Cases reported "Death"

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11/69. adolescent grief: "It never really hit me...until it actually happened".

    In the united states, more than 2 million children and adolescents (3.4%) younger than 18 years have experienced the death of a parent. When death can be anticipated, as with a terminal illness, and even when the death is sudden, as in the September 11, 2001, attacks on the World Trade Center and Pentagon, physicians and other health care professionals have an opportunity to ameliorate the impact of the loss. Developmental factors shape adolescents' reactions and responses to the death of a parent. Recent research in childhood and adolescent bereavement shows how health professionals can support the adolescent's coping strategies and prepare the family to facilitate an adolescent's mastery of adaptive tasks posed by the terminal phase of the parent's illness, the death, and its aftermath. Robert, a bereaved 14-year-old, illustrates some of these adaptive challenges.
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12/69. Caregiving at the end of life.

    Meeting the demands of chronic illness and disease states is challenging, at best. Too often, the chronicity of the illness hastens death. The physical, psychological, and sociological changes that accompany the death of an individual require attention and forethought if the life transition is to be made with elegance and grace. This article addresses the caregiving demands for the professional and familial/social support surrounding the chronically ill individual at the end of life. Focus is placed on the preparation of advance directives-legal documents that set clear boundaries for honoring the wishes of the patient.
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13/69. Moving on: recovering from the death of a spouse.

    Grieving is a complex multidimensional process in response to loss. The grief work involved in coping with a loved one's death does not end when the loved one dies. Rather, the grief work continues through a series of recovery stages. Six stages of recovery--loss, protest, searching, despair, reorganization, and reinvestment--are illustrated and discussed using a case study that highlights a wife's recovery from the death of her husband. Recognition of the stages of grief recovery after a death are significant for health care professionals so that bereavement support may be provided throughout the entire recovery process.
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14/69. The dream in terminal illness: a Jungian formulation.

    It is a central assumption of jungian theory that psychical transformation occurring during the critical developmental stages of the life cycle is anticipated, inspired, and orchestrated by the archetypal symbol. In this way, archetypal dreams are afforded particular significance during these transitional stages. The present paper purports to consider the clinical and theoretical implications of this understanding with reference to the dying process. The concepts discussed are illustrated by a series of dreams of a terminally ill cancer patient, which are elucidated by way of the method of amplification. Thematic analysis of the dream series supports Jung's conceptualization of death and dying as being a critical stage of the individuation process, characterized by profound psychical development of a specific and purposeful nature. The value of using dreams in the psychotherapeutic care of dying patients and their families is discussed, with case illustrations. It is suggested that such an approach may foster creative development, assist patients to integrate meaningfully subjective experiences pertaining to dying, and counteract the sense of isolation experienced by the terminally ill. The need for further research and the development of specific treatment modalities is highlighted.
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15/69. Donation after cardiac death: two case studies.

    Few transplant centers consider using lungs from cardiac death donors because of warm ischemic damage. In certain scenarios, the recovery and transplantation of lungs from cardiac death donors are appropriate. A young person with a severe neurologic and spinal cord injury, who is not brain dead and who is otherwise healthy, should be considered as a cardiac death donor. A protocol should be established with local lung transplant surgeons to facilitate the successful procurement of lungs from cardiac death donors. In addition, when patients present to hospital emergency rooms with nonsurvivable injuries either in cardiac arrest or with extremely labile vital signs, uncontrolled donation after cardiac death can be considered. It is important to obtain informed consent from the family and to suspend any previous do-not-resuscitate orders before initiating resuscitative efforts. If an organ procurement coordinator and team are within close proximity to the hospital, consideration should be given to uncontrolled donation after cardiac death.
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16/69. Postoperative death of a patient in apparent remission of malignant lymphoma after dissection for squamous cell carcinoma.

    A 67-year-old man in apparent remission of malignant lymphoma had squamous cell carcinoma of the left buccal mucosa. The patient underwent partial resection of the mandible, including the excision of the tumor. During the fourth postoperative night the patient suddenly became febrile and had a spiking fever for the next 5 days. His general condition deteriorated afterward, and acute aggravation of malignant lymphoma was suspected. On day 16 disseminated intravascular coagulation was indicated by a decreased platelet count of 3.8 x 10(4), a tendency toward bleeding, and multiple organ failure. The patient died 18 days postoperatively. We alert anesthesiologists and surgeons that surgically treating patients with malignant lymphoma who are receiving immunosuppressive drugs is precarious even though their disease is considered to be in apparent remission.
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17/69. Anomalous origin of the coronary arteries from the pulmonary trunk in two separate patients with a review of the clinical implications and current treatment recommendations.

    Anomalous origin of a coronary artery from the pulmonary artery (PA) is an unusual abnormality. These anomalies are often hemodynamically significant and can lead to myocardial ischemia, myocardial infarction, and sudden cardiac death. Anomalous origin of the left coronary artery (LCA) from the pulmonary trunk is known as Bland-White-Garland syndrome and causes death in 80% to 85% of affected children in the first year of life. Treatment of the LCA arising from the PA is typically surgical, with ligation and reimplantation of the LCA to the aorta. In contrast, origination of the right coronary artery from the PA is usually a benign anomaly, although clinically significant sequelae can develop. Controversy exists regarding the need to intervene in the cases of patients with this usually incidentally discovered anomaly. We review the clinical presentation and treatment of patients with each anomaly and the current recommendations regarding the clinical course and management of such patients.
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18/69. subarachnoid hemorrhage and death following coingestion of MDMA with other drugs.

    Ecstasy, the popular name for 3,4-methylenedioxymethamphetamine (MDMA), is a synthetic amphetamine derivative. It stimulates the sympathetic nervous system, producing serious adverse effects on the cardiovascular system. We present a 20-year-old female patient, who developed subarachnoid hemorrhage (SAH) and death following MDMA and coingestion with other drugs. She suffered from severe headache followed by vomiting, and conscious change 5 hours after an intake of 1 tablet MDMA and other drugs at a dance club. Her blood pressure was 226/164 mmHg, pulse rate 164/min, respiratory rate 30/min on arrival at our emergency department. Diffuse rales were heard over both lung fields. Both pupils' sizes were 4 mm, with sluggish reaction to light. A 12 lead electrocardiograph showed sinus tachycardia, ST depression in the inferior leads and V4 to V6 precordial leads. Laboratory findings revealed normal except a slightly raised white cell count and glucose. Arterial blood gas analysis showed pH was 7.333, with PaCO2 24.6 mmHg, PaO2 151.7 mmHg and HCO3 12.8 mmol/L. Chest x-ray revealed acute pulmonary edema. Urgent computerized tomography scanning of the head demonstrated SAH. Her condition continued to deteriorate, and went to deep coma and shock status. She expired on the second day although we treated aggressively.
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19/69. 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.
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20/69. Near-death experience in a boy undergoing uneventful elective surgery under general anesthesia.

    Near-death experience (NDE) is a complex subjective experience, which may include affective elements such as a sense of peacefulness, paranormal components such as a sensation of floating out of the body, and a perception of being in a dark tunnel and seeing a brilliant light. It is usually reported to occur in association with a wide range of life-threatening situations, as for instance, cardiopulmonary resuscitation. We report on an episode of NDE that occurred in a 12-year-old boy who underwent a general anesthesia for an elective uncomplicated surgery. To our knowledge, this is the first case of NDE in a child that has been reported in this context.
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