Cases reported "Respiratory Insufficiency"

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1/13. Unusual injury pattern in a case of postmortem animal depredation by a domestic German shepherd.

    A case is presented of a 38-year-old woman with skeletization of the head, neck, and collar region and a circumscribed 26-cm x 19-cm defect on the left chest with sole removal of the heart through the opened pericardium but undamaged mediastinum and lungs. The injuries showed V-shaped puncture wounds and superficial claw-induced scratches adjacent to the wound margins that have been described as typical for postmortem animal depredation of carnivore origin and derived from postmortem animal damage by the woman's domestic German shepherd. The circumscribed destruction of the left chest with unusual opening of the pericardium is explained by the physiognomy of the muzzle of the German shepherd and differs from previous reports. Any case presented as postmortem animal mutilation should be viewed with skepticism and undergo a full autopsy.
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2/13. citrobacter sepsis and severe newborn respiratory failure supported with extracorporeal membrane oxygenation.

    An infant with fulminant citrobacter sepsis and respiratory failure is presented. The severity of respiratory failure and the need for systemic heparinization on extracorporeal membrane oxygenation delayed the opportunity of initial lumbar puncture to rule out meningitis. The infant was successfully treated with extracorporeal membrane oxygenation and long-term antibiotics. Repeated cranial computed tomography scans remained negative for intracerebral abscesses, and the infant is within normal limits for growth, neurologic status, and developmental status.
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3/13. Bilateral frontal haemorrhages associated with continuous spinal analgesia.

    We report a case of intracerebral haemorrhages associated with continuous spinal analgesia. Continuous spinal analgesia is frequently employed for postoperative analgesia in high-risk patients in our institution. The analgesia is administered via a 20 gauge catheter passed through an 18 gauge Tuohy needle (Portex). A 71-year-old man with severe respiratory impairment had an intrathecal catheter placed for postoperative analgesia. He had a difficult postoperative course, including wound dehiscence, and died from respiratory failure some five weeks postoperatively. On day nine postoperatively he had two tonic-clonic seizures and was subsequently found to have developed bilateral frontal intracerebral haemorrhages. There was no previous history of seizures. Although several confounding variables exist, the most likely explanation for the intracerebral event appears to be an association with the dural puncture and intrathecal catheter Possible mechanisms and risk factors are discussed.
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4/13. Neonatal transthoracic puncture in a case of congenital cystic adenomatoid malformation of the lung.

    A patient with congenital cystic adenomatoid malformation of the lung (CCAM) is presented who showed severe respiratory deterioration in the neonatal period caused by hyperinflation of the cystic component and compression of the contralateral lung. Transthoracic drainage of the cyst was performed to avoid preoperative artificial ventilation. On aspiration, air and liquid was removed from the cyst. After stabilization, surgical intervention was performed within 24 hours. Postoperative recovery was uneventful, and the child was discharged at day 13.
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5/13. mycoplasma pneumoniae causing nervous system lesion and SIADH in the absence of pneumonia.

    A patient was admitted for fever and acute respiratory failure (ARF), rapidly progressive tetraparesis, delirium, behavioral abnormalities, and diplopia. leukocytosis and a rise in c-reactive protein were present. A syndrome of inappropriate anti-diuretic hormone secretion (SIADH) was also diagnosed. Lumbar puncture yielded colorless CFS with mononuclear pleocytosis and protein rise. electrodiagnosis revealed demyelinating polyneuropathy and axonal degeneration. serum IgG and IgM for mycoplasma pneumoniae (MP) was consistent with acute infection, and erythromycin was started with rapid resolution of symptoms. Contrarily to most reports, an associated respiratory disease was not present and SIADH in association with MP has been reported only once, in a patient without direct central nervous system (CNS) involvement. Differential diagnosis and possible pathogenic mechanisms are discussed.
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6/13. Acute respiratory failure due to sweet syndrome.

    A 67-year-old patient with newly diagnosed acute myeloid leukemia developed acute respiratory failure with high-grade fever and bilateral pulmonary infiltrates. blood cultures were sterile and no bacterial or fungal pathogen was identified in the endotracheal aspirate. The patient did not respond to antibiotic and antifungal therapy. One week after intensive care unit (ICU) admission, erythematous skin lesions appeared at the vascular catheter puncture sites. sweet syndrome with pulmonary involvement was suspected and a treatment with corticosteroids was started. sweet syndrome was confirmed by skin biopsy. After corticosteroid therapy respiratory symptoms rapidly improved, the patient became afebrile and the cutaneous lesions rapidly disappeared. Only three cases of sweet syndrome presenting with pulmonary involvement before the appearance of skin lesions are reported in the literature. Even if typical skin lesions are initially absent, early recognition of sweet syndrome with pulmonary involvement is important because of the possibility of severe respiratory impairment, which can be avoided through prompt administration of corticosteroids.
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7/13. Cerebral spinal fluid recovery of lidocaine and bupivacaine following respiratory arrest subsequent to retrobulbar block.

    A 75-year-old man experienced a self-limited respiratory arrest following a retrobulbar injection. The injection was a mixture of bupivacaine and lidocaine. Forty-five minutes after the injection, quantities of both drugs were recovered from the patient's cerebral spinal fluid (CSF) obtained via a lumbar puncture. Theoretical evidence is presented to show that the drug levels obtained resulted from a direct intrathecal injection.
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8/13. Respiratory depression complicating epidural diamorphine. Two case reports of administration after dural puncture.

    Two cases of severe respiratory depression complicating epidural diamorphine administration are reported. In both cases, the dura had been punctured. The risk of epidural opiate administration in association with a breach in the dura is reiterated.
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9/13. Transitory heart pacemaker for the prophylaxis of hypoxic cardiac standstill in cases of severe pulmonary insufficiency.

    patients with hypoxia due to severe pulmonary insufficiency show a tendency towards hypoxic cardiac arrest. Asystole can occur in patients during therapeutic and nursing measures such as endotracheal suction. Experience indicates that the hypoxic cardiac arrest is difficult to resuscitate. External heart massage also shows a variety of complications. We propose the appropriately timed and prophylactic use of a transitory heart pacemaker for patients with a tendency towards hypoxic cardiac arrest. Our results show that a transitory heart pacemaker is capable of producing heart contractions even in cases of the severest hypoxia, in which otherwise cardiac arrest already would have occurred. The subclavian vein is punctured, and the electrode is pushed into the right ventricle. The electrode tip is positioned accurately by means of X-ray examination, and also by monitoring the threshold of the stimulating current. We consider that the proposed method should be used in patients who would have an increased chance of survival as a result of the additional measure of using a transitory heart pacemaker in cases of pulmonary hypoxia. It would not be indicated in patients with unfavourable prognoses due to progressive changes in the lungs.
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10/13. Respiratory arrest and cervical spinal cord infarction following lumbar puncture in meningitis.

    A 6-year-old child with meningitis had a respiratory arrest 20 minutes after a lumbar puncture. Thereafter she required maintenance on a ventilator, had a flaccid quadriplegia, and died 12 days later. Necropsy showed infarction of the central portion of the cord at the level of the decussation of the pyramids. The suggested mechanism of damage is compression of the arterial supply to the cord at the level of the foramen magnum by herniated cerebellar tonsils; concomitant hypotension may have contributed to production of the damage. Four similar cases, who survived with residual deficit, have also been reported. Other separate mechanisms by which the cord can be damaged in meningitis are vasculitis, thrombosis and arachnoiditis.
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