1/48. Possible venous argon gas embolism complicating argon gas enhanced coagulation during liver surgery.We report a case of a major venous argon embolism during argon beam coagulation of a liver biopsy. The essential signs were an abrupt reduction in end-tidal carbon dioxide partial pressure, in SpO2 and in systolic arterial pressure, at the time of coagulation. Spontaneous recovery was observed within 10 min. Precautions in respect of usage are highlighted.- - - - - - - - - - ranking = 1keywords = coagulation (Clic here for more details about this article) |
2/48. splenic rupture associated with severe preeclampsia. A case report.BACKGROUND: splenic rupture is a very rare event complicating pregnancy. Approximately 5% of cases reported have involved the postpartum period. Unrecognized, this complication is universally fatal. CASE: Preeclampsia and pulmonary edema complicated a 42-year-old woman's intrapartum care. After cesarean delivery she was supported with mechanical ventilation, blood products and invasive monitoring. Shortly thereafter, she became hypotensive and developed disseminated intravascular coagulation. During exploratory laparotomy a splenic capsular rupture was identified. splenectomy and continued intensive care support ultimately reversed the severe end-organ consequences. CONCLUSION: It is extremely important that this condition be maintained in the diagnostic differential of post-operative hemodynamic instability. Failure to identify it is invariably fatal. awareness and intervention are essential to ensure a good outcome.- - - - - - - - - - ranking = 2.626321783755keywords = intravascular coagulation, intravascular, coagulation (Clic here for more details about this article) |
3/48. coma as an acute presentation of adrenoleukodystrophy.X-linked adrenoleukodystrophy is a metabolic disorder with broad clinical variations. A 4-year-old male admitted to the hospital with fever, hypotension, and coma as the presenting signs of adrenoleukodystrophy is reported. The initial presentation followed by rapidly developing disseminated intravascular coagulopathy and multiorgan failure suggested an initial diagnosis of septic shock. However, bronze skin pigmentation and a cranial computed tomography scan demonstrating posterior demyelination consistent with adrenoleukodystrophy led to the final diagnosis. The diagnosis was confirmed by the findings of elevated very-long-chain fatty acid levels and an elevated C24/C16 ratio in plasma and fibroblast cultures. Atypical presentations of the disease require a high index of suspicion to initiate treatment before the appearance of irreversible sequelae.- - - - - - - - - - ranking = 0.84137519668782keywords = coagulopathy, intravascular (Clic here for more details about this article) |
4/48. amniotic fluid embolism.amniotic fluid embolism is a rare occurrence, with no single pathognomonic clinical or laboratory finding. diagnosis is based on clinical presentation and supportive laboratory values. We describe the case of a 17-year-old nulliparous woman at 27 weeks' gestation who had uterine bleeding, hematuria, hemoptysis, hypotension, dyspnea, and hypoxemia within 30 minutes of vaginal delivery. Laboratory values revealed diffuse intravascular coagulation. Chest films were consistent with adult respiratory distress syndrome. pulmonary artery catheterization revealed moderately increased pulmonary capillary wedge pressure. Supportive measures, including oxygenation, fluid resuscitation, and plasma, were administered. Central hemodynamic monitoring and inotropic support were necessary. Our patient recovered uneventfully and 6 weeks later was living an unrestricted life-style.- - - - - - - - - - ranking = 2.626321783755keywords = intravascular coagulation, intravascular, coagulation (Clic here for more details about this article) |
5/48. Anaesthesia for caesarean section in a patient with Eisenmenger's syndrome.Eisenmenger's syndrome was originally described in 1897 and redefined by wood in 1958. This syndrome includes pulmonary hypertension with reversed or bi-directional shunt associated with septal defects or a patent ductus arteriosus. A 27-year-old G2 PO with Eisenmenger's syndrome presented to the hospital for management at 17 weeks of pregnancy. She was advised termination of pregnancy but she refused. An elective caesarean section was performed successfully under general anaesthesia uneventfully at 29 weeks due to severe intrauterine growth retardation (IUGR). Patient's postoperative complications like pulmonary thromboembolism, the advantages and disadvantages of anticoagulation are discussed. pregnancy carries substantial maternal and fetal risk for patients with pulmonary hypertension and Eisenmenger's syndrome. Although pregnancy should be discouraged in women with Eisenmenger's syndrome it can be successful.- - - - - - - - - - ranking = 0.16666666666667keywords = coagulation (Clic here for more details about this article) |
6/48. Mucosal lesions in the human small intestine in shock.Characteristic mucosal lesions in resected small intestinal segments from seven patients are reported. Preoperatively, four patients were in shock and general hypotension while the three remaining cases showed signs of local intestinal hypotension. The microscopic appearance of the mucosal lesions was in all patients identical with that previously observed in the feline and canine small intestine after haemorrhage or local intestinal hypotension. It is proposed that an extravascular short-circuiting of oxygen in the mucosal countercurrent exchanger and an intravascular aggregation of blood cells might produce tissue hypoxia which makes the mucosa vulnerable to enzymatic degradation.- - - - - - - - - - ranking = 0.29147361805328keywords = intravascular (Clic here for more details about this article) |
7/48. Acute renal failure. Experience with 52 patients treated at Livingstone Hospital.Fifty-two cases of acute renal failure at Livingstone Hospital were studied. Twenty-two cases were obstetric, 10 surgical and 20 medical. The aetiological factors are tabulated and the pathophysiology is reported. Clinical features and biochemical abnormalities are presented. infection was the commonest associated factor, followed by hypotension and volume problems, coagulation disorders, jaundice and hepatic failure, respiratory failure, pancreatitis and typhoid fever. In 7 of the medical cases the aetiology was unknown and was assumed to be toxic. A case history of a patient with leptospirosis, acute renal failure, liver failure and pancreatitis is presented. The mortality in this series was 32%.- - - - - - - - - - ranking = 0.16666666666667keywords = coagulation (Clic here for more details about this article) |
8/48. Nutrition support for the patient with an open abdomen after major abdominal trauma.OBJECTIVE: Nutrition support in the severely injured trauma patient is crucial to minimize the hypermetabolic stress response. Even though enteral nutrition is the preferred method of feeding, it is not always feasible after multiple trauma. We present a complex nutritional case in a patient who sustained severe abdominal trauma with a severe liver injury, rib fractures, and pulmonary contusion. methods: The patient required several repeat laparotomies, abdominal packing, and temporary abdominal closure. The clinical course was complicated by hypotension requiring multiple vasopressors; coagulopathy requiring more than 35 U of packed red cells, more than 50 U of fresh frozen plasma, and more than 80 U of platelets; acute renal failure requiring dialysis; and pneumonia and acute respiratory distress syndrome requiring intricate ventilator management. Nutrition intervention began on post-trauma day 4 with total parenteral nutrition due to hypotension, resuscitation, and massive bowel edema; by post-trauma day 8. the patient was receiving goal nutrients. RESULTS: On post-trauma day 27, bowel edema was significantly less, and a nasoenteric feeding tube was placed and enteral feeding initiated. By post-trauma day 31, full enteral feeds were tolerated, and total parenteral nutrition was stopped. Nutrient provision was adjusted daily to account for organ and metabolic changes including hepatic, pulmonary, and renal dysfunction. The patient did well and was eventually extubated and eating a regular diet. CONCLUSION: With careful monitoring and adjusting of the nutritional plan, a hypermetabolic complex trauma patient with an open abdomen can be fed optimally, safely, and successfully despite increased bowel edema and multiple organ dysfunction.- - - - - - - - - - ranking = 0.54990157863454keywords = coagulopathy (Clic here for more details about this article) |
9/48. dengue hemorrhagic fever with fulminant hepatic failure in an immigrant returning to bangladesh.An immigrant from bangladesh living in the United Kingdom presented with a nonspecific febrile illness after visiting his homeland and subsequently developed fulminant hepatic failure accompanied by hypotension, ascites, a generalized coagulopathy, and thrombocytopenia. serology and detection of dengue virus serotype 3 by PCR established a postmortem diagnosis of hepatic failure secondary to dengue hemorrhagic fever.- - - - - - - - - - ranking = 0.54990157863454keywords = coagulopathy (Clic here for more details about this article) |
10/48. Multiple infarcted regenerative nodules in liver cirrhosis after systemic hypotension due to septic shock: radiologic findings.We describe a case of multiple infarcted regenerative nodules in a patient with advanced liver cirrhosis who had experienced an episode of septic shock. Sonography showed multiple hypoechoic or isoechoic nodules; contrast-enhanced computed tomography showed multiple, low-attenuating nodules with rim enhancement; and magnetic resonance imaging showed multiple nodules of low, iso-, or high signal intensity. Explanted liver showed coagulation necrosis of multiple regenerative nodules. Peribiliary cysts in chronic liver diseases, liver abscesses, spontaneous necrosis of hepatocellular carcinomas, and metastasis should be differentiated.- - - - - - - - - - ranking = 0.16666666666667keywords = coagulation (Clic here for more details about this article) |
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