Cases reported "Shock, Surgical"

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1/12. Regression of cancer following surgery.

    Postsurgical tumor regressions are rare but well-recognized entities. The causes of such phenomena are unknown but probably are multiple. Regression of any tumor must ultimately come about by changes in the host-tumor interaction which suddenly becomes unfavorable for tumor growth. This is likely a manifestation of changes in the immunocompetence of the host. There are many variables influencing the host-tumor interaction, and the study of tumor immunology is stil in its infancy. It is through the exploration and investigation of basic mechanisms of the immunology of cancer that the most potentially fruitful associations between tumor growth or regression and surgical manipulations may be made and applied to the treatment of cancer patients. ( info)

2/12. Unusual manifestations of penetrating cardiac injuries.

    Penetrating cardiac injuries frequently first appear in an unusual and insidious manner, and their diagnosis may not be immediately obvious. In a series of 20 cases of cardiac injury, ten cases were indicative of such subtle symptoms, several of which were life-threatening. These unusual manifestations can be categorized as early, intermediate, or late. Early problems of four patients included the following: (1) sudden onset of shock during laparotomy, performed due to apparent abdominal trauma; (2) cardiac arrest on arrival in the emergency room; and (3) cerebral air embolus and mimicked symptoms of possible irreversible anoxic brain damage. The intermediate manifestations of cardiac injury are usually discovered in the early recovery period, and include myocardial infarction with cardiogenic shock and bullet embolus to a peripheral artery. Intermediate manifestations were observed in two patients. Four patients had late complications that included pseudoaneurysm, ventricular septal defect, valvular damage, and recurrent pericarditis. These late complications were observed between one month and 21 years after cardiac injury. This indicates the necessity of long-term follow-up of these patients. ( info)

3/12. Mucosal lesions in the human small intestine in shock.

    Characteristic mucosal lesions in resected small intestinal segments from seven patients are reported. Preoperatively, four patients were in shock and general hypotension while the three remaining cases showed signs of local intestinal hypotension. The microscopic appearance of the mucosal lesions was in all patients identical with that previously observed in the feline and canine small intestine after haemorrhage or local intestinal hypotension. It is proposed that an extravascular short-circuiting of oxygen in the mucosal countercurrent exchanger and an intravascular aggregation of blood cells might produce tissue hypoxia which makes the mucosa vulnerable to enzymatic degradation. ( info)

4/12. Hemodynamic changes after resection of thoracic duct for en bloc resection of esophageal cancer.

    An en bloc resection of esophageal cancer is one of the most radical forms of esophagectomy, and includes the resection of the thoracic duct, but a relatively high hospital mortality rate has been reported. There is very little knowledge on the pathophysiological changes after resection of the thoracic duct. We examined 24 patients who underwent en bloc resection. Some patients developed severe tachycardia or shock postoperatively which subsided after a massive infusion of plasma. Analysis of the fluid balance revealed that much more fluid was necessary during surgery and the postoperative 24 h than in patients treated by a standard esophagectomy. Postoperative lymphangiography or CT revealed abnormal collateral lymphatics around the kidneys or in the pelvic cavity. This suggests the development of the lymphaticovenous shunts, which differed depending on the anatomy of each patient. One patient with chronic hepatitis developed uncontrollable ascites. These are important findings which can hopefully reduce the high rate of hospital death after this operation. ( info)

5/12. Cerebral fat embolism diagnosed by magnetic resonance imaging at one, eight, and 50 days after hip arthroplasty: a case report.

    PURPOSE: To describe cardiovascular collapse during a cemented hip hemiarthroplasty in a patient who, despite a successful cardiopulmonary resuscitation, remained in a persistent vegetative state due to cerebral fat embolism diagnosed by magnetic resonance imaging (MRI). CLINICAL FEATURES: A 75-yr-old woman with no medical history underwent cemented hip hemiarthroplasty under spinal anesthesia for a right femoral neck fracture. Shortly after insertion of the prosthesis, a sudden oxygen desaturation, hypotension, bradycardia, and cardiac arrest occurred. The patient was successfully resuscitated, but did not regain consciousness. The patient developed high-grade fever, thrombocytopenia, anemia, and oliguria. MRI scans of the brain revealed multiple high intensity signals throughout the white matter, the basal ganglia, the cerebellum, and the brain stem. The diagnosis of fat embolism was made on the basis of clinical findings and MRI images. Although her cardiorespiratory status improved over the next week, the patient remained in a persistent vegetative state. CONCLUSION: When fat embolism is suspected, serial MRI scans of the brain should be performed to diagnose the etiology of cerebral embolism as well as to evaluate the severity of brain damage. ( info)

6/12. Acute adrenal insufficiency presenting as shock after trauma and surgery: three cases and review of the literature.

    Profound nonhemorrhagic shock developed in one postoperative and two trauma patients. Cardiovascular collapse was characterized by severe hypotension (systolic blood pressure less than 80 mm Hg), hyperdynamic cardiac indices (CI greater than 4 L/min/m2), low systemic vascular resistance (SVR less than 500 dyne.sec/cm5.m2), and multiple organ failure. sepsis was not found by culturing of specimens or visual inspection at laparotomy. Screening cortisol levels were low (less than 2 micrograms/dL in two patients) and did not respond appropriately to synthetic ACTH (cosyntropin) challenge. Administration of exogenous glucocorticoids promptly and dramatically reversed shock and organ failure in two patients. Oral glucocorticoid and mineralocorticoid supplementation were required at hospital discharge. Acute adrenal insufficiency is rare after trauma, but may produce life-threatening cardiovascular collapse, mimicking the "septic" shock state. cosyntropin stimulation testing confirms the diagnosis and is accurate in traumatized patients. Outcome is dependent upon early recognition and exogenous glucocorticoid administration. Appropriate endocrine evaluation prevents unnecessary use of steroids in a population of trauma patients who are already in a state of immunosuppression. ( info)

7/12. Severe von Willebrand's disease during labor and delivery.

    In pregnant women with severe von Willebrand's disease, the prepartum period should include monitoring for a rise in factor viii-related activities (factor viii coagulant activity [factor viii:C], factor viii-related antigen [VIII R:Ag], and factor viii ristocetin cofactor [factor viii R:Cof]). Two women whose pregnancies were so monitored were delivered of normal infants: one by cesarean section and one by vaginal delivery. The failure of factor viii:Ag or factor viii R:Cof to rise above the level of 50% at term in the woman who delivered vaginally predicted hemostatic difficulty during the postpartum period. She was, therefore, treated with cryoprecipitate. In the woman who gave birth by cesarean section, although all factor viii-related activities rose into the normal range, the additional surgical trauma anticipated in cesarean section prompted the use of cryoprecipitate as well. ( info)

8/12. Near fatal gas embolism during laparoscopic cholecystectomy.

    Laparoscopic cholecystectomy has been greeted with enthusiasm by surgeons and patients alike. However, with the passage of time reports of complications related to this new approach are being published. We report an unusual complication of gas embolism in laparoscopic cholecystectomy. A high index of suspicion along with vigilant intraoperative monitoring will help in the early diagnosis and reduction of morbidity associated with gas embolism. ( info)

9/12. Surgical shock presenting as lower limb ischaemic rest pain.

    Ischaemic rest pain affecting the lower limb is characteristically constant, severe and distressing. attention is thereby concentrated on the affected leg and its vascular supply which may distract the attending clinician from a precipitating cause. We present two patients with shock that led to acute onset of ischaemic leg pain. ( info)

10/12. Cardiovascular collapse during gynecologic laparoscopy complicated by pulmonary edema: report of a case.

    Although gynecologic laparoscopic surgery has recently become a routine and widespread operative procedure in taiwan, the potential risks and complications in the clinical practice of laparoscopy should not be overlooked. Whilst the incidence of complications are rare, they can sometimes be serious, even life-threatening. This case report presents a woman with ruptured endometrioma, who developed sudden-onset cardiovascular collapse during laparoscopic procedure, in which carbon dioxide was used for insufflation. After resuscitation including cardioversion, her vital functions were restored; pulmonary edema developed soon afterwards but was resolved with conservative treatment. We discuss the possible causes of cardiovascular collapse during laparoscopic procedure and the management of resulting complications. ( info)
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