maneuvers applied to choking victims will ever be known. This case report and literature review suggests that the treatment for acute elderly choking victims should be applied carefully and that esophageal food impaction, which should be rapidly distinguishable from choking, can have serious complications with application of the HM.

  10. Transfusion of blood and blood products: indications and complications.

    Sharma, Sanjeev; Sharma, Poonam; Tyler, Lisa N

    2011-03-15

    Red blood cell transfusions are used to treat hemorrhage and to improve oxygen delivery to tissues. Transfusion of red blood cells should be based on the patient's clinical condition. Indications for transfusion include symptomatic anemia (causing shortness of breath, dizziness, congestive heart failure, and decreased exercise tolerance), acute sickle cell crisis, and acute blood loss of more than 30 percent of blood volume. Fresh frozen plasma infusion can be used for reversal of anticoagulant effects. Platelet transfusion is indicated to prevent hemorrhage in patients with thrombocytopenia or platelet function defects. Cryoprecipitate is used in cases of hypofibrinogenemia, which most often occurs in the setting of massive hemorrhage or consumptive coagulopathy. Transfusion-related infections are less common than noninfectious complications. All noninfectious complications of transfusion are classified as noninfectious serious hazards of transfusion. Acute complications occur within minutes to 24 hours of the transfusion, whereas delayed complications may develop days, months, or even years later.

  11. Oral complications of cancer therapies. Oral complications in the pediatric population

    Leggott, P.J. (Univ. of California, San Francisco (USA))

    1990-01-01

    A number of acute oral complications may be associated with cancer therapy in children, but the extent and duration of these complications, and the most effective management techniques. have not been well described. The few studies differ in design, making comparisons difficult. Well-controlled, prospective clinical studies are needed to define the most effective strategies for the management of acute oral complications in children. However, it is clear that dental intervention prior to cancer therapy is an important factor in the optimal preparation of the patient. During cancer therapy, intensive supervised oral preventive protocols appear to be of benefit to the child's oral health, overall comfort, and well-being. Furthermore, the prevention of oral infection may significantly reduce the morbidity associated with cancer therapy. Long-term preventive oral care may help prevent dental disease and infection in medically compromised children and contribute to improving the quality of life. 41 references.

  12. 脓毒血症并发急性肾损伤早期诊断标志物的研究%Prediction of acute kidney injury complicated by sepsis with neutronphil gelatinase-associated lipocalin as an early marker

    李萍珠; 徐炜新

    2010-01-01

    NGAL可作为脓毒血症后AKI的早期诊断标志物.%Objective To investigate the accuracy of NGAL in prediction of acute kidney injury (AKI) complicated by sepsis. Methods Blood and urine samples were collected at different time points in 74 sepsis patients, and 17 AKI patients were got from them.Cysteine Cys C levels were detected with Latex enhanced turbidimetric immunoassay (LETIA). Urine NGAL and Scr levels were detected with solid-phase sandwich enzyme-linked immunosorbent assay and creatinine enzymatic assay respectively. At the same time, 57 non-AKI patients were set as controls. Dynamic changes of urine NGAL and Scr were observed in sepsis patients in test and control group. ROC curve was used to evaluate the performance of AKI diagnosis by urinary NGAL.Results The Scr base line was (59. 38 ±16. 72) μmol/L.The median time of diagnose of AKI was 24 (12, 48) h past-sepsis diagnosis, while the Scr was(100. 35± 28. 26) μmol/L. Of the group, 17 cases of sepsis were diagnosed with AKI, accounting for 23% (17/74) prevalence. In sepsis group, base line value[(0. 61 ± 0. 15) mg/L] of serum Cys C was not upregulated at 2, 4 and 6 h, which was (0. 63 ± 0. 14) mg/L, (0. 68 ± 0. 16) mg/L and (0.65±0. 14) mg/L respectively. As to 8 h [(0. 85 ± 0. 22) mg/L], a slight upregulation was found with no significant difference (t = 1.63, P > 0. 05).A trend of gradual increase of serum Cys C levels was found in sepsis AKI group at 12, 18, 24, 36, 48 and 72 h. A significant difference was found compared with base line (t = 2. 81, 2.98, 3.05, 3.11, 3. 38,3. 17,P <0.01). NGAL level[(96.21 ±45.32) μg/L] was significantly higher than base line value [(4. 98 ± 1.65) μg/L]. Subsequently, in each time point from the 2 h to 48 h, a trend of gradual increase in urinary NGAL levels was showed. The differences were significant compared with the baseline values (t =2. 74,2. 83,2. 91,3.04,3.15,3.22,3. 31,3.45,3.57 ,P <0. 01). Urinary NGAL levels of sepsis AKI group were

  13. COMPLICATIONS OF PERCUTANEOUS NEPHROLITHOTOMY

    Ottra

    2016-03-01

    Full Text Available BACKGROUND The increasing global prevalence of nephrolithiasis continues to burden the health care delivery systems of developing nations. Percutaneous Nephrolithotomy (PCNL is considered the standard treatment for many types of calculi. This study focuses on the complications of PCNL in private practice setting at a peripheral center using the modified Clavien system and role of Guy’s stone score as a predictor of stone free rate and complications. METHODS This is a prospective cohort study of 480 patients who underwent PCNL during August 2011 to July 2015. The complications were classified according to modified Clavien system and correlated with the stone complexity as per the Guy’s stone score. RESULTS It was found that overall 120 complications were reported in 480 patients with the incidence of complications of Grade I, II, IIIa, IIIb, IVb being 48 (10%, 38 (7.9%, 15 (3.5%, 12 (2.5% and 4 (0.8% respectively. As per the Guy’s stone score there were 336, 104 and 40 cases belonging to GSS I, II and III respectively. All grades of complications were more common in GSS II and III. The stone clearance was found to be complete in 95%, 82% and 75% of GSS I, II, III respectively. CONCLUSION The stone complexity is related to complication rate and GSS helps to predict stone free rate and complications

  14. Pellagra complicating Crohn's disease.

    Zaki, I.; Millard, L

    1995-01-01

    We report a 53-year-old patient with clinical features of pellagra as a complication of Crohn's disease. His symptoms improved rapidly on taking oral nicotinic acid and vitamin B complex. We suggest the paucity of reported cases of pellagra in Crohn's disease is a reflection of poor recognition of this complication.

  15. Bulimia Nervosa - medical complications.

    Mehler, Philip S; Rylander, Melanie

    2015-01-01

    As with anorexia nervosa, there are many medical complications associated with bulimia nervosa. In bulimia nervosa, these complications are a direct result of both the mode and the frequency of purging behaviours. For the purposes of this article, we will review in detail the many complications of the two major modes of purging, namely, self-induced vomiting and laxative abuse; these two account for more than 90% of purging behaviours in bulimia nervosa. Some of these complications are potentially extremely dangerous and need to be well understood to effectively treat patients with bulimia nervosa. Other methods of purging, such as diuretic abuse, are much less frequently utilized and will only be mentioned briefly. In a subsequent article, the treatments of these medical complications will be presented.

  16. 早期机械通气治疗连枷胸并发急性肺挫伤的疗效评价%Evaluation of the effect of early mechanical ventilation in the treatment of flail chest complicated with acute pulmonary contusion

    严四军; 邓波荣; 刘燕; 曹祥; 黄洁健; 乔德成

    2011-01-01

    Objective:To investigate the therapeutic efficacy of mechanical ventilation in the treatment of ilail chest complicated with acute pulmonary contusion. Method:The data of 51 cases suffered of flail chest complicated with acute pulmonary contusion in our hospital from March 2001 to February 2010 were retrospectively analyzed.According to the starting time of mechanical ventilation, the patients were divided into two groups: the early mechanical ventilation group (n = 32) and the later mechanical ventilation group (n = 19). The parameters of blood gas,time of mechanical ventilation, time in intensive care unit(ICU),incidence of complications,and the mortality were compared between the two groups. Result: The degree of respiratory failure of the early mechanical ventilation group was serious than that of the later mechanical ventilation group on admission. However, the degree of respiratory failure of the former was more lightly than that of the latter 24 hours after ventilation(P<0.01). The time of mechanical ventilation and in ICU of the former were obviously shorter than that of the latter,and the incidence of acute respiratory distress syndrome(ARDS) of the former was obviously lower too(P<0.01 ). The incidence of pulmonary infection and multiple organ dysfunction syndrome(MODS) and mortality of the former were lower than those of the latter as well(P<0.05). Conclusion: Early mechanical ventilation on patients suffered from flail chest complicated with acute pulmonary contusion can not only get satisfactory internal fixation but also effectively improve hypoxemia,reduce complications such as ARDS, MODS,shorten the time of mechanical ventilation and the time in ICU,and improve the cure rate.%目的:观察不同时期机械通气对连枷胸并发急性肺挫伤的治疗效果.方法:回顾性分析2001年3月-2010年2月我院收治的51例连枷胸并发肺挫伤患者的临床资料.根据受伤后至实施机械通气的间隔时间分

  17. Acute pancreatitis, acute hepatitis and acute renal failure favourably resolved in two renal transplant recipients.

    Voiculescu, Mihai; Ionescu, Camelia; Ismail, Gener; Mandache, Eugen; Hortopan, Monica; Constantinescu, Ileana; Iliescu, Olguta

    2003-03-01

    Renal transplantation is often associated with severe complications. Except for acute rejection, infections and toxicity of immunosuppressive treatment are the most frequent problems observed after transplantation. Infections with hepatic viruses (HBV, HDV, HCV, HGV) and cytomegalic virus (CMV) are the main infectious complications after renal transplantation. Cyclosporine toxicity is not unusual for a patient with renal transplantation and is even more frequent for patients with hepatic impairment due to viral infections. The subjects of this report are two renal transplant recipients with acute pancreatitis, severe hepatitis and acute renal failure on graft, receiving immunosuppressive therapy for maintaining renal graft function

  18. Toxoplasmosis complicating lung cancer: a case report

    2015-01-01

    Nianhong Lu, Caihong Liu, Jiangyuan Wang, Ying Ding, Qing Ai Department of Clinical Laboratory, The First Hospital of Jilin University, Changchun, People’s Republic of China Abstract: Toxoplasmosis complicating lung cancer has been described only rarely. Here, we report a case of acute Toxoplasma gondii infection in a patient with squamous lung cancer. A 64-year-old woman was admitted to our hospital with a history of cough of 6 months' duration and chest pain of 1 week&...

  19. [Complications of blepharoplasty].

    Morax, S

    2004-06-01

    Blepharoplasty complications are infrequent, most often minor and transitory, rarely major and permanent with functional or esthetic consequences. Treatment is above all preventive: screening at risk patients with a history of ophthalmic problems, but also general illnesses that would contraindicate blepharoplasty. Patients must be informed of possible risks through informative booklets with the most important points underlined. Complications can be purely ophthalmological, the more serious sequelae being partial or complete visual loss due to ischemic optical neuropathy, with very poor prognosis, or more rarely compression of the ocular globe by intraorbital hemorrhage, which has a better prognosis provided the origins are quickly recognized and treated immediately. Other visual complications include oculomotor problems, keratoconjunctivitis sicca, epiphora, and chemosis of lymphatic origin. Eyelid complications are more frequent: ptosis on the upper eyelid or lagophthalmia caused by incorrect resection of the skin, scarring and eyelid fold anomalies. The most serious esthetic complication is the malposition of the lower eyelid, which can manifest as retraction, lagophthalmia, ectropion, deformation of the external canthus, or lower eyelid tissue relaxation. These malpositions are quite often minor, sometimes reversible, but at times major, with psychological, esthetic and functional consequences that are difficult for the patient. Other local complications also arise: enophthalmia with a sunken lid, as well as under- and overcorrection. General complications can include scarring related to pigmentation problems and residual hematomas, and exceptionally infections going as far as the orbital fat tissue. Finally, other complications are related to new laser surgical techniques that are responsible for ectropion of the lower eyelid and even burns or residual redness, or complications related to periocular injections of filling material. A comprehensive review of

  20. Late complications of radiation therapy

    Masaki, Norie [Osaka Prefectural Center for Adult Diseases (Japan)

    1998-03-01

    There are cases in which, although all traces of acute radiation complications seem to have disappeared, late complications may appear months or years to become apparent. Trauma, infection or chemotherapy may sometimes recall radiation damage and irreversible change. There were two cases of breast cancer that received an estimated skin dose in the 6000 cGy range followed by extirpation of the residual tumor. The one (12 y.o.) developed atrophy of the breast and severe teleangiectasis 18 years later radiotherapy. The other one (42 y.o.) developed severe skin necrosis twenty years later radiotherapy after administration of chemotherapy and received skin graft. A case (52 y.o.) of adenoidcystic carcinoma of the trachea received radiation therapy. The field included the thoracic spinal cord which received 6800 cGy. Two years and 8 months after radiation therapy she developed complete paraplegia and died 5 years later. A truly successful therapeutic outcome requires that the patient be alive, cured and free of significant treatment-related morbidity. As such, it is important to assess quality of life in long-term survivors of cancer treatment. (author)

  1. Epidemiology of Intratemporal Complications of Otitis Media

    Maranhão, André

    2014-01-01

    Full Text Available Introduction Despite the advent of antibiotics and immunizations in the last century, complications of otitis media remain quite frequent, have high morbidity and mortality rates, and pose a challenge to the otorhinolaryngologist. Objective To establish the annual incidence of intratemporal complications of otitis media and prospectively evaluate patients via an analysis of epidemiologic and clinical aspects. Methods Prospective, observational study. Between February 2010 and January 2011, patients admitted to a tertiary care, university-based otology practice with diagnosis of otitis media and an associated intratemporal complication (ITC were included in the study. The following data were evaluated: age, sex, type of ITC, treatment, imaging tests findings, type and degree of hearing loss, and clinical outcome. The overall incidence of all complications and of each complication individually was determined. Results A total of 1,816 patients were diagnosed with otitis media. For 592 (33% individuals, the diagnosis was chronic otitis media; for 1,224 (67%, the diagnosis was acute otitis media. ITCs of otitis media were diagnosed in 15 patients; thus, the annual incidence of intratemporal complications was 0.8%. We identified 19 ITC diagnoses in 15 patients (3 patients had more than one diagnosis. Labyrinthine fistulae were diagnosed in 7 (36.8% individuals, mastoiditis in 5 (26.3%, facial palsy in 4 (21.1%, and labyrinthitis in 3 (15.8%. Conclusion The incidence of intratemporal complications in Brazil remains significant when compared with developed countries. Chronic otitis media with cholesteatoma is the most frequent etiology of intratemporal complications. Labyrinthine fistula is the most common intratemporal complication.

  2. 酚妥拉明联合毛花苷丙治疗小儿肺炎合并急性心功能不全的疗效%Phentolamine and allocor in the treatment of infantile pneumonia complicated with acute heart failure

    曲春霞

    2015-01-01

    Objective:To investigate the effect of phentolamine combined with allocor in the treatment of infantile pneumonia complicated with acute heart failure.Methods:68 children with pneumonia complicated with acute heart failure were selected.They were randomly divided into the treatment group and the control group with 34 cases in each.Patients in the treatment group were given phentolamine combined with allocor,while patients in the control group were treated with allocor.Results:The total effect of the treatment group was better than that of the control group.The time of correcting heart failure of the treatment group was shorter than that of the control group.The differences were statistically significant(P<0.05).Conclusion:Phentolamine combined with allocor in the treatment of infantile pneumonia complicated with acute heart failure can shorten the time of correcting heart failure, and it also can improve the cure rate.%目的:探讨酚妥拉明联合毛花苷丙对小儿肺炎合并急性心功能不全的治疗作用。方法:收治小儿肺炎合并急性心功能不全患儿68例,随机分为治疗组和对照组,各34例,治疗组给予酚妥拉明联合毛花苷丙治疗,对照组给予毛花苷丙治疗。结果:治疗组总有效率优于对照组,治疗组心衰纠正时间短于对照组,差异均有统计学意义(P<0.05)。结论:酚妥拉明联合毛花苷丙治疗小儿肺炎合并急性心功能不全可缩短心衰的纠正时间,提高治愈率。

  3. 急性脑卒中并发脑心综合征临床分析%Acute Cerebral Stroke Complicated by Brain Heart Syndrome Clinical Anal-ysis

    吴文华; 韩国花

    2015-01-01

    目的:探讨急性脑卒中后并发脑心综合征(cerebro-cardiac syndrome,CCS)的临床特点。方法对该院神经内科住院急性脑卒中合并CCS患者的病变性质、部位、心电图、心肌酶检查、治疗与预后进行分析。结果 CCS在出血性卒中发病率(51.43%),高于缺血性卒中(19.09%),病灶位于基底节及丘脑发病率较高(68.42%),心电图表现包括各种类型心律失常、Q-T间期延长、心肌缺血等改变,实验室检查心肌酶不同程度的升高。结论急性脑卒中治疗原发病的同时应重视脑心综合征的发生,及时发现和治疗脑心综合征,可提高急性脑卒中的疗效。%Objective To study brain heart syndrome of acute cerebral apoplexy (cerebro-cardiac syndrome, CCS) clinical char-acteristics. Methods The department of neurology patients with acute brain stroke combined CCS, electrocardiogram (ecg), myocar-dial enzymes of lesion nature, part of the examination, treatment and prognosis were analyzed. Results CCS in the incidence of hemorrhagic stroke(51.43%), higher than that of ischemic stroke (19.09%), higher incidence of lesions in the basal ganglia and tha-lamus (68.42%), electrocardiogram (ecg) performance including all kinds of arrhythmia, Q-T extended, myocardial ischemia, such as change, laboratory examination elevated myocardial enzymes of different level. Conclusion Acute stroke treatment of the prima-ry disease at the same time should pay attention to the occurrence of brain heart syndrome, timely detection and treatment of brain heart syndrome, can improve the curative effect of acute brain stroke.

  4. Septic arthritis of the temporomandibular joint as a complication of acute otitis media in a child: A rare case and the importance of real-time PCR for diagnosis.

    Bast, F; Collier, S; Chadha, P; Collier, J

    2015-11-01

    We document the case of a 7-year-old boy who presented with pain in his left ear and trismus after a diagnosis of acute otitis media one week previously. His blood inflammatory markers were raised and magnetic resonance imaging (MRI) showed significant left temporomandibular joint effusion and partial attenuation of the left mastoid. A clinical diagnosis of septic arthritis of the TMJ was made and the patient was commenced on broad-spectrum antibiotics. Analysis using real time PCR enabled identification of the offending organism, confirmation of the diagnosis and antibiotic treatment to be specifically tailored for treatment.

  5. Application of CT guided ozone therapy in the treatment of lumbar disc herniation complicated with acute muscle fiber%CT引导臭氧治疗椎间盘突出合并急性肌纤维炎的临床应用

    彭浩; 彭丽静; 胡效坤; 李子祥

    2016-01-01

    目的:探讨CT引导臭氧( O3)消融术治疗椎间盘突出症合并急性肌纤维炎的适应症、消融方法,并判断其疗效。方法112例椎间盘突出症合并急性肌纤维炎行CT引导下O3消融治疗,其中颈椎间盘11例,腰椎间盘101例。结果本组病例随访1~12月。近期疗效急性疼痛消失65例,疼痛级别降低1~2级47例,有效率100%。远期疗效明显82例,有效26例,无效4例,总有效率达96.4%。无出现明显的并发症。结论 CT引导O3消融术治疗椎间盘突出症合并急性肌纤维炎效果明显,操作简便,定位准确,严格掌握适应症及消融方法对提高短期疗效及长期疗效有着重要的意义。%Objective To investigate the indications and ablation methods of CT guided ozone therapy in the treatment of lum -bar disc herniation with acute muscle fiber , and to judge the curative effect .Methods CT guided ozone therapy was performed in 112 patients with lumbar disc herniation complicated with acute muscle fiber .Among them , 11 cases of cervical intervertebral disc and 101 cases of lumbar intervertebral disc were treated .Results The patients were followed up for 1~12 months.The recent efficacy of acute pain disappeared in 65 cases, the pain level of 47 cases lower to 1~2, the effective rate was 100%.Long term curative effect was obvious in 82 cases, effective in 26 cases, ineffective in 4 cases, the total effective rate was 96.4%.There were no obvious complications .Conclusion CT guided ozone treatment of intervertebral disc herniation with acute muscle inflam -mation effect obviously has the advantages of simple operation , accurate positioning .Strictly grasping the indications and ablation method has important significance has important significanle in impruving the short -term and lorg-oerm curative effect .

  6. Neurological complications in chronic kidney disease

    Ria Arnold

    2016-10-01

    Full Text Available Patients with chronic kidney disease (CKD are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.

  7. Acute otitis media and acute bacterial sinusitis.

    Wald, Ellen R

    2011-05-01

    Acute otitis media and acute bacterial sinusitis are 2 of the most common indications for antimicrobial agents in children. Together, they are responsible for billions of dollars of health care expenditures. The pathogenesis of the 2 conditions is identical. In the majority of children with each condition, a preceding viral upper respiratory tract infection predisposes to the development of the acute bacterial complication. It has been shown that viral upper respiratory tract infection predisposes to the development of acute otitis media in 37% of cases. Currently, precise microbiologic diagnosis of acute otitis media and acute bacterial sinusitis requires performance of tympanocentesis in the former and sinus aspiration in the latter. The identification of a virus from the nasopharynx in either case does not obviate the need for antimicrobial therapy. Furthermore, nasal and nasopharyngeal swabs are not useful in predicting the results of culture of the middle ear or paranasal sinus. However, it is possible that a combination of information regarding nasopharyngeal colonization with bacteria and infection with specific viruses may inform treatment decisions in the future.

  8. Cardiovascular complications of cirrhosis

    Møller, S; Henriksen, Jens Henrik Sahl

    2008-01-01

    and electrophysiological abnormalities, an entity that is different from alcoholic heart muscle disease. Being clinically latent, cirrhotic cardiomyopathy can be unmasked by physical or pharmacological strain. Consequently, caution should be exercised in the case of stressful procedures, such as large volume paracentesis......Cardiovascular complications of cirrhosis include cardiac dysfunction and abnormalities in the central, splanchnic and peripheral circulation, and haemodynamic changes caused by humoral and nervous dysregulation. Cirrhotic cardiomyopathy implies systolic and diastolic dysfunction....... The clinical significance of cardiovascular complications and cirrhotic cardiomyopathy is an important topic for future research, and the initiation of new randomised studies of potential treatments for these complications is needed....

  9. Cardiovascular complications of cirrhosis

    Møller, Søren; Henriksen, Jens Henrik

    2008-01-01

    and electrophysiological abnormalities, an entity that is different from alcoholic heart muscle disease. Being clinically latent, cirrhotic cardiomyopathy can be unmasked by physical or pharmacological strain. Consequently, caution should be exercised in the case of stressful procedures, such as large volume paracentesis......Cardiovascular complications of cirrhosis include cardiac dysfunction and abnormalities in the central, splanchnic and peripheral circulation, and haemodynamic changes caused by humoral and nervous dysregulation. Cirrhotic cardiomyopathy implies systolic and diastolic dysfunction....... The clinical significance of cardiovascular complications and cirrhotic cardiomyopathy is an important topic for future research, and the initiation of new randomised studies of potential treatments for these complications is needed.  ...

  10. Acute leukemic appendicitis in a patient with acute promyelocytic leukemia

    Hatim Karachiwala

    2012-01-01

    Full Text Available Leukemic and lymphomatous infiltration of the appendix is a rare complication. We present the case of a 31-year-old male with acute promyelocytic leukemia who developed acute abdomen on day 11 of induction chemotherapy with idarubicin and cytarabine. After appropriate work-up, a clinical diagnosis of acute appendicitis was made. Despite severe pancytopenia, he successfully underwent laparoscopic appendectomy. The final pathology revealed leukemic infiltration of the appendix. It is hypothesized that the leukemic infiltration may play a role in the development of acute appendicitis. Further, this case demonstrates the need to maintain a high index of suspicion and prompt surgical intervention for surgical pathologies in neutropenic patients.

  11. Emergency management of complicated jejunal diverticulosis.

    Johnson, Kevin N; Fankhauser, Grant T; Chapital, Alyssa B; Merritt, Marianne V; Johnson, Daniel J

    2014-06-01

    Jejunal diverticulosis is a rare condition that is usually found incidentally. It is most often asymptomatic but presenting symptoms are nonspecific and include abdominal pain, nausea, diarrhea, malabsorption, bleeding, obstruction, and/or perforation. A retrospective review of medical records between 1999 and 2012 at a tertiary referral center was conducted to identify patients requiring emergency management of complicated jejunal diverticulosis. Complications were defined as those that presented with inflammation, bleeding, obstruction, or perforation. Eighteen patients presented to the emergency department with acute complications of jejunal diverticulosis. Ages ranged from 47 to 86 years (mean, 72 years). Seven patients presented with evidence of free bowel perforation. Six had either diverticulitis or a contained perforation. The remaining five were found to have gastrointestinal bleeding. Fourteen of the patients underwent surgical management. Four patients were successfully managed nonoperatively. As a result of the variety of presentations, complications of jejunal diverticulosis present a diagnostic and therapeutic challenge for the acute care surgeon. Although nonoperative management can be successful, most patients should undergo surgical intervention. Traditional management dictates laparotomy and segmental jejunal resection. Diverticulectomy is not recommended as a result of the risk of staple line breakdown. The entire involved portion of jejunum should be resected when bowel length permits.

  12. Complications as a result of the Heimlich maneuver.

    Lee, Steven L; Kim, Stephen S; Shekherdimian, Shant; Ledbetter, Daniel J

    2009-03-01

    The Heimlich maneuver is a well-described emergency procedure for management of foreign body airway obstructions. Although rare, complications of the Heimlich maneuver do exist. The purpose of this report is to review the known complications of this procedure. All reported complications published in English on Medline and PubMed were reviewed. Additionally, we present a rare case of acute pancreatitis with associated pseudocyst formation after the administration of the Heimlich maneuver on a healthy 3-year-old boy. Although life saving, the Heimlich maneuver may be associated with significant complications; thus, symptomatic patients after this maneuver should be thoroughly evaluated with appropriate laboratory and radiographic studies.

  13. 2030例急性脑梗死患者合并代谢综合征临床特点分析%2030 patients with acute cerebral infarction complicating metabolic syndrome: a clinical characteristic analysis

    王栋梁; 李新; 王纪佐

    2010-01-01

    Objective To observe the levels of serum lipid, blood pressure, waist circumference and blood glucose and to investigate the clinical features of metabolic syndrome in patients with acute cerebral infarction. Methods Serum lipid, blood pressure (systolic/diastolic blood pressure), waist circumference, and blood glucose in 2030 patients with acute cerebral infarction were analyzed retrospectively. Results The prevalence of metabolic syndrome of 2030 inpatients with acute cerebral infarction was 67.73%, and the men and women were 71.80% and 62.00% respectively. The proportions of hypertension, abnormal waist circumference, lipid abnormalities, and impaired fasting glucose in the men were significantly higher than those in the women (all P < 0.05 ). The proportions of metabolic syndrome,hypertension, abnormal waist circumference, and impaired fasting glucose increase with the age (all P < 0.05 ). Conclusions The prevalence of metabolic syndrome in patients with acute cerebral infarction is high. It is very important to evaluate metabolic syndrome in patients with acute cerebral infarction. Controlling dyslipidemia, hypertension, hyperglycosemia, and obesity in the primary and secondary prevention of ischemic stroke can not be ignored.%目的 观察急性脑梗死患者血脂、血压、腰围和空腹血糖水平,并探讨其代谢综合征的临床特点.方法 回顾性分析2030例急性脑梗死患者的血脂、血压(收缩压、舒张压)、腰围和空腹血糖水平.结果 2030例急性脑梗死住院患者的代谢综合征患病率为67.73%,男性为71.80%,显著高于女性的62.00%(P<0.001).男性患者高血压、腰围异常、血脂异常和窄腹血糖受损比例均显著高于女性(P<0.005).代谢综合征以及高血压、腰围异常、血脂异常和空腹血糖受损比例随年龄增大而增高(P<0.05).结论 脑梗死患者的代谢综合征患病率很高.对脑梗死患者进行代谢综合征评价非常重要,控制血脂异

  14. Complications of shoulder dystocia.

    Dajani, Nafisa K; Magann, Everett F

    2014-06-01

    Complications of shoulder dystocia are divided into fetal and maternal. Fetal brachial plexus injury (BPI) is the most common fetal complication occurring in 4-40% of cases. BPI has also been reported in abdominal deliveries and in deliveries not complicated by shoulder dystocia. Fractures of the fetal humerus and clavicle occur in about 10.6% of cases of shoulder dystocia and usually heal with no sequel. Hypoxic ischemic brain injury is reported in 0.5-23% of cases of shoulder dystocia. The risk correlates with the duration of head-to-body delivery and is especially increased when the duration is >5 min. Fetal death is rare and is reported in 0.4% of cases. Maternal complications of shoulder dystocia include post-partum hemorrhage, vaginal lacerations, anal tears, and uterine rupture. The psychological stress impact of shoulder dystocia is under-recognized and deserves counseling prior to home discharge.

  15. Pertussis (Whooping Cough) Complications

    ... CDC Cancel Submit Search The CDC Pertussis (Whooping Cough) Note: Javascript is disabled or is not supported ... friendly Fact Sheet Pertussis Vaccination Pregnancy and Whooping Cough Clinicians Disease Specifics Treatment Clinical Features Clinical Complications ...

  16. Complications of Mumps

    ... Serology Publications and Resources Multimedia MMWR Articles Outbreak Articles Related Links World Health Organization Medline Plus Complications of Mumps Language: English Español (Spanish) Recommend on Facebook Tweet Share Compartir ...

  17. Complications of Circumcision

    Aaron J. Krill

    2011-01-01

    Full Text Available In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by pediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events.

  18. Infection and Other Complications

    ... 6) Position Papers (9) LSAP Perspective (9) National Lymphedema Network is now hiring! The NLN is looking ... and improve your overall health. Other Complications of Lymphedema The sudden onset of swelling anywhere in the ...

  19. Dental Implant Complications.

    Liaw, Kevin; Delfini, Ronald H; Abrahams, James J

    2015-10-01

    Dental implants have increased in the last few decades thus increasing the number of complications. Since many of these complications are easily diagnosed on postsurgical images, it is important for radiologists to be familiar with them and to be able to recognize and diagnose them. Radiologists should also have a basic understanding of their treatment. In a pictorial fashion, this article will present the basic complications of dental implants which we have divided into three general categories: biomechanical overload, infection or inflammation, and other causes. Examples of implant fracture, loosening, infection, inflammation from subgingival cement, failure of bone and soft tissue preservation, injury to surround structures, and other complications will be discussed as well as their common imaging appearances and treatment. Lastly, we will review pertinent dental anatomy and important structures that are vital for radiologists to evaluate in postoperative oral cavity imaging.

  20. Pancreatic Pseudocyst after Acute Organophosphate Poisoning

    Kawabe, Ken; Ito, Tetsuhide; Arita, Yoshiyuki; Sadamoto, Yojiro; Harada, Naohiko; Yamaguchi, Koji; Tanaka, Masao; Nakano, Itsuro; Nawata, Hajime; Takayanagi, Ryoichi

    2006-01-01

    Acute organophosphate poisoning(OP) shows several severe clinical symptoms due to its strong blocking effect on cholinesterase. Acute pancreatitis is one of the complications associated with acute OP, but this association still may not be widely recognized. We report here the case of a 73-year-old man who had repeated abdominal pain during and after the treatment of acute OP. Hyperamylasemia and a 7-cm pseudocyst in the pancreatic tail were noted on investigations. We diagnosed pancreatic pse...

  1. Application of intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated right heart failure%主动脉内球囊反搏在急性心肌梗死并右心衰竭中的应用

    张治平; 刘成伟; 吴明祥; 许志勇; 杨遇春; 陈国洪; 苏晞

    2012-01-01

    目的:探讨主动脉内球囊反搏(IABP)在急性心肌梗死并右心衰竭中应用的价值.方法:69例急性心肌梗死并心源性休克行IABP辅助循环治疗患者中急性右心衰竭12例(17.4%),回顾性分析此12例患者临床资料,病人年龄(64.1±9.7)岁,IABP辅助循环治疗时间15~288 h,(95±76)h,9例(75%)行经皮冠状动脉介入术(PCI).结果:12例患者住院期间主要并发症包括:出血3例(25%),肢体缺血1例(8.3%),急性肾功能衰竭2例(16.7%),多器官功能衰竭1例(8.3%).1例死于多器官功能衰竭,其余11例(91.7%)成功撤除IABP辅助循环,病情好转出院.结论:急性心肌梗死并严重右心衰竭死亡率高,在常规治疗疗效不佳时,主动脉内球囊反搏辅助循环治疗可能有益.%Objective: To study application of intra-aortic balloon pump (IABP) in patients with acute myocardial infarction (AMI) complicated right heart failure. Methods: There were 12 (17. 4%) cases with acute right heart failure among 69 patients with AMI complicated cardiogenic shock undergoing IABP auxiliary circulation treatment, clinical data of the 12 patients were retrospectively analyzed. Mean age of the 12 patients was (64. 1 ± 9. 7) yearsold, duration of auxiliary circulation treatment with IABP was 15~288 (95 ± 76) h. And there were nine (75%) patients undergoing percutaneous coronary intervention (PCI). Results: Main complications of 12 patients during admission included bleeding (n = 3, 25%), limb ischemia (n= 1, 8.3%), acute renal failure (n = 2, 16. 7%) and multi - organ failure (n = 1, 8. 3%). Except one case died from multi-organ failure, IABP was successfully removed in other 11 (91. 7%) patients and their condition improved, all discharged from hospital. Conclusion: There is high mortality rate in acute myocardial infarction complicated severe right heart failure. Intra-aortic balloon pump may be beneficial for treatment when effect of routine therapy is poor.

  2. Neurologic complications in oncology

    Andrea Pace

    2010-06-01

    Full Text Available Neurologic side effects related to cancer therapy are a common problem in oncology practice. These complications can negatively affect the management of the patient, because they can inhibit treatment and diminish quality of life. Therefore specific skills are required to recognise symptoms and clinical manifestations. This review focuses on the most common neurologic complications to improve physician’s familiarity in determining the aetiology of these symptoms.

  3. Complications of pancreatic surgery

    Åke Andrén-Sandberg

    2011-01-01

    Full Text Available Many diseases, including pancreatitis benign tumors and cancer, may require pancreas surgery. Pancreatic resection can lead to a prolonged survival in pancreatic cancer and even a potential chance for cure. However, the pancreatic surgery can result in complications, and high postoperative morbidity rates are still presence. This article reviews the pancreatic abstracts of American Pancreas Club 2011, which involves the more common complications, their prevention and treatment.

  4. 急性心肌梗死并心源性休克患者早期主动脉内球囊反搏联合急诊介入的疗效观察%Effect of early intra-aortic balloon pumping support combined emergency intervention in patients of acute myocardial infarction complicated with cardiac Shock

    裘毅钢; 李田昌; 陈宇; 李贤峰; 曹毅; 田海涛; 李东韬

    2014-01-01

    目的:探讨早期主动脉内球囊反搏(IABP)植入在急性心肌梗死(AMI)合并心源性休克(CS)患者救治中的价值。方法140例主动脉内球囊反搏联合急诊经皮管状动脉介入治疗(PCI)治疗的AMI合并CS患者,按照发生CS至IABP入的时间,分为:A组为CS至IABP辅助治疗时间<3 h,B组为>3 h;观察指标为靶血管、冠脉病变情况等,并记录总IABP辅助时间,死亡、急性呼吸衰竭、急性肾功能衰竭等临床事件。结果两组间基线情况、靶血管病变、静脉用药等无统计学差异;A组三支病变比率、无复流发生率低于B组,但无统计学差异;A组总IABP辅助时间、全因病死率低于B组,有统计学差异,P<0.05;A组心源性死亡、急性呼吸发生率、急性肾衰发生率均低于B组,但无统计学差异。结论在AMI合并CS的患者尽早应用IABP联合血运重建可能有助于改善生存率。%Objective To investigate the effect of early Intra-aortic balloon pumping (IABP) support combined emergency intervention in patients of acute myocardial infarction (AMI) complicated with cardiac Shock (CS). Methods Clinical data of AMI complicated with cardiac shock in 140 cases of IABP combine with emergency percutaneous coronary intervention (PCI) admitted in Navy General Hospital of the PLA in between January 2011 and December 2012 were collected and divided into two groups according to the time from CS to IABP. The time interval in group A (n=61) was less than 3 hours and group B (n=79) were more than 3 hours. The target coronary artery, the number of culprit vessel, the total time of IABP treatment, hospital mortality, acute respiratory failure, acute renal failure were observed. Results No statistical significance in the rates of triple vessel disease, no-reflow, cardiogenic death, acute respiratory failure and acute renal failure was found between the two groups even although they all reflected lower in

  5. [Type 2 diabetes complications].

    Schlienger, Jean-Louis

    2013-05-01

    People with type 2 diabetes are at increased risk of many complications, which are mainly due to complex and interconnected mechanisms such as hyperglycemia, insulino-resistance, low-grade inflammation and accelerated atherogenesis. Cardi-cerebrovascular disease are frequently associated to type 2 diabetes and may become life threatening, particularly coronaropathy, stroke and heart failure. Their clinical picture are sometimes atypical and silencious for a long time. Type 2 diabetes must be considered as an independent cardiovascular risk factor. Nephropathy is frequent in type 2 diabetes but has a mixed origin. Now it is the highest cause of end-stage renal disease. Better metabolic and blood pressure control and an improved management of microalbuminuria are able to slowdown the course of the disease. Retinopathy which is paradoxically slightly progressive must however be screened and treated in these rather old patients which are globally at high ophthalmologic risk. Diabetic foot is a severe complication secondary to microangiopathy, microangiopathy and neuropathy. It may be considered as a super-complication of several complications. Its screening must be done on a routine basis. Some cancer may be considered as an emerging complication of type 2 diabetes as well as cognitive decline, sleep apnea syndrome, mood disorders and bone metabolism impairments. Most of the type 2 diabetes complications may be prevented by a strategy combining a systematic screening and multi-interventional therapies.

  6. Posterior Circulation Stroke After Bronchial Artery Embolization. A Rare but Serious Complication

    Laborda, Alicia [Universidad de Zaragoza, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain); Tejero, Carlos [Hospital Clinico Universitario Lozano Blesa, Servicio de Neurologia (Spain); Fredes, Arturo, E-mail: fredesarturo@gmail.com [Universidad de Zaragoza, Hospital Quiron, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain); Cebrian, Luis; Guelbenzu, Santiago; Gregorio, Miguel Angel de, E-mail: mgregori@unizar.es [Universidad de Zaragoza, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain)

    2013-06-15

    Bronchial artery embolization (BAE) is the treatment of choice for massive hemoptysis with rare complications that generally are mild and transient. There are few references in the medical literature with acute cerebral embolization as a complication of BAE. We report a case of intracranial posterior territory infarctions as a complication BAE in a patient with hemoptysis due to bronchiectasis.

  7. Pulmonary complications of transcatheter arterial chemoembolization for hepatocellular carcinoma

    Nhu, Quan M; Knowles, Harry; Pockros, Paul J; Frenette, Catherine T

    2016-01-01

    Transarterial chemoembolization (TACE) is an effective palliative intervention that is widely accepted for the management of hepatocellular carcinoma (HCC). Post-TACE pulmonary complications resulting in acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) are rare events. Pulmonary complications after TACE are thought to be related to chemical injury subsequent to the migration of the infused ethiodized oil or chemotherapeutic agent to the lung vasculature, facilitated by arteriovenous (AV) shunts within the hyper-vascular HCC. We review herein the literature on pulmonary complications related to TACE for HCC. Post-TACE pulmonary complications have included pulmonary oil embolism, interstitial pneumonitis, chemical pneumonitis, ALI, ARDS, lipoid pneumonia, acute eosinophilic and neutrophilic pneumonia, bilious pleuritis, pulmonary abscess, pulmonary tumor embolism, and possibly pulmonary metastasis with HCC. The risk factors associated with post-TACE pulmonary complications identified in the literature include large hyper-vascular HCC with AV shunts, large-volume Lipiodol infusion, and embolization via the right inferior phrenic artery. However, the absence of known risk factors is not a guarantee against serious complications. An astute awareness of the potential post-TACE pulmonary complications should expedite appropriate therapeutic interventions and increase potential for early recovery. PMID:27904836

  8. Acute pancreatitis

    ... its blood vessels. This problem is called acute pancreatitis. Acute pancreatitis affects men more often than women. Certain ... pancreatitis; Pancreas - inflammation Images Digestive system Endocrine glands Pancreatitis, acute - CT scan Pancreatitis - series References Forsmark CE. Pancreatitis. ...

  9. Cystitis - acute

    Uncomplicated urinary tract infection; UTI - acute cystitis; Acute bladder infection; Acute bacterial cystitis ... cause. Menopause also increases the risk for a urinary tract infection. The following also increase your chances of having ...

  10. Acute hypocomplementemic post-infectious glomerulonephritis as a complication of sinus-related orbital cellulitis: case report Glomerulonefrite pós-infecciosa hipocomplementêmica aguda como complicação de celulite orbitária relacionada aos seios paranasais: relato de caso

    Jayter Silva Paula

    2008-08-01

    Full Text Available Group A beta-hemolytic streptococcus is the most common agent implicated in post-infectious acute glomerulonephritis. We report a case of acute poststreptococcal glomerulonephritis associated with sinus-related orbital abscess in an 11-year-old boy treated with surgical drainage and intravenous ceftriaxone and clindamycin. Twelve days after supportive measures, renal function was normalized. We also discuss this potentially severe nonsuppurative complication of orbital cellulitis caused by group A beta-hemolytic streptococcus.Os estreptococos beta-hemolíticos do grupo A são os agentes mais comumente envolvidos na glomerulonefrite aguda pós-infecciosa. Relatamos um caso de glomerulonefrite pós-estreptocócica aguda associada a um abscesso orbitário secundário à sinusite, em menino de 11 anos de idade, o qual foi tratado com ceftriaxona e clindamicina endovenosas e drenagem cirúrgica. Doze dias após tratamento de suporte, a função renal se normalizou. Também discutimos a importância desta grave e potencial complicação não supurativa das celulites orbitárias causadas pelos estreptococos beta-hemolíticos do grupo A.

  11. Spontaneous pnemomedastinum in acute severe asthma

    Aleemuddin N

    2010-01-01

    Full Text Available Spontaneous medastinal emphysema, as a complication of acute severe asthma, is an uncommon entity. It usually runs a benign course and resolves spontaneously without any surgical intervention. Recognition of this complication is critical, as it has to be differentiated from other life threatening ones including oesophageal rupture, Boerhave′s syndrome, acute coronary syndrome and pulmonary embolism. This case is being presented to emphasize its recognition in the differential diagnosis of complications arising from acute severe asthma and to present its management strategy in detail.

  12. Appendicitis in Pregnancy: Presentation, Management and Complications

    Abdoulhossein Davoodabadi

    2016-06-01

    Full Text Available Background Diagnosis of acute appendicitis in pregnancy is difficult. Delay operation, increase complications. Objectives This study focused on early operation on base of careful history, precise physical examination, and rational close observation and evaluates its results with conventional investigation in pregnant women suspected acute appendicitis. Materials and Methods A cross sectional study in100 pregnant women and 100 aged matched non pregnant women underwent appendectomy during Sep 2011 - Dec 2014. The data were analyzed by chi-square test through SPSS 16.0. Results Age 16 - 37 years, mean age in pregnant women and no pregnant women were24.75 ± 4.4 and 27.56 ± 6.53 years (P > 0.05, respectively. 20 - 25 years age group, were more frequent = 44%. 70% patients were gravid 1, mean hospital stay in pregnant women, and non-pregnant women were 48 ± 6 and 85.2 ± 43.19 hours (P value < 0.001. respectively. acute appendicitis was confirmed histological in non-pregnant was 72%, but In pregnant women 62%, most cases were in the third Trimester 66% (n = 41. Peri umbilical pain, with migration to the right lower quadrant, was in 75% of patients. Right-lower-quadrant pain was the most common presenting symptom. Diagnosis (62% was made on base care full history and precise physical examination and close observation of 12 ± 8 hours. there were no maternal and fetal complications related to all of the appendectomies during the all trimester up to delivery period. Conclusions There are no diagnostic laboratory findings in acute appendicitis during pregnancy. Careful history and physical examination and close observation of 12 ± 8 hours are sufficient for surgery decision making. In spite of high negative appendectomy since it has no Surgical and obstetric complication, early Appendectomy without aggressive investigation recommend.

  13. Multiple Ligament Knee Injury: Complications

    Manske, Robert C; Hosseinzadeh, Pooya; Giangarra, Charles E.

    2008-01-01

    Non-operative and operative complications are common following multiple ligament knee injuries. This article will describe common complications seen by the surgeon and physical therapist following this complex injury. Complications include fractures, infections, vascular and neurologic complications following injury and surgery, compartment syndrome, complex regional pain syndrome, deep venous thrombosis, loss of motion and persistent laxity issues. A brief description of these complications ...

  14. [Surgical complications of pancreatectomy].

    Sauvanet, A

    2008-01-01

    The mortality for pancreatectomy has decreased to a very low level in recent years but morbidity remains high. The most frequent post-operative complications of pancreaticoduodenectomy (PD) are delayed gastric emptying (DGE) in 20% and pancreatic fistula (PF) in 10-15%. DGE is associated with other abdominal complications in half the cases; these must be delineated by CT scan and specifically treated. Isolated DGE usually resolves within three weeks with the use of nasogastric suction and pro-kinetic drugs. FP following PD may be preventable with the use of temporary trans-jejunal intubation of Wirsung's duct or by intussusception of the pancreatic margin into the jejunal lumen. FP occurring after PD will heal with conservative management (total parenteral nutrition, peripancreatic drainage, somatostatin analogues) in 80-90% of cases but secondary complications such as peritonitis, arterial erosion and pseudo-aneurysm may be life-threatening. Early hemorrhage (in the first 48-72 hours) must be treated by re-operation. Late hemorrhage (usually secondary to PF) and ischemic complications are rare (3% and 1% respectively), difficult to treat, and associated with high mortality. PF is also the main complication of distal pancreatectomy and enucleation of pancreatic tumors (10-20% and 30% respectively). These PF resolve with conservative treatment in more than 95% of cases but may justify an ERCP sphincterotomy if drainage is prolonged. After medial pancreatectomy, PF occurs in 20-30% of cases, arising from either of the two transected pancreatic surfaces.

  15. Metabolomics in diabetic complications.

    Filla, Laura A; Edwards, James L

    2016-04-01

    With a global prevalence of 9%, diabetes is the direct cause of millions of deaths each year and is quickly becoming a health crisis. Major long-term complications of diabetes arise from persistent oxidative stress and dysfunction in multiple metabolic pathways. The most serious complications involve vascular damage and include cardiovascular disease as well as microvascular disorders such as nephropathy, neuropathy, and retinopathy. Current clinical analyses like glycated hemoglobin and plasma glucose measurements hold some value as prognostic indicators of the severity of complications, but investigations into the underlying pathophysiology are still lacking. Advancements in biotechnology hold the key to uncovering new pathways and establishing therapeutic targets. Metabolomics, the study of small endogenous molecules, is a powerful toolset for studying pathophysiological processes and has been used to elucidate metabolic signatures of diabetes in various biological systems. Current challenges in the field involve correlating these biomarkers to specific complications to provide a better prediction of future risk and disease progression. This review will highlight the progress that has been made in the field of metabolomics including technological advancements, the identification of potential biomarkers, and metabolic pathways relevant to macro- and microvascular diabetic complications.

  16. Thrombophilia in complicated pregnancies

    Ayşe Şahin

    2013-12-01

    Full Text Available Objective: To investigate the incidence and etiology of pregnancy complications associated with thrombophilic factors. Methods: Fifty-four patients with complicated pregnancy and 40 healthy pregnant subjects were included the study. Factor V Leiden (FVL mutation, protein S, protein C, anti-thrombin deficiency levels were investigated. Results: Of the 54 patients with complicated pregnancy, 29 had preeclampsia, 18 had intra uterine growth retardation, and 7 had intrauterine fetal loss. The most common defect was FVL mutation. FVL mutations in patient group and the control group were 27.2% and 10%, respectively, which were statistically significant. The protein S, protein C, and anti-thrombin deficiencies were found higher in the patient group compared to control (p>0.05 for each. Conclusion: FVL mutation was found higher in patient group compared to the control group, Protein C deficiency and anti-thrombin deficiency were related to preeclampsia but not other pregnancy complications. Clinicians should take into account the thrombophilia in complicated pregnancy, especially preeclampsia. J Clin Exp Invest 2013; 4 (4: 497-502

  17. [Complications of tubal sterilization].

    Schreiner, W E

    1986-05-01

    In Europe and the US, tubal sterilization by laparoscopy has become the most widely used technique for female sterilization. The overall rate of intra- and postoperative complications differs between 0.145% and 0.85% in the numerous studies which have been done. This means 1 severe complication in 120-700 laparoscopic sterilizations. The lethality of tubal sterilization by laparoscopy lies between 3-10 deaths/100,000 interventions. The so-called "post-tubal ligation syndrome" is a rare complication. The overall pregnancy rate after tubal sterilization is 3-10/1000 women. The rate of ectopic pregnancy is very high and varies between 13.6% and 90%. Only 5% of the sterilized women show dissatisfaction. Several factors are relevant with regard to psychological sequelae and must be considered before tubal sterilization can be performed. 1 of the most important is the individual comprehensive counselling of the female or the couple prior to the sterilization.

  18. Complication with intraosseous access

    Hallas, Peter; Brabrand, Mikkel; Folkestad, Lars

    2013-01-01

    INTRODUCTION: Intraosseous access (IO) is indicated if vascular access cannot be quickly established during resuscitation. Complication rates are estimated to be low, based on small patient series, model or cadaver studies, and case reports. However, user experience with IO use in real...... physicians, anesthesiologists and pediatricians. RESULTS: 1,802 clinical cases of IO use was reported by n=386 responders. Commonly reported complications with establishing IO access were patient discomfort/pain (7.1%), difficulties with penetration of periosteum with IO needle (10.3%), difficulties...... with aspiration of bone marrow (12.3%), and bended/broken needle (4.0%). When using an established IO access the reported complications were difficulties with injection fluid and drugs after IO insertion (7.4%), slow infusion (despite use of pressure bag) (8.8%), displacement after insertion (8...

  19. Tattoo complaints and complications

    Serup, Jørgen; Carlsen, Katrina Hutton; Sepehri, Mitra

    2015-01-01

    Tattoos cause a broad range of clinical problems. Mild complaints, especially sensitivity to sun, are very common and seen in 1/5 of cases. Medical complications are dominated by allergy to tattoo pigment haptens or haptens generated in the skin, especially in red tattoos but also in blue and green...... tattoos. Symptoms are major and can be compared to cumbersome pruritic skin diseases. Tattoo allergies and local reactions show distinct clinical manifestations, with plaque-like, excessive hyperkeratotic, ulcero-necrotic, lymphopathic, neuro-sensory, and scar patterns. Reactions in black tattoos...... are papulo-nodular and non-allergic and associated with the agglomeration of nanoparticulate carbon black. Tattoo complications include effects on general health conditions and complications in the psycho-social sphere. Tattoo infections with bacteria, especially staphylococci, which may be resistant...

  20. 高龄结肠癌患者合并急性肠梗阻的诊治体会%Experience in Diagnosis and Treatment of Elderly Patients with Colorectal Carcinoma Complicated with Acute Intestinal Obstruction

    徐文斌

    2015-01-01

    Objective To investigate the diagnosis and treatment method of elderly colonic obstruction caused by colon cancer patients. Methods To review 46 cases of aged patients with colon cancer were retrospectively analyzed and the clinical data of acute intestinal obstruction. Results Al the patients were treated with operation, 41 cases were cured, 2 cases died, 3 cases of postoperative critical y il and discharged from hospital. Conclusion The diagnosis and operation should be treated as early as possible, choosing the reasonable operation methods and the importance of peri operation period processing, improve the cure rate, prolong life.%目的:探讨高龄梗阻性结肠癌患者的诊断治疗方法。方法回顾性分析收治的46例高龄患者结肠癌并急性肠梗阻的临床资料。结果全部病例均手术治疗,治愈41例,死亡2例,3例术后因病情危重自动出院。结论应尽早确诊及手术治疗,选择合理的手术方法和重视围手术期处理,提高治愈率,延长寿命。