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https://www.readbyqxmd.com/read/29140803/use-of-postmortem-computed-tomography-to-detect-bowel-obstruction-and-its-relationship-to-the-cause-of-death
#1
Dominic Gascho, Sarah Schaerli, Lucile Tuchtan-Torrents, Michael J Thali, Guillaume Gorincour
Bowel distension frequently indicates bowel obstruction, which is a common diagnosis in clinical radiology. Typically, symptoms and complaints lead to radiological examinations and the detection of the etiology. Untreated intestinal obstructions can lead to a fatal outcome through cardiac failure due to septic shock. Certain of these cases undergo medicolegal investigations depending on the case history, the condition of the decedent, the location of the finding, or recent visits to medical professionals. Computed tomography (CT) is a recommended method in clinical radiology for the detection of bowel obstruction, which is indicated by bowel distension and further radiological signs (eg, the whirl sign, which indicates a volvulus)...
November 15, 2017: American Journal of Forensic Medicine and Pathology
https://www.readbyqxmd.com/read/29137105/urgent-laparoscopic-ureterolithotomy-for-proximal-ureter-stones-accompanied-with-obstructive-pyelonephritis-is-it-safe-and-effective-without-preoperative-drainage
#2
Huan Yang, Xiao Yu, Ejun Peng, Cong Li, Lei Cui, Xing Zeng, Shen Wang, Chao Wei, Zhihua Wang, Xiaolin Guo, Zhiqiang Chen, Zhangqun Ye, Shaogang Wang, Chenming Zhao
To evaluate the safety and efficacy of retroperitoneal laparoscopic ureterolithotomy (RLU) in the treatment of proximal ureteral stones accompanied with obstructive pyelonephritis without preoperative drainage.We retrospectively reviewed 21 cases of proximal ureteral stones with infected kidney undergoing RLU between July 2013 and September 2016. Stone-induced obstructive infected hydronephrosis was diagnosed using blood and urine tests and imaging modalities. Empirical effective broad spectrum antibiotic therapy was initiated immediately, and then urgent RLU was performed without preoperative drainage...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29128300/enteral-versus-parenteral-early-nutrition-in-ventilated-adults-with-shock-a-randomised-controlled-multicentre-open-label-parallel-group-study-nutrirea-2
#3
Jean Reignier, Julie Boisramé-Helms, Laurent Brisard, Jean-Baptiste Lascarrou, Ali Ait Hssain, Nadia Anguel, Laurent Argaud, Karim Asehnoune, Pierre Asfar, Frédéric Bellec, Vlad Botoc, Anne Bretagnol, Hoang-Nam Bui, Emmanuel Canet, Daniel Da Silva, Michael Darmon, Vincent Das, Jérôme Devaquet, Michel Djibre, Frédérique Ganster, Maité Garrouste-Orgeas, Stéphane Gaudry, Olivier Gontier, Claude Guérin, Bertrand Guidet, Christophe Guitton, Jean-Etienne Herbrecht, Jean-Claude Lacherade, Philippe Letocart, Frédéric Martino, Virginie Maxime, Emmanuelle Mercier, Jean-Paul Mira, Saad Nseir, Gael Piton, Jean-Pierre Quenot, Jack Richecoeur, Jean-Philippe Rigaud, René Robert, Nathalie Rolin, Carole Schwebel, Michel Sirodot, François Tinturier, Didier Thévenin, Bruno Giraudeau, Amélie Le Gouge
BACKGROUND: Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition. METHODS: In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20-25 kcal/kg per day), within 24 h after intubation...
November 8, 2017: Lancet
https://www.readbyqxmd.com/read/29106557/surgical-results-of-mitral-valve-repair-for-congenital-mitral-valve-stenosis-in-paediatric-patients
#4
Sungkyu Cho, Woong-Han Kim, Jae Gun Kwak, Jeong Ryul Lee, Yong Jin Kim
OBJECTIVES: Mitral valve (MV) repairs have been performed in paediatric patients with congenital MV stenosis. However, congenital MV stenosis lesions are a heterogeneous group of lesions, and their repair remains challenging. METHODS: From March 1999 to September 2014, MV repair was performed in 22 patients with congenital MV stenosis. The median age was 10.3 months (ranging from 22 days to 9.1 years), and the mean body weight was 7.9 ± 4.0 kg at the time of the operation...
July 4, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29069033/postrenal-acute-kidney-injury-in-a-patient-with-unilateral-ureteral-obstruction-caused-by-urolithiasis-a-case-report
#5
Itsuro Kazama, Toshiyuki Nakajima
RATIONALE: In patients with bilateral ureteral obstruction, the serum creatinine levels are often elevated, sometimes causing postrenal acute kidney injury (AKI). In contrast, those with unilateral ureteral obstruction present normal serum creatinine levels, as long as their contralateral kidneys are preserved intact. However, the unilateral obstruction of the ureter could affect the renal function, as it humorally influences the renal hemodynamics. PATIENT CONCERNS: A 66-year-old man with a past medical history of hypertension and diabetes mellitus came to our outpatient clinic because of right abdominal dullness...
October 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29065405/risk-factors-for-uroseptic-shock-in-patients-with-urolithiasis-related-acute-pyelonephritis
#6
Hiroaki Kakinoki, Shohei Tobu, Yuka Kakinoki, Kazuma Udo, Jiro Uozumi, Mitsuru Noguchi
OBJECTIVES: To analyze the risk factors of uroseptic shock induced by calculous acute pyelonephritis (APN). METHODS: This study included 69 patients (41 were women and 28 were men) who were admitted to our hospital for APN treatment associated with urolithiasis during the period from January 2005 to December 2012. We reviewed the electronic medical records of these patients to analyze risk factors contributing to the development of uroseptic shock from APN in patients with urolithiasis...
October 24, 2017: Urologia Internationalis
https://www.readbyqxmd.com/read/29058996/successful-use-of-extracorporeal-membrane-oxygenation-in-a-child-with-obstructive-shock-due-to-massive-bilateral-pulmonary-embolism
#7
Aditya Badheka, Pradeep Bangalore Prakash, Veerajalandhar Allareddy
BACKGROUND: Acute massive pulmonary embolism (PE) is a very rare condition in children. We report the successful use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) as a lifesaving modality in a child with acute massive PE. CASE PRESENTATION: A nine-year-old female with spinal muscular atrophy type 1, chronic respiratory failure with tracheostomy and ventilator dependence presented with tachypnea and hypoxia. She had recent coiling of her pulmonary arterio-venous malformation...
October 1, 2017: Perfusion
https://www.readbyqxmd.com/read/29057883/non-muscular-myosin-light-chain-kinase-triggers-intermittent-hypoxia-induced-interleukin-6-release-endothelial-dysfunction-and-permeability
#8
Sylvain Recoquillon, Manuel Gómez-Guzmán, Marion Rodier, Camille Koffi, Mathieu Nitiéma, Frédéric Gagnadoux, M Carmen Martínez, Ramaroson Andriantsitohaina
Obstructive sleep apnea is characterized by intermittent hypoxia (IH) which alters endothelial function, induces inflammation and accelerates atherosclerosis-induced cardiovascular diseases. The non-muscular myosin light chain kinase (nmMLCK) isoform contributes to endothelial cell-cell junction opening. Deletion of nmMLCK protects mice from death in septic shock models and prevents atherosclerosis in high-fat diet-fed mice. The aim of the study was to analyze the implication of nmMLCK in IH-induced vascular inflammation...
October 20, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29039623/the-challenge-of-takotsubo-syndrome-heterogeneity-of-clinical-features
#9
Susanne Anna Schlossbauer, Jelena-Rima Ghadri, Frank Scherff, Christian Templin
Takotsubo syndrome (TTS) was first described in 1991 as a rare, spontaneous and completely reversible left ventricular regional systolic dysfunction. Today the incidence of TTS is estimated at 2% in patients with an initial diagnosis of acute coronary syndrome (ACS). Notably, the incidence can be as high as 5.9 to 7.5% in female patients. TTS occurs predominantly in postmenopausal women, but both sexes may be affected, at any age. Acute chest pain or dyspnoea is a characteristic symptom of TTS, but initial presentation can also include more severe disease manifestation such as acute heart failure with pulmonary oedema or haemodynamic instability, especially in an in-hospital setting...
October 17, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/29034045/severe-obstructive-calcification-of-the-descending-aorta-a-case-report-of-coral-reef-aorta
#10
Takahiro Ishigaki, Hitoshi Matsuda, Soichiro Henmi, Masato Yoshida, Nobuhiko Mukohara
An 82-year-old man suffering from lower back pain and dyspnea presented to our institute in a state of shock. Computed tomography showed subtotal occlusion of the descending aorta with massive atherosclerotic calcification. As the proximal portion of the superior mesenteric artery was obstructed, emergency bypass from the right axillary artery to the bilateral external iliac arteries was performed, but the patient died 2 days later. Autopsy revealed that reddish-brown and verrucous masses obstructed the descending aorta, and high-grade thickening of the intima and extensive deposits of calcium in the lumina and medial layer were detected in the descending aorta histologically...
June 25, 2017: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/29026736/giant-duplication-cyst-presenting-as-a-discharging-umbilicus
#11
Ravi Kumar Garg, Monika Bawa, Katragadda Lakshmi Narasimha Rao
Alimentary tract duplication cysts are rare congenital anomalies, most commonly located in the ileum, but may present anywhere from mouth to anus.Clinically, they may be asymptomatic, incidentally diagnosed or may present with obstruction, volvulus, intussusception or gastrointestinal bleed. Here we report a case of a one year old male child presenting in gasping state and shock. Despite the initial strong suspicion of Meckel's diverticulum and tubercular abdomen, the final diagnosis remained elusive till exploratory laparotomy was performed which revealed a duplication cyst of ileum with perforation into the umbilicus...
September 2017: Pediatric Gastroenterology, Hepatology & Nutrition
https://www.readbyqxmd.com/read/28988256/primary-leiomyosarcoma-of-the-atrium-with-heterologous-differentiation
#12
Shaesta Zaidi, Sufia Husain, Dona Barakah
We report a case of a 47-year-old female who presented with breathlessness and palpitations for two weeks. On clinical evaluation, bilateral pedal edema was noticed. A CT pulmonary angiogram showed a mass in the left atrium causing significant obstruction to cardiovascular outflow. After extensive work-up, the mass was surgically resected. Histopathological findings from the acquired specimen revealed a high-grade leiomyosarcoma with extensive necrosis and heterologous (cartilaginous) differentiation. The early postoperative period was complicated by cardiac tamponade and the patient died on the second postoperative day due to ventricular arrhythmia, shock and multiorgan failure...
September 2017: Annals of Saudi Medicine
https://www.readbyqxmd.com/read/28979907/the-perfect-storm-a-quadrifecta-of-complications-with-takotsubo-cardiomyopathy
#13
Raj Amin, Timothy Fritz, Richard McNamara
Takotsubo cardiomyopathy is generally considered to have a favorable prognosis. However, several major problems may complicate the clinical course. We present a patient with four simultaneous complications of shock, left ventricular thrombus, left ventricular outflow obstruction, and severe mitral regurgitation. Despite this dramatic presentation, the patient had a complete recovery with resolution of all four complications within weeks.
December 30, 2016: Global Cardiology Science & Practice
https://www.readbyqxmd.com/read/28976774/proteomic-analysis-of-extracellular-hmgb1-identifies-binding-partners-and-exposes-its-potential-role-in-airway-epithelial-cell-homeostasis
#14
Sharon L Wong, Joyce To, Jerran Santos, Venkata Sita Rama Raju Allam, John P Dalton, Steven P Djordjevic, Sheila Donnelly, Matthew P Padula, Maria B Sukkar
The release of damage-associated molecular patterns (DAMPs) by airway epithelial cells is believed to play a crucial role in the initiation and development of chronic airway conditions such as asthma and chronic obstructive pulmonary disease (COPD). Intriguingly, the classic DAMP high-mobility group box-1 (HMGB1) is detected in the culture supernatant of airway epithelial cells under basal conditions, indicating a role for HMGB1 in the regulation of epithelial cellular and immune homeostasis. To gain contextual insight into the potential role of HMGB1 in airway epithelial cell homeostasis, we used the orthogonal and complementary methods of high-resolution clear native electrophoresis, immunoprecipitation, and pull-downs coupled to liquid chromatography-tandem mass spectrometry (LC-MS/MS) to profile HMGB1 and its binding partners in the culture supernatant of unstimulated airway epithelial cells...
November 14, 2017: Journal of Proteome Research
https://www.readbyqxmd.com/read/28954070/strong-renal-expression-of-heat-shock-protein-70-high-mobility-group-box-1-inducible-nitric-oxide-synthase-and-nitrotyrosine-in-mice-model-of-severe-malaria
#15
Loeki Enggar Fitri, Ervina Rosmarwati, Yesita Rizky, Niniek Budiarti, Nur Samsu, Karyono Mintaroem
INTRODUCTION: Renal damage is a consequence of severe malaria, and is generally caused by sequestration of Plasmodium falciparum -infected erythrocytes in the renal microcirculation, which leads to obstruction, hypoxia, and ischemia. This triggers high mobility group box 1 (HMGB1) to send a danger signal through toll-like receptors 2 and 4. This signal up-regulates inducible nitric oxide (iNOS) and nitrotyrosine to re-perfuse the tissue, and also increases heat shock protein 70 (HSP70) expression...
July 2017: Revista da Sociedade Brasileira de Medicina Tropical
https://www.readbyqxmd.com/read/28950331/direct-transatrial-implantation-of-balloon-expandable-valve-for-mitral-stenosis-with-severe-annular-calcifications-early-experience-and-lessons-learned
#16
Abdallah El Sabbagh, Mackram F Eleid, Thomas A Foley, Mohammed A Al-Hijji, Richard C Daly, Charanjit S Rihal, Sameh M Said
OBJECTIVES: Patients with symptomatic severe mitral annular calcification present a therapeutic challenge. Direct transatrial implantation of SAPIEN valve has emerged as an alternative to surgical mitral valve (MV) replacement for high-risk surgical candidates. METHODS: This series includes 6 consecutive patients with symptomatic severe mitral annular calcification deemed to be at high risk for standard surgery. All patients underwent direct transatrial implantation of balloon-expandable SAPIEN valve in the mitral position...
July 26, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28947230/indications-risk-factors-and-outcomes-of-30-day-readmission-after-infrarenal-abdominal-aneurysm-repair
#17
Hanaa N Dakour Aridi, Satinderjit Locham, Besma Nejim, Nasr S Ghajar, Husain Alshaikh, Mahmoud B Malas
OBJECTIVE: Reducing readmissions is an important target for improving patient care and enhancing health care quality and cost-effectiveness. The aim of this study was to assess rates, risk factors, and indications of 30-day readmission after open aortic repair (OAR) and endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms (AAAs). METHODS: A retrospective analysis of the Premier Healthcare Database from 2009 to 2015 was performed. Indications for readmission after the index procedure, risk factors, and outcomes of the index admission and rehospitalization were evaluated...
September 22, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28929717/-thunderstorm-and-asthma-outbreaks-during-pollen-season
#18
Maria D'Amato, Isabella Annesi-Maesano, Antonio Molino, Mauro Mormile, Carolina Vitale, Alessandro Vatrella, Alessandro Sanduzzi, Gennaro D'Amato
An increasing body of evidence shows the occurrence of asthma epidemics, sometimes also severe, during thunderstorms in the pollen season in various geographical zones. The main hypothesis explaining association between thunderstorms and asthma claims that thunderstorms can concentrate pollen grains at ground level; these grains may then release allergenic particles of respirable size in the atmosphere after their rupture by osmotic shock. During the first 20-30 minutes of a thunderstorm, patients suffering from pollen allergy may inhale a high concentration of the allergenic material dispersed into the atmosphere, which can, in turn, induce asthmatic reactions, often severe...
May 2017: Epidemiologia e Prevenzione
https://www.readbyqxmd.com/read/28917022/epidemiology-pathogenesis-and-management-of-takotsubo-syndrome
#19
REVIEW
Shams Y-Hassan, Per Tornvall
Takotsubo syndrome is a recently recognized acute cardiac disease entity with a clinical presentation resembling that of an acute coronary syndrome. The typical takotsubo syndrome patient has a unique circumferential left (bi-) ventricular contraction abnormality profile that extends beyond a coronary artery supply territory and appears to follow the anatomical cardiac sympathetic innervation. The syndrome predominantly affects postmenopausal women and is often preceded by emotional or physical stress. Patients with predisposing factors such as malignancy and other chronic comorbidities are more prone to suffer from takotsubo syndrome...
September 15, 2017: Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society
https://www.readbyqxmd.com/read/28916516/an-uncommon-manifestation-of-shock-takotsubo-syndrome
#20
Ying X Gue, Sanjay S Bhandari, Mubarak Ahamed
76 year old female presented following an episode of collapse. She was hypotensive with the paramedics and remained refractory despite fluid resuscitation. Her initial baseline tests revealed an elevated troponin; she subsequently underwent a coronary angiogram which showed mild coronary artery disease. Left ventriculogram was performed which showed abnormal mid-wall ballooning and severely impaired systolic function, characteristic of takotsubo syndrome. Echocardiogram confirmed presence of diagnosis and presence of left ventricular outflow tract obstruction with high gradient...
September 15, 2017: Echo Research and Practice
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