1/99. The application of immobilized polymyxin b fiber in the treatment of septic shock associated with severe acute pancreatitis: report of two cases.The elimination of endotoxin by direct hemoperfusion over immobilized polymyxin b fiber (PMX-F) was carried out in two patients who developed septic shock associated with severe acute pancreatitis. Parameters such as blood pressure, body temperature, and plasma endotoxin level improved after PMX-F treatment, and the infected lesions were successfully and safely removed by surgery. Although an aggressive operative strategy of debridement with ultimate closure over drains is generally associated with low mortality in patients with this devastating disease, we often hesitate to perform this operation due to the poor condition of the patient in the acute period, with multiple organ failure and/or septic shock status, and also because of the difficulty in diagnosing the pancreatic infection. In this situation, endotoxin elimination using PMX-F is a useful tool for treating secondary pancreatic infections to help the patient recover in preparation for surgery, or for treating perioperative endotoxemia.- - - - - - - - - - ranking = 1keywords = shock, septic shock (Clic here for more details about this article) |
2/99. Necrotizing proctitis caused by streptococcus pyogenes.We report the case of a 65-year-old patient with peritonitis, septicaemia and toxic shock syndrome in whom the primary focus of infection was acute purulent proctitis with necrosis. streptococcus pyogenes serotype T28R28 was isolated from blood culture and peritoneal pus. The patient recovered after a prolonged period of intensive therapy and four abdominal operations including anterior resection of the rectum. We believe this to be the first clinical description of streptococcal necrotizing proctitis.- - - - - - - - - - ranking = 0.3051490557159keywords = toxic shock syndrome, shock, shock syndrome, toxic shock (Clic here for more details about this article) |
3/99. anorexia nervosa with ischemic necrosis of the segmental ileum and cecum.A 41-year-old woman with long-standing anorexia nervosa showed paralytic ileus and serum creatine kinase elevation. Surgical treatment showed necrosis of the segmental ileum and cecum with perforation. She died of septic shock 3 days after the operation. Postmortem examination revealed no occlusion of the superior mesenteric artery or its main branches, and no arteriosclerotic changes. Histological examinations confirmed non-occlusive mesenteric infarction. This case suggested that necrosis of bowels might have been caused by poor blood supply due to severe malnutrition and dehydration for many years, which could be one of the fatal complications of anorexia nervosa.- - - - - - - - - - ranking = 0.16666666666667keywords = shock, septic shock (Clic here for more details about this article) |
4/99. Anatomo-pathologic observations on epidemic nephropathy.Two cases of necropsy and 5 cases of renal biopuncture were studied on the occassion of an epidemic of "hemorrhagic fever with renal syndrome" identified in mountainous areas of Transylvania. The prevalent pathogenic process was capillary toxicosis which injured the renal tubules and vessels. The severity of the disease was determined by the phenomena of tubular failure, by the hemorrhagic syndrome and shock.- - - - - - - - - - ranking = 0.094396708588587keywords = shock (Clic here for more details about this article) |
5/99. streptococcus pyogenes pyomyositis.Group A beta-hemolytic Streptococcus pyomyositis continues to be an uncommon disease. We present a case of a 7-year-old boy with an M protein type 1, streptococcal pyrogenic exotoxin A and B, streptococcus pyogenes pyomyositis and streptococcal toxic shock syndrome.- - - - - - - - - - ranking = 0.3051490557159keywords = toxic shock syndrome, shock, shock syndrome, toxic shock (Clic here for more details about this article) |
6/99. Late-onset warfarin necrosis.A 43-year-old woman developed tenderness and induration of her thighs and lower abdomen, 56 days after commencing warfarin for aortic and mitral valve replacements. Investigations showed elevated inflammatory markers, mild renal impairment, normal echocardiogram and low protein c and S levels consistent with warfarin therapy. Three weeks later, purpuric areas evolved into large tender haemoserous bullae, which broke down to form ulcers. histology confirmed the clinical impression of warfarin-induced skin necrosis with dermal and subcutaneous venular thrombi. Despite cessation of warfarin and commencement of heparin, the lesions progressed. When the patient became febrile, blood cultures grew pseudomonas aeruginosa, which was treated with intravenous imipenem and vancomycin. Wound swabs grew methycillin-resistant staphylococcus aureus and the antibiotics were changed. The patient developed septic shock and, despite intensive care management, her condition deteriorated and she died 9 weeks after the onset of the skin symptoms.- - - - - - - - - - ranking = 0.16666666666667keywords = shock, septic shock (Clic here for more details about this article) |
7/99. fatal outcome in Eisenmenger syndrome.AIM: To assess correlations between fatal outcome and histologic findings of pulmonary vascular disease in different situations of Eisenmenger syndrome, either during the natural course or early-late after surgery. MATERIAL AND methods: The clinical follow-up and fatal outcome of 20 patients affected by Eisenmenger syndrome were investigated. In addition to the pathologic report and gross reexamination of the heart, the lung tissue was studied by histology. patients were divided into three groups: 6 non-operated patients who died during the natural course (Group 1), 11 patients who underwent correction of the congenital defect and died in the perioperative period (Group 2), and 3 patients who died late after surgery (Group 3). RESULTS: In Group 1, five patients (83%) died of cardiac arrest a few days after the onset of hypoxic attacks; in four patients histology showed Grade IV pulmonary vascular disease with diffuse fibrinoid necrosis in the distal pulmonary arterial vasculature. In Group 2, nine patients (82%) died on the first or second postoperative day after a refractory pulmonary hypertensive crisis, with histologic evidence in three patients of fibrinoid necrosis of the distal pulmonary small arteries and arterioles. In Group 3, two patients (67%) died suddenly, 6 and 18 years after cardiac surgery, following onset of dyspnea and cardiogenic shock; autopsy showed aneurysmal dilatation of the pulmonary artery with massive thrombosis in the setting of Grades III-IV pulmonary vascular disease without fibrinoid necrosis. CONCLUSION: fatal outcome in Eisenmenger syndrome, either in the natural course or after refractory hypertensive attacks post surgery, is frequently associated with fibrinoid necrosis of the small pulmonary arteries and arterioles.- - - - - - - - - - ranking = 0.094396708588587keywords = shock (Clic here for more details about this article) |
8/99. skin necrosis after extravasation of low-dose vasopressin administered for septic shock.OBJECTIVE: To describe a case of severe skin necrosis resulting from peripheral intravenous administration of low-dose vasopressin in a patient with catecholamine-resistant septic shock. DESIGN: Case report. SETTING: Medical intensive care unit at the University of chicago, chicago, IL. PATIENT: A 46-yr-old female with ventilator-dependent, proliferative-phase acute respiratory distress syndrome complicated by pseudomonas aeruginosa bacteremia and sepsis. MEASUREMENTS AND MAIN RESULTS: A patient recovering from acute respiratory distress syndrome developed septic shock from pseudomonas aeruginosa bacteremia while in the medical intensive care unit. Vasopressin (0.04 units/min) was administered through a peripheral venous catheter for hypotension unresponsive to exogenous catecholamines. The patient subsequently developed severe ischemic necrosis of the skin and soft tissue surrounding the catheter site. The vasopressin was stopped, and the skin lesion progressed to bullae formation with extensive superficial erosion. CONCLUSIONS: Peripheral administration of low-dose vasopressin for septic shock should be discouraged because of the risk of ischemic skin complications.- - - - - - - - - - ranking = 1.1666666666667keywords = shock, septic shock (Clic here for more details about this article) |
9/99. Angiographic and ultrasonographic appearance of renal cortical and medullary necrosis in the newborn.Renal cortical and medullary infarction are 2 of the severe complications of perinatal asphyxia and shock. The angiographic and ultrasonographic findings in these conditions have not been described previously. They demonstrate nephromegaly, a nonhomogeneous nephrogram, and internal echoes. Similar findings may be seen in renal vein thrombosis, hydronephrosis, and polycystic kidneys.- - - - - - - - - - ranking = 0.094396708588587keywords = shock (Clic here for more details about this article) |
10/99. Multifocal necrotizing leukoencephalopathy in septic shock.OBJECTIVE: Multifocal necrotizing leukoencephalopathy, characterized by multiple microscopic foci of necrosis involving the white matter of the pons, has been described mainly after chemotherapy or radiotherapy for brain cancer and in hiv infection. The role of circulating cytokines has been suggested but remains to be assessed. DESIGN: Prospective case series. SETTING: A 26-bed general medical intensive care unit at a university hospital. patients: Septic shock patients. MEASUREMENTS AND patients: In three patients who died from septic shock, careful postmortem examination of the brain was performed, including studies of neuronal apoptosis and cytokine expression. MAIN RESULTS: In one patient, typical lesions of multifocal necrotizing leukoencephalopathy were seen. As compared with control 1 and control 2 who did not have multifocal necrotizing leukoencephalopathy, marked lesions of the pons, including vacuolization, apoptosis, microglial activation, and expression of tumor necrosis factor-alpha and interleukin-1beta, were observed in the case. Simultaneously, case 1 had markedly increased circulating levels for tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, interleukin-8, interleukin-10, soluble tumor necrosis factor receptor II, and for interleukin-1 receptor antagonist. CONCLUSION: Septic shock is a newly described cause of multifocal necrotizing leukoencephalopathy, probably mediated by an excessive systemic inflammatory response.- - - - - - - - - - ranking = 1.0221267505105keywords = shock, septic shock (Clic here for more details about this article) |
| | Next -> |