1/16. Gas embolism during hysteroscopy.PURPOSE: Gas embolism during hysteroscopy is rare but sometimes fatal. A fatal case of gas embolism during diagnostic hysteroscopy using carbon dioxide (CO2) is presented. CLINICAL FEATURES: A 68 yr old woman was admitted for treatment of myoma and cancer of the uterus. hysteroscopy using CO2 was performed without monitoring or anesthesia on the ward. At the end of the examination, just after the hysteroscope was removed, she developed tonic convulsions, lost consciousness, and her pulse was impalpable. Cardiac massage was started, anesthesiologists were called and the trachea was intubated. She was transferred to the intensive care unit with continuous cardiac massage. Cardiac resuscitation was successful. A central venous line was inserted into the right ventricle under echocardiography in an attempt to aspirate gas with the patient in the Trendelenberg position, but the aspiration failed. Positive end expiratory pressure and heparin for emboli, midazolam for brain protection, and catecholamines were administered. Fifteen hours after resuscitation, the pupils were enlarged and she died 25 hr after resuscitation. CONCLUSION: Gas embolism is a rare complication of hysteroscopy. The procedure should be performed with monitoring of blood pressure, heart rate, oxygen saturation and end-tidal CO2 concentration.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/16. Benign occipital epilepsy mimicking a catastrophic intracranial event.OBJECTIVE: To describe the rare, dramatic, presentation of benign occipital epilepsy. methods: We describe three children who presented to the pediatric emergency department from 1992 to 1996 with a clinical picture of catastrophic intracranial event. RESULTS: The main signs and symptoms were loss of consciousness in all patients, apnea in two, hemiclonus in two, general hypertonicity in two, eye deviation in two, fixed dilated pupils in one, and decorticate rigidity in two. All underwent emergency intubation, brain scan, and lumbar puncture, and all were treated with antibiotics, in addition to antiviral drugs in two. Two patients were also treated for suspected increased intracranial pressure. Two patients recovered within a few hours and one within 24 hours of admission without any residual neurologic deficit. Electroencephalograms, done within 48 hours after the event, revealed the classic pattern of occipital epilepsy in two patients and bilateral occipital slow wave in one. A 3- to 5-year clinical and electroencephalographic follow-up supported the diagnosis. CONCLUSION: Benign occipital epilepsy in children can mimic a catastrophic intracranial event. electroencephalography, performed early in the Pediatric intensive care Unit, may avoid or shorten unnecessary and aggressive treatments such as hyperventilation, diuretic agents, and prolonged antiviral therapy.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/16. Prolonged sustained ventricular fibrillation without loss of consciousness in patients supported by a left ventricular assist device.patients with cardiomyopathy of either ischemic or nonischemic origin are at increased risk for malignant ventricular arrhythmias. Normally sustained ventricular fibrillation (VF) leads to death very rapidly. We report two patients who remained in sustained VF, supported by a left ventricular assist device, for a prolonged period of time. perfusion pressure through the device was sufficient to allow the patients to remain awake and responsive for several hours while in VF. The cases represent two of the longest reported episodes of sustained VF recorded in awake patients implanted with such devices.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/16. Oculocardiac reflex caused by contact lenses.PURPOSE: To report two cases of patients who fell unconscious because of the oculocardiac reflex when attempting to wear contact lenses. case reports: Case 1: A 15-year-old healthy boy came to our clinic to be fitted with contact lenses. As soon as a hard contact lens was inserted forcibly, he became unconscious. Case 2: A 22-year-old man fell unconscious the instant that the eye was compressed with a hard contact lens. Neither patient had used glasses or contact lenses before. Their blood pressure was decreased while unconscious. They recovered consciousness after about 10 min, and nausea and vomiting settled subsequently. Contact lens insertion was tried again carefully after 1 week avoiding compression of the eyes and there were no problems. They are currently using contact lenses without any problems. CONCLUSION: Insertion of contact lenses may rarely provoke the oculocardiac reflex.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
5/16. Pulmonary oedema--prehospital treatment. Caution with morphine dosage.OBJECTIVE: To inform doctors of potential hazards if opioids are administered in excessive doses to patients with acute pulmonary oedema. CLINICAL FEATURES: Three elderly patients were unresponsive and hypotensive on arrival in the emergency department. All had received morphine parenterally as a component of prehospital treatment for acute pulmonary oedema. INTERVENTIONS AND OUTCOME: All were given naloxone intravenously, regained consciousness and had a rise in blood pressure. CONCLUSION: Parenteral administration of opioids should be used with caution in acute pulmonary oedema. The authors present a protocol for prehospital drug therapy.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
6/16. Modafinil for the treatment of diminished responsiveness in a patient recovering from brain surgery.PRIMARY OBJECTIVE: This case report reviews the history and post-operative status of a 77-year-old woman who underwent transcallosal resection of an intra-ventricular haemorrhagic subependymoma and who remained in a deep post-operative state of lethargy and listlessness. MAIN OUTCOME MEASURES: glasgow coma scale (GCS) and detailed clinical observations. RESULTS: The patient (GCS=8) was initiated on methylphenidate 20 mg per day on the 6th day after surgery, but treatment was discontinued 2 days later due to elevated blood pressure and persistent tachycardia. pemoline 37.5 mg per day was initiated, but treatment was stopped after 3 days due to lack of response. Treatment with modafinil 400 mg per day was initiated on the 11th day after surgery and the patient's consciousness level rapidly improved on the 14th day. On the 16th day after surgery, she was completely alert (GCS=15). CONCLUSIONS: Modafinil appeared to be beneficial for improving wakefulness and responsiveness in a patient with central nervous system trauma in the post-operative state.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
7/16. A case of anaphylactic shock possibly caused by intravesical Hexvix.BACKGROUND: We report a case of a 69-year-old Caucasian male who experienced a severe drop in blood pressure and a skin rash after fluorescence cystoscopy and transurethral resection of the prostate. The diagnostic agent used for fluorescence cystoscopy and suspected of causing the anaphylaxis was hexaminolevulinate hydrochloride (Hexvix). INCIDENT: A profound fall in blood pressure associated with atrial fibrillation, the appearance of a rash, vomiting and transient loss of consciousness occurred immediately after surgery. The hypotension persisted for several hours despite intensive treatment. The reaction commenced approximately 5 h after exposure to Hexvix. There was an increase in serum tryptase (almost nine-fold) and a positive skin prick test to undiluted Hexvix. CONCLUSION: The mechanism of the anaphylaxis is uncertain, but is considered likely to be a non-immunoglobulin e-mediated allergic reaction possibly caused by Hexvix. This is the first reported case of a severe allergic reaction after intravesical instillation of Hexvix.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/16. Concentration of 3', 5' cyclic adenosine monophosphate in ventricular cerebrospinal fluid of patients with prolonged coma after head trauma or intracranial hemorrhage.A previous study showed that cerebrospinal fluid from the lateral ventricle of patients without disturbance of sensorium or intracranial pressure contains 15 to 30 nm 3', 5' cyclic adenosine monophosphate. We measured the concentration of this cyclic nucleotide by radioimmunoassay in cerebrospinal fluid from the lateral ventricle of six patients with prolonged coma (20 days or longer) after head trauma (four), or spontaneous intracranial hemorrhage (two). Coma was graded IV to I in order of decreasing severity. Fluid was removed at intervals of six to 72 hours from a Rickham reservoir placed in the lateral ventricle. Concentration of the cyclic nucleotide (mean /- S.E.M.) in coma of Grades IV, III, II and I was 2.1 /- 0.3, 4.6 /- 0.5, 6.3 /- 1.4 and 12.5 /- 2.4 nM respectively. After sensorium became normal, cAMP was 21.0 /- 1.4 nM. Correlation between grade of coma and concentration was -0.89 (P less than 0.01). Thus, prolonged coma appears to be associated with a disturbance of cyclic amp metabolism within the central nervous system.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
9/16. Combined arterial gas embolism and decompression sickness following no-stop dives.decompression sickness (DCS) has been clinically classified as Type I (predominantly joint pain) or Type II (predominantly spinal cord lesions). We present 3 cases that are all characterized by severe (Type II) DCS with signs and symptoms of spinal cord injury occurring in conjunction with arterial gas embolism (AGE). We consider the AGE "minor" because only 2 of the 3 subjects initially lost consciousness, and in all cases the signs and symptoms of the AGE had essentially resolved within 1 h or by the time recompression therapy began. DCS was resistant to recompression therapy, even though treatment began promptly after the accident in 2 of the 3 cases. None of the cases had a good neurologic outcome and there has been one death. None of the divers exceeded the U.S. Navy "no-stop" limits for the depths at which they were diving. We have observed a previously unreported clinical syndrome characterized by severe Type II DCS subsequent to AGE following pressure-time exposures that would normally not be expected to produce DCS. We postulate that AGE may have precipitated or predisposed to this form of DCS.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
10/16. prazosin-induced first-dose phenomenon possibly associated with hemorrhagic stroke: a report of three cases.A small initial dose of prazosin ranging from 0.5 to 1 mg has been recommended to avoid the first-dose phenomenon characterized by a sudden and severe drop in blood pressure after the administration of the first dose of prazosin. However, even with an initial dose of 0.5 mg, hypotension with consciousness disturbance developed in three hypertensive patients with recent cerebral hemorrhage. We present this report to alert physicians and pharmacists about the potential risk of the first-dose phenomenon even at the recommended initial doses of prazosin in hypertensive patients who have suffered a recent stroke.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
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