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1.
JAMA ; 322(13): 1261-1270, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573637

RESUMO

Importance: Experimental data suggest that intravenous vitamin C may attenuate inflammation and vascular injury associated with sepsis and acute respiratory distress syndrome (ARDS). Objective: To determine the effect of intravenous vitamin C infusion on organ failure scores and biological markers of inflammation and vascular injury in patients with sepsis and ARDS. Design, Setting, and Participants: The CITRIS-ALI trial was a randomized, double-blind, placebo-controlled, multicenter trial conducted in 7 medical intensive care units in the United States, enrolling patients (N = 167) with sepsis and ARDS present for less than 24 hours. The study was conducted from September 2014 to November 2017, and final follow-up was January 2018. Interventions: Patients were randomly assigned to receive intravenous infusion of vitamin C (50 mg/kg in dextrose 5% in water, n = 84) or placebo (dextrose 5% in water only, n = 83) every 6 hours for 96 hours. Main Outcomes and Measures: The primary outcomes were change in organ failure as assessed by a modified Sequential Organ Failure Assessment score (range, 0-20, with higher scores indicating more dysfunction) from baseline to 96 hours, and plasma biomarkers of inflammation (C-reactive protein levels) and vascular injury (thrombomodulin levels) measured at 0, 48, 96, and 168 hours. Results: Among 167 randomized patients (mean [SD] age, 54.8 years [16.7]; 90 men [54%]), 103 (62%) completed the study to day 60. There were no significant differences between the vitamin C and placebo groups in the primary end points of change in mean modified Sequential Organ Failure Assessment score from baseline to 96 hours (from 9.8 to 6.8 in the vitamin C group [3 points] and from 10.3 to 6.8 in the placebo group [3.5 points]; difference, -0.10; 95% CI, -1.23 to 1.03; P = .86) or in C-reactive protein levels (54.1 vs 46.1 µg/mL; difference, 7.94 µg/mL; 95% CI, -8.2 to 24.11; P = .33) and thrombomodulin levels (14.5 vs 13.8 ng/mL; difference, 0.69 ng/mL; 95% CI, -2.8 to 4.2; P = .70) at 168 hours. Conclusions and Relevance: In this preliminary study of patients with sepsis and ARDS, a 96-hour infusion of vitamin C compared with placebo did not significantly improve organ dysfunction scores or alter markers of inflammation and vascular injury. Further research is needed to evaluate the potential role of vitamin C for other outcomes in sepsis and ARDS. Trial Registration: ClinicalTrials.gov Identifier: NCT02106975.


Assuntos
Ácido Ascórbico/administração & dosagem , Insuficiência de Múltiplos Órgãos/prevenção & controle , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Sepse/tratamento farmacológico , Vitaminas/administração & dosagem , Adulto , Idoso , Ácido Ascórbico/uso terapêutico , Biomarcadores/sangue , Proteína C-Reativa/análise , Método Duplo-Cego , Feminino , Humanos , Infusões Intravenosas , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Escores de Disfunção Orgânica , Síndrome do Desconforto Respiratório do Adulto/complicações , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Sepse/complicações , Sepse/mortalidade , Trombomodulina/sangue , Vitaminas/uso terapêutico
2.
Pan Afr Med J ; 33: 122, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31558922

RESUMO

Dermatomyositis is a systemic idiopathic disease characterized by a combination of both muscle and skin symptoms. It is a paraneoplastic dermatosis. Its association with rectal cancer has been rarely described in the literature. We here report the case of a female patient with paraneoplastic dermatomyositis associated with metastatic rectal adenocarcinoma presenting with clinical symptoms commonly found in subjects with paraneoplastic dermatomyositis. Other complementary examinations (CPK test + EMG + skin biopsy) were performed which confirmed this diagnosis. The patient underwent chemotherapy, but after the second cycle, she experienced a rapid worsening of her general condition and died after some days in a state of multisystem organ failure. This study aims to highlight paraneoplastic dermatomyositis' aggressive nature and to update current knowledge on the importance of chemotherapy in the management of neoplastic dermatomyositis.


Assuntos
Adenocarcinoma/diagnóstico , Dermatomiosite/diagnóstico , Neoplasias Retais/diagnóstico , Adenocarcinoma/patologia , Idoso , Biópsia , Dermatomiosite/etiologia , Evolução Fatal , Feminino , Humanos , Insuficiência de Múltiplos Órgãos/etiologia , Síndromes Paraneoplásicas/diagnóstico , Síndromes Paraneoplásicas/etiologia , Neoplasias Retais/patologia
3.
Khirurgiia (Mosk) ; (9): 73-79, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532170

RESUMO

Modern surgical and intensive care achievements did not result decrease of mortality in patients with acute small bowel obstruction (ASBO). Direct cause of mortality in ASBO patients is peritonitis followed by multiple organ failure syndrome including acute failure of liver, kidneys, lungs and other organs. Publications devoted to the problem of acute liver failure and its complicationsare reviewed in the article. Mechanisms of pathogenesis and clinical manifestations of multiple organ failure syndrome in patients with acute small bowel obstruction are analyzed.


Assuntos
Obstrução Intestinal/mortalidade , Falência Hepática/mortalidade , Insuficiência de Múltiplos Órgãos/mortalidade , Peritonite/mortalidade , Doença Aguda , Humanos , Obstrução Intestinal/etiologia , Intestino Delgado , Falência Hepática/diagnóstico , Falência Hepática/etiologia , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Peritonite/etiologia
4.
BMC Surg ; 19(1): 113, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31419970

RESUMO

BACKGROUND: Abdominal compartment syndrome (ACS) is an uncommon complication of severe pancreatitis. It is defined as a sustained intraabdominal pressure (IAP) > 20 mmHg (with or without an abdominal perfusion pressure (APP) < 60 mmHg), associated with new organ dysfunction/failure. ACS confers a poor prognosis and should be promptly diagnosed and managed. However, it is often missed on clinical examination, leading to a delay of diagnosis. CASE PRESENTATION: A 38-year old Sri Lankan man presented with severe alcohol-induced pancreatitis associated with abdominal compartment syndrome. Diagnosis was delayed due to false reassurance from clinical examination. The patient was managed with a decompressive laparotomy, after which he required treatment with continuous renal replacement therapy (CRRT), total parenteral nutrition (TPN) and broad-spectrum antibiotics for a prolonged period of time. Despite significant post-operative multi-organ failure, the patient survived. CONCLUSIONS: Early trans-bladder measurement of IAP is important for severe pancreatitis. Serial measurements of IAP should be implemented early when any known risk factor for ACS is present in a critically ill patient.


Assuntos
Descompressão Cirúrgica , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/cirurgia , Laparotomia/métodos , Pancreatite Alcoólica/complicações , Adulto , Antibacterianos/uso terapêutico , Diagnóstico Tardio , Humanos , Hipertensão Intra-Abdominal/diagnóstico , Masculino , Insuficiência de Múltiplos Órgãos/etiologia , Nutrição Parenteral Total , Diálise Renal , Fatores de Risco
5.
Am J Forensic Med Pathol ; 40(4): 356-360, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31318708

RESUMO

We present the case of a male adult who was admitted to an emergency department after having sustained envenomation from a black mamba (Dendroaspis polylepis). According to the available history, a single fang hooked his right index finger, post venom extraction. After administering antivenom in the accident and emergency department, further vials were transfused in the intensive care unit. An urticarial rash was noted, which was thought to be related to the antivenom. The victim remained in a coma for 3 days, after which he was declared dead. A medicolegal postmortem examination was performed 4 days after death because of logistical reasons. The complexities of differentiating acute envenomation from black mamba versus early acute reactions to polyvalent antivenom administration are highlighted in this case study.


Assuntos
Antivenenos/administração & dosagem , Antivenenos/efeitos adversos , Dendroaspis , Mordeduras de Serpentes/complicações , Venenos de Serpentes/imunologia , Adulto , Anafilaxia/diagnóstico , Animais , Diagnóstico Diferencial , Coagulação Intravascular Disseminada/etiologia , Oxigenação por Membrana Extracorpórea , Humanos , Masculino , Insuficiência de Múltiplos Órgãos/etiologia , África do Sul
7.
Acta Vet Scand ; 61(1): 22, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060620

RESUMO

BACKGROUND: Bite wounds are one of the most common traumatic injuries in dogs and depending on their severity, location, etc., urgent care including antibiotic therapy may be necessary. Serious complications can result from these injuries, such as multiple organ dysfunction syndrome (MODS), as well as a generalized reduction in cerebral perfusion, e.g. during cardiac arrest, shock, or severe hypotension that may cause global brain ischemia (GBI). CASE PRESENTATION: A 5-year-old spayed female Maltese dog was presented with generalized seizures, ataxia, and obtunded mentation. The dog was injured by severe bite wounds that penetrated its abdomen and had received blood transfusions, antibiotic therapy (including metronidazole and cefazoline) and underwent emergency surgery 4 days before its visit. Based on a clinical examination, intracranial hypoxic damage with elevated intra-cranial pressure and MODS were highly suspected, and GBI was confirmed following magnetic resonance imaging. Increased signal intensity diffusely distributed in the olfactory bulb and frontal, temporal, and parietal grey matter was evident on the T2-weighted and fluid attenuated inversion recovery transverse images, along with corresponding high signal intensity observed on diffusion weighted imaging. During the 10-month follow-up period, the clinical signs gradually improved, but intermittent circling and cognitive dysfunction deficits remained. CONCLUSIONS: GBI should be included among the differential diagnoses in case of any peracute non-progressive neurological dysfunction that occurs with episodes of hypotension or hypoxia. The abnormal signal intensity observed on diffusion weighted imaging was a useful indicator for diagnosing this condition. Long-term medical management with antibiotics and anti-convulsant and anti-oxidant therapies were considered to be helpful in managing the GBI concurrent with MODS in this dog.


Assuntos
Mordeduras e Picadas/veterinária , Isquemia Encefálica/veterinária , Doenças do Cão/etiologia , Insuficiência de Múltiplos Órgãos/veterinária , Animais , Mordeduras e Picadas/complicações , Mordeduras e Picadas/terapia , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/etiologia , Doenças do Cão/patologia , Doenças do Cão/terapia , Cães , Feminino , Hidrocefalia/tratamento farmacológico , Hidrocefalia/veterinária , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/patologia , Insuficiência de Múltiplos Órgãos/terapia
8.
J Dermatol ; 46(6): 540-543, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31106904

RESUMO

Toxic epidermal necrolysis (TEN) is a rare condition, causing life-threatening adverse cutaneous reactions. TEN occurrence after bone marrow transplantation (BMT) is a well-known phenomenon; however, to date, only a few cases have been reported in the published work. Here, we describe the case of a 53-year-old woman who experienced TEN after undergoing allogenic BMT for malignant lymphoma. Skin erosion spread across a maximum of 70% of the body surface area and severe mucosal lesions developed. Steroid pulse therapy, plasma apheresis and immunoglobulin therapy were administrated, which resulted in the complete resolution of TEN. However, she developed hemophagocytic lymphohistiocytosis and died 38 days after BMT, owing to rupture of the lower digestive tract complicated by multi-organ failure. In our case, engraftment failure occurred, and the peripheral white blood cell count was less than 100/µL during the TEN course, suggesting that the presence of only a few immune cells could cause TEN. Our findings showed that high mortality rates and widespread skin erosion could be regarded as the most important characteristics of TEN occurring after BMT.


Assuntos
Transplante de Medula Óssea/efeitos adversos , Rejeição de Enxerto/imunologia , Síndrome de Stevens-Johnson/imunologia , Evolução Fatal , Feminino , Rejeição de Enxerto/complicações , Rejeição de Enxerto/prevenção & controle , Humanos , Enteropatias/etiologia , Linfo-Histiocitose Hemofagocítica/etiologia , Linfoma/terapia , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Ruptura Espontânea/etiologia , Síndrome de Stevens-Johnson/complicações , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/terapia
9.
Int J Mol Sci ; 20(9)2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31064097

RESUMO

Ventilator-associated pneumonia (VAP) leads to increased patients' mortality and medical expenditure. Monocyte chemoattractant protein-1 (MCP-1) plays a role in the pathogenesis of lung inflammation and infection. Therefore, the plasma concentration of MCP-1 was assessed and correlated with the clinical course in VAP patients. This retrospective observational study recruited 45 healthy volunteers, 12 non-VAP subjects, and 30 VAP patients. The diagnostic criteria for VAP were based on the American Thoracic Society guidelines, and the level of plasma MCP-1 was determined by ELISA. Plasma MCP-1 concentration was significantly elevated in the acute stage in VAP patients when compared with the control (p < 0.0001) and non-VAP patient groups (p = 0.0006). Subsequently, it was remarkably decreased following antibiotic treatment. Moreover, plasma MCP-1 concentration was positively correlated with indices of pulmonary dysfunction, including the lung injury score (p = 0.02) and the oxygenation index (p = 0.02). When patients with VAP developed adult respiratory distress syndrome (ARDS), their plasma MCP-1 concentrations were significantly higher than those of patients who did not develop ARDS (p = 0.04). Moreover, plasma MCP-1 concentration was highly correlated with organ failure scores, including simplified acute physiology score II (SAPS II, p < 0.0001), sequential organ failure assessment score (SOFA, p < 0.0001), organ dysfunctions and/or infection (ODIN, p < 0.0001), predisposition, insult response and organ dysfunction (PIRO, p = 0.005), and immunodeficiency, blood pressure, multilobular infiltrates on chest radiograph, platelets and hospitalization 10 days before onset of VAP (IBMP-10, p = 0.004). Our results demonstrate that plasma MCP-1 is an excellent marker for recognizing VAP when the cut-off level is set to 347.18 ng/mL (area under the curve (AUC) = 0.936, 95% CI = 0.863-0.977). In conclusion, MCP-1 not only could be a biological marker related to pulmonary dysfunction, organ failure, and mortality in patients with VAP, but also could be used for early recognition of VAP.


Assuntos
Quimiocina CCL2/sangue , Insuficiência de Múltiplos Órgãos/sangue , Pneumonia Associada à Ventilação Mecânica/sangue , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Pneumonia Associada à Ventilação Mecânica/complicações , Pneumonia Associada à Ventilação Mecânica/mortalidade
10.
Drug Discov Ther ; 13(2): 101-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080200

RESUMO

Acute febrile illness (AFI) is one of the commonest indications for hospitalization and can present with varying severity including single or multiple organ dysfunction syndrome (MODS). During monsoon season, there is a spurt of AFI often caused by vector borne diseases leading to substantial morbidity and mortality. Our aim was to determine distribution of etiological causes, differential organ involvement and predictors of mortality in critically ill patients with AFI. It was a hospital based observational study which included patients with AFI with dysfunction of at least one organ system. The study was conducted over 4 months during monsoon season. Admitted patients were included who had been subjected to a standard battery of tests and managed with standard hospital based management protocol. 145 patients were included and etiology of fever was ascertained in 81.4% of patients with the most common single infection being chikungunya (20.7%) followed by dengue (20%) fever. Thrombocytopenia and deranged liver biochemistry each were seen in nearly 75% of the patients. Renal (50.3%) and nervous system (46.2%) dysfunction were the predominant organ failures. 49 patients died (33.8%) which correlated with predicted mortality by APACHE (acute physiological assessment and chronic health evaluation) II score. Independent predictors for mortality were older age (> 55 years) (p = 0.01), acidemia (p = 0.01), altered sensorium (p = 0.02) and coagulopathy (p = 0.048). Sub-group analysis revealed that amongst patients with MODS, hypotension could help differentiate between bacterial and non-bacterial causes (p = 0.01). Critically ill patients with AFI suffer from significant morbidity and mortality. Features like the presence of hypotension in MODS may differentiate between a bacterial cause vis-à-vis viral or protozoal etiology.


Assuntos
Febre de Chikungunya/epidemiologia , Estado Terminal/mortalidade , Dengue/epidemiologia , Hipotensão/epidemiologia , Insuficiência de Múltiplos Órgãos/etiologia , APACHE , Adolescente , Adulto , Febre de Chikungunya/complicações , Febre de Chikungunya/transmissão , Criança , Dengue/complicações , Dengue/transmissão , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/classificação , Insuficiência de Múltiplos Órgãos/mortalidade , Estudos Prospectivos , Fatores de Risco , Estações do Ano , Centros de Atenção Terciária , Adulto Jovem
11.
Ann Lab Med ; 39(5): 454-463, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31037864

RESUMO

BACKGROUND: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Biologically active adrenomedullin (bio-ADM) is an emerging biomarker for sepsis. We explored whether bio-ADM concentration could predict severity, organ failure, and 30-day mortality in septic patients. METHODS: In 215 septic patients (109 patients with sepsis; 106 patients with septic shock), bio-ADM concentration was measured at diagnosis of sepsis, using sphingotest bio-ADM (Sphingotec GmbH, Hennigsdorf, Germany) and analyzed in terms of sepsis severity, vasopressor use, and 30-day mortality. The number of organ failures, sequential (sepsis-related) organ failure assessment (SOFA) score, and 30-day mortality were compared according to bio-ADM quartiles. RESULTS: Bio-ADM concentration was significantly higher in patients with septic shock, vasopressor use, and non-survivors than in patients with solitary sepsis, no vasopressor use, and survivors, respectively (all P<0.0001). Bio-ADM quartiles were associated with the number of organ failures (P<0.0001), as well as SOFA cardiovascular, renal, coagulation, and liver subscores (all P<0.05). The 30-day mortality rate showed a stepwise increase in each bio-ADM quartile (all P<0.0001). Bio-ADM concentration and SOFA score equally predicted the 30-day mortality (area under the curve: 0.827 vs 0.830). CONCLUSIONS: Bio-ADM could serve as a useful and objective biomarker to predict severity, organ failure, and 30-day mortality in septic patients.


Assuntos
Adrenomedulina/sangue , Insuficiência de Múltiplos Órgãos/etiologia , Sepse/diagnóstico , Idoso , Área Sob a Curva , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Curva ROC , Sepse/complicações , Sepse/mortalidade , Índice de Gravidade de Doença , Choque Séptico/complicações , Choque Séptico/diagnóstico , Choque Séptico/mortalidade , Taxa de Sobrevida
12.
BMC Gastroenterol ; 19(1): 67, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046705

RESUMO

BACKGROUND: Systemic alterations in coagulation are associated with complications of acute pancreatitis (AP). D-dimer, a fibrin degradation product, was recently described as a marker of pancreatitis outcome. Early prediction is essential for reducing mortality in AP. The present study aims to assess the relationship between elevated serum D-dimer levels and the severity of AP. METHODS: We performed an observational retrospective study with data from 3451 enrolled patients with AP. Serum D-dimer levels were measured upon admission, after 24 h and during the week after admission by immunoturbidimetry. Univariate and multivariate analyses were used to determine whether elevated D-dimer levels were independently associated with the severity of AP. RESULTS: Of the 3451 AP patients, 2478 (71.8%) had serum D-dimer levels measured within 24 h of hospital admission; 1273 of these patients had D-dimer levels ≤2.5 mg/L, and 1205 had D-dimer levels > 2.5 mg/L (934 patients had mild AP (MAP); 1086, moderately severe AP (MSAP); and 458, severe AP (SAP)). Patients with D-dimer levels > 2.5 mg/L (n = 1205) had higher incidences of SAP (75.5% vs. 24.5%), acute peripancreatic fluid collection (APFC) (53.3% vs. 46.7%), acute necrotic collection (ANC) (72.4% vs. 27.6%), pancreatic necrosis (PN) (65.2% vs. 34.8%), infected pancreatic necrosis (IPN) (77.7% vs. 22.8%), organ failure (OF) (68.5% vs. 31.5%), persistent organ failure (POF) (75.5% vs. 24.5%), ICU requirement (70.2% vs. 29.8%), and mortality (79.2% vs. 20.8%) than did patients with D-dimer levels ≤2.5 mg/L (n = 1273). The multivariate analysis showed that patients with higher serum D-dimer levels had poorer prognoses that worsened over time. CONCLUSION: The measurement of D-dimer levels at admission may be useful for risk stratification of AP.


Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Pancreatite/sangue , Pancreatite/diagnóstico , Índice de Gravidade de Doença , Doença Aguda , Adulto , Biomarcadores/sangue , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Necrose/etiologia , Pancreatite/complicações , Pancreatite/mortalidade , Prognóstico , Estudos Retrospectivos , Medição de Risco
13.
J Card Surg ; 34(6): 506-510, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30981210

RESUMO

A 66-year-old Asian female diagnosed with an occupied mass of the inferior vena cava (IVC) case with extension to the right atrium, bilateral renal vasculature, and venae iliaca communis, which caused severe thrombocytopenia and severe liver and kidney dysfunction. The postoperative pathological diagnosis was high-grade undifferentiated intimal sarcoma. There have been less than 10 cases of venous undifferentiated intimal sarcomas reported in the literature, three of which occurred in the IVC. Unfortunately, the patient died of multiple organ failure in the intensive care unit postoperatively.


Assuntos
Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/patologia , Veia Ilíaca , Rim/irrigação sanguínea , Sarcoma/complicações , Sarcoma/patologia , Trombocitopenia/etiologia , Túnica Íntima , Neoplasias Vasculares/complicações , Neoplasias Vasculares/patologia , Veia Cava Inferior , Idoso , Evolução Fatal , Feminino , Átrios do Coração , Neoplasias Cardíacas/diagnóstico , Humanos , Insuficiência de Múltiplos Órgãos/etiologia , Invasividade Neoplásica , Sarcoma/diagnóstico , Sarcoma/cirurgia , Índice de Gravidade de Doença , Neoplasias Vasculares/diagnóstico , Neoplasias Vasculares/cirurgia
14.
Leg Med (Tokyo) ; 38: 64-68, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30991227

RESUMO

Although fatal colchicine intoxications are rare and mostly related to suicidal intake or accidental overdose, other hypotheses should be considered when dealing with colchicine poisoning. We present a case of double, acute, and subacute, fatal colchicine intoxication in a married couple. The 70-year-old male victim suddenly died after vomiting and diarrhea. The next day his wife showed aggravating gastrointestinal symptoms and was hospitalized with a diagnosis of septic shock. A complete postmortem examination on the man was performed, together with histopathological analysis. Toxicological examination performed through liquid chromatography coupled to mass spectrometry revealed a colchicine blood peripheral concentration of 33 ng/mL. A few days after hospitalization, the woman showed a colchicine plasma concentration of 32 ng/mL. Despite veno-venous hemofiltration, she ultimately died of septic shock and multi-organ failure. Death scene investigation revealed that, a few days before the death of the male victim, the couple had collected wild saffron and had eaten a presumed saffron risotto. The integrated analysis of circumstantial, clinical, postmortem and toxicological data allowed to establish that the couple had died of a fatal accidental intoxication due to the ingestion of natural colchicine, mistaken for saffron. The death of the male was deemed caused by acute cardiovascular collapse induced by acute intoxication, while the female had suffered a subacute poisoning by antimitotic agent, resulting in immunosuppression and systemic infection. Toxicological analyses, promptly performed on the man for forensic purposes, directed the investigations and suggested the clinical diagnosis on the woman.


Assuntos
Antimitóticos/envenenamento , Colchicina/envenenamento , Crocus , Medicina Legal , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/patologia , Choque Séptico/etiologia , Choque Séptico/patologia , Choque/etiologia , Choque/patologia , Acidentes , Doença Aguda , Idoso , Autopsia , Colchicina/sangue , Evolução Fatal , Feminino , Humanos , Masculino , Cônjuges
15.
Rinsho Shinkeigaku ; 59(4): 195-199, 2019 Apr 25.
Artigo em Japonês | MEDLINE | ID: mdl-30930366

RESUMO

A 73-year-old women visited emergency department because of sudden right hemiplegia. She had a history of duodenum papilla cancer terminal stage and multiple liver metastasis. On admission, diffusion weighted images revealed high intensity area at left middle cerebral artery territory. In addition, 3D-TOF MRA depicted proximal part of the left internal carotid artery. We performed endovascular thrombectomy because low platelet count met contraindication of intravenous recombinant tissue plasminogen activator therapy. Although we could get partial recanalization of middle cerebral artery occlusion after thrombectomy, the patient eventually died due to multiple organ failure. Autopsy findings showed white thrombus on mitral valve and also left middle cerebral artery occluded by similar white thrombus without infective findings. The patient was finally diagnosed with nonbacterial thrombotic endocarditis due to white thrombus on the mitral valve. We should select appropriate mechanical thrombectomy devices with a case of cerebral infarction due to nonbacterial thrombotic endocarditis because its thrombus is often white thrombus and would be hard.


Assuntos
Autopsia , Endocardite não Infecciosa/complicações , Endocardite não Infecciosa/patologia , Procedimentos Endovasculares , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/patologia , Trombectomia/métodos , Idoso , Plaquetas/patologia , Endocardite não Infecciosa/cirurgia , Evolução Fatal , Feminino , Humanos , Imagem por Ressonância Magnética , Valva Mitral/patologia , Insuficiência de Múltiplos Órgãos/etiologia , Infarto do Miocárdio/cirurgia , Neuroimagem , Trombectomia/instrumentação
16.
Tex Heart Inst J ; 46(1): 32-35, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30833835

RESUMO

Infections from coxsackie B2 viruses often cause viral myocarditis and, only rarely, multisystem organ impairment. We present the unusual case of a 42-year-old man in whom coxsackie B2 virus infection caused multiorgan infection, necessitating distal pancreatectomy, splenectomy, renal dialysis, and venoarterial extracorporeal membrane oxygenation with mechanical ventilation. In addition, the patient had a rapid-eye-movement sleep-related conduction abnormality that caused frequent sinus pauses of longer than 10 s, presumably due to myocarditis from the coxsackievirus infection. He recovered after permanent pacemaker placement and was discharged from the hospital. We discuss our aggressive supportive care and the few other reports of multiorgan impairment from coxsackieviruses.


Assuntos
Infecções por Coxsackievirus/complicações , Insuficiência de Múltiplos Órgãos/etiologia , Choque Cardiogênico/etiologia , Adulto , Infecções por Coxsackievirus/diagnóstico , Infecções por Coxsackievirus/virologia , Ecocardiografia , Humanos , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Choque Cardiogênico/diagnóstico , Tomografia Computadorizada por Raios X
17.
Mil Med ; 184(Suppl 1): 282-290, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901474

RESUMO

OBJECTIVE: Blast injury is associated with multi-organ failure (MOF), causing significant morbidity and mortality in trauma patients. However, the pathogenesis of blast-induced MOF still remains obscure. In this study, we evaluate the pathophysiological changes related to blast-induced MOF in a clinically relevant rat model of blast injury. METHODS: A moderate blast overpressure was applied to induce injury in anesthetized rats. Pathological changes were evaluated by H&E staining. Complement activation, plasminogen, and myeloperoxidase levels were analyzed by complement hemolytic assay (CH50) and/or ELISA in blood samples. RESULTS: Analysis of lung, brain, and liver tissue at 24 hour after blast overpressure revealed severe injuries. The level of complement components C3 and C1q decreased in parallel with the reduction of CH50 level in injured animals at 1, 3, and 6 hours after blast. Consumption of plasminogen was also detected as early as 1 hour post-injury. Myeloperoxidase levels were elevated within 1 hour of blast injury. CONCLUSION: Our data reveal that blast injury triggers the complement and fibrinolytic systems, which likely contribute to blast-induced MOF. Conceivably, therapies that target these systems early may improve clinical outcomes in blast patients.


Assuntos
Traumatismos por Explosões/tratamento farmacológico , Fibrinolíticos/farmacocinética , Insuficiência de Múltiplos Órgãos/etiologia , Animais , Traumatismos por Explosões/complicações , Encéfalo/efeitos dos fármacos , Encéfalo/patologia , Encéfalo/fisiopatologia , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática/métodos , Fibrinolíticos/sangue , Fibrinolíticos/uso terapêutico , Escala de Gravidade do Ferimento , Fígado/efeitos dos fármacos , Fígado/patologia , Fígado/fisiopatologia , Pulmão/efeitos dos fármacos , Pulmão/patologia , Pulmão/fisiopatologia , Masculino , Insuficiência de Múltiplos Órgãos/tratamento farmacológico , Ratos , Ratos Sprague-Dawley/sangue , Estatísticas não Paramétricas
18.
BMJ Case Rep ; 12(3)2019 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-30902844

RESUMO

A 59-year-oldwoman presented with a 2-month history of malaise, abdominal distention and unintentional weight loss. She was initially managed as community acquired pneumonia with a suspicion of underlying chronic liver disease but she deteriorated rapidly into a multiorgan failure necessitating transfer to intensive care unit of a tertiary hospital. She was investigated with liver and bone marrow biopsy that confirmed the diagnosis of hepatosplenic T cell lymphoma. She was treated with cyclophosphamide, doxorubicin, vincristine, etoposide and prednisolone chemotherapy that was changed to salvage ifosfamide carboplatin etoposide (ICE) chemotherapy due to poor response with first-line chemotherapy and disease progression. Unfortunately, her disease progressed further and she opted for palliative management.


Assuntos
Neoplasias Hepáticas/complicações , Linfoma de Células T/complicações , Insuficiência de Múltiplos Órgãos/etiologia , Neoplasias Esplênicas/complicações , Feminino , Humanos , Pessoa de Meia-Idade
19.
Zhonghua Shao Shang Za Zhi ; 35(3): 161-162, 2019 Mar 20.
Artigo em Chinês | MEDLINE | ID: mdl-30897860

RESUMO

Objective: A series of pathophysiological changes occur in a body with burn, among which the pathophysiological changes in organs are rather insidious but have far-reaching effects. At present, in clinical practice, we mainly adopt symptomatic or alternative treatment to deal with organ dysfunction, lacking systematic intervention measures based on clear and perfect theoretical data. Theme of the key article of this issue is the injury and protection of organs in the early stage after burns. The collected articles show the current status and frontiers of the research on this topic in China, including the retrospective analysis of clinical data, exploration of cell-level injury mechanism, and experimental treatment scheme in animal models. However, until now, few instructive or inspiring articles have been published. I appeal more colleagues could focus on this, explore more, research more, and share more.


Assuntos
Queimaduras/complicações , Queimaduras/patologia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Animais , China , Rim/fisiopatologia , Fígado/fisiopatologia , Pulmão/fisiopatologia , Insuficiência de Múltiplos Órgãos/etiologia , Estudos Retrospectivos
20.
Zhonghua Shao Shang Za Zhi ; 35(3): 163-168, 2019 Mar 20.
Artigo em Chinês | MEDLINE | ID: mdl-30897861

RESUMO

Objective: To analyze the clinical characteristics of early organ injury in elderly patients with severe burns and the effects on the prognosis of patients. Methods: From January 2010 to August 2018, 62 patients with severe burns (43 men and 19 women, aged from 60 to 89 years at the time of admission) who were hospitalized in the Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University, hereinafter referred to as the author's affiliation), meeting the inclusion criteria, were included in elderly (E) group, and 124 patients with severe burns (86 men and 38 women, aged from 18 to 59 years at the time of admission) at the same term were included in young and middle-aged (YM) group. Treatment of patients in the 2 groups followed the conventional procedures of the author's affiliation. The following data of patients in the 2 groups were retrospectively analyzed. (1) Fluid replacement volume and urine volume within the first and second post injury hour (PIH) 24 were recorded. The levels of hemoglobin, haematocrit, and blood lactic acid at admission, PIH 24 and 48 were recorded. (2) The creatine kinase isozyme-MB (CK-MB), total bilirubin, blood creatinine, oxygenation index, and blood platelet count at admission, at shock stage, and on post injury day (PID) 3 to 7 were collected. (3) The days of seriously or critically ill and deaths were recorded. Data were processed with chi-square test, group t test, Mann-Whitney U test, analysis of variance for repeated measurement, and Bonferroni correction. Results: (1) There were no statistically significant differences in fluid replacement volume within the first and second PIH 24, and urine volume within the second PIH 24 between patients in the 2 groups (t=0.351, 1.307, 1.110, P>0.05). The urine volume of patients in group E within the first PIH 24 was significantly less than that in group YM (t=5.628, P<0.05). There were no statistically significant differences in levels of hemoglobin (t=0.011, 1.075, 0.239), haematocrit (t=0, 0.033, 0.199), and blood lactic acid (t=0.017, 1.002, 0.739) at admission, PIH 24 and 48 between patients in the 2 groups (P>0.05). (2) There were no statistically significant differences in levels of CK-MB at admission and on PID 3 to 7 between patients in the 2 groups (t=0.069, 0.001, P>0.05). The level of CK-MB of patients in group E at shock stage was significantly higher than that in group YM (t=4.017, P<0.05). There were no statistically significant differences in levels of total bilirubin at admission and on PID 3 to 7 between patients in the 2 groups (t=0.227, 0.002, P>0.05). However, the level of total bilirubin of patients in group E at shock stage was significantly higher than that in group YM (t=6.485, P<0.05). The levels of blood creatinine of patients in group E at admission and shock stage were significantly higher than those in group YM (t=4.226, 12.299, P<0.05 or P<0.01), while there was no statistically significant difference between them on PID 3 to 7 (t=0.693, P>0.05). The oxygenation indexes of patients in group E at admission and shock stage and on PID 3 to 7 [(371±16), (263±16), and (228±18) mmHg (1 mmHg=0.133 kPa)] were lower than (420±13), (327±13), and (281±17) mmHg of patients in group YM, respectively (t=5.650, 9.782, 4.856, P<0.05 or P<0.01). There were no statistically significant differences in levels of blood platelet count at admission and shock stage between patients in the 2 groups (t=0.038, 0.588, P>0.05), while the level of blood platelet count of patients in group E on PID 3 to 7 was significantly lower than that in group YM (t=6.636, P<0.05). (3) The days of seriously or critically ill and death rate of patients in group E were respectively longer or higher than those in group YM (Z=-2.303, χ(2)=13.676, P<0.05 or P<0.01). Conclusions: In the case of the same tissue perfusion at shock stage, injuries in heart, liver, kidney, lung, and coagulation system in elderly patients with severe burns are more obvious than those in young and middle-aged patients, with more severe illness and higher mortality.


Assuntos
Queimaduras/complicações , Insuficiência de Múltiplos Órgãos/fisiopatologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
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