scholarly journals Life-Saving Emergency Adrenalectomy in a Pheochromocytoma Crisis with Cardiogenic Shock

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Thalia Bekelaar ◽  
Gervais Nougon ◽  
Marc Peters ◽  
Frederic De Roeck ◽  
Steven Haine ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiogenic Shock ◽  
Adrenal Mass ◽  
Hemodynamic Instability ◽  
Multiple Organ ◽  
Histological Investigation ◽  
Cyclic Pattern ◽  
Life Saving ◽  
First Choice ◽  
Life Threatening

Cardiogenic shock during a pheochromocytoma crisis is a life-threatening disorder. This case report illustrates a 49-year-old male with profound cardiogenic shock, extreme hemodynamic instability (systolic blood pressure ranging from 45 up to 290 mmHg in a cyclic pattern), and progressive multiple organ failure in the presence of a unilateral adrenal mass. Emergency adrenalectomy led to rapid hemodynamic stabilization. Histological investigation confirmed the diagnosis of pheochromocytoma. This case indicates that emergency adrenalectomy, although usually not considered first choice, is a valid option in cardiogenic shock and extremely fluctuating hemodynamics due to a pheochromcytoma-induced catecholamine storm.

Extracorporeal membrane oxygenation in pheochromocytoma-induced cardiogenic shock

2017 ◽  
Vol 26 (4) ◽  
pp. 314-316 ◽  
Author(s):  
Nadia Bouabdallaoui ◽  
Denis Bouchard ◽  
E. Marc Jolicoeur ◽  
Alexandra Chronopoulos ◽  
Pierre Y Garneau ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Specific Treatment ◽  
Left Ventricular ◽  
Clinical Value ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Support ◽  
Life Saving ◽  
Adrenal Pheochromocytoma ◽  
Life Threatening

Extracorporeal membrane oxygenation has been extensively used for cardiopulmonary support in cardiogenic shock. However, its clinical value in the management of pheochromocytoma crisis remains unclear. We report a rare case of life-threatening cardiogenic shock managed with peripheral venoarterial extracorporeal membrane oxygenation combined with endovascular left ventricular venting, in a 40-year-old female patient, in the setting of unknown adrenal pheochromocytoma. We highlight the life-saving role of extracorporeal membrane oxygenation in undiagnosed endocrine emergencies, allowing cardiac and end-organ recovery, and giving time for accurate diagnosis and specific treatment in such unusual situations.

scholarly journals Perioperative hemodynamic instability in pheochromocytoma and sympathetic paraganglioma patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jung Hee Kim ◽  
Hyung-Chul Lee ◽  
Su-jin Kim ◽  
Soo Bin Yoon ◽  
Sung Hye Kong ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Predictive Factors ◽  
Medical Records ◽  
Adrenergic Receptor ◽  
Perioperative Management ◽  
Hemodynamic Instability ◽  
Receptor Blocker ◽  
Long Duration ◽  
Life Threatening ◽  
Sympathetic Paraganglioma

AbstractFor pheochromocytoma and sympathetic paraganglioma (PPGL), surgery can be used as a curative treatment; however, the life-threatening risk of perioperative hemodynamic instability (HI) presents challenges. This study aimed to analyze the incidence and predictive factors of perioperative HI. The electronic medical records of 114 consecutive patients who underwent surgery for PPGLs at our institution were retrospectively reviewed. HI was defined as one or more episodes of systolic blood pressure > 200 mmHg or mean blood pressure < 60 mmHg during surgery. The factors predictive of perioperative HI were determined using both univariate and multivariate analyses. Intraoperative HI occurred in 79 (69.3%) patients. In multivariate analysis, α-adrenergic receptor blocker duration (days) (odds ratio, 1.015; 95% confidence interval, 1.001–1.029) was a predictor for intraoperative HI. Postoperative hypotension occurred in 36 (31.6%) patients. Higher urine epinephrine levels, and greater preoperative highest heart rate (HR) were predictive factors for postoperative hypotension in PPGL patients. Caution should be taken in perioperative management for PPGL, especially with long duration of α-adrenergic receptor blocker use, higher urine epinephrine levels, and greater preoperative highest HR.

To be a surgeon may be life saving

Trauma ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 320-323
Author(s):  
Erhan Aysan
Keyword(s):  
Hemodynamic Instability ◽  
Rib Fractures ◽  
General Surgeon ◽  
Late Development ◽  
Multiple Rib Fractures ◽  
Motorcycle Accident ◽  
Life Saving ◽  
Massive Hemothorax ◽  
Life Threatening ◽  
At Home

In the first 24 h after multiple rib fractures, a life-threatening massive hemothorax is very rare but can cause death at home in cases who have been discharged. A 50-year-old male general surgeon, was admitted to the emergency unit after a motorcycle accident. Multiple rib fractures were diagnosed but no hemopneumothorax or hemodynamic instability were observed. After 24 h of observation, he was discharged. On the fifth day at home he was woken by symptoms of acute massive hemothorax. With the assistance of his wife he commenced intravenous fluid resuscitation to treat his own hemodynamic instability and transferred himself to his own hospital via ambulance where he subsequently underwent thoracotomy for arrest of haemorrhage. Late development of a massive hemopneumothorax after multiple rib fractures is rare, but may be a life-threatening risk. Such patients should be more closely followed up and informed about symptoms and treatment.

Selective Use of Cardiopulmonary Bypass in Trauma Patients

2005 ◽  
Vol 71 (1) ◽  
pp. 46-50
Author(s):  
Christine Dauphine ◽  
Charles Mckay ◽  
Christian De Virgilio ◽  
Bassam Omari
Keyword(s):  
Cardiopulmonary Bypass ◽  
Los Angeles ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Chest Injuries ◽  
Life Saving ◽  
Life Threatening ◽  
Level I

The need for cardiopulmonary bypass (CPB) in the treatment of trauma patients is controversial, and not all level I trauma centers have CPB readily available. Our purpose was to review the selective use of CPB in the management of trauma victims at a level I trauma center in Los Angeles County. We reviewed the records of all patients for whom the CPB team was called in from 1994 to 2002. Perfusionists were present for the initial operative management of 24 patients, 22 (92%) of which were male. Twelve patients had penetrating and nine had blunt injuries, two were severely hypothermic, and the last suffered embolization of a bullet to the pulmonary artery. Overall survival was 75 per cent. Sixteen (67%) patients required CPB due to the life-threatening nature of their injuries and/or hemodynamic instability; 11 (69%) survived. The remaining 8 patients were operated on with the CPB team present but on standby; 7 (88%) survived. Cardiopulmonary bypass could be life-saving in select trauma patients with major chest injuries. Hypothermia, acidemia, and shock can be reversed earlier while allowing increased time to gain adequate exposure and perform quality repairs. Level I trauma centers should have CPB capabilities immediately available.

scholarly journals Percutaneous Mechanical Support in Cardiogenic Shock: A Review

2015 ◽  
Vol 9s2 ◽  
pp. CMC.S19707
Author(s):  
Fahad Syed Gilani ◽  
Sarah Farooqui ◽  
Rajiv Doddamani ◽  
Luis Gruberg
Keyword(s):  
Cardiogenic Shock ◽  
Pharmacological Therapy ◽  
Mechanical Support ◽  
Significant Morbidity ◽  
First Line ◽  
Life Saving ◽  
Threatening Condition ◽  
Life Threatening ◽  
Hemodynamic Improvement ◽  
Support Devices

Cardiogenic shock (CS) is a life-threatening condition associated with significant morbidity and mortality. Pharmacological therapy is often the first line of treatment but mechanical support can provide substantial hemodynamic improvement in refractory CS. Percutaneous mechanical support devices are placed in a minimally invasive manner and provide life-saving assistance to the failing myocardium. We review the percutaneous devices currently available, the evidence behind their use, and the new advances in percutaneous technology being evaluated for the treatment of CS.

scholarly journals Ruptured cornual ectopic pregnancy: a case report

2020 ◽  
Vol 9 (8) ◽  
pp. 3483
Author(s):  
Arti Sharma ◽  
Dipika Singh ◽  
Sarika Verma
Keyword(s):  
Case Report ◽  
Ectopic Pregnancy ◽  
Multidisciplinary Approach ◽  
Hemodynamic Instability ◽  
Emergency Laparotomy ◽  
New Delhi ◽  
Life Saving ◽  
Life Threatening ◽  
Ectopic Pregnancies ◽  
Labour Room

A cornual gestation is one of the most hazardous and life-threatening type of ectopic pregnancy with a mortality rate of 2-5 times higher than other ectopic pregnancies. Because of the myometrium stretch ability, they usually present late around 7-12 weeks of gestation. Thus, the diagnosis and treatment of such cases become challenging. In the case of ruptured cornual ectopic pregnancy, the patient usually presents with hemodynamic instability. Presenting a case report of a 28-year-old female who presented to the labour room of ESI hospital, Okhla, New Delhi at 12 weeks of pregnancy in a state of shock. A provisional diagnosis of ruptured cornual ectopic was made based on clinical examination and ultrasound report. Resuscitation followed by emergency laparotomy done as a life-saving procedure for the patient. Ruptured cornual ectopic needs urgent intervention and multidisciplinary approach. However, with the advancement and expertise in the field of radiology and early diagnosis can be made which can contribute towards more conservative management of such cases.

scholarly journals Pemberian Agen Vasoaktif Berdasarkan Hemodinamik pada Syok Kardiogenik

2017 ◽  
pp. 89-98
Author(s):  
Muhammad Yusuf Alsagaff ◽  
Laily Djihan
Keyword(s):  
Nitric Oxide ◽  
Cardiogenic Shock ◽  
Multiple Organ Failure ◽  
Pharmacological Treatment ◽  
Multiple Organ ◽  
Recent Analysis ◽  
Organ Perfusion ◽  
Vasoactive Agents ◽  
Cardiovascular Failure ◽  
Life Threatening

Cardiogenic shock is a life-threatening emergency that occurs frequently with acutemyocardial infarction (AMI) and the mortality remains over 50% in most studies. Despitesuccessful revascularization, cardiovascular failure leading to multiple organ failure mayoccur. Therapy with vasoactive agents should be initiated to restore adequate arterialpressure and organ perfusion in patients with shock. Recent analysis suggests that systemicinflammatory response syndrome (SIRS) is an important component of the hemodynamicinstability in cardiogenic shock. Inflammation through the nitric oxide (NO) pathway leadingto decrease in vascular resistance and these patients may necessitate supplementalvasopressor therapy. A subanalysis of a prospective randomized trial suggested that norepinephrine(NE) may be preferred over dopamine in patients with cardiogenic shock,while dobutamine is the inotrope of choice. We present a case of a shock cardiogenicand a review of a therapeutic scheme for the pharmacological treatment of patients incardiogenic shock.

PENGARUH PEMBERIAN BELIMBING DAN MENTIMUN TERHADAP PENDERITA HIPERTENSI DI DESA LAU KERSIK KECAMATAN GUNUNG SITEMBER KABUPATEN DAIRI

2019 ◽  
Vol 2 (1) ◽  
pp. 18-23
Author(s):  
Herri Novita Br Tarigan ◽  
Prista Hotmarina Purba
Keyword(s):  
Blood Pressure ◽  
Data Analysis ◽  
Fruit Juice ◽  
Blood Pressure Reduction ◽  
Reduce Blood Pressure ◽  
Pharmacological Therapy ◽  
Hypertensive Patients ◽  
Star Fruit ◽  
Equivalent Time ◽  
Life Threatening

Hypertension is a disease that is not uncommon in the community, including the Bukit Lau Kersik village. People with hypertension often do not show long-term symptoms and can be life-threatening. However, one of the management of hypertension that can be used as non-pharmacological therapy is consuming starfruit juice and cucumber which is quite easy to find in the Bukit Lau Kersik village. This combination of juices contains potassium which can reduce blood pressure in patients with hypertension. This study used Equivalent Time Sample Design with 14 subjects with hypertension in the Bukit Lau Kersik Village, Gunung Sitember Subdistrict, Dairi District. The technique of this research sample used Non-Probability Sampling with Saturated Sampling. The instrument used was a sphygmomanometer and a stethoscope. Bivariate data analysis in this study was the Wilcoxon statistical test. Based on the data analysis performed, the value of p = 0.011 (p= < 0.05) was obtained, meaning that there was a significant relationship between giving star fruit juice and cucumber to hypertensive patients. Then it can be concluded that there is an influence between giving star fruit and cucumber juice to blood pressure reduction in hypertensive patients in Bukit Lau Kersik Village Gunung Sitember Subdistrict, Dairi District in 2019. Suggestion: The factors that affect blood pressure in hypertensive patients and checking blood pressure before drinking star fruit juice and cucumber.

A Review of the Therapeutic Benefits of Moringa oleifera in Controlling High Blood Pressure (Hypertension)

2019 ◽  
Vol 5 (3) ◽  
pp. 232-245
Author(s):  
Chuku Okorie ◽  
Kola Ajibesin ◽  
Adekunle Sanyaolu ◽  
Adeena Islam ◽  
Selciya Lamech ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Moringa Oleifera ◽  
Kidney Diseases ◽  
Treatment Strategies ◽  
Secondary Hypertension ◽  
Therapeutic Benefits ◽  
Northern Regions ◽  
Long Time ◽  
Life Threatening

Moringa oleifera (M. oleifera) is an angiosperm plant that is a member of the Moringaceae family. It is a natural plant that is native to the sub-Himalayan northern regions of India, Bangladesh, Pakistan, and Afghanistan. The plant grows abundantly throughout tropical and subtropical areas of the world. For several centuries, many cultures have utilized various parts of the moringa plant as traditional medicine to treat common illnesses and control life-threatening conditions such as hypertension (HTN), diabetes, hyperlipidemia, inflammation, etc. This article reviewed the current literature on the therapeutic benefits of M. oleifera on hypertension, primarily focusing on identifying the plant’s key components and its roles in hindering the common pathophysiological pathways associated with hypertension. The number of people living with HTN has been predicted to increase to 1.56 billion worldwide by 2025 in spite of the myriads of preventive and treatment strategies available today. Therefore, it would be of great value to explore alternative complementary ways of controlling high blood pressure. HTN is commonly defined as blood pressure equal to or higher than 140/90 mm Hg. HTN itself is not a disease condition and does not elicit specific symptoms, however, if left untreated for a long time, it can lead to complicated cardiovascular diseases such as angina, congestive heart failure, myocardial infarction as well as stroke and chronic kidney diseases. Primary hypertension is diagnosed when there is no known identifiable underlying cause for the onset of the condition. Secondary hypertension is diagnosed when there is evidence of a disease or disorder triggering the onset of the condition. It is apparent that understanding the role of M. oleifera in the management of hypertension would expand the valuable strategies for the control of this condition.

The Role of Histones and Heparin in Sepsis: A Review

2021 ◽  
pp. 088506662199232
Author(s):  
Xiaojuan Zhang ◽  
Xin Li
Keyword(s):  
Septic Shock ◽  
Multiple Organ ◽  
Clinical Settings ◽  
The Past ◽  
Life Saving ◽  
Extracellular Histones ◽  
Sepsis And Septic Shock ◽  
Development And Management ◽  
Made In

Septic shock with multiple organ failure is a devastating situation in clinical settings. Through the past decades, much progress has been made in the management of sepsis and its underlying pathogenesis, but a highly effective therapeutic has not been developed. Recently, macromolecules such as histones have been targeted in the treatment of sepsis. Histones primarily function as chromosomal organizers to pack DNA and regulate its transcription through epigenetic mechanisms. However, a growing body of research has shown that histone family members can also exert cellular toxicity once they relocate from the nucleus into the extracellular space. Heparin, a commonly used anti-coagulant, has been shown to possess life-saving capabilities for septic patients, but the potential interplay between heparin and extracellular histones has not been investigated. In this review, we summarize the pathogenic roles of extracellular histones and the therapeutic roles of heparin in the development and management of sepsis and septic shock.

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