Cases reported "Multiple Organ Failure"

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1/50. extracorporeal membrane oxygenation discontinuation despite technically successful reoperation: A case report.

    death remains a probable outcome of pediatric cardiac extracorporeal membrane oxygenation (ECMO) despite increasing efforts to improve the results. On venoarterial ECMO, in an obviously hopeless situation, the decision to withdraw a life supporting measure resulting in the sudden death of a child places a heavy burden on the team. After valvulotomy of critical aortic stenosis in a prenatally diagnosed term neonate, ECMO had to be installed during postoperative resuscitation. Despite technically successful homograft implantation while on ECMO complicated by postoperative bleeding, advancing multiorgan failure resulted in ECMO withdrawal. As shown in this case report, exact termination criteria are lacking but are necessary to prevent increasing team and resource related conflicts in pediatric cardiac ECMO.
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2/50. Purulent pericarditis due to group B streptococcus and mycotic aneurysm of the ascending aorta: case report.

    A 61-year-old female, with a history of uterine and cervical cancer treated with radical hysterectomy and 2 years of postoperative chemotherapy, presented to the emergency department with dyspnea on exertion. Computed tomography of the chest revealed a large pericardial effusion and a sacciform aneurysm of the ascending aorta. The patient subsequently underwent emergency pericardiocentesis with drainage of approximately 330 ml of a bloody and turbid effusion. Cultures from the effusion yielded group B streptococcus. multiple organ failure and disseminated intravascular coagulation syndrome occurred in the acute phase, but gradually improved with continuous antibiotic therapy. On the 194th hospital day, in situ reconstruction of the ascending aorta was successfully performed using a synthetic graft. Although rarely reported, both purulent bacterial pericarditis and mycotic aneurysm can be life-threatening.
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3/50. Acute pancreatitis following resection of juxtarenal abdominal aortic aneurysm.

    A case of acute pancreatitis following resection of a juxtarenal abdominal aortic aneurysm is reported. The patient was a 73 year old man who underwent resection of a juxtarenal abdominal aortic aneurysm. The aneurysm was repaired with a 20 mm. gelatin coated Dacron graft. Proximal control of the aneurysm was performed with supraceliac aortic cross clamping. The clamping time was 50 minutes. Postoperatively, he developed progressive abdominal distension with deterioration of renal and pulmonary function necessitating relaparotomy on the 7th postoperative day. The second operation revealed evidence of saponification and fat necrosis in the omentum. The pancreas was edematous and swollen compatible with acute pancreatitis. The aortic graft and other intraabdominal organs appeared normal. Despite intensive supportive care, the patient died 2 weeks later from multiple system organ failure. The possible causes of acute pancreatitis following aortic surgery described in the literature are 1. systemic and regional hypoperfusion, 2. atheromatous emboli to arteries supplying the pancreas and 3. direct trauma to the pancreas during the operation from retractors or surgical dissection. All of which may be the etiology of acute pancreatitis in our patient. Avoidance of such factors during aortic surgery is recommended to prevent this potentially fatal complication.
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4/50. Postoperative fatal intestinal necrosis after enalapril treatment in a patient with rheumatoid arthritis.

    The inappropriate use of antihypertensive medications may cause hypotensive responses associated with organ failure. We describe a patient who developed nonocclusive splanchnic ischemia leading to death following the administration of enalapril to treat postoperative hypertension. The mechanisms and consequences of refractory hypotension induced by angiotensin-converting enzyme inhibitors are discussed.
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5/50. Intramedullary spinal cord metastasis from gastric cancer. Case report.

    A case of intramedullary spinal cord metastasis from gastric cancer is reported. A 51-year-old woman presented with hemicord syndrome that had progressed within 1 month to tetraplegia. Despite total resection of the tumor, she died of disseminated intravascular coagulation and multiple organ failure. Examination of pathological findings demonstrated undifferentiated adenocarcinoma, and postoperative gastroendoscopic study revealed advanced gastric cancer. To the authors' knowledge this is the first case of intramedullary spinal cord metastasis from gastric cancer. The clinical characteristics of the disease are discussed.
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6/50. Toxic shock syndrome after suction lipectomy.

    We present a case of toxic shock syndrome with necrotizing fasciitis after suction lipectomy. The patient underwent aesthetic suction lipectomy of the abdomen, buttocks, and thighs during an office procedure by a cosmetic surgeon. On postoperative day 2, the patient was referred to the emergency department of our hospital because of pain. On admission, the patient was in toxic shock. She required intensive medical treatment for about 1 month, along with psychiatric help to adapt after the illness. Although toxic shock syndrome is a rare postoperative complication, every plastic surgeon should be acquainted with it. A combination of early recognition, diagnosis, and aggressive supportive therapy is the only successful treatment.
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7/50. Malignant melanoma arising from the sphenoidal sinus--case report.

    Malignant melanomas arising from the sella turcica or sphenoidal sinus with bilateral invasion of the base of the skull or cavernous sinus are extremely rare. Whether the sella turcica or sphenoidal sinus is the site of origin is difficult to determine based on neuroradiological findings. An 83-year-old Japanese female presented with headache as the initial symptom. She suffered rapid progression of bilateral obstruction of the nasal cavity, left nasal bleeding, and bilateral visual field defects. The preoperative diagnosis was pituitary adenoma, metastatic tumor, or malignant paranasal tumor. biopsy was performed. The histological diagnosis was malignant melanoma. Postoperatively, the tumor progressed rapidly. She suffered several cranial nerve pareses and hypopituitarism. She died within 6 months. Tumors arising from the sphenoidal sinus cause obstruction of the nasal cavity or nasal bleeding first, and then cause cranial nerve pareses by invasion of the cavernous sinus. This sequence of clinical manifestations can be attributed to the anatomical relationships between the sphenoidal sinus, nasal cavity, and cavernous sinus. Differential diagnosis of the origin in the sella turcica or sphenoidal sinus appears to be relatively easy based on further observation of the clinical course and symptoms.
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8/50. Continuous haemofiltration with r-hirudin (lepirudin) as anticoagulant in a patient with heparin induced thrombocytopenia (HIT II).

    A 60-year-old man was admitted to the hospital with aortic dissection. An operative excision and replacement with a Y-graft was performed. Postoperatively he developed multiple organ dysfunction and required intermittent haemofiltration (anticoagulation with heparin). An ischemia of the left leg occurred at the third postoperative day. The initial platelet count was 99,000/microliter. Continuous haemofiltration (CVVH) was started three days later. Thrombotic obstructions of haemodialysis filters and catheters occurred frequently and heparin-induced thrombocytopenia (HIT II) was suspected. antibodies against heparin were found in the HIPA test. Despite heparin free citrate dialysis and anticoagulation with danaparoid thrombotic obstructions of filters and catheters continued. Therefore the anticoagulation therapy during CVVH was changed to recombinant hirudin (lepirudin). Starting dose was a bolus of 0.01 mg/kg bw followed by the same amount as maintenance dose per hour. Anticoagulation was adjusted to an increase of aPTT (activated partial thromboplastin time) to 1.5-2 times its normal value. A dose of 0.005 mg/kg bw/h lepirudin was sufficient to maintain adequate anticoagulation. After changing to lepirudin no further catheter obstructions were observed and the platelets recovered slowly. Renal function improved and five weeks after admission endogenous creatinine clearance showed a value of 25 ml/min. We conclude that lepirudin is an effective anticoagulant during CVVH in patients with HIT II. In partly permeable polysulfon filters a dose of 0.005 mg/kg bw/h lepirudin is sufficient to maintain adequate anticoagulation. Monitoring anticoagulation by measuring the increase of aPTT (factor 1.5-2.0) seems to be safe. However, optimally the r-hirudin concentration should be measured directly using the Ecarin clotting time.
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ranking = 1.5
keywords = operative
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9/50. candida tropicalis pacemaker endocarditis.

    A rare case of candida tropicalis pacemaker endocarditis was diagnosed in a 77-year-old male who presented with lethargy. The organism was isolated from cultures of blood and vegetations on the tricuspid valve, interatrial septum and the pacing wire removed at surgery. The postoperative course was stormy and he succumbed to multiorgan failure.
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10/50. Massive lower gastrointestinal hemorrhage caused by CMV disease as a presentation of hiv in an infant.

    The gastrointestinal (GI) manifestations of acquired immunodeficiency syndrome in children are related to opportunistic infections like cytomegalovirus (CMV). CMV disease of the GI tract is a major cause of morbidity and mortality in immunocompromised patients: it typically produces mucosal ulcerations that can result in pain, bleeding, diarrhea, and GI perforation, often around the cecum. Preoperative diagnosis may be difficult, plain films and barium enema are often non-specific, and endoscopic evaluation is impossible when there is massive bleeding. The patient usually needs surgery to establish the correct diagnosis and initiate appropriate treatment. The use of gancyclovir for CMV disease in the postoperative period has improved the prognosis.
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