Cases reported "Hypothermia"

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1/7. pancytopenia induced by hypothermia.

    hypothermia has been demonstrated to induce pancytopenia in animals, but whether this association exists in humans is unknown. The authors report the case of an 8-year-old girl in whom hypothermia (temperature 33 degrees C-35 degrees C) is the cause of pancytopenia. The patient developed thermoregulatory dysfunction subsequent to surgical resection of a craniopharyngioma. Her recurrent cytopenias could not be explained by any etiology except chronic hypothermia. The pancytopenia improved upon rewarming the patient to a temperature of 36 degrees C. This association between hypothermia and pancytopenia has rarely been reported in humans and may be underdiagnosed especially in cases of transient or milder presentations. The authors recommend careful hematologic monitoring of patients with thermoregulatory dysfunction.
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2/7. 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.
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3/7. Treatment of an acquired coagulopathy with recombinant activated factor vii in a damage-control patient.

    Recombinant activated factor vii is commonly used for the treatment of hemophiliac patients with inhibitors and has been studied for use in trauma. We report the use of recombinant activated factor vii for a male patient who was injured in a motor vehicle accident. We also summarize the animal studies and clinical trials that have been reported.
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4/7. naltrexone-induced hypothermia in the rat.

    naltrexone, in relatively high doses, has been reported to cause a fall in body temperature in human ex-heroin addicts who had been abstinent for at least 6 weeks. The underlying mechanism of this hypothermic effect has been investigated in rats. The first consideration was that the temperature change was a reflection of delayed withdrawal but rats implanted with a morphine pellet 45 days earlier showed no significant change in temperature after a dose of naltrexone that caused marked withdrawal hypothermia in dependent rats implanted 3 days previously. A fall in core temperature was only induced in rats after doses of 80 and 160 mg/kg i.p. of naltrexone. Behavioral thermoregulatory studies revealed that the animals correct the falling body temperature by increased exposure to a radiant heat source indicating that the central thermostats had not been significantly affected by the drug. These data suggest that the major component in the hypothermic effect of naltrexone is activation of efferent heat loss pathways or peripheral heat loss mechanisms. Due to current suggestions that opiate receptors might represent the receptors for an endogenous transmitter the results are discussed in relation to this consideration. When compared to the sites and mechanism of action of opiates on thermoregulation the results with naltrexone lend little support to the hypothesis that the fall in temperature is due to displacement of an endogenous substance from central opiate receptors.
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5/7. Closed thoracic cavity lavage in the treatment of severe hypothermia in human beings.

    life-threatening hypothermia can be treated by active and passive rewarming techniques, the treatment of choice being partial cardiopulmonary bypass. The use of closed thoracic cavity lavage has been evaluated in animals, but no formal presentations in human beings have been reported. We report two cases in which rapid rewarming in severe hypothermia was accomplished when cardiopulmonary bypass was not available.
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6/7. rewarming by hemodialysis for hypothermia: failure of heparin to prevent DIC.

    disseminated intravascular coagulation (DIC) is an infrequent but known complication of hypothermic injury. Previous work with a dog model had indicated that DIC could be prevented if the animals were treated with heparin prior to rewarming. We report here the case of a young man treated with core rewarming by hemodialysis who developed DIC despite the use of heparin during dialysis.
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7/7. Recurrent thrombocytopenia, erythroid hypoplasia and sideroblastic anaemia associated with hypothermia.

    A distinct and previously undescribed haematological picture was noted in three patients with hypothermia. During hypothermia there was anaemia with reduced normoblastic erythropoiesis, marked sideroblastic change and thrombocytopenia in the presence of a normal number of megakaryocytes. In two patients as the body temperature returned to normal these changes were slowly reversed. Evidence both from observations in patients and from animal experiments is given why the haematological changes are due to the hypothermia.
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