1/67. Abrupt exacerbation of acute subdural hematoma mimicking benign acute epidural hematoma on computed tomography--case report.A 75-year-old male was hit by a car, when riding a bicycle. The diagnosis of acute epidural hematoma was made based on computed tomography (CT) findings of lentiform hematoma in the left temporal region. On admission he had only moderate occipitalgia and amnesia of the accident, so conservative therapy was administered. Thirty-three hours later, he suddenly developed severe headache, vomiting, and anisocoria just after a positional change. CT revealed typical acute subdural hematoma (ASDH), which was confirmed by emergent decompressive craniectomy. He was vegetative postoperatively and died of pneumonia one month later. Emergent surgical exploration is recommended for this type of ASDH even if the symptoms are mild due to aged atrophic brain.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
2/67. Temporary remission of an alveolar rhabdomyosarcoma diagnosed and treated as acute leukemia.A 29-year-old man with alveolar rhabdomyosarcoma was considered to be suffering from acute leukemia. A bone marrow aspirate had revealed extensive infiltration by atypical blast-like cells which were interpreted as acute lymphoblastic leukemia. Although there was no confirmation of this diagnosis by immunophenotyping chemotherapy with a protocol suited for the treatment of acute lymphoblastic leukemia was started prior to histological analysis and resulted in a complete temporary remission after the first cycle. Histological analysis of a bone marrow biopsy revealed an alveolar rhabdomyosarcoma, as further confirmed by molecular genetic analysis. Two months after the end of chemotherapy, there was an extensive recurrence and the patient died one year after initial diagnosis with chemotherapy refractory disease. In conclusion, rhabdomyosarcoma should always be included in the differential diagnosis of systemic diseases with extensive bone marrow infiltration by tumor cells which could otherwise be misinterpreted as a haematological malignancy.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
3/67. Physical therapy for a patient in acute respiratory failure.BACKGROUND AND PURPOSE: The main indications for physical therapy for patients in intensive care units (ICUs) are excessive pulmonary secretions or atelectasis. Timely physical therapy interventions may improve gas exchange and reverse pathological progression, thereby curtailing or avoiding artificial ventilation. The purpose of this case report is to illustrate 24-hour availability of physical therapy for a patient with acute respiratory failure. CASE DESCRIPTION: The patient was a 66-year-old man who was admitted to an ICU for acute respiratory failure. Intensive physical therapy, based on Dean's physiologic treatment hierarchy for treatment of patients with impaired oxygen transport, consisted of upright body positioning, mobilization and exercise, and active cycles of breathing techniques every 2 hours for the first 12 hours he was in the ICU. OUTCOMES: In total, the patient received 11 physical therapy sessions over his 48-hour stay in the ICU (6 sessions on day 1 and 5 sessions on day 2). Arterial oxygenation improved markedly with radiographic resolution of infiltrates, and planned endotracheal intubation and mechanical ventilation were avoided. DISCUSSION: This patient with acute respiratory failure received physical therapy in a timely manner afforded by 24-hour access to physical therapy. The intensive physical therapy might be more cost-effective than if the patient had been managed with intubation and mechanical ventilation. patients in ICUs who have excessive pulmonary secretions or atelectasis may benefit from access to physical therapy 24 hours a day.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
4/67. A pancreatic intraductal papillary mucinous tumor causing recurrent acute pancreatitis at the onset of menstrual periods.The unusual case of a young woman with pancreatitis recurring at onset of her menstrual periods is reported. The patient was diagnosed with pancreatic intraductal papillary mucinous tumor (IPMT). The temporal relation of clinical exacerbation of pancreatitis to the menstrual cycle is suggestive of a hormonal-mediated mechanism. The hypothesis of a possible role of progesterone receptors was dismissed with verification of the absence of progesterone and estrogen receptors in the neoplastic tissue. The possible role of activin A or inhibin A in our patient's clinical picture is theorized.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
5/67. Traumatic cardiac rupture with acute ascites.A rare accumulation of serous ascites following traumatic cardiac rupture is reported for a 21-year-old man transferred to the emergency center of our hospital from a community hospital suffering from severe shock due to a motorcycle accident. Computed tomography scan showed moderate pericardial and intrapelvic fluid accumulation strongly suggesting cardiac and visceral injuries. An emergency sternotomy disclosed a rupture of the right atrial appendage, successfully closed with primary sutures. A laparotomy was done to aspirate moderate serous fluid, which was clear and not bloody. edema of the retroperitoneal space and hepatic congestion were noted with no accompanying organ injury. ascites pathogenesis is unknown but appeared to be related to portal venous congestion induced by cardiac tamponade combined with massive intravenous fluid infusion done to correct the patient's deteriorating hemodynamics.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
6/67. Transient hepatopulmonary syndrome in a patient with acute hepatitis a.The hepatopulmonary syndrome is defined as the triad of liver disease, hypoxaemia and intrapulmonary vascular dilatation. This syndrome has been described in patients with liver cirrhosis, noncirrhotic portal hypertension, and fulminant hepatic failure, however, there are no previous descriptions of hepatopulmonary syndrome in patients with acute nonfulminant viral hepatitis. We report a 47-year-old, previously healthy man that presented with acute hepatitis a, and developed progressive dyspnoea, platypnoea and orthodeoxia with no evidence of parenchymal or thromboembolic lung disease. PaO2 on room air was 58 mmHg, O2 saturation was 88% and alveolar-arterial O2 gradient was 62%. During his hospitalization serum albumin level decreased to 3.1 g/dl and prothrombin time was prolonged to 16.8 s, however, he remained alert with no signs of hepatic encephalopathy. Contrast echocardiography revealed left heart chamber opacification 3-4 cardiac cycles after the opacification of the right heart chamber, consistent with hepatopulmonary syndrome. During the following days there was a gradual improvement in the patient's condition, with resolution of his dyspnoea and gradual increase of PaO2. Repeat contrast echocardiography and PaO2 determinations, 3 weeks later, were normal. On long-term follow-up the patient remained asymptomatic with normal liver function tests and normal O2 saturation. This report indicates that hepatopulmonary syndrome may be a transient manifestation of acute hepatitis a in the absence of fulminant liver failure.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
7/67. Telogen effluvium after allergic contact dermatitis of the scalp.OBJECTIVE: After observing 2 cases of acute telogen effluvium induced by allergic contact dermatitis to hair dyes, we decided to evaluate the effects of acute contact dermatitis of the scalp on the hair cycle. DESIGN: Single-center, 6-month study of consecutive patients affected by acute scalp dermatitis. SETTING: Department of dermatology, University of Bologna, Bologna, italy. patients: diagnosis of allergic contact dermatitis of the scalp was confirmed by patch testing. Eight women presenting with acute contact dermatitis of the scalp entered the study. Hair shedding was evaluated monthly for 6 months by pull test and wash test. Increased hair loss was detected in 4 of the 7 patients who completed the study. Hair loss was mild to moderate and appeared 2 to 4 months after the episode of scalp dermatitis. A scalp biopsy specimen from 2 patients confirmed the diagnosis of telogen effluvium. CONCLUSIONS: Allergic contact dermatitis of the scalp should be included among the possible causes of telogen effluvium. The pathogenesis of telogen effluvium caused by contact dermatitis is unknown but may be related to cytokine release during the inflammatory process.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
8/67. Spontaneous acute tumor lysis syndrome with advanced gastric cancer.Acute tumor lysis syndrome (TLS) occurs frequently in hematologic malignancies such as high-grade lymphomas and acute leukemia, which are rapidly proliferating and chemosensitive tumors. It occurs rarely in solid tumors and has never been reported in gastric adenocarcinoma. Typical biochemical findings of acute tumor lysis syndrome are hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia in patients with a malignancy. Rapid changes of these electrolytes may cause cardiac arrhythmia, seizure, acute renal failure and sudden death. Therefore, as soon as it is detected, it should be taken care of immediately. Until now almost all cases of TLS associated with solid tumor have developed after cytoreductive therapy in chemosensitive tumors. We report here a case of spontaneous acute tumor lysis in a patient of advanced gastric cancer with hepatic metastases and multiple lymphadenopathy. The biochemical finding of TLS improved with the management and tumor burden also showed slight response to the one cycled combination chemotherapy but the patient died of progressive pneumonia.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
9/67. renal artery dissection after blunt abdominal trauma: a rare cause of acute cortical necrosis.renal artery injury is an uncommon complication of blunt abdominal trauma. We present a case of a 19-year-old man who developed acute cortical necrosis in a congenital single kidney after a motorcycle accident. On initial presentation, he had signs of splenic injury and required immediate laparotomy and splenectomy. His renal function deteriorated, and he became dialysis dependent. Computed tomography followed by percutaneous angiography showed a dissection of a single renal artery causing the formation of a large pseudoaneurysm. A second angiogram showed an increase in the size of the pseudoaneurysm. We performed a laparotomy and attempted in situ vein graft repair of the renal artery. A wedge biopsy specimen taken at laparotomy revealed acute cortical necrosis, and plain radiographs showed cortical calcification. renal artery dissection and pseudoaneurysm formation are rare events after blunt trauma. Iatrogenic damage is the most common cause of pseudoaneurysm. Traumatic pseudoaneurysms have a poor prognosis without prompt surgical intervention. Renal arterial damage may occur after blunt trauma, and early imaging and intervention are essential to salvage renal function.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
10/67. Axonal hyperpolarization associated with acute hypokalemia: multiple excitability measurements as indicators of the membrane potential of human axons.Multiple nerve excitability measurements have been proposed for clinical testing of nerve function, and an important determinant of excitability is membrane potential. We report a patient with acquired hypokalemic paralysis in whom multiple excitability indices (stimulus-response curve, strength-duration properties, threshold electrotonus, recovery cycle) were measured during and after an acute hypokalemic attack (serum K( ) level, 2.1 mEq/L and 4.5 mEq/L, respectively). During hypokalemia, there was a shift of the stimulus-response curve to the right, a decrease in strength-duration time constant, a "fanning-out" of responses during threshold electrotonus, a reduction in relative refractory period, and an increase in superexcitability; all of these indicate axonal hyperpolarization, presumably due to the K( ) equilibrium potential being more negative. These indices returned to normal 20 h later, associated with normalization of the serum K( ) level. These results demonstrate that the changes associated with hypokalemic paralysis are not confined to muscle and that axons undergo hyperpolarization in vivo. Multiple excitability measurements can be used as a tool to identify changes in membrane potential of human axons.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
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