Transfusion-Associated Circulatory Overload (Taco) Presentations In Pediatric Patients

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S160-S160
Author(s):  
A Sallagonda ◽  
C Andrzejewski
Keyword(s):  
Case Series ◽  
Mitigation Strategies ◽  
Prior History ◽  
Ivig Infusion ◽  
Bowel Surgery ◽  
Circulatory Overload ◽  
Vulnerable Patient ◽  
History Of ◽  
Chest X Ray ◽  
Male Neonate

Abstract Introduction/Objective Limited literature exists regarding Transfusion Associated Circulatory Overload(TACO) in children. Its clinical expressions compared to those in adults remains to be fully explored. We report two TACO cases in children <18 months of age describing their clinical presentations compared to those in older patients. Methods/Case Report Case series Results (if a Case Study enter NA) Case 1: 1.13 kg 18 day old male neonate (27 weeks premature) with anemia requiring hemotherapy(HT). He received 35 ml aliquot of Red Blood Cells(RBCs) which he tolerated well on postoperative day(POD) 1 after bowel surgery. On POD 2, he was transfused RBCs(18 mls). Within 15 minutes of HT initiation, marked elevations in blood pressure(BP) were noted. Workup for a suspected transfusion reaction(STR) was initiated. Blood Bank studies revealed vital sign value(VSV) changes similarly seen in adults with TACO(Transfusion: 52; 2311, 2012). NT-proBNP levels post HT were markedly elevated (8,000 and 64,000 pg/ml).Case 2: 17 month old(11 kg) female with a three weeks prior history of COVID-19 admitted with fever/dehydration and subsequently diagnosed with multisystem inflammatory syndrome in children (MIS-C). Intravenous immunoglobulin(IVIG) infusion ordered and within 20 minutes of starting IVIG, she developed grunting. STR workup showed post HT BP/temperature elevations/chest X-ray with increased interstitial markings. Of note she had also received 1070 ml of intravenous fluids within 48 hours prior to HT. Elevated NT-proBNP levels pre/post HT were measured(17,121 pg/ml and 19, 824 pg/ml respectively). Symptoms improved with diuretics. Conclusion Children experiencing TACO can clinically manifest similarly as in adults with respect to BP elevations and pulmonary changes. Grunting may be an underappreciated manifestation of TACO in pts < 18 months of age. IVIG infusions used in the treatment of patients with MIS-C may present problematic fluid challenges. Recognition of and mitigation strategies for TACO risk factors in such patients may enhance HT safety in this vulnerable patient population.

Labyrinthitis ossificans: How accurate is MRI in predicting cochlear obstruction?

2009 ◽  
Vol 140 (5) ◽  
pp. 692-696 ◽  
Author(s):  
Brandon Isaacson ◽  
Timothy Booth ◽  
Joe W. Kutz ◽  
Kenneth H. Lee ◽  
Peter S. Roland
Keyword(s):  
High Resolution ◽  
Bacterial Meningitis ◽  
Cochlear Implant ◽  
Tertiary Care ◽  
Fibrous Tissue ◽  
Case Series ◽  
Prior History ◽  
Basal Turn ◽  
Labyrinthitis Ossificans ◽  
History Of

Objective: To determine the accuracy of preoperative MRI in predicting cochlear obstruction in pediatric patients with a history of bacterial meningitis. Methods: A case series with chart review was performed at a tertiary care multidisciplinary cochlear implant program. Forty-five children with hearing loss that resulted from bacterial meningitis were implanted from 1991 to 2006. Twenty-five children had preoperative MRI with high-resolution axial T2-weighted images to assess for cochlear patency. Results: Seventeen of 25 patients (68%) had surgical evidence of cochlear obstruction. Six patients (37.5%) required circummodiolar drill-outs, and one patient (6.25%) underwent placement of a double array cochlear implant. The nine remaining patients (56%) with cochlear obstruction required removal of fibrous tissue or drilling of the inferior basal turn, but did not require manipulation of the ascending basal turn to achieve full electrode insertion. The sensitivity, specificity, and positive and negative predictive value of MRI predicting intraoperative cochlear obstruction with 95 percent confidence intervals was 94.1 percent (71–99), 87.5 percent (47–99), 94.1 percent (71–99) and 87.5 percent (47–99), respectively. Conclusion: Preoperative high-resolution T2 MRI may be useful in predicting cochlear obstruction in patients with a prior history of bacterial meningitis.

scholarly journals Spontaneous Gallbladdre Perforation: A case series

2016 ◽  
Vol 18 (3) ◽  
pp. 31
Author(s):  
Sujit Kumar ◽  
Sanjay Negi ◽  
BN Patowary ◽  
Aditya Jalan ◽  
Sulabh Rajbhandari
Keyword(s):  
Rare Complication ◽  
Case Series ◽  
Biliary Colic ◽  
Gallbladder Perforation ◽  
Prior History ◽  
Aged Patients ◽  
Abdominal Radiographs ◽  
History Of ◽  
Abdominal Paracentesis ◽  
Fluid Levels

Background: Gallbladder is rarely injured as it is embedded in the liver and well protected by ribcage. Gallbladder perforation is a rare complication of acute calculus cholecystitis. Spontaneous gallbladder perforation is even rarer.Case Series: We present our experience of 4 cases of spontaneous gallbladder perforation. The patients were mostly males (3:1) with age ranging from 42-64 years. All the patients presented with abdominal pain, distension, ileus and fever ranging from 2-5 days duration. There was no prior history of biliary colic. Examination revealed abdominal tenderness and ileus. Abdominal radiographs showed multiple air-fluid levels and no pneumoperitoneum. Sonography and CT scan of abdomen revealed pericholecystic fluid, intra-abdominal collection with no evidence of gallstones. Provisional diagnosis was peritonitis in 3 and acute pancreatitis in one case. Image guided abdominal paracentesis yielded bilious fluid. In view of lack of clinical improvement and aspiration of bilious content all the patients were subjected to laparotomy. Gallbladder perforation in fundus region without stones and intra-abdominal bile collection was noted in all the patients. Cholecystectomy with peritoneal lavage and abdominal drainage was performed in all cases. Postoperative course was uneventful except wound infection in 2 cases. Histopathology report revealed features of acute cholecystitis in 2 and acute on chronic cholecystitis in the remaining 2 patients.Conclusion: Diagnosis of spontaneous gallbladder perforation should be suspected in middle aged patients who present with acute abdomen but does not have classical signs of peritonitis and in whom paracentesis has yielded bilious fluid.

scholarly journals 1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S308-S308 ◽  
Author(s):  
Adam Pettigrew ◽  
Ripal Jariwala ◽  
Kristen Zeitler ◽  
Jose Montero ◽  
Sandra Gompf ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Clostridium Difficile ◽  
Bloodstream Infection ◽  
Broad Spectrum ◽  
Case Series ◽  
Prior History ◽  
Broad Spectrum Antibiotics ◽  
History Of ◽  
Polymicrobial Bacteremia ◽  
Hospital Acquired

Abstract Background While Clostridium difficile gastrointestinal infection (CDI) is the most common hospital-acquired infectious disease, C. difficile bacteremia (CDB) is exceedingly rare and its risk factors, mortality rate, and modalities of treatment are not well defined. Methods We conducted a retrospective, IRB approved, chart review of adult patients with a diagnosis of CDB admitted to our institutions from 2011 through 2017. Variables catalogued included previous antibiotic and proton pump inhibitor (PPI) use, co-morbid conditions, prior history of CDI, diarrhea at the time of CDB, active malignancy, and gastrointestinal (GI) disruption (e.g., perforated viscous, GI bleeding, abdominal malignancy). Treatment courses and outcomes for CDB were also gleaned. Results Seven patients with CDB were identified, with ages ranging from 35 to 81 years (median 65 years). Six (85.7%) patients had evidence of GI disruption and three (42.9%) were noted to have active cancer. Three (42.9%) patients had previous CDI by testing and three (42.9%) had complaints of diarrhea at the time of diagnosis. Six (85.7%) patients had exposure to PPIs before CDB diagnosis, and five (71.4%) had prior antibiotic exposure in the past 30 days. Five (71.4%) patients had a polymicrobial bloodstream infection, with the majority of organisms being enteric in nature. In terms of CDB treatment, the majority of patients received intravenous (IV) metronidazole and/or IV vancomycin in addition to broad-spectrum antibiotics due to the polymicrobial nature of their infection. Three (42.9%) patients died during their hospitalization, only one who had polymicrobial bacteremia. Conclusion CDI is the most common cause of hospital acquired infection, although rarely causes bacteremia. Notable findings in our population included older age, concomitant malignancy, evidence of GI disruption, and prior exposure to PPIs and antibiotics. Antibiotics chosen to treat CDB were IV metronidazole and/or IV vancomycin, with other broad-spectrum antibiotics utilized due to polymicrobial bacteremia. CDB is associated with a high mortality rate and is commonly manifested as a polymicrobial bloodstream infection. This is one of the larger case series that adds to the scant literature characterizing patients diagnosed with CDB. Disclosures All authors: No reported disclosures.

scholarly journals Post-operative functional neurological symptom disorder after anesthesia

2020 ◽  
Author(s):  
Ryan S D'Souza ◽  
Matthew NP Vogt ◽  
Edwin Rho
Keyword(s):  
Neurological Symptom ◽  
Past History ◽  
Significant Proportion ◽  
Case Series ◽  
Pharmacologic Therapy ◽  
Prior History ◽  
General Anesthetic ◽  
Tertiary Referral Hospital ◽  
History Of ◽  
Functional Neurological Symptom Disorder

A rare manifestation during the post-anesthetic period may include the occurrence of functional neurological symptom disorder (FNSD). FNSD is described as neurological symptoms that are not consistently explained by neurological or medical conditions. We report a case series consisting of six patients who underwent a general anesthetic at a tertiary referral hospital and experienced FNSD in the immediate post-anesthetic period. Life-threatening causes were excluded based on benign physical exam findings and knowledge of past history. Five of six cases manifested with FNSD only in the immediate post-operative setting after exposure to anesthesia, and never otherwise experienced these symptoms during their normal daily lives. MEDLINE and Google Scholar were searched through October 2019 using a highly-sensitive search strategy and identified 38 published cases of post-anesthetic FNSD. Meta-analysis of pooled clinical data revealed that a significant proportion of patients were females (86%), reported a history of psychiatric illness (49%), reported a prior history of FNSD (53%), and underwent general anesthesia as the primary anesthetic (93%). The majority of patients were exposed to diagnostic studies (66% received radiographic tests and 52% received electroencephalogram) as well as pharmacologic therapy (57%). While no deaths occurred, many patients had unanticipated admission to the hospital (53%) or to the intensive care unit (25%). These data may help inform the anesthesia literature on presentation, risk factors, and treatment outcomes of FNSD in the context of anesthetic administration. We contemplate whether anesthetic agents may predispose a vulnerable brain to manifest with involuntary motor and sensory control seen in FNSD.

The Novel Use of Flexible Endoscopic Techniques in the Management of Pharyngocutaneous Fistulas

2021 ◽  
Author(s):  
Shivam Patel ◽  
Colin G. DeLong ◽  
Luis De Jesus Sanchez ◽  
Neerav Goyal ◽  
Eric M. Pauli
Keyword(s):  
Case Series ◽  
Spontaneous Resolution ◽  
Prior History ◽  
Pharyngocutaneous Fistula ◽  
The Novel ◽  
Endoscopic Techniques ◽  
Anterolateral Thigh ◽  
Successful Resolution ◽  
History Of ◽  
Reduced Rate

AbstractPharyngocutaneous fistula (PCF) is a complication of laryngectomies in 14 to 23% of patients. The rate of spontaneous resolution of small and low-output fistulas has been shown to be 65 to 94% in those who are radiation-naive, with a reduced rate of resolution in patients who were previously radiated as low as 33%. Two patients are presented who underwent total laryngopharyngectomy and anterolateral thigh free flap reconstruction at our institution eventually complicated with PCF. All the pertinent patient data were retrieved through chart review from the records of our institution. The cases presented had a prior history of radiation or chemoradiation complicating the spontaneous resolution of the PCF. Both patients had successful resolution of PCF with the flexible endoscopic techniques presented. This case series highlights the management of small PCFs using flexible endoscopic techniques including over-the-scope clips and Vicryl mesh plugs.

scholarly journals Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 patients—a case series

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Akshat Agrawal ◽  
Kamal Kumar Sen ◽  
Gitanjali Satapathy ◽  
Humsheer Singh Sethi ◽  
Ajay Sharawat ◽  
...  
Keyword(s):  
Subcutaneous Emphysema ◽  
Case Series ◽  
Prior History ◽  
Invasive Ventilation ◽  
Computed Tomography Scan ◽  
Case Presentation ◽  
Spontaneous Pneumomediastinum ◽  
History Of ◽  
Time Of Admission ◽  
Tomography Scan

Abstract Background Spontaneous pneumomediastinum, pneumothorax and spontaneous subcutaneous emphysema are rare entities. A rising trend in the setting of COVID-19 even in patients who are not put on invasive ventilation can suggest an alternative aetiology. Case presentation We describe four cases which presented with suspected symptoms of COVID-19 and were diagnosed with pneumomediastinum, pneumothorax, and subcutaneous emphysema which would have been missed if not for computed tomography scan performed at the time of admission. Three of these cases had no prior history of any iatrogenic intervention, and the fourth person developing pneumothorax and subcutaneous emphysema after intubation. Conclusions Pneumomediastinum, pneumothorax and subcutaneous emphysema can be noted as a complication of COVID-19 itself as well as the complication of management of COVID-19.

scholarly journals 1448. Prostate Abscess: Clinical Features, Management, and Outcomes of a “Stealth” Infection: A Case Series

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S528-S529
Author(s):  
Margaux E Wooster ◽  
Glen Huang ◽  
John W Sanders ◽  
James E Peacock
Keyword(s):  
Antibiotic Therapy ◽  
Median Duration ◽  
Case Series ◽  
Prior History ◽  
Abscess Drainage ◽  
Presenting Symptoms ◽  
Acute Prostatitis ◽  
All Cause Mortality ◽  
History Of ◽  
Comorbidity Index

Abstract Background Prostate abscess (PA) is uncommon and the diagnosis is often delayed or missed. Traditionally, PA has resulted from acute prostatitis or ascending genitourinary (GU) infection due to gram-negative bacilli but S. aureus is an emerging cause. Methods A retrospective review of all adult patients admitted with an ICD-9 or -10 diagnosis of PA between January 2013 and July 2018 was conducted. Inclusion criteria included age ≥18 years, a compatible GU infection syndrome, and imaging consistent with PA. Results Twenty-two patients with PA were identified. The median age was 57 years. Five patients (22.7%) were immunosuppressed and 11 (50%) had diabetes. The median Charlson Comorbidity Index was 2. No patient had a prior history of PA but 3 patients had a past diagnosis of prostatitis. Only 1 patient had GU instrumentation in the preceding 6 weeks and no patient had an indwelling urethral catheter. Fever (59%), dysuria (49%), and urinary retention (32%) were the most common presenting symptoms. Only 7/18 (39%) patients had a tender prostate on examination; fluctuance was not described. Pelvic CT revealed PAs in all patients; 14 (64%) were solitary and 16 (73%) were >2 cm in greatest diameter. The median abscess size was 3.2 cm. Urine cultures were positive in 11/18 (61%) patients with 6/11 (55%) growing S. aureus (MRSA 3); 9/16 (56%) patients had positive blood cultures (S. aureus 7 with MRSA 3) and 5/5 had positive PA cultures (S. aureus 1). Nine patients (41%) were managed with antibiotics alone whereas 13 (59%) underwent abscess drainage. The median duration of antibiotic therapy was 34.5 days. All-cause mortality at 4 weeks was 9.1%. No relapses were documented at 6 months. When comparing patients with S. aureus PA to those with other causes, S. aureus patients more often had diabetes (86% vs. 33%, P = 0.06) and a longer median duration of antibiotic therapy (35 days vs. 31 days, P = 0.04) but age, abscess size, and mortality did not differ between groups. Conclusion PA is relatively uncommon and may be difficult to distinguish clinically from acute prostatitis. CT is critical to an accurate diagnosis. Optimal management usually requires both antibiotics and drainage. Given the frequent occurrence of S. aureus as a cause, coverage for MRSA should be a component of empiric treatment for PA. Disclosures All authors: No reported disclosures.

scholarly journals Insight into the current practice of ototoxicity monitoring during cisplatin therapy

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
N. M. Santucci ◽  
B. Garber ◽  
R. Ivory ◽  
M. A. Kuhn ◽  
M. Stephen ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Monitoring Program ◽  
Case Series ◽  
Prior History ◽  
Study Cohort ◽  
Aural Rehabilitation ◽  
Academic Medical ◽  
History Of ◽  
Monitoring Protocols

Abstract Background The aim of this study is to evaluate the current state of ototoxicity monitoring for patients receiving cisplatin chemotherapy in an academic medical center with particular attention to how closely monitoring adheres to national ototoxicity guidelines. Methods Case series including retrospective medical records review of patients (age > 18) treated with cisplatin at University of California Davis Medical Center between January 2014 and August 2017. Patient and ototoxicity related variables were analyzed. Patients that underwent a transfer of care during treatment and with less than 3 months of follow-up were excluded. Results Three hundred seventy-nine patients met study criteria, of which 104 (27.4%) had a prior history of hearing loss. Prior to treatment, 196 (51.7%) patients were counseled regarding the ototoxic nature of cisplatin and 92 (24.3%) patients had a pretreatment audiogram. During treatment, 91 (24%) patients had documented otologic complaints. Only 17 patients (4.5%) patients had an audiogram ordered during their cisplatin treatment period. 130 (34.3%) patients had otologic complaints following cisplatin treatment. Audiograms were ordered for 20 (7.8%), 13 (5.1%), and 16 (6.2%) patients at 1-month, 3-month, and 6-month follow-ups, respectively. No patients in the study cohort received baseline, treatment, and post-treatment audiograms as recommended by national ototoxicity monitoring protocols. Patients with Head and Neck Cancer (HNC) represented the largest subgroup that received cisplatin (n = 122, 32.2%) and demonstrated higher rates of ototoxicity counseling (n = 103, 84.4%) and pretreatment audiograms (n = 70, 57.4%) compared to the non HNC group (n = 36, 36.2%, P < 0.0001 and n = 22, 8.5%, P < 0.0001). Conclusions There is poor adherence to national ototoxicity monitoring guidelines at a large academic medical center. This is a missed opportunity for intervention and aural rehabilitation. Improved education and collaboration between otolaryngology, audiology, and medical oncology is needed to develop and promote an effective ototoxicity-monitoring program. Graphical abstract

Teriparatide in individuals with a prior history of radiation therapy—a case series

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yee-Ming Melody Cheung ◽  
Ole-Petter Riksfjord Hamnvik
Keyword(s):  
Radiation Therapy ◽  
Case Series ◽  
Prior History ◽  
History Of

scholarly journals A cardiac manifestation in patients with COVID-19: a case series

2020 ◽  
Vol 8 (1) ◽  
pp. 124
Author(s):  
Archita Ravindranath ◽  
Madhumati Ramaiah ◽  
Parvaiz Kadloor
Keyword(s):  
Case Series ◽  
Respiratory Illness ◽  
Prior History ◽  
Microvascular Damage ◽  
Hypoxic Injury ◽  
History Of ◽  
Artery Disease ◽  
Cardiac Manifestation ◽  
Cardiac Manifestations ◽  
Severe Acute Respiratory Illness

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus or the coronavirus 2019 (COVID-19) infection is a novel viral infection causing the 2020 pandemic affecting primarily the respiratory system in the form of influenza like illness, severe acute respiratory illness or asymptomatic respiratory illness and other systems. The cardiovascular system may also be affected, with or without a prior history of cardiovascular diseases. Myocardial injury is common among patients hospitalized with COVID-19 due to stress cardiomyopathy, hypoxic injury, ischemic injury due to cardiac microvascular damage or epicardial coronary artery disease and cytokine storm, however rhythm abnormalities is affected rarely in a transient or severe manner causing rhythm disturbances. The concerns about COVID‐19 may result in a delay in proper approach and prompt management in many emergent medical conditions, such as cardiovascular problems. Here, we describe our experience with 4 COVID-19 patients with varied cardiac manifestations presenting to our hospital during the months of September- October 2020.

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