1/6. Unusual manifestations of penetrating cardiac injuries.Penetrating cardiac injuries frequently first appear in an unusual and insidious manner, and their diagnosis may not be immediately obvious. In a series of 20 cases of cardiac injury, ten cases were indicative of such subtle symptoms, several of which were life-threatening. These unusual manifestations can be categorized as early, intermediate, or late. Early problems of four patients included the following: (1) sudden onset of shock during laparotomy, performed due to apparent abdominal trauma; (2) cardiac arrest on arrival in the emergency room; and (3) cerebral air embolus and mimicked symptoms of possible irreversible anoxic brain damage. The intermediate manifestations of cardiac injury are usually discovered in the early recovery period, and include myocardial infarction with cardiogenic shock and bullet embolus to a peripheral artery. Intermediate manifestations were observed in two patients. Four patients had late complications that included pseudoaneurysm, ventricular septal defect, valvular damage, and recurrent pericarditis. These late complications were observed between one month and 21 years after cardiac injury. This indicates the necessity of long-term follow-up of these patients.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
2/6. Mucosal lesions in the human small intestine in shock.Characteristic mucosal lesions in resected small intestinal segments from seven patients are reported. Preoperatively, four patients were in shock and general hypotension while the three remaining cases showed signs of local intestinal hypotension. The microscopic appearance of the mucosal lesions was in all patients identical with that previously observed in the feline and canine small intestine after haemorrhage or local intestinal hypotension. It is proposed that an extravascular short-circuiting of oxygen in the mucosal countercurrent exchanger and an intravascular aggregation of blood cells might produce tissue hypoxia which makes the mucosa vulnerable to enzymatic degradation.- - - - - - - - - - ranking = 2.5keywords = shock (Clic here for more details about this article) |
3/6. Hemodynamic changes after resection of thoracic duct for en bloc resection of esophageal cancer.An en bloc resection of esophageal cancer is one of the most radical forms of esophagectomy, and includes the resection of the thoracic duct, but a relatively high hospital mortality rate has been reported. There is very little knowledge on the pathophysiological changes after resection of the thoracic duct. We examined 24 patients who underwent en bloc resection. Some patients developed severe tachycardia or shock postoperatively which subsided after a massive infusion of plasma. Analysis of the fluid balance revealed that much more fluid was necessary during surgery and the postoperative 24 h than in patients treated by a standard esophagectomy. Postoperative lymphangiography or CT revealed abnormal collateral lymphatics around the kidneys or in the pelvic cavity. This suggests the development of the lymphaticovenous shunts, which differed depending on the anatomy of each patient. One patient with chronic hepatitis developed uncontrollable ascites. These are important findings which can hopefully reduce the high rate of hospital death after this operation.- - - - - - - - - - ranking = 0.5keywords = shock (Clic here for more details about this article) |
4/6. Acute adrenal insufficiency presenting as shock after trauma and surgery: three cases and review of the literature.Profound nonhemorrhagic shock developed in one postoperative and two trauma patients. Cardiovascular collapse was characterized by severe hypotension (systolic blood pressure less than 80 mm Hg), hyperdynamic cardiac indices (CI greater than 4 L/min/m2), low systemic vascular resistance (SVR less than 500 dyne.sec/cm5.m2), and multiple organ failure. sepsis was not found by culturing of specimens or visual inspection at laparotomy. Screening cortisol levels were low (less than 2 micrograms/dL in two patients) and did not respond appropriately to synthetic ACTH (cosyntropin) challenge. Administration of exogenous glucocorticoids promptly and dramatically reversed shock and organ failure in two patients. Oral glucocorticoid and mineralocorticoid supplementation were required at hospital discharge. Acute adrenal insufficiency is rare after trauma, but may produce life-threatening cardiovascular collapse, mimicking the "septic" shock state. cosyntropin stimulation testing confirms the diagnosis and is accurate in traumatized patients. Outcome is dependent upon early recognition and exogenous glucocorticoid administration. Appropriate endocrine evaluation prevents unnecessary use of steroids in a population of trauma patients who are already in a state of immunosuppression.- - - - - - - - - - ranking = 3.5keywords = shock (Clic here for more details about this article) |
5/6. Surgical shock presenting as lower limb ischaemic rest pain.Ischaemic rest pain affecting the lower limb is characteristically constant, severe and distressing. attention is thereby concentrated on the affected leg and its vascular supply which may distract the attending clinician from a precipitating cause. We present two patients with shock that led to acute onset of ischaemic leg pain.- - - - - - - - - - ranking = 2.5keywords = shock (Clic here for more details about this article) |
6/6. Hypovolaemia and phaeochromocytoma.The state of shock which frequently follows removal of a phaeochromocytoma is due to the hypovolaemia resulting from prolonged excessive secretion of vasoconstrictor substances and should be treated with intravenous fluids. The gradient between central and peripheral temperatures provides a reliable guide to the hypovolaemic state. Two illustrative cases are described.- - - - - - - - - - ranking = 0.5keywords = shock (Clic here for more details about this article) |