1/617. Successful treatment of traumatic acute posterior fossa subdural hematoma: report of two cases.BACKGROUND: Acute traumatic subdural hematoma of the posterior cranial fossa after a closed-head injury, excluding those in newborns, is a very rare clinical event. Generally, the outcome is poor and the overall mortality rate is high. methods: Acute posttraumatic subdural hematomas of the posterior fossa associated with acute hydrocephalus in two patients were removed by standard suboccipital approach. Preoperatively, one patient was in a coma and the Glasgow coma Score was 9 in another. CT scans showed obliterated mesencephalic cisterns in both cases. In the former there was a complex posterior fossa lesion, i.e., combined subdural and intracerebellar hematoma. The surgical decompression was completed 3 and 11 hours after injury, respectively. Intraoperative tapping of the lateral ventricle through a burr hole in the occipital area was performed in the latter case. RESULTS: Both patients survived; one made a good recovery, (i.e., glasgow outcome scale 4 in a patient who was comatose on admission), the other did not do as well (GOS 3). CONCLUSIONS: Our experience justifies the policy of mandatory early operation in cases of traumatic acute subdural hematoma of the posterior fossa associated with poor neurologic condition, even in patients of advanced age. In patients with obliterated mesencephalic cisterns and/or complex posterior fossa lesions the same approach must be followed. These clinical and CT features are not necessarily predictors of a poor outcome.- - - - - - - - - - ranking = 1keywords = hour (Clic here for more details about this article) |
2/617. Acute tumor lysis syndrome associated with concurrent biochemotherapy of metastatic melanoma: a case report and review of the literature.BACKGROUND: Treatment of solid tumors rarely has been associated with tumor lysis syndrome. However, to the authors' knowledge the clinical scenario has not been reported previously in melanoma patients. methods: A patient with bulky metastatic melanoma was treated with concurrent biochemotherapy using interleukin-2, interferon-alpha, and a combination of cisplatin, vinblastine, and dacarbazine. RESULTS: Within 24 hours of the initiation of treatment, brisk tumor lysis occurred and led to a fatal outcome. CONCLUSIONS: Improvements in the treatment of solid tumors may increase the incidence of tumor lysis syndrome for tumors once believed to be marginally responsive. Oncologists should remain cognizant of this problem as more active regimens become available.- - - - - - - - - - ranking = 1keywords = hour (Clic here for more details about this article) |
3/617. 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 = hour (Clic here for more details about this article) |
4/617. Ventricular rhythms in acute myocardial infarction.Ectopic ventricular activity in acute myocardial infarction is considered to be benign if it is slow and regular (accelerated idioventricular rhythm), but ominous when rapid (ventricular tachycardia). However, it has been observed in an increasing number of reports that these two types may coexist in the same patient, altering thereby the clinical significance of both. In the present study electrocardiograms were analyzed of 55 patients hospitalized for acute myocardial infarction, in whom idioventricular rhythm occurred. It was found that three major types of ventricular rhythms could be identified: a regular-stable rhythm, an irregularunstable one, and a third variant which was a combination of these two types. The stable ventricular rhythm was self limited and harmless. The unstable and combined types which were characterized by random coupling times and varying interbeat intervals, were frequently associated with re-entrant beats and fast ventricular rates and therefore a potentially ominous prognosis. It is suggested that the Ca dependent slow diastolic depolarization may be the mechanism responsible for the unstable ventricular rhythm, and the reasons for this assumption are discussed. A therapeutic approach based on the above considerations is described.- - - - - - - - - - ranking = 91.56690066246keywords = rhythm (Clic here for more details about this article) |
5/617. Acute embolic carotid occlusion after cardiac catheterization: effect of local intra-arterial urokinase thrombolysis.A 64-year-old woman developed a severe embolic cerebral attack with total left hemiplegia approximately 30 hours after cardiac catheterization for mitral stenosis. She underwent intra-arterial thrombolysis of the right internal carotid artery four and one-half hours after the onset of neurologic deficit with subsequent recanalization of the occluded vessel and near complete neurologic recovery.- - - - - - - - - - ranking = 2keywords = hour (Clic here for more details about this article) |
6/617. Extremely acute phenytoin-induced peripheral neuropathy.PURPOSE: Peripheral neuropathy is a rare adverse effect associated with phenytoin (PHT), and it usually occurs after the prolonged use of PHT. Acute PHT-induced peripheral neuropathy is extremely rare. methods: An 18-year-old girl was admitted for the control of epilepsy. Just a few hours after the administration of PHT, she complained of distal lower-extremity paresthesia in a stocking distribution and motor weakness: the achilles tendon reflex was absent. RESULTS: Electrophysiological studies revealed slightly reduced sensory-conduction velocity and mild prolongation of distal latency in the lower extremities. After the discontinuation of PHT, these symptoms disappeared gradually, and sensory-conduction velocity and distal latency became normal. CONCLUSIONS: Although it has been reported that peripheral neuropathy occurred after treatment with PHT for a week, there has been no report of a patient such as ours, who developed peripheral neuropathy just a few hours after the initial administration of PHT. The underlying mechanism remains unknown; however, we should pay attention to such extremely acute peripheral neuropathy when using PHT.- - - - - - - - - - ranking = 2keywords = hour (Clic here for more details about this article) |
7/617. Superselective intraarterial fibrinolysis in central retinal artery occlusion.Intraarterial fibrinolysis was performed in three patients with acute central retinal artery occlusion using recombinant tissue plasminogen activator as a fibrinolytic agent. In two cases the ophthalmic artery was selectively catheterized, and in the other a thrombolytic drug was infused into the ophthalmic artery by way of the meningeal collaterals. All patients experienced visual improvement. fibrinolysis can produce better results than obtained from conservative treatment. A good prognosis can be achieved if the treatment starts within the first 4 to 5 hours after occlusion.- - - - - - - - - - ranking = 1keywords = hour (Clic here for more details about this article) |
8/617. Acute orbital compartment syndrome after lateral blow-out fracture effectively relieved by lateral cantholysis.PURPOSE: To report the observation of an acute traumatic orbital compartment syndrome in an 80-year-old man. methods: Lateral canthotomy and cantholysis. Computed x-ray tomography. RESULTS: Unilateral proptosis, blindness, a frozen globe and a dilated pupil developed within one hour after a blunt trauma to the left orbital region. Surgery two hours later resulted in normal orbital tension and near-complete recovery of functions. An orbital hematoma was found overlying a lateral blow-out fracture. CONCLUSION: Under favorable conditions, the orbital compartment syndrome can be effectively relieved by lateral canthotomy and cantholysis. The present and previous reports suggest that two hours of orbital ischemia is near the critical time limit for recovery of full visual function.- - - - - - - - - - ranking = 3keywords = hour (Clic here for more details about this article) |
9/617. Acute gastroenteritis in children.BACKGROUND: Acute gastroenteritis is a common childhood illness. Most cases are caused by rotavirus infection. OBJECTIVE: This article discusses the classic presentation of gastroenteritis in children, which includes a short history of vomiting followed by diarrhoea. DISCUSSION: dehydration is the main problem in children with gastroenteritis, and severe dehydration is a medical emergency. Mild to moderately dehydrated children can be safely treated at home with oral rehydration therapy, however parents require careful explanation of the disease, its course and potential complications. Early reintroduction of usual foods (breast milk, formula or solids) has been shown to shorten the illness. Babies may need to be reviewed within 8 hours and older children within a day.- - - - - - - - - - ranking = 1keywords = hour (Clic here for more details about this article) |
10/617. edwardsiella tarda bacteraemia--complicated by acute pancreatitis and pyomyoma.edwardsiella tarda (E. tarda) has recently become recognized as a pathogen in humans. Here we report a new case of E. tarda bacteraemia complicated by acute pancreatitis and pyomyoma. A 46-year-old female came to our emergency room complaining of sudden onset of left upper quadrant pain and vomiting for the previous few hours after drinking three bottles of wine. An abdominal computed tomography (CT) scan revealed multiple biliary stones, acute pancreatitis with extensive inflammatory change, and a large uterine myoma. fever, watery diarrhoea, and mild suprapubic discomfort with vaginal spotting were noted soon after admission. The patient's blood cultures yielded E. tarda and symptoms subsided after antibiotic therapy. fever and severe suprapubic pain with rebound tenderness developed 12 days later. Repeat abdominal CT scan revealed an enlarged uterine myoma with central necrosis. The patient subsequently underwent anterior total hysterectomy and bilateral salpingo-oophorectomy, revealing a uterine myoma with infarction and abscess formation. The patient recovered uneventfully and was discharged 1 week later.- - - - - - - - - - ranking = 1keywords = hour (Clic here for more details about this article) |
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