1/60. Bronchoaspiration as a possible cause in a case of tetanus. A reminder on the importance of adulthood immunizations.Although preventable by immunization tetanus still takes a large death toll, mostly in developing countries, where adult population is often unprotected and opportune medical care unavailable. We present a case of tetanus in an elderly patient with bronchoaspiration pneumonia after a near-drowning incident, in which no objective entry site could be suspected with as much temporal relation as the bronchoaspiration incident. Bronchoaspiration of organic matter and feces provides both a source of the causative agent and an adequate polymicrobial environment for the development of the disease. It is under such conditions that we propose this unusual entry site as the cause of tetanus in our patient. Special emphasis is made on the importance of adulthood immunization programs and how incidents like this one should be taken into account in the overall care provided to the elderly population.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/60. kerosene-induced severe acute respiratory failure in near drowning: reports on four cases and review of the literature.OBJECTIVE: The purpose of this study is to present an unusual respiratory and cardiovascular course after intoxication and near drowning in a river contaminated with kerosene. DESIGN: case reports and review of the literature. SETTING: intensive care unit of a university-affiliated hospital. patients: Four patients after near drowning. INTERVENTION: Supportive only. RESULTS: The four patients developed acute respiratory failure. Cardiomyopathy was present in three patients and a persistent hypokalemia in two patients. The onset of the symptoms was delayed, which led to underestimation of the severity of their illness. Two of the four patients died. The diagnosis of hydrocarbon intoxication was based on bronchoalveolar lavage results, neutrophilic alveolitis with the presence of lipid-laden macrophages, and evidence of lipoid pneumonia from the autopsy performed on one victim. One patient who clinically deteriorated and another who developed a severe restrictive pulmonary disorder were treated with corticosteroids, which were effective only in the latter patient. CONCLUSIONS: Acute kerosene intoxication in a near-drowning event often results in severe respiratory and cardiac failure, with a high fatality rate. Treatment with corticosteroids may lead to a rapid improvement in lung function.- - - - - - - - - - ranking = 7keywords = near (Clic here for more details about this article) |
3/60. rhabdomyolysis associated with near-drowning.A variety of conditions can lead to rhabdomyolysis. Only a few cases of rhabdomyolysis resulting from near-drowning exist in the literature. We describe a victim of near-drowning who developed rhabdomyolysis and acute renal failure requiring dialysis. We review the existing literature on near-drowning-induced rhabdomyolysis and discuss the possible pathogenesis.- - - - - - - - - - ranking = 7keywords = near (Clic here for more details about this article) |
4/60. Drowning and near-drowning--some lessons learnt.Over a period of sixteen months, 17 cases of submersion injury (encompassing victims of drowning and near-drowning) were attended to at our Accident and Emergency Department at Changi General Hospital. Most of the victims were inexperienced recreational swimmers, and in 6 of them, early bystander cardiopulmonary resuscitation enabled them to recover without severe morbidity. Non-cardiogenic pulmonary oedema with resulting chest infection was the commonest complication in survivors. Most of the episodes occurred in an urban setting in swimming pools without supervision by lifeguards. About two-thirds of the cases were adults over the age of fifteen years. In addition, there were patients in whom submersion injury was associated with more sinister conditions (fits, traumatic cervical spine injury, dysbarism, intoxication from alcohol or drugs), some of which were unsuspected by the doctors initially. Apart from the immediate threats of hypoxia and pulmonary injury, active search for any possible precipitating causes and associated occult injury should be made. In this study, the determinants of survival from near-drowning were early institution of cardiopulmonary resuscitation, presence of pupil reactivity, and presence of a palpable pulse and cardiac sinus rhythm.- - - - - - - - - - ranking = 6keywords = near (Clic here for more details about this article) |
5/60. Acute subdural hematoma due to near-drowning--case report.A 46-year-old male was transferred to our hospital after near-drowning when swimming. Examination found no subcutaneous hematoma or abrasion on his head. cardiopulmonary resuscitation was started immediately. Emergent computed tomography (CT) revealed no abnormalities. The next day, his consciousness level improved and repeat CT suggested an acute spontaneous subdural hematoma in the parieto-occipital region. The acute subdural hematoma was evacuated. The source of bleeding was probably an abnormally large vein located in the center of the hematoma. The patient was discharged without neurological deficit. Repeat CT is needed even if there were no abnormality on initial CT after drowning.- - - - - - - - - - ranking = 5keywords = near (Clic here for more details about this article) |
6/60. McArdle's disease in childhood: report of a new case.McArdle's disease (glycogenosis type V) is an inherited glycogen storage disease characterized clinically by myalgia, cramps and sometimes myoglobinuria, triggered by exercise. The onset of exercise intolerance is usually in late childhood or adolescence and diagnosis is exceptionally established during infancy. We report the case of a 6-year-old girl who had been complaining of aching muscles for a long time, and who presented after a near-drowning incident, with extensive muscle necrosis, probably secondary to myophosphorylase deficiency-induced cramps. These unusual manifestations led to the diagnosis of this rare disorder. We compare the clinical findings of this case to nine previous reports. This highlights the heterogeneous spectrum of this disease in childhood and supports the distinction of three clinical pictures in childhood: a neonatal form rapidly fatal, a milder form with congenital myopathic symptoms and a benign classical form with myalgia, cramps and pigmenturia.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/60. Heterotopic ossification in childhood and adolescence.Heterotopic ossification, or myositis ossificans, denotes true bone in an abnormal place. The pathogenic mechanism is still unclear. A total of 643 patients (mean age, 9.1 years) admitted for neuropediatric rehabilitation were analyzed retrospectively with respect to the existence of neurogenic heterotopic ossification. The purpose of this study was to obtain information about incidence, etiology, clinical aspect, and consequences for diagnosis and therapy of this condition in childhood and adolescence. Heterotopic ossification was diagnosed in 32 patients (mean age, 14.8 years) with average time of onset of 4 months after traumatic brain injury, near drowning, strangulation, cerebral hemorrhage, hydrocephalus, or spinal cord injury. The sex ratio was not significant. In contrast to what has been found in adult studies, serum alkaline phosphatase was not elevated during heterotopic ossification formation. A persistent vegetative state for longer than 30 days proved to be a significant risk factor for heterotopic ossification. The incidence of neurogenic heterotopic ossification in children seems to be lower than in adults. A genetic predisposition to heterotopic ossification is suspected but not proven. As a prophylactic regimen against heterotopic ossification we use salicylates for those patients in a coma or persistent vegetative state with warm and painful swelling of a joint and consider continuous intrathecal baclofen infusion and botulinum toxin injection for those patients with severe spasticity. We prefer to wait at least 1 year after trauma before excision of heterotopic ossification.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/60. Rapidly progressive pneumonia due to aeromonas hydrophila shortly after near-drowning.An 87-year-old woman died of rapidly progressive pneumonia due to aeromonas hydrophila shortly after a near-drowning event. autopsy showed necrotizing pneumonia and postmortem cultures of both blood and lung revealed the organism. Fulminant pneumonia should be considered in patients of a near-drowning event.- - - - - - - - - - ranking = 6keywords = near (Clic here for more details about this article) |
9/60. Resuscitation in near drowning with extracorporeal membrane oxygenation.We report a case of near drowning of a 3-year-old girl, who was admitted to our emergency room with a core temperature of 18.4 degrees C. After rewarming on cardiopulmonary bypass and restitution of her circulation, respiratory failure resistant to conventional respiratory therapy prohibited weaning from cardiopulmonary bypass. Therefore, we instituted extracorporeal membrane oxygenation (ECMO). Fifteen hours later, she could be weaned from ECMO but required assisted ventilation for another 12 days. Twenty months later there are no neurologic deficits.- - - - - - - - - - ranking = 5keywords = near (Clic here for more details about this article) |
10/60. Unusual freshwater near-drowning syndrome in a hospitalized postlobectomy patient.Near-drowning syndrome depends on the duration of submersion, the amount of fluid aspirated, and the severity of hypoxia. We report a case in which a patient developed ARDS shortly after undergoing a left upper lobectomy and a chest wall resection for a lung carcinoma. On further investigation, the ARDS was caused by near-drowning in a basin of freshwater: the patient's face was submerged by the patient's companion as part of a cultural tradition of trying to clean his lung. We believe that this case presents the etiology of freshwater near-drowning syndrome due to an ethnogenic practice not previously reported.- - - - - - - - - - ranking = 6keywords = near (Clic here for more details about this article) |
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