1/168. Meropenem pharmacokinetics in a patient with multiorgan failure from Meningococcemia undergoing continuous venovenous hemodiafiltration.Meropenem is a carbapenem antibiotic with a broad antibacterial spectrum of activity. Its main route of elimination is through the kidneys, with 63% of the drug excreted unchanged in the urine. Meropenem clearance is diminished in renal impairment; therefore, doses need to be adjusted in patients with varying degrees of renal function. An appropriate dose of meropenem for patients undergoing continuous venovenous hemodiafiltration (CVVHDF) is unknown. We evaluated the pharmacokinetics of meropenem in a patient with fulminant meningococcemia undergoing CVVHDF. Meropenem concentrations in serial venous, arterial, and ultrafiltrate samples after a 1 g intravenous dose were measured using high-performance liquid chromatography (HPLC). Meropenem clearance was found to be 129.36 mL/min and 141.29 mL/min for every 8- and 12-hour dosing, respectively. Trough levels were above the MIC90 for neisseria meningitidis and most anaerobic pathogens. We recommend that meropenem 1 g intravenously every 12 hours be used as the initial dose in patients undergoing CVVHDF. Differences between meropenem clearance during CVVHDF and other forms of renal replacement therapy are discussed.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
2/168. Cirrhosis in a child with hypothalamic syndrome and central precocious puberty treated with cyproterone acetate.Before the advent of gonadotropin-releasing-hormone analogues, cyproterone acetate (CPA) had been widely prescribed for the treatment of precocious puberty. Although it is usually well tolerated, liver toxicity has been recognized as a complication of its long-term use. We report the occurrence of cirrhosis in a 10-year-old boy with hypothalamic syndrome and precocious puberty who was treated with CPA for over 50 months. Despite discontinuation of the medication, the liver disease progressed. The patient died of sepsis and multiorgan failure at the age of 14 years. This is the first paediatric report of substantial liver damage and liver toxicity progressing to cirrhosis associated with CPA treatment. CONCLUSION: Prolonged cyproterone acetate treatment may induce cirrhosis. Monitoring of liver function both during treatment and for several months after discontinuation of therapy is recommended.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
3/168. The first case of H5N1 avian influenza infection in a human with complications of adult respiratory distress syndrome and Reye's syndrome.Avian influenza virus was not known to cause systemic infection in humans before. We report a 3-year-old boy with good past health who developed pneumonia caused by H5N1 avian influenza a virus (A/hong kong/156/97). The virus was isolated from a tracheal aspirate. There were complications of Reye's syndrome, adult respiratory distress syndrome, and multiple organ system failure. He had a history of receiving aspirin. His adult respiratory distress syndrome did not respond to endotracheal surfactant replacement therapy. He died 6 days after admission. Clinicians should be alert to the importance of a new human influenza strain.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
4/168. Malakoplakia of the caecum in a kidney-transplant recipient: presentation as acute tumoral perforation and fatal outcome.Malakoplakia is a rare pseudotumoral inflammatory disease known to affect immunocompromised subjects, mainly with a history of recurrent escherichia coli infection. The urinary tract is the most frequent site of the disease, although all organs can be involved. In the present article, we report a case of malakoplakia of the caecum, that developed in a 52-year-old man, who had received a kidney transplant 9 years before and had a history of recurrent E. coli urinary tract infections. Malakoplakia presented as acute intestinal perforation, and, despite aggressive surgical and medical management, disease progressed toward a fatal outcome due to sepsis and multiple organ failure 9 months later. A defect in the macrophagic activity was demonstrated.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
5/168. The clearance of procalcitonin (PCT) during continuous veno-venous hemodiafiltration (CVVHD)OBJECTIVE: To evaluate the Procalcitonin (PCT) clearance during continuous veno-venous hemodiafiltration (CVVHD). DESIGN: Case report SETTING: Surgical intensive care unit.PATIENT: 51-year-old man, who had undergone total thyroidectomy about ten years before owing to multiple endocrine neoplasia 2 (MEN 2), suffering from multiple organ dysfunction syndrome (MODS) with acute renal failure after severe trauma caused by a traffic accident. MEASUREMENTS AND MAIN RESULT: The samplings of prefilter (afferent) and post-filter (efferent) blood and of ultradiafiltrate were 6 times performed during 24 h of CVVHD to calculate the PCT clearance of hemdiafiltration. During the first half period of CVVHD the serum PCT concentration did not decrease, though PCT had been eliminated from serum. On the other hand during the latter half period of it the serum PCT value decreased (from 46.8 ng/ml to 29.4 ng/ml) and the amount of the eliminated PCT from serum was about 100 ng per minute and its clearance was 2.3 approximately 3.4 ml/min. CONCLUSION: The CVVHD could eliminate PCT from serum. First it was brought about by the adsorption by the filter membrane and then by ultradiafiltration.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
6/168. Relapsing acute pancreatitis induced by re-exposure to the cholesterol lowering agent bezafibrate.We report a 75-yr-old patient, who presented three times with acute pancreatitis, accompanied by high temperature, shock, and multiorgan involvement and associated each time with exposure to the cholesterol lowering agent bezafibrate. Extensive workup excluded other possible causes for recurrent pancreatitis in this patient, further supporting bezafibrate as the cause of the patient's acute illness. Based on the short time elapsing between rechallenge and development of manifestations and the specific features of the attacks, we proposed hypersensitivity to bezafibrate as the underlying mechanism. The present report includes, for the first time, bezafibrate among definite causes of acute pancreatitis.- - - - - - - - - - ranking = 8keywords = rate (Clic here for more details about this article) |
7/168. Multi-organ failure caused by reactivated coccidioidomycosis without dissemination in a patient with renal transplantation.OBJECTIVE: The acute respiratory failure caused by pulmonary coccidioidomycosis without dissemination is an extremely unusual event. CASE REPORT: We report a 47-year-old renal transplanted man with a reactivated pulmonary coccidioidomycosis, whose clinical course presented as fulminant respiratory failure, disseminated intravascular coagulation and profound hypotension mimicking bacterial pneumonia and septic shock. lung biopsy showed conglomerated necrotizing granulomas containing many spherules filled with endospores of coccidioides immitis. CONCLUSION: coccidioidomycosis should be included in the differential diagnosis of acute sepsis, particularly in an immunocompromised host who has travelled in an endemic area.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
8/168. Toxic epidermal necrolysis associated with quinidine administration.Toxic epidermal necrolysis (TEN) is a rare, life threatening, drug induced cutaneous reaction first reported by Lyell in 1956. He named the condition TEN to distinguish it from staphylococcal scalded skin syndrome. It is characterized by a separation of the epidermis and dermis with subsequent desquamation of skin. The denuded areas of skin have the appearance of second-degree burn. Drug induced TEN is a disease of severe morbidity and high mortality. The drugs most frequently associated with onset of the condition are sulfonamides, anticonvulsants, non-steroidal anti-inflammatory drugs, and allopurinol. This study reports the occurrence of TEN in a patient receiving quinidine.- - - - - - - - - - ranking = 72.268965992384keywords = mortality (Clic here for more details about this article) |
9/168. Pancreatic injury following acute methanol poisoning.BACKGROUND: methanol ingestion is a cause of potentially life-threatening poisoning with numerous systemic manifestations. Clinicians may overlook the possibility of acute pancreatitis in this setting. The objective of this paper is to document the incidence of this complication in a series of 22 patients and to discuss the respective role of methanol and ethanol in its pathogenesis. CASE REPORT: A 54-year-old woman developed acute necrotizing pancreatitis following acute methanol poisoning. She was treated by hemodialysis, ethanol infusion, and folinic acid, but, despite maximal supportive therapy, she died from multiple organ failure 54 hours after the ingestion. CASE SERIES: In a series of 22 consecutive patients admitted with a diagnosis of acute methanol poisoning, we found evidence of pancreatic damage in 11 patients. The abnormalities were present from admission and before ethanol therapy in 7 cases and developed after ethanol therapy in 4 cases. Seven patients had a history of chronic ethanol abuse, but no patient had previously suffered from acute or chronic pancreatitis. Three patients presented moderate-to-severe acute pancreatitis according to clinical and radiological criteria and required aggressive supportive therapy including peritoneal dialysis. One patient died from the direct consequences of acute necrotizing pancreatitis and 2 fully recovered from this event. Three patients evolved to brain death; autopsy revealed hemorrhagic lesions in the pancreas in only 1 case. CONCLUSIONS: Clinical, biological, and radiographic signs of acute pancreatic injury may be more common than previously realized. Acute methanol poisoning appears to produce pancreatic injury, although antidotal treatment with ethanol or prior chronic ethanol abuse may be contributing factors. Because ethanol treatment may complicate the pancreatic injury, fomepizole (4-methylpyrazole) may be the preferable antidote in acute methanol poisoning.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
10/168. Intramedullary spinal cord metastasis from gastric cancer. Case report.A case of intramedullary spinal cord metastasis from gastric cancer is reported. A 51-year-old woman presented with hemicord syndrome that had progressed within 1 month to tetraplegia. Despite total resection of the tumor, she died of disseminated intravascular coagulation and multiple organ failure. Examination of pathological findings demonstrated undifferentiated adenocarcinoma, and postoperative gastroendoscopic study revealed advanced gastric cancer. To the authors' knowledge this is the first case of intramedullary spinal cord metastasis from gastric cancer. The clinical characteristics of the disease are discussed.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
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