1/31. Enlargement of ulcer-like projections after repair of acute type A aortic dissection.We treated two cases of enlargement of ulcer-like projections in the descending thoracic aorta, which were recognized after emergency graft replacement from the ascending aorta to the aortic arch for acute type A aortic dissection. The intimal tear, which was near the left subclavian artery, was resected during the initial operation. Graft replacement of the descending thoracic aorta was successful.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/31. Successful resuscitation of a verapamil-intoxicated patient with percutaneous cardiopulmonary bypass.OBJECTIVE: To describe our experience with the use of percutaneous cardiopulmonary bypass as a therapy for cardiac arrest in an adult patient intoxicated with verapamil. DESIGN: Case report. SETTING: Emergency department of a university hospital. PATIENT: A patient with cardiac arrest after severe verapamil intoxication. INTERVENTIONS: Percutaneous cardiopulmonary bypass and theophylline therapy. CASE REPORT: A 41-yr-old white male had taken 4800-6400 mg of verapamil in a suicide attempt. On arrival of the ambulance physician, the patient was conscious with weak palpable pulses and was transported to a nearby hospital. The patient developed a pulseless electrical activity, and cardiopulmonary resuscitation was started. Despite all advanced life support efforts, the patient remained in cardiac arrest. Therefore, he was transferred under ongoing cardiopulmonary resuscitation to our department, where percutaneous cardiopulmonary bypass was initiated immediately (2.5 hrs after cardiac arrest). The first verapamil serum concentration obtained at admittance to our institution was 630 ng/mL. After several ineffective intravenous epinephrine applications, the administration of 0.48 g of theophylline as an intravenous bolus 6 hrs and 18 mins after cardiac arrest led to the return of spontaneous circulation. The patient remained stable and was transferred to an intensive care unit the same day. He woke up on the 12th day and was extubated on the 18th day. After transfer to a neuropsychiatric rehabilitation hospital, he recovered totally. CONCLUSION: In patients with cardiac arrest attributable to massive verapamil overdose, percutaneous extracorporeal cardiopulmonary bypass can provide adequate tissue perfusion and sufficient cerebral oxygen supply until the drug level is reduced and restoration of spontaneous circulation can be achieved.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/31. Blunt thoracic aortic injuries: initial evaluation and management.In at least one large study, the average time from arrival at the emergency department to arrival in the operating room was nearly 6 hours. That 30% of survivors will die in the same amount of time underscores the need for rapid diagnosis and treatment. In blunt thoracic aortic injury, beta-blockers have been shown to reduce the incidence of rupture, and their use is rarely contraindicated. A working knowledge of the mechanisms of injury likely to produce this lesion, commonly associated injuries, clinically relevant and easily recognizable chest film findings, and appropriate use of beta-blockade can have a significant impact on mortality. Any physician responsible for evaluation of trauma patients should be familiar with this information.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/31. Case discussions on the pathophysiology and clinical features of near-fatal asthma episodes.This article reviews the definition of near-fatal asthma. The slow-onset, late arrival group and the sudden-onset groups of near-fatal asthma patients are discussed. risk factors for near-fatal asthma and the pathologic differences between the two groups are elucidated.- - - - - - - - - - ranking = 7keywords = near (Clic here for more details about this article) |
5/31. A case of withdrawal from the GHB precursors gamma-butyrolactone and 1,4-butanediol.We describe a case of withdrawal from the gamma hydroxybutyric acid (GHB) precursors gamma butyrolactone and 1,4-butanediol. Symptoms included visual hallucinations, tachycardia, tremor, nystagmus, and diaphoresis. Administration of benzodiazepines and phenobarbital successfully treated the withdrawal symptoms. As predicted from the metabolism of gamma butyrolactone and 1,4-butanediol to GHB, the symptoms were nearly identical to those reported from GHB withdrawal. Because GHB is now illegal in the united states, individuals have begun abusing the legal and easier to acquire GHB precursors. More frequent cases of both abuse and withdrawal from these GHB precursors can be expected.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/31. Caesarean delivery during maternal cardiopulmonary resuscitation for status asthmaticus.A patient who sustained a recurrent cardiopulmonary resuscitation due to status asthmaticus during one pregnancy followed by a birth of an apparently normal infant is described. Promptly performed caesarean delivery might have saved the mother and her infant. cardiopulmonary resuscitation is less effective in a near term pregnant woman.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/31. pulmonary edema associated with salt water near-drowning: new insights.In this case report we describe the clinical and laboratory findings of a man who nearly drowned after aspirating a large quantity of seawater. The aspiration of salt water, which is strongly hypertonic with respect to plasma, resulted in severe pulmonary edema, both from the quantity of aspirated seawater and the osmotically driven ultrafiltrate of plasma that accumulated in the air spaces. The initial concentration of protein in the edema fluid sample was very low, 0.7 g/dl, consistent with only a minimal increase in epithelial permeability. Approximately 4 h later, there was a marked increase in the concentration of protein in the residual alveolar fluid associated with improvement in several clinical indices, indicating that the excess alveolar fluid was reabsorbed very rapidly. In addition, the magnesium concentration was markedly elevated because of the aspiration of magnesium-containing seawater, which may have diagnostic importance for near-drowning in salt water. The data from this case provide evidence for well-preserved alveolar epithelial barrier function after aspiration of large quantities of hypertonic salt water.- - - - - - - - - - ranking = 6keywords = near (Clic here for more details about this article) |
8/31. Emergency pylorus-preserving pancreatoduodenectomy followed by second-stage pancreatojejunostomy for a gastrointestinal stromal tumor of the duodenum with an intratumoral gas figure: report of a case.We report a case of a duodenal gastrointestinal stromal tumor (GIST) necessitating urgent surgery because of a gas figure on computed tomography (CT). A 46-year-old woman, complaining chiefly of upper abdominal pain and tarry stools, consulted a local doctor. A gastrointestinal fiberscopy revealed an ulcer in the second part of the duodenum, and the patient was admitted to our hospital where a dynamic CT scan showed a hypervascular solid tumor in the pancreatic head. A repeat CT scan done 4 days later showed a gas figure in the tumor, necessitating an emergency pylorus-preserving pancreatoduodenectomy (PpPD). First, we performed a tube pancreatostomy for complete external drainage of the pancreatic juice, and planned a second-stage pancreatojejunostomy for the near future. Histopathologically, the tumor was diagnosed as a GIST originating in the duodenum. The patient was discharged on postoperative day 23 after an uneventful postoperative recovery. Her local doctor completed the second-stage pancreatojejunostomy.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/31. Postcesarean pulmonary embolism, sustained cardiopulmonary resuscitation, embolectomy, and near-death experience.BACKGROUND: survival after surgical embolectomy for massive postcesarean pulmonary embolism causing sustained cardiac arrest is rare. CASE: One day after an uneventful cesarean delivery, a woman developed cardiac asystole and apnea due to pulmonary embolism. Femoral-femoral cardiopulmonary bypass performed during continuous cardiopulmonary resuscitation allowed a successful embolectomy. Upon awakening, the patient reported a near-death experience. pulmonary embolism causes approximately 2 deaths per 100,000 live births per year in the united states, and postcesarean pulmonary embolism is probably more common than pulmonary embolism after vaginal delivery. CONCLUSION: Massive pulmonary embolism is a potentially treatable catastrophic event after cesarean delivery, even if continuous cardiopulmonary resuscitation is required until life-saving embolectomy is done.- - - - - - - - - - ranking = 5keywords = near (Clic here for more details about this article) |
10/31. CT diagnosis of strangulated diaphragmatic hernia.Strangulated diaphragmatic hernia is a surgical emergency which on occasions can be a diagnostic dilemma. We report of a 2-year-old-male child with strangulated diaphragmatic hernia in whom a correct preoperative diagnosis was made with progression of illness. CT depicted a curvilinear fat stripe in a fluid filled hemithorax.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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