Cases reported "Pulmonary Edema"

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31/89. 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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32/89. pulmonary edema in scuba divers: recurrence and fatal outcome.

    pulmonary edema occurring in divers using a self-contained underwater breathing apparatus (scuba) is an uncommon, probably under-reported, but potentially life-threatening and recurrent condition. We report six episodes of pulmonary edema in five scuba divers seen during a period of 15 months. The four men and one woman ranged in age from 37 to 56 years and two were treated for hypertension. Symptoms were mostly dyspnea onset at depth, cough, hemoptysis and hypoxemia, which in the recurrent case led to cardiac arrest and death. All cases occurred in rather cold water. Findings on thoracic computed tomography (CT) scanning ranged from pleural effusion to ground-glass opacities restricted to a few areas of the lung. The complex underlying mechanisms that would contribute to a raised transalveolar pressure or to a disruption of the blood-gas barrier are discussed. It is important for emergency care providers to be aware of this syndrome for prompt recognition and optimal treatment.
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keywords = death
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33/89. Mycotic aneurysms and death in a hemodialysis patient.

    A patient with newly diagnosed end-stage renal disease (ESRD) received a femoral catheter for hemodialysis (HD). Shortly thereafter he developed fever, and blood cultures grew methicillin-resistant staphylococcus aureus. The catheter was removed and the patient was treated with both vancomycin and rifampin; however, blood culture positivity persisted. The cerebrospinal fluid showed sterile meningitis. Subsequent imaging studies demonstrated aortic valve endocarditis and multiple mycotic aneurysms that appeared to include the intra- and extracranial vessels. The patient eventually died from sepsis. This case illustrates the aggressive and invasive nature of systemic infection with S. aureus and underscores the high morbidity and mortality associated with infections related to HD catheters.
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ranking = 0.8
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34/89. Early perioperative death associated with reexpansion pulmonary edema during liver transplantation.

    hydrothorax is a frequent finding in patients with end-stage liver disease. During the hepatectomy phase of liver transplantation, it is often needed to evacuate large pleural effusions. The acute expansion of the collapsed lung can cause reexpansion pulmonary edema with variable clinical significance. However, this complication has rarely been reported after liver transplantation. In conclusion, we report on an overwhelming reexpansion pulmonary edema during a liver transplantation that rapidly led to the patient's demise and speculate if this condition has not been under recognized in the transplantation setting.
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ranking = 0.8
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35/89. True-true, unrelated: a case report.

    OBJECTIVES: Sudden cardiac deaths in previously healthy children are frequently due to undiagnosed cardiovascular diseases, either congenital or acquired. In an uncommon clinical entity known as commotio cordis, sudden death from cardiac arrest can occur in young athletes after a blunt blow to the chest, in the absence of preexisting cardiovascular disease. We present a case in which the clinician's high index of suspicion leads to the diagnosis of acute myocarditis in a patient whose sudden cardiac deterioration was initially attributed to the result of recent blunt chest trauma. methods: A case report and review of literature via medline (1996-2004) search using the key words "myocarditis," "commotio cordis," and "myocardial contusion." RESULTS: A 12-year-old boy was admitted with elevated cardiac enzymes and respiratory distress after being hit in the chest with a dodgeball. Shortly after admission, the patient developed refractory ventricular arrhythmia, which was thought to be the result of blunt chest trauma. Further evaluation with endomyocardial biopsy, however, demonstrated acute myocarditis as the true etiology, for which the patient received immunosuppressive treatment. Unfortunately, the patient eventually required cardiac transplantation because of progressive irreversible cardiac dysfunction due to myocarditis. CONCLUSIONS: Although acute myocarditis, commotio cordis, and myocardial contusion can all present with malignant ventricular arrhythmia, other clinical features and approaches to management of each disease are very different. This case illustrates the importance of having a broad differential diagnosis in mind when presented with a previously healthy child in sudden cardiogenic shock.
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36/89. An unusual mechanical asphyxia in a homicide-suicide case by smothering and strangulation.

    A very unusual homicide of 2 children by smothering and strangulation by means of a rubber adhesive band carried out by the mother who committed suicide by the same manner is presented. Smothering is supposed to be one major cause of death in child homicide. suicide by smothering is relatively uncommon. Suicidal smothering by winding strips of adhesive tape around the head to cover the nose and mouth is an even rarer method recently described in literature. The circumstances of the crime and the macroscopic and microscopic evidence are discussed to reduce the potential for underdiagnoses or mistakes in such cases in which it may be difficult to establish whether suicide or homicide occurred.
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37/89. pulmonary edema as a radiologic manifestation of venous air embolism secondary to dental implant surgery.

    Three serial cases of fatal venous air embolism were reported after mandibular prosthetic dental surgery. Initially attributed to anesthetic factors, the deaths resulted from intraosseous irrigation with coolant tap water and air. pulmonary edema was seen on chest roentgenograms and might have suggested the cause of death.
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38/89. Obstructive sleep apnea presenting with nocturnal angina, heart failure, and near-miss sudden death.

    An obese woman with a one-year history of episodic nocturnal chest pain was admitted because of shock and pulmonary edema. A clinical diagnosis of acute myocardial infarction and cardiogenic shock was made. She was ventilated and successfully resuscitated. Subsequent investigations showed no evidence of cardiac dysfunction or coronary disease, but sleep study confirmed the diagnosis of obstructive sleep apnea syndrome (OSAS). We suggest that the nocturnal angina and heart failure in this patient might have resulted from extreme hypoxemia produced by OSAS. This case raised the possibility that the high cardiovascular mortality rate reported in OSAS might not necessarily relate to underlying coronary artery disease. Further investigations are required to delineate the true incidence of coronary disease in patients with OSAS.
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ranking = 0.8
keywords = death
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39/89. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience.

    Fifteen patients with high-risk intracranial saccular aneurysms were treated using electrolytically detachable coils introduced via an endovascular approach. The patients ranged in age from 21 to 69 years. The most frequent clinical presentation was subarachnoid hemorrhage (eight cases). Considerable thrombosis of the aneurysm (70% to 100%) was achieved in all 15 patients, and preservation of the parent artery was obtained in 14. Although temporary neurological deterioration due to the technique was recorded in one patient, no permanent neurological deficit was observed in this series and there were no deaths. It is believed that this new technology is a viable alternative in the management of patients with high-risk intracranial saccular aneurysms. It may also play an important role in the occlusion of aneurysms in the acute phase of subarachnoid hemorrhage.
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ranking = 0.2
keywords = death
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40/89. Overzealous resuscitation of an extremely malnourished patient with nutritional cardiomyopathy.

    Overzealous resuscitation of the severely malnourished patient may be associated with life-threatening complications. A variety of electrolyte, hemodynamic, septic, and nutritional derangements may result in sudden decompensation and even death. We present a case that dramatically illustrates these complications and focuses on the key role of underlying nutritional cardiomyopathy.
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ranking = 0.2
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