A rare anomaly: duodenal Dieulafoy’s lesion in a preterm baby

2021 ◽  
Vol 14 (7) ◽  
pp. e242911
Author(s):  
Devendrasing Vijaysing Jadhav ◽  
Anees Ahmed Siddiqui ◽  
Dalwinder Singh ◽  
Shiva Shankar
Keyword(s):  
Birth Weight ◽  
Gastrointestinal Haemorrhage ◽  
Acute Blood Loss ◽  
Blood Products ◽  
Timely Manner ◽  
Preterm Baby ◽  
Dieulafoy’S Lesion ◽  
Endoscopic Intervention ◽  
Male Baby ◽  
Life Threatening

Neonatal Dieulafoy’s lesion is a rare but serious condition that can be life-threatening if not diagnosed and intervened in a timely manner. It presents with episodes of sudden acute gastrointestinal haemorrhage in the form of blood in vomit and/or blood in stool. In general, most of the lesions are successfully treated with endoscopic or angiographic intervention. Surgery is usually reserved for cases that fail endoscopic or angiographic intervention. We present a neonatal case of duodenal Dieulafoy’s lesion that occurred in a 29-week-old male baby with birth weight of 1.2 kg. He developed melena and haematemesis at 4 weeks of life. He required normal saline boluses and transfusion of blood products for acute blood loss. The lesion was successfully treated with endoscopic intervention.

scholarly journals Continuous renal replacement therapy rescued life-threatening capillary leak syndrome in an extremely-low-birth-weight premature: a case report

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Li-Fen Yang ◽  
Jia-Chang Ding ◽  
Ling-Ping Zhu ◽  
Li-Xia Li ◽  
Meng-Qi Duan ◽  
...  
Keyword(s):  
Birth Weight ◽  
Renal Replacement Therapy ◽  
Low Birth Weight ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Therapeutic Option ◽  
Capillary Leak Syndrome ◽  
Extremely Low Birth Weight ◽  
Capillary Leak ◽  
Life Threatening

Abstract Background Capillary leak syndrome (CLS) is a rare disease characterized by profound vascular leakage and presents as a classic triad of hypotension, hypoalbuminemia and hemoconcentration. Severe CLS is mostly induced by sepsis and generally life-threatening in newborns, especially in premature infants. Continuous renal replacement therapy (CRRT) plays an important role of supportive treatment for severe CLS. Unfortunately, CRRT in preterm infants has rarely been well defined. Case presentation We report the case of a 11-day-old girl with CLS caused by sepsis, who was delivered by spontaneous vaginal delivery (SVD) at gestational age of 25 weeks and 4 days, and a birth weight of 0.89 Kilograms(kg). The infant received powerful management consisting of united antibiotics, mechanical ventilation, intravenous albumin and hydroxyethyl starch infusion, vasoactive agents, small doses of glucocorticoids and other supportive treatments. However, the condition rapidly worsened with systemic edema, hypotension, pulmonary exudation, hypoxemia and anuria in about 40 h. Finally, we made great efforts to perform CRRT for her. Fortunately, the condition improved after 82 h’ CRRT, and the newborn was rescued and gradually recovered. Conclusion CRRT is an effective rescue therapeutic option for severe CLS and can be successfully applied even in extremely-low-birth-weight premature.

Pericardial Effusion as a Complication of PICC Line Insertion

2021 ◽  
pp. 097321792110076
Author(s):  
Abdah Hrfi ◽  
Mohammed H.A. Mohammed ◽  
Omar Tamimi
Keyword(s):  
Birth Weight ◽  
Pericardial Effusion ◽  
Metabolic Diseases ◽  
Neonatal Period ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Preterm Baby ◽  
Line Insertion ◽  
Uncommon Condition ◽  
Picc Line

Cardiac tamponade as a result of pericardial effusion (PE) is a serious uncommon condition in the neonatal period. PE in such cases could be associated with hydrops fetalis, neonatal sepsis, metabolic diseases, or as a complication of percutaneous indwelling central catheter. 1 We are reporting a preterm baby, with low birth weight who developed large PE as a complication of total parenteral nutrition via a peripherally inserted central catheter, managed successfully with pericardiocentesis.

scholarly journals Thromboembolic Conditions, Aetiology Diagnosis and Treatment in Dogs and Cats

2010 ◽  
Vol 79 (3) ◽  
pp. 497-508 ◽  
Author(s):  
Filip Konečný
Keyword(s):  
Veterinary Medicine ◽  
Clinical Presentation ◽  
Medical Condition ◽  
Definitive Diagnosis ◽  
Diagnosis And Treatment ◽  
Window Of Opportunity ◽  
Timely Manner ◽  
Human Counterpart ◽  
Life Threatening ◽  
Diagnostic Capabilities

In veterinary medicine, thrombo-embolism (TE) is an under-appreciated medical condition that requires immediate recognition. Since TE is multifactorial and its mode of presentation may vary, veterinarians face great difficulties in making a definitive diagnosis in a timely manner. In addition, most of the underlying conditions that give rise to TE are life-threatening and an aggressive diagnostic and therapeutic approach is required. Not only does the diagnosis and treatment of this condition require the collaboration of many specialties, the costs of therapy can be excessive with a high risk of recurrence. As such, owners have to be thoroughly informed before the therapy commences. While TE has been well-characterized in humans and is associated with significant morbidity and mortality, little information of similar quality is available in veterinary medicine. In addition, TE in animals is distinct from its human counterpart and we cannot simply adapt what is known from human clinical trials. With the promise of improvements in imaging modalities that improve our diagnostic capabilities, the window of opportunity to treat TE increases. This article focuses on aetiology, clinical presentation, diagnosis, and treatment of dogs and cats affected by TE.

scholarly journals Anatomic accuracy, physiologic characteristics, and fidelity of very low birth weight infant airway simulators

2021 ◽  
Author(s):  
Patricia Lengua Hinojosa ◽  
Frank Eifinger ◽  
Michael Wagner ◽  
Jochen Herrmann ◽  
Monika Wolf ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Reference Values ◽  
Very Low Birth Weight ◽  
List Type ◽  
Preterm Baby ◽  
Low Birth Weight Infants ◽  
Low Birth Weight Infant ◽  
Ventilation Technique ◽  
One Simulator

Abstract Background Medical simulation training requires realistic simulators with high fidelity. This prospective multi-center study investigated anatomic precision, physiologic characteristics, and fidelity of four commercially available very low birth weight infant simulators. Methods We measured airway angles and distances in the simulators Premature AirwayPaul (SIMCharacters), Premature Anne (Laerdal Medical), Premie HAL S2209 (Gaumard), and Preterm Baby (Lifecast Body Simulation) using computer tomography and compared these to human cadavers of premature stillbirths. The simulators’ physiologic characteristics were tested, and highly experienced experts rated their physical and functional fidelity. Results The airway angles corresponded to those of the reference cadavers in three simulators. The nasal inlet to glottis distance and the mouth aperture to glottis distance were only accurate in one simulator. All simulators had airway resistances up to 20 times higher and compliances up to 19 times lower than published reference values. Fifty-six highly experienced experts gave three simulators (Premature AirwayPaul: 5.1 ± 1.0, Premature Anne 4.9 ± 1.1, Preterm Baby 5.0 ± 1.0) good overall ratings and one simulator (Premie HAL S2209: 2.8 ± 1.0) an unfavorable rating. Conclusion The simulator physiology deviated significantly from preterm infants’ reference values concerning resistance and compliance, potentially promoting a wrong ventilation technique. Impact Very low birth weight infant simulators showed physiological properties far deviating from corresponding patient reference values. Only ventilation with very high peak pressure achieved tidal volumes in the simulators, as aimed at in very low birth weight infants, potentially promoting a wrong ventilation technique. Compared to very low birth weight infant cadavers, most tested simulators accurately reproduced the anatomic angular relationships, but their airway dimensions were relatively too large for the represented body. The more professional experience the experts had, the lower they rated the very low birth weight infant simulators.

scholarly journals Dieulafoy Lesion of Ileum: A Case Report

2020 ◽  
Vol 3 (1) ◽  
pp. 64-66
Author(s):  
Prakash Poudel ◽  
Ramesh Dhakwa
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Gastrointestinal Bleeding ◽  
Gastrointestinal Haemorrhage ◽  
Definitive Diagnosis ◽  
Gi Bleeding ◽  
Mucosal Defect ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
Dieulafoy Lesion

Dieulafoy lesion is a rare cause of massive GI bleeding. It’s an abnormal sub-mucosal artery protruding from a minute mucosal defect (≤3 mm). A 31 yearold male presented with complaints of hematochezia. Preliminary investigations failed to locate the exact source of bleed. Enteroscopy suggested distal ileal bleed. At laparotomy, an ulcerated nodular lesion, approximately 0.5 cm was identified in distal ileum. 30 cm of ileum along with mesentery was resected. Histology revealed it to be Dieulafoy lesion. Dieulafoy lesion is uncommon but one of the causes of obscure gastrointestinal bleeding that could result in treacherous and life-threatening gastrointestinal haemorrhage. This lesion is difficult to identify and high index of suspicion is required to make diagnosis. Hence, it should be considered in the differential diagnosis of active GI bleeding. The definitive diagnosis is based only on histopathology.

scholarly journals An unusual cause of delayed hematoma after carotid endarterectomy: a case report

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yi Zhao ◽  
Zhichao Lai ◽  
Xiaojun Song ◽  
Rong Zeng ◽  
Changwei Liu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Case Report ◽  
Carotid Endarterectomy ◽  
Early Stage ◽  
Prostatic Hyperplasia ◽  
Surgical Patients ◽  
Blood Products ◽  
Case Presentation ◽  
Life Threatening ◽  
History Of

Abstract Background Neck hematoma is a complication of carotid endarterectomy, usually occurring in the comparatively early stage postoperatively. Case presentation We described a patient developing life-threatening hemorrhage and non-clotting hematoma at a comparatively later stage after CEA. DIC was diagnosed according to the lab results, and the patient underwent re-operation and was supported with blood products until the coagulopathy was corrected. The patient had a history of prostatic hyperplasia and experienced malaise during the hospitalization. Prostate cancer with bone metastases was diagnosed. Conclusions This case report describes a rare underlying cause of hematoma after CEA, which reminds us to pay attention to prostate symptoms or related medical history, especially malignancy, in surgical patients, which may result in severe complications.

scholarly journals Fish Oil Monotherapy for Intestinal Failure-Associated Liver Disease on SMOFlipid in the Neonatal Intensive Care Unit

2020 ◽  
Vol 9 (11) ◽  
pp. 3393
Author(s):  
Sanghoon Lee ◽  
Se In Sung ◽  
Hyo Jung Park ◽  
Yun Sil Chang ◽  
Won Soon Park ◽  
...  
Keyword(s):  
Liver Disease ◽  
Birth Weight ◽  
Fish Oil ◽  
Neonatal Intensive Care ◽  
Lipid Emulsion ◽  
Intestinal Failure ◽  
Direct Bilirubin ◽  
Low Birth Weight Infants ◽  
Life Threatening

Intestinal failure-associated liver disease (IFALD) is a life-threatening complication of parenteral nutrition (PN) and is most prevalent in the preterm neonatal population receiving long-term PN. In this study, we report the outcome of our experience with fish oil monotherapy for IFALD in a fish oil-based combination lipid emulsion administered to preterm low birth weight infants. Fasting neonates were administered as PN according to our center’s nutrition protocol. A diagnosis of IFALD was made when the serum direct bilirubin levels were >2.0 mg/dL in two consecutive measurements that were more than one week apart, without evidence of intrinsic causes of liver dysfunction. The management of IFALD was conducted by switching the lipid emulsion from combination lipid emulsion to fish oil monotherapy at 1.0 g/kg/day, infused over 24 h. Fifteen infants met the criteria for IFALD and received fish oil monotherapy. The median gestational age was 27.5 weeks and the median birth weight was 862.5 g. IFALD was successfully reversed in 11 infants (11/15, 73.3%). The median duration of fish oil monotherapy was 39 days. Direct bilirubin values were initially elevated and then steadily declined from the third week of treatment onward. The enteral tolerance increased in varying degrees during the treatment period. The mean weight gain was 26.0 g/day during fish oil monotherapy. Omegaven® (Fresenius Kabi Austria Gmbh, Graz, Austria) at a dose of 1.0 g/kg/day was well tolerated, and no adverse events related to Omegaven use were seen. The reversal of IFALD in preterm infants on combination lipid emulsion containing fish oil was achieved by switching to fish oil monotherapy.

Management of radiation poisoning

2016 ◽  
Author(s):  
Francis Chin Kuok Choon ◽  
Phua Dong Haur
Keyword(s):  
Radiation Treatment ◽  
Gastric Lavage ◽  
Hospital Staff ◽  
Whole Body ◽  
Intensive Management ◽  
Blood Products ◽  
Radiation Characteristics ◽  
Acute Radiation Syndrome ◽  
Cell Transplants ◽  
Life Threatening

In radiation poisoning, a distinction between exposure and contamination should be made. Decontamination by removing clothes, washing of skin, and removal of debris can remove up to 90% of external contaminated radiation. Treatment of acute life-threatening injuries takes priority over treatment of radiation poisoning. Triage of severely exposed patients can give an indication of dose and severity of the radiation dose absorbed. Survival is related to dose absorbed. Identification of the radiation source should be made by the radiation characteristics to determine the shielding necessary for protection of hospital staff and the antidote required. Early gastric lavage and specific antidotes for ingested radiation poisoning should be used with caution. Death is mainly due to infection and haemorrhage. Acute radiation syndrome (ARS) is a manifestation of haematopoietic, gastrointestinal, cardiovascular, central nervous system, and cutaneous syndromes. Those receiving whole body doses of 1–5 Gy may recover easily with appropriate medical management; those with doses of 6–10 Gy may survive with intensive management; and those with doses of >10 Gy seldom survive. Treatment of ARS is supportive with the use of antibiotics, colony-stimulating factors, blood products, and stem cell transplants. Protection of the staff is by reducing time exposed, increasing distance from source and proper shielding. Psychological counselling should be available to patient or staff if required.

scholarly journals Rapid Progression of Kaposi’s sarcoma complicated with hemophagocytic syndrome in a severely immunosuppressed patient with HIV-infection: a case report

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Pingzheng Mo ◽  
Liping Deng ◽  
Xiaoping Chen ◽  
Yong Xiong ◽  
Yongxi Zhang
Keyword(s):  
Hiv Infection ◽  
Kaposi's Sarcoma ◽  
Hemophagocytic Syndrome ◽  
Kaposi’S Sarcoma ◽  
Rapid Progression ◽  
Immunosuppressed Patient ◽  
Timely Manner ◽  
Cutaneous Lesions ◽  
Case Presentation ◽  
Life Threatening

Abstract Background AIDS-related KS generally involves cutaneous lesions, that slowly progress over months to years. Neither rapidly progressing of KS nor KS complicated with hemophagocytic syndrome (HPS) has rarely been reported. Case presentation We report a rare case of rapid progression of Kaposi’s sarcoma complicated with hemophagocytic syndrome in a severely immunosuppressed patient with HIV-infection. The symptoms of this patient were atypical, showing only persistent high fever and rapid progressed to hemophagocytic syndrome. This patient was successfully treated with antiretroviral therapy combined with liposomal doxorubicin. Conclusions The condition of the KS patient could deteriorate rapidly over a period of days and even developeded into HPS, which was life-threatening. However, chemotherapy initiated in a timely manner might improve prognosis.

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