1/18. Severe non-infectious circulatory shock related to hypopituitarism.The authors report a case of refractory non-infectious circulatory shock with catecholamine and massive fluid loading-resistant features related to hypopituitarism. A 76-year-old man was admitted for shock after suffering from gastroenteritis for 3 days. He was pale and had sparse axillary and pubic hair and small testes. Right catheterization showed shock with low preload pressure and a low oxygen extraction ratio relevant for septic shock. Ultrasound tomography revealed a distended gallbladder due to a stone without peritoneal effusion. A non-inflammatory hydrops of the gallbladder was removed surgically. No microorganism was isolated. Cerebral computed tomography (CT) scan showed a pituitary mass. In the post-surgical period the shock became uncontrollable. Cortisol replacement therapy was instituted and clinical and hemodynamic improvement occurred after 2 h. Hormonal screening on admission before catecholamine administration showed a major decrease in all the hypothalamic-pituitary hormone concentrations. The patient died on day 15 with multiple organ failure. hypopituitarism, probably owing to pituitary adenoma, was the only disease identified in this case. hormone replacement therapy dramatically improved the clinical and hemodynamic status, although the role of an abdominal sepsis could not be eliminated. Arguments that pituitary hormone deficiency might increase the hemodynamic consequences of adrenal deficiency are discussed.- - - - - - - - - - ranking = 1keywords = shock, septic shock (Clic here for more details about this article) |
2/18. A new therapeutic strategy for streptococcal toxic shock syndrome: a key target for cytokines.We searched for innovative treatments specifically targeted to the cytokines of three critically ill patients with streptococcal toxic shock syndrome (STSS). Direct hemoperfusion with polymyxin b-immobilized fiber improved the hemodynamics in all three patients who had developed shock at presentation. Continuous hemodiafiltration coupled with plasma exchange for simultaneous removal of several mediators of the inflammatory cascade improved outcome in case 2 and lessened the aggressive clinical course and prolonged survival in case 3. The application of these technologies appears to open new and interesting therapeutic options and may lead to improved survival in STSS.- - - - - - - - - - ranking = 1.5730113961345keywords = toxic shock syndrome, shock, shock syndrome, toxic shock (Clic here for more details about this article) |
3/18. Spontaneous empyema and overwhelming septic shock due to pasteurella multocida.Invasive pasteurella multocida infection, although uncommon, has been recognized to occur more frequently among patients with hepatic cirrhosis. This study reports a fatal case of bacteremic P. multocida empyema without pneumonia associated with refractory septic shock in a patient with both cirrhosis and asplenia.- - - - - - - - - - ranking = 0.8170750741371keywords = shock, septic shock (Clic here for more details about this article) |
4/18. Toxicity of food Drug and Cosmetic Blue No. 1 dye in critically ill patients.food Drug and Cosmetic Blue No. 1 dye (FD&C Blue No. 1) is commonly added to enteral nutrition formulations in order to facilitate the detection of gastric aspirate in tracheal secretions of critically ill patients. However, reports of systemic blue dye absorption and associated adverse outcomes are emerging. We report two cases of abnormal systemic absorption of FD&C Blue No. 1 in critically ill patients who subsequently died of refractory shock and metabolic acidosis. risk factors and mechanisms of FD&C Blue No. 1 toxicity are discussed, and alternate approaches to gastric aspiration detection in critically ill patients are considered.- - - - - - - - - - ranking = 0.10457312314657keywords = shock (Clic here for more details about this article) |
5/18. Percutaneous mitral commissurotomy using the metallic valvulotome technique in a critically ill adult.A 25-year-old man presented with cardiogenic shock secondary to rheumatic mitral stenosis. Despite aggressive medical treatment he continued to deteriorate. This report describes the successful use of the metallic valvulotome technique for mitral commissurotomy in the context of a critically ill patient.- - - - - - - - - - ranking = 0.10457312314657keywords = shock (Clic here for more details about this article) |
6/18. campylobacter fetus meningitis in a diabetic adult cured by imipenem.Reported here is the successful management of a severe case of campylobacter fetus subspecies fetus meningitis, complicated by septic shock, in a patient without overt immunosuppression who was cured by imipenem. meningitis caused by C. fetus has rarely been reported in adults, and only exceptionally in non-immunocompromised patients, and septic shock has not previously been reported as a complication of such meningitis. The best antibiotic regimen for treating this condition remains to be determined. imipenem has displayed high in vitro activity against C. fetus but has been used rarely in clinical practice. It was administered in this case with good results.- - - - - - - - - - ranking = 0.32683002965484keywords = shock, septic shock (Clic here for more details about this article) |
7/18. Successful use of ECMO in adults with life-threatening infections.Two cases of critically ill patients who received extracorporeal membrane oxygenation (ECMO) using different forms of circuitry and for different indications are presented. Both patients had life-threatening infections with septic shock and were not able to be supported by conventional means. The first patient had staphylococcal septicaemia and received venoarterial ECMO for circulatory failure. The second patient had psittacosis and received venovenous ECMO for respiratory failure. We discuss the expanding indications for this technology and the role it has to play in adult intensive care.- - - - - - - - - - ranking = 0.16341501482742keywords = shock, septic shock (Clic here for more details about this article) |
8/18. Three cases of leptospirosis requiring intensive care.Presented here are three cases of severe leptospirosis, one icteric and two pulmonary hemorrhagic, that occurred in patients in Styria, austria. leptospirosis presents with protean and nonspecific manifestations. Thus, as these three cases emphasize, the key to diagnosis may be maintaining a high index of suspicion for the disease in previously healthy febrile patients with septic shock, acute renal and hepatic dysfunction and respiratory failure requiring intensive care.- - - - - - - - - - ranking = 0.16341501482742keywords = shock, septic shock (Clic here for more details about this article) |
9/18. role of electrophysiological study and ablation in the management of recurrent atrial flutter associated with haemodynamic compromise in a critically ill patient.atrial flutter is a common arrhythmia. In the critical care setting, the arrhythmia may present in any patient, but it is most commonly seen in patients with impaired ventricular function, valvular disease, atrial dilatation or after cardiac surgery. We present a 68-year-old lady with recurrent poorly tolerated atrial flutter that was resistant to multiple pharmacological interventions and complicated by cardiogenic shock following direct current cardioversion. The flutter was successfully cured with radiofrequency ablation and was followed by an immediate improvement in her haemodynamic status. We review the management of acute atrial flutter and discuss the role of electrophysiologically guided ablation.- - - - - - - - - - ranking = 0.10457312314657keywords = shock (Clic here for more details about this article) |
10/18. Successful treatment of life-threatening bleeding after cesarean section with recombinant activated factor vii.Hemorrhagic shock developed in a 29-year-old nullipara without coagulopathy after emergency caesarean section. Treatment with uterotonic drugs, prostaglandins, and conservative procedures with transfusion of packed red cells and fresh-frozen plasma failed to control the diffuse vaginal and uterine bleeding. Finally an intravenous bolus injection of 90 microg/kg recombinant activated factor vii (rFVIIa, NovoSeven, Novo Nordisk A/S, Bagsvaerd, denmark), was given and showed success within 20 minutes after administration, without any side effects.- - - - - - - - - - ranking = 0.10457312314657keywords = shock (Clic here for more details about this article) |
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