1/15. Trauma, sepsis, and disseminated intravascular coagulation.disseminated intravascular coagulation (DIC) was first observed clinically in a case of sepsis following severe trauma. It was postulated that the observed clotting defect and bleeding were due to the using up of clotting factors in an episode of intravascular clotting. It was also postulated that the multiple organ failure observed was due to obstruction of the microcirculation of the organs by microclots. Evidence for this process was worked out in many animal studies. It was then postulated that if these microclots could be lysed before organ necrosis was produced, organ failure could be prevented. This prevention was shown to be possible in animals. It was then tried in humans using plasminogen activators, and the approach was found to be effective. Using a low dose of plasminogen activator over a 24-hour period caused no changes in the coagulation profile or bleeding.- - - - - - - - - - ranking = 1keywords = animal (Clic here for more details about this article) |
2/15. Massive rhabdomyolysis and multiple organ dysfunction syndrome caused by leptospirosis.We report a case of leptospiral infection in a 63-year-old man who acquired the infection while swimming in canals and streams in hawaii. The patient's course was atypical in that he was anicteric and had no evidence of meningitis when he presented with fever, rapidly progressive and severe rhabdomyolysis, thrombocytopenia, acute renal failure, and respiratory distress syndrome. Although he recovered after a protracted illness, he required major life support, including mechanical ventilation and hemodialysis. Initial antimicrobial therapy was designed to cover major bacterial and atypical pathogens, including leptospires. An in-depth work-up for causes of this catastrophic illness confirmed acute leptospirosis. Although rare, leptospirosis is a potentially lethal infection classically associated with hepatitis, azotemia, and meningitis. Most patients experience self-limited illness, with fever, myalgias, and malaise followed by an immune-mediated aseptic meningitis. A small proportion develop shock and multiple organ dysfunction. Whereas myalgias are ubiquitous in leptospiral infection, and most patients show mildly elevated muscle enzymes, life-threatening rhabdomyolysis is rare. This atypical case is reported to urge clinicians to consider leptospirosis in the evaluation of a patient with cryptogenic sepsis who develops multiple organ dysfunction associated with rhabdomyolysis. Appropriate antimicrobial therapy, with penicillin or doxycycline, can be life-saving.- - - - - - - - - - ranking = 4.6364559572061keywords = hepatitis (Clic here for more details about this article) |
3/15. Delayed fatal hemorrhage from pseudoaneurysm of the hepatic artery after percutaneous liver biopsy.hemorrhage is the most common serious complication of percutaneous liver biopsy. Liver biopsy is usually done in an outpatient setting because most significant hemorrhage is evident within a few hours after biopsy. Delayed hemorrhage occurs much less frequently but carries a much higher mortality. We present a 41-yr-old man with chronic hepatitis c who underwent a percutaneous liver biopsy uneventfully but was found to have a pseudoaneurysm of the hepatic artery 5 days later. Shortly after admission, the patient experienced bleeding into the liver from the pseudoaneurysm, which was controlled initially by angiographic embolization. However, recurrent bleeding could not be controlled by repeat angiography and surgical intervention, and the patient expired. The diagnosis and management of pseudoaneurysm of the hepatic artery complicating liver biopsy is reviewed.- - - - - - - - - - ranking = 4.6364559572061keywords = hepatitis (Clic here for more details about this article) |
4/15. mycobacterium mucogenicum isolated from a patient with granulomatous hepatitis.mycobacterium mucogenicum is a recently characterized, rapid-growing mycobacteria rarely seen in human infections. We describe the case of a 51-year-old man with rapidly progressive granulomatous hepatitis caused by M. mucogenicum. Although premortem evaluation failed to identify an etiologic agent, autopsy liver cultures produced smooth, rapid-growing mycobacterial colonies. Biochemical, growth, and cell wall fatty acid characteristics were consistent with the identification of M. mucogenicum.- - - - - - - - - - ranking = 23.182279786031keywords = hepatitis (Clic here for more details about this article) |
5/15. Multiorgan failure due to coarctation of the aorta: management and outcome of five neonates.Coarctation of the aorta can manifest in a number of ways. Differential diagnosis is particularly difficult during the neonatal period, especially in newborns presenting with a sepsis-like or metabolic disease-like condition. We describe five newborns who presented with metabolic acidosis, renal insufficiency, or ischemic hepatitis and stress the importance of early diagnosis to prevent adverse outcome.- - - - - - - - - - ranking = 4.6364559572061keywords = hepatitis (Clic here for more details about this article) |
6/15. Acute q fever pericarditis followed by chronic hepatitis in a two-year-old girl.Acute coxiella burnetii infection is most commonly a mild and self-limiting disease with fever, pneumonia and hepatitis. endocarditis is the most frequent clinical presentation of chronic infection. We report a 2-year-old child with q fever who presented with acute pericarditis and cardiac tamponade and who developed a chronic hepatic infection.- - - - - - - - - - ranking = 23.182279786031keywords = hepatitis (Clic here for more details about this article) |
7/15. cardiopulmonary resuscitation after near drowning and hypothermia: restoration of spontaneous circulation after vasopressin.Recent animal data have challenged the common clinical practice to avoid vasopressor drugs during hypothermic cardiopulmonary resuscitation (CPR) when core temperature is below 30 degrees C. In this report, we describe the case of a 19-year-old-female patient with prolonged, hypothermic, out-of-hospital cardiopulmonary arrest after near drowning (core temperature, 27 degrees C) in whom cardiocirculatory arrest persisted despite 2 mg of intravenous epinephrine; but, immediate return of spontaneous circulation occurred after a single dose (40 IU) of intravenous vasopressin. The patient was subsequently admitted to a hospital with stable haemodynamics, and was successfully rewarmed with convective rewarming, but died of multiorgan failure 15 h later. To the best of our knowledge, this is the first report about the use of vasopressin during hypothermic CPR in humans. This case report adds to the growing evidence that vasopressors may be useful to restore spontaneous circulation in hypothermic cardiac arrest patients prior to rewarming, thus avoiding prolonged mechanical CPR efforts, or usage of extracorporeal circulation. It may also support previous experience that the combination of both epinephrine and vasopressin may be necessary to achieve the vasopressor response needed for restoration of spontaneous circulation, especially after asphyxial cardiac arrest or during prolonged CPR efforts.- - - - - - - - - - ranking = 0.5keywords = animal (Clic here for more details about this article) |
8/15. Liver support in fulminant liver failure after hemorrhagic shock.Acute liver failure (ALF) is a rare clinical syndrome associated with a mortality of up to 80% and its management remains an interdisciplinary challenge. Despite recent improvements in intensive care management, the mortality of patients with ALF remains high and is related to complications such as cerebral edema, sepsis and multiple organ failure. Emergency orthotopic liver transplantation (OLT) is currently the only effective treatment for those patients who are unlikely to recover spontaneously. Nevertheless, OLT is not always possible because of the shortage of the organs and/or complications related to ALF. Newly introduced liver-assist devices can temporarily support the patient's liver until native liver recovers or can serve as a bridging device until a liver graft is available. The support devices use both cell-based and non-cell-based techniques. One of the latest non-cell-based extracorporeal hepatic support devices, the molecular adsorbent recycling system (mars), is based on the concept of albumin dialysis. mars utilises selective hemodiafiltration with countercurrent albumin dialysis aiming to selectively remove both water-soluble and albumin-bound toxins of the low and middle molecular-weight range. We report on a young patient who presented with clinical symptoms of ischemic hepatitis and multi-organ failure (apache II score 38-->predicted postoperative mortality 87%) due to prolonged hemorrhagic shock. OLT was contraindicated because of history of pancreas cancer with metastases. It was necessary to use aggressive conservative therapy and an extracorporeal liver-assist device until liver regeneration began and hemodynamic conditions were stable. The patient underwent five treatments with mars. During the treatment, there were improvements of hemodynamics, respiratory function, acid-base disturbances and laboratory parameters. The plasma disappearance rate of indocyanine green, a parameter of dynamic liver function, improved during mars treatment. Although repeated neurological examination predicted diffuse brain damage (brain oedema, decreased cerebral blood flow), the patient recovered without any neurological deficits. The patient survived and was discharged from the hospital in good condition. In this case mars treatment was successful in supporting the patient through the most critical period of ALF.- - - - - - - - - - ranking = 4.6364559572061keywords = hepatitis (Clic here for more details about this article) |
9/15. ceftriaxone-induced hemolytic anemia and hepatitis in an adolescent with hemoglobin sc disease.OBJECTIVES: To describe a case of a ceftriaxone-induced hemolytic anemia and hepatitis leading to multiple organ failure and death in an adolescent with hemoglobin sc disease and to review the previous cases of this rare and potentially fatal disorder in children. DESIGN: Case report and literature review. SETTING: intensive care unit. Patient: adolescent with hemoglobin SC. INTERVENTIONS: emergency treatment. MEASUREMENTS AND MAIN RESULTS: After 4 days of ceftriaxone therapy, the adolescent experienced an acute hemolytic reaction (hemoglobin decreased to 5 g/dL with hemoglobinuria) and severe hepatitis (all enzymes increasing dramatically including aminoaspartate transferase >20,000 IU/L). Renal failure and ultimately multiple organ failure ensued, and the patient died on hospital day 19. Direct antiglobulin tests on red cells obtained from the patient on hospital day 2 showed microscopic agglutination with polyspecific and anticomplement (C3) antiglobulin reagents. plasma samples showed macroscopic agglutination reactions when incubated in the presence of ceftriaxone, many days after cessation of ceftriaxone, indicating the continued presence of ceftriaxone-dependent antibodies. CONCLUSIONS: Drug reactions leading to hemolysis are relatively uncommon, and a total of ten cases of ceftriaxone-induced hemolytic anemia have been reported in children. The present case describes an adolescent who ultimately died on hospital day 19 from multiple organ failure, although the presentation of this case seems atypical in several respects. Children with clinical syndromes that place them at risk for hemolysis and children who frequently require broad spectrum antibiotics present unique diagnostic challenges, and the possibility that hemolytic syndromes may be due to ceftriaxone must be considered.- - - - - - - - - - ranking = 27.818735743237keywords = hepatitis (Clic here for more details about this article) |
10/15. Carboxyatractyloside poisoning in humans.OBJECTIVE: Cocklebur (xanthium strumarium) is an herbaceous annual plant with worldwide distribution. The seeds contain the glycoside carboxyatractyloside, which is highly toxic to animals. We describe nine cases of carboxyatractyloside poisoning in humans which, to our knowledge, has not previously been reported. The clinical, laboratory and histopathological findings and our therapeutic approach are also discussed. SUBJECTS AND methods: The patients presented with acute onset abdominal pain, nausea and vomiting, drowsiness, palpitations, sweating and dyspnoea. Three of them developed convulsions followed by loss of consciousness and death. RESULTS: Laboratory findings showed raised liver enzymes, indicating severe hepatocellular damage. BUN and creatinine levels were raised, especially in the fatal cases who also displayed findings of consumption coagulopathy. CPK-MB values indicative of myocardial injury were also raised, especially in the fatal cases. Three of the patients died within 48 hours of ingesting carboxyatractyloside. Post-mortem histopathology of the liver confirmed centrilobular hepatic necrosis and renal proximal tubular necrosis, secondary changes owing to increased permeability and microvascular haemorrhage in the cerebrum and cerebellum, and leucocytic infiltrates in the muscles and various organs including pancreas, lungs and myocardium. CONCLUSIONS: Carboxyatractyloside poisoning causes multiple organ dysfunction and can be fatal. Coagulation abnormalities, hyponatraemia, marked hypoglycaemia, icterus and hepatic and renal failure are signs of a poor prognosis. No antidote is available and supportive therapy is the mainstay of treatment.- - - - - - - - - - ranking = 0.5keywords = animal (Clic here for more details about this article) |
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