1/19. Posterior ischemic optic neuropathy related to profound shock after penetrating thoracoabdominal trauma.Ischemic optic neuropathy is a rare cause of blindness reported most commonly in association with collagen-vascular diseases, infectious processes, and systemic hypotension related to massive exsanguinating hemorrhage. We report what we believe to be the first case of posterior ischemic optic neuropathy due to perioperative hypotension in a patient who had a penetrating thoracoabdominal injury with massive hemorrhage, severe hypotension, massive microcapillary circulatory leak, multiple system organ failure, and acute respiratory distress syndrome. Although the incidence of postoperative visual loss is low (-0.002%), awareness of this entity must be raised within the trauma surgical community.- - - - - - - - - - ranking = 1keywords = capillary, leak (Clic here for more details about this article) |
2/19. Systemic capillary leak syndrome presenting as recurrent shock.OBJECTIVE: To report a case of systemic capillary leak syndrome (SCLS) in a child. DESIGN: Case report. SETTING: Pediatric intensive care unit. PATIENT: A 6-yr-old girl was admitted twice to the pediatric intensive care unit, at a 10-month interval, in severe shock with important edema. RESULTS: The patient presented with acute symptoms of abdominal pain, vomiting, and syncope in the hour preceding the shock. During both episodes necessary management included aggressive intravenous fluid rehydration, mechanical ventilation, and use of inotropes/vasopressors. Suspicion of a lower limb fasciitis necessitated surgical exploration, but pathology reports were negative on both occasions revealing only subcutaneous tissue edema. The patient recovered within 24 hrs on both episodes. Investigation ruled out cardiogenic shock and septic shock due to bacterial etiology. On the first episode, a nasopharyngeal aspirate was positive for influenza A (H3N2) by both viral immunofluorescence and culture. The presumed diagnosis was toxic shock syndrome associated with influenza virus. On the second episode, all bacterial and virology cultures remained negative. Hypovolemic shock was suspected, but there was no history of dehydration, bleeding, or gastrointestinal losses (persistent vomiting or diarrhea). Noninfectious causes of hypovolemic shock with edema were ruled out, leading us to believe that she suffered from SCLS. CONCLUSIONS: Although well described in the adult literature, there have been few reports of SCLS in pediatric patients. SCLS should be considered in the differential diagnosis of recurrent hypovolemic shock without identifiable cause. The only therapeutic intervention is to obtain vascular access when initial manifestations occur and give aggressive fluid reanimation.- - - - - - - - - - ranking = 9735.6125179515keywords = capillary leak syndrome, systemic capillary leak syndrome, systemic capillary leak, capillary leak, leak syndrome, systemic capillary, capillary, leak (Clic here for more details about this article) |
3/19. Treatment strategies in shock: use of oxygen transport measurements.shock has traditionally been categorized according to its cause. shock can result from hemorrhage, primary cardiac failure, central nervous system failure, trauma, or sepsis. Therapeutic principles have been developed for each etiologic type. End points for such therapy have included optimization of pulmonary capillary wedge pressure, cardiac output, blood pressure, and urine output. Recent investigators agree that the common denominator in each of the shock syndromes is a reduction in the amount of oxygen consumed by the cell. The logical therapeutic approach would be to increase oxygen delivery to support the increased metabolic demand of the cells. The end point of resuscitation should be optimization of oxygen delivery and oxygen consumption. These variables are easily calculated by using data obtained from pulmonary artery catheter and laboratory measurements. The physician or nurse caring for critical ill patients should have a thorough understanding of the rationale for the use of oxygen transport calculations and the methods of manipulating oxygen delivery. A simple explanation of these principles including the importance of hemoglobin, cardiac index, and percent saturation of hemoglobin and suggested treatment strategies are presented.- - - - - - - - - - ranking = 0.89321153234716keywords = capillary (Clic here for more details about this article) |
4/19. Systemic capillary leak syndrome.Systemic capillary leak syndrome is a rare condition characterized by unexplained episodic capillary hyperpermeability. A shift of fluid and protein from the intravascular to the interstitial space results in hypovolaemia. Attacks vary in frequency, severity and duration and can be fatal, although they often remit spontaneously. During acute episodes there is a pathognomonic elevated haematocrit and reduced serum albumin, frequently associated with a monoclonal gammopathy. Treatment has been largely empirical but there are anecdotal reports of beneficial therapy. We describe a further case which highlights the typical clinical presentation, course and investigate findings and review the other cases described.- - - - - - - - - - ranking = 8348.496511043keywords = capillary leak syndrome, capillary leak, leak syndrome, capillary, leak (Clic here for more details about this article) |
5/19. Capillary leakage complicated by compartment syndrome necessitating surgery.A single episode of systemic capillary leak syndrome is reported in a hiv-positive patient. The shock had necessitated the infusion of large amounts of fluid with concomitant diffuse swelling and weight gain leading to compartment syndrome of both legs. This required surgical relief. The initial high hematocrit (62%) and low serum protein concentration (48 g/l) with normal factor v (molecular weight above 300,000) concentrations are the hallmark of capillary leak when they are associated with hypovolemic shock. It must be emphasized that fluid resuscitation may worsen the muscle damage with ultimate compartment syndrome. Therefore, it appears reasonable to monitor muscular pressure during volume expansion in patients with capillary leak syndrome, severe shock and muscular swelling.- - - - - - - - - - ranking = 5027.6682532843keywords = capillary leak syndrome, systemic capillary leak syndrome, systemic capillary leak, capillary leak, leak syndrome, systemic capillary, capillary, leak (Clic here for more details about this article) |
6/19. Injuries to the large abdominal vessels during lumbar nucleotomy.The rare complication of iatrogenic damage to the large abdominal blood vessels during lumbar intervertebral disc operations is demonstrated by three case reports. A sudden decrease in blood pressure and tachycardia are major signs of such vessel lacerations. Due to a valve mechanism which prevents a dorsal blood leakage through the intervertebral space, early detection of this problem by the surgeon or anesthesiologist may prove to be difficult. myocardial infarction, pulmonary embolism, abnormal volume distribution after positioning, dysfunction of circulatory regulation due to anesthesia or faulty positioning, obstruction of the subclavian artery due to false placement of chest padding, all occur more frequently and therefore must be considered and excluded. A wrong interpretation of this acute occurrence carries a mortality of 70%. Even immediate intervention by vascular surgery shows a mortality rate of 50% for this uncommon emergency. In order to prevent the disastrous sequelae to this complication, blood vessel injury should be suspected for every unexplained intraoperative decrease in blood pressure during lumbar nucleotomy. Only a rapid termination of the operation and appropriate preparation for vascular surgery can lower the mortality of this rare occurrence.- - - - - - - - - - ranking = 0.10678846765284keywords = leak (Clic here for more details about this article) |
7/19. Elevated pulmonary capillary wedge pressure in a patient with hypovolemia.Since its introduction in 1969, the balloon-tipped pulmonary artery catheter has become widely accepted. Pulmonary capillary wedge pressures have been used diagnostically to determine left ventricular preload and volume status. We report on a patient with noncardiogenic pulmonary edema, secondary to a heroin overdose, who was hypovolemic and had an elevated pulmonary capillary wedge pressure. We discuss possible explanations and present evidence that the pulmonary capillary wedge pressure does not always accurately reflect volume status.- - - - - - - - - - ranking = 6.2524807264302keywords = capillary (Clic here for more details about this article) |
8/19. Isolated ultrafiltration in the therapy of volume overload accompanying oliguric vascular shock states.Isolated ultrafiltration (removal of plasma water and solute without dialysis) was used as a "last resort" therapy in three patients with diuretic and pressor resistant oliguria complicating severe volume overload and vascular shock. The improvement in clinical and hemodynamic parameters is reported and the possible mechanisms of action (decreased pulmonary capillary wedge pressure and increased colloid osmotic pressure) are discussed.- - - - - - - - - - ranking = 0.89321153234716keywords = capillary (Clic here for more details about this article) |
9/19. pulmonary artery pressure versus pulmonary capillary wedge pressure and central venous pressure in shock.Evidence is presented from 43 dogs and 30 patients that under conditions of severe hemorrhagic, traumatic or septic shock, there may be partial obstruction of the pulmonary microcirculation due to disseminated intravascular coagulation (DIC) particularly in the pulmonary venules. This may cause the left atrial pressure to fall and the pulmonary artery pressure to rise, in some cases drastically. pulmonary edema may result. This dangerous rise in pulmonary artery pressure is not reflected by the wedged pulmonary artery catheter which will monitor only the status of the left heart. central venous pressure (CVP) may remain within normal limits even after pulmonary artery pressure has risen to dangerous levels with the development of pulmonary edema. It is only with right ventricle failure against the high pulmonary pressure that CVP rises. It is concluded that pulmonary artery pressure measurements are very important in monitoring intravenous fluid administration in severe shock. Wedged pulmonary artery pressures monitor the left heart but may be misleading if taken alone. central venous pressure gives a delayed response to fluid overload.- - - - - - - - - - ranking = 3.5728461293887keywords = capillary (Clic here for more details about this article) |
10/19. Pathogenesis and renal function in acute toxic nephropathies.Acute toxic nephropathy may be produced by a variety of poisons and drugs. Cellular poisons, such as mercuric bichloride, produce tubular necrosis. Many drugs induce an immunologically mediated response presenting as interstitial nephritis, glomerulonephritis or angiitis. Substances, which are not primarily nephrotoxic but induce dehydration, shock, hemolysis, rhabdomyolysis and/or electrolyte disturbances may also lead to secondary acute renal failure. Reduced renal blood flow, suppressed glomerular filtration, increased tubular pressure due to obstruction, and tubular leakage are responsible for the functional breakdown. In addition, specific tubular functions may be impaired. Complete or incomplete recovery is the rule.- - - - - - - - - - ranking = 0.10678846765284keywords = leak (Clic here for more details about this article) |
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