Death following ceftazidime-induced Kounis syndrome

2017 ◽  
Vol 85 (4) ◽  
pp. 215-218 ◽  
Author(s):  
IDG Kitulwatte ◽  
S Gangahawatte ◽  
ULMS Perera ◽  
PAS Edirisinghe
Keyword(s):  
Care Management ◽  
Myocardial Injury ◽  
Healing Process ◽  
Myocardial Necrosis ◽  
Inflammatory Cells ◽  
Cellular Infiltration ◽  
Laryngeal Oedema ◽  
Kounis Syndrome ◽  
Tryptase Level ◽  
Allergic Angina

Kounis syndrome, also known as allergic myocardial infarction or allergic angina syndrome, coincides with chest pain and allergic reactions. It involves the activation of interrelated inflammatory cells following allergic, anaphylactic or anaphylactoid insults. We report a case of Kounis syndrome complicated by an injection of ceftazidime. A 52-year-old man developed shortness of breath and hypotension, leading to immediate unconsciousness, after a ceftazidime injection. Despite intensive care management, he showed no improvement and died approximately 19 h after ceftazidime administration. Autopsy showed massive laryngeal oedema, mucous plugging and collapsed lungs. An ImmunoCAP tryptase assay showed the tryptase level in an autopsy sample to be 118 µg/L (normal < 11.4 µg/L). Microscopy of the myocardium showed cellular infiltration preceding myocardial necrosis. These findings support the pathophysiological theory of Kounis syndrome, with cellular infiltration proposed as the cause of myocardial injury rather than an effect related to the healing process.

Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management

2016 ◽  
Vol 54 (10) ◽  
Author(s):  
Nicholas G. Kounis
Keyword(s):  
Plaque Rupture ◽  
Coronary Artery Spasm ◽  
Clinical Manifestations ◽  
Inflammatory Cells ◽  
Coronary Event ◽  
Mesenteric Arteries ◽  
Kounis Syndrome ◽  
Anaphylactoid Reactions ◽  
Coronary Events ◽  
Allergic Angina

AbstractKounis syndrome has been established as a hypersensitivity coronary disorder induced by various conditions, drugs, environmental exposures, foods and coronary stents. Allergic, hypersensitivity, anaphylactic and anaphylactoid reactions are associated with this syndrome. Vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells constitute are the three reported, so far, variants of this syndrome. Apart from coronary arteries, it affects the cerebral and mesenteric arteries. Its manifestations are broadening and its etiology is continuously increasing. Kounis syndrome is a ubiquitous disease which represents a magnificent natural paradigm and nature’s own experiment in a final trigger pathway implicated in cases of coronary artery spasm and plaque rupture. Kounis syndrome seems to be not a rare disease but an infrequently diagnosed clinical entity which has revealed that the same mediators released from the same inflammatory cells are also present and in acute coronary events of non allergic etiology. These cells are not only present in the culprit region before plaque erosion or rupture but they release their contents just before an actual coronary event. Therefore, awareness of etiology, epidemiology, pathogenesis and clinical manifestations seems to be important for its prognosis, diagnosis, treatment, prevention.

scholarly journals BIOLOGICAL PROPERTIES OF CELL WALL MUCOPEPTIDE OF HEMOLYTIC STREPTOCOCCI

1969 ◽  
Vol 130 (1) ◽  
pp. 31-47 ◽  
Author(s):  
Jiři Rotta ◽  
Blahoslav Bednář
Keyword(s):  
Escherichia Coli ◽  
Cell Wall ◽  
Intravenous Injection ◽  
Ultrasonic Treatment ◽  
Myocardial Necrosis ◽  
Inflammatory Cells ◽  
Biological Properties ◽  
Cellular Infiltration ◽  
Febrile Response ◽  
Shwartzman Reaction

Several of the toxic properties of streptococcal mucopeptide have been studied in detail. Intravenous injection of as little as 1 µg of mucopeptide, solubilized by ultrasonic treatment, elicits a reproducible febrile response. Rabbits which are made tolerant to Escherichia coli endotoxin are only partially tolerant to the subsequent injection of streptococcal mucopeptide. Soluble mucopeptide was successfully employed to prepare and provoke the localized Shwartzman reaction. Intravenous injection of 80 µg of solubilized mucopeptide leads to diffuse cellular infiltration as well as focal areas of myocardial necrosis, surrounded by inflammatory cells.

Late laryngo-tracheal cartilage necrosis with external fistula 44 years after radiotherapy

2003 ◽  
Vol 117 (8) ◽  
pp. 658-659 ◽  
Author(s):  
Yoshitaka Takiguchi ◽  
Hiro-Oki Okamura ◽  
Ken Kitamura ◽  
Seiji Kishimoto
Keyword(s):  
Clinical Course ◽  
Subcutaneous Tissue ◽  
Bacterial Colonization ◽  
Histological Study ◽  
Inflammatory Cells ◽  
Late Complications ◽  
Laryngeal Oedema ◽  
Anterior Neck ◽  
Tracheal Cartilage ◽  
Cutaneous Flap

Major late complications, following radiotherapy of head and neck carcinomas, such as laryngeal oedema, perichondritis and chondronecrosis usually occur between three and 12 months after treatment. However, the present case displayed necrosis of the laryngo-tracheal cartilage and ulceration of anterior neck skin with a tracheal fistula 44 years after irradiation. The reasons for the long interval between irradiation and late complications may be explained by long-standing hypovascularity and/or infection of the irradiated area. Histological study revealed chondronecrosis without inflammatory cells in the laryngo-tracheal cartilage and bacterial colonization of subcutaneous tissue. Necrotic tissue was removed and tracheostomy was performed. The fistula was almost completely closed using a delto-pectoral cutaneous flap and the clinical course of patient has been good. This paper demonstrates the possibility of laryngo-tracheal necrosis in cases that had received radiation as long ago as 44 years.

scholarly journals Tribulus terrestris protects rat myocardium against isoproterenol-induced ischemic injury: role of HSP 70 and cardiac endogenous antioxidants

2011 ◽  
Vol 1 (1) ◽  
pp. 9
Author(s):  
Ipseeta Ray Mohanty ◽  
Ujjwala Maheswari ◽  
Daniel Joseph ◽  
Yeshwant Deshmukh
Keyword(s):  
Myocardial Injury ◽  
Stress Protein ◽  
Myocardial Necrosis ◽  
Thiobarbituric Acid ◽  
Antioxidant Defense System ◽  
Control Group ◽  
Tribulus Terrestris ◽  
Marker Enzyme ◽  
Hsp 70 ◽  
Endogenous Antioxidants

The present study was undertaken to evaluate the cardioprotective activity of Tribulus terrestris (Tt), a medicinal herb following isoproterenol (ISP)-induced myocardial injury. The contribution of heat shock protein (HSP) 70, key anti-stress protein, endogenous antioxidants and oxidant -antioxidant balance in attenuating myocardial injury was further studied. Hydroalcoholic extract of Tt {1, 2.5, 5 &amp; 10 mg/kg} were orally fed once a daily to Wistar rats for 21 days. On the 20th and 21st day, both control (ISP control) and Tt fed rats were challenged with ISP (85 mg/ kg, s. c. two doses at 24h intervals) induced myocardial necrosis. Histopathological evaluation, cardiac marker enzyme: Creatinine phospho - kinase(CPK) and antioxidative parameters: Glutathione (GSH), Thiobarbituric acid reactive substances (TBARS), Catalase (CAT), Glutathione peroxidase (GSHPx) and Superoxide dismutase (SOD) levels were estimated. Tt (2.5 mg/kg) intake per se upregulated HSP 70; increased basal SOD, CAT activity (P&lt;0.05) and caused a marked fall in basal TBARS levels (P&lt;0.05) in comparison to sham. Following ISP challenge, significant oxidative stress with evidence of myocardial necrosis was observed in the ISP control group. ISPinduced changes in myocardial SOD, GSHPx and GSH were prevented by both the 2.5 and 10 mg/kg doses of Tt, though cellular injury was minimal with 2.5 mg/kg dose. The results emphasize that pre-treatment with Tt offered significant protection against ISP-induced myocardial necrosis through a unique property of enhancement of endogenous antioxidants, stabilization of cytoskeleton structure which in turn is attributed to HSP 70 expression along with fortified antioxidant defense system.

Temporal relation between neutrophil accumulation and myocardial reperfusion injury

1988 ◽  
Vol 255 (5) ◽  
pp. H1060-H1068 ◽  
Author(s):  
E. F. Smith ◽  
J. W. Egan ◽  
P. J. Bugelski ◽  
L. M. Hillegass ◽  
D. E. Hill ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Reperfusion Injury ◽  
Time Course ◽  
Myocardial Injury ◽  
Inflammatory Cells ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Neutrophil Accumulation ◽  
Cell Responses ◽  
Significant Linear Correlation

Infiltration of polymorphonuclear leukocytes (PMN) is associated with the progression of myocardial infarction and reperfusion injury. However, little is known about the time course of cellular infiltration. To investigate this issue, rats were subjected to 30 min of coronary artery occlusion followed by reperfusion for less than or equal to 96 h. Myocardial injury was determined by measuring the depletion of myocardial creatine phosphokinase activity, and PMN infiltration was assessed by measuring myeloperoxidase (MPO) activity. MPO activity increased from 0.7 U/g tissue in non-operated animals, to a peak of 6.7 +/- 0.8 and 6.4 +/- 1.4 U/g at 6 and 24 h after coronary artery reperfusion, respectively. MPO activity decreased to 3.3 +/- 0.8 U/g at 48 h and 1.1 +/- 0.4 U/g at 96 h, suggesting diminished PMN accumulation. Histological examination confirmed the accumulation and resolution of PMN over the 96-h period. At 24 h, there was a significant linear correlation between infarct size and MPO activity, whereas at 96 h no relationship was found. These data indicate that PMN infiltration occurs early in response to reperfusion injury and persists for only 24 h after initiation of reperfusion. These findings suggest that attempts to moderate inflammatory cell responses to myocardial injury should be administered early after coronary artery reperfusion to limit the accumulation of potentially deleterious inflammatory cells.

scholarly journals Evaluation of effect of local exogenous application of Myrrh oil on healing of wound incisions of facial skin (Histochemical, Histological and Histomorphometrical study in rabbits)

2019 ◽  
Vol 31 (4) ◽  
Author(s):  
Nawar Bahjet Kamil ◽  
Nada M. Al-Ghaban
Keyword(s):  
Healing Process ◽  
Inflammatory Cells ◽  
Control Group ◽  
Facial Skin ◽  
Histological Findings ◽  
Control Groups ◽  
Mean Values ◽  
Significant Difference ◽  
The Right ◽  
New Zealand Rabbits

Aim of the study: Is to evaluate the effect of myrrh oil local application on the healing process of skin wounds histologically , histomorphometrically and , histochemically. Materials and methods:Twenty male white New Zealand rabbits were used in this study. An incisional wounds with full thickness depth and of 2 cm length were done on both sides of the cheek skin of each rabbit. The left sided incisions (the control group) were irrigated with distilled water (10µL). The right sided incisions (the experimental groups) were treated with myrrh oil (10µL). Each group was subdivided into 4 subgroups according to the healing interval into 1,3,7 and 14 days(5 rabbits for each group). Results: Histological findings of our current study showed a highly significant difference between the experimental and the control groups in count of the inflammatory cells which showed that mean values increased with time for the control and the experimental groups. The histomorphometrical findings had shown that the thickness of the epithelium was nearly completed at about 7 days for the experimental groups and at about 14 days for the control. The blood vessels count was recorded to have a highly significant difference between the groups at days 1 and 3 only. The histochemical findings had shown that the collagen fibers remodeling had recorded a highly significant difference between the control and the experimental groups at days 7 and 14. Conclusion: The current study had revealed that myrrh oil accelerates wounds healing in rabbits. Key word:Wound healing , Myrrh oil, Masson’s Trichrome staining.

scholarly journals 16. Healing Process Of Burns (Vulnus combustion) Degrees IIB Using Mixed Leaf (Spondias dulcis F.) Fresh And Dry With Vaselin In Rats (Rattus Norvegicus)

2019 ◽  
Vol 13 (1) ◽  
pp. 114-124
Author(s):  
Ummu Balqis ◽  
Mirna Safrani Fauzi ◽  
Zuhrawati NA ◽  
Nazaruddin Nazaruddin ◽  
Razali Daud ◽  
...  
Keyword(s):  
Rattus Norvegicus ◽  
Inflammatory Cell ◽  
Healing Process ◽  
Inflammatory Cells ◽  
Inflammatory Cell Infiltration ◽  
Cell Infiltration ◽  
Treatment Groups ◽  
White Rats ◽  
Grade Ii ◽  
Hematoxylin And Eosin

           The aims of this research was looked to determine the healing process of burns  Grade II B using a mixture of fresh and dried leaf kedondong with vaseline white rats (Rattus norvegicus). Animals used were 18 rats. This study was designed using three treatment groups namely (KI) vaseline, (KII) mixture of crushed leaves and fresh kedondong (KIII) mixture of crushed dried leaves kedondong and each two replications. Burns made on the backs of mice and the treatments are done twice a day for 21 days.Observation research parameter is the description of macroscopic and microscopic observed at day 7, 14, and 21 in the skin tissue with hematoxylin and eosin staining. The observation of macroscopic studies showed that the formation of a reddish color, presence of edema, and loss of the fastest consecutive scab is KI, KIII, and KII, while the formation of a scab fastest respectively KIII, KI and KII. The observation of histopathology showed on day 7, KI, KII and KIII found inflammatory cell infiltration, hemorrhage and edema with the spread of many.on the 14th day of KI and KII infiltration of inflammatory cells and their udema much, whereas KIII inflammatory cell infiltration decreased, and hyperemia increase, on the 21st day KI, KII and KII inflammatory cell infiltration, hyperemia and hemorrhage spread with a little, but KI and KII oedemanya still being spread. Based on the results of this study concluded that KIII accelerate the healing process of burns on rats

Abstract 2422: Short Term Effects of Milrinone on Biomarkers in Severe Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
David Lanfear ◽  
Ramesh C Gupta ◽  
Rasha N Bazari ◽  
Reema Hasan ◽  
Celeste Williams ◽  
...  
Keyword(s):  
Heart Failure ◽  
Myocardial Injury ◽  
Fas Ligand ◽  
Troponin I ◽  
Severe Heart Failure ◽  
Myocardial Necrosis ◽  
Adverse Outcomes ◽  
P Values ◽  
Damage Initiation ◽  
Tnf Α

Introduction: Inotrope use is associated with adverse outcomes in heart failure (HF), raising concern that it may cause or accelerate myocardial injury/damage. Whether biomarkers of myocardial necrosis, stretch, inflammation and apoptosis change in response to inotrope initiation is not known. Methods: Ten patients with severe HF and cardiac index < 2.0 L/m/M2 who were planned to receive intravenous milrinone were studied. All patients were at bed rest in cardiac intensive care unit. Blood was drawn immediately before initiation of milrinone and after 24 hours of continuous infusion. Milrinone dosing was at the discretion of the patient’s attending physician (0.375 –0.5 mcg/kg/min were used). Blood samples were immediately centrifuged, plasma aliquoted, and frozen at -70°C. Troponin I (TnI), Myoglobin, N-terminal pro-BNP (NTproBNP), interleukin 6 (IL6), Tumor Necrosis Factor α (TNF α), soluble Fas (sFas), and Fas ligand (FasL) levels were measured. TnI levels were replicated to assess precision of measurement, yielding a correlation coefficient > 0.995 and power > 90% to detect a mean difference as small as 0.02 ng/ml. Statistical comparisons were made between baseline levels and 24 hour levels using the paired t-test. P values < 0.05 were considered significant. Results: Baseline mean biomarker levels, 24 hour levels, absolute change, percent change, and associated p-values are shown in the Table . Troponin I was elevated at baseline in all patients (range 0.0205– 0.56 ng/ml). There was no significant change in TnI after 24 hours of milrinone compared to baseline. There were significant improvements in NTproBNP, IL6, TNF α, sFas, and FasL. Conclusions: In this sample of patients with severe HF and reduced cardiac output, all had elevated troponin at baseline, consistent with ongoing myocardial damage. Initiation of milrinone therapy did not result in changes indicative of accelerated myocardial injury, and was associated with salutary effects on other markers. This research has received full or partial funding support from the American Heart Association, Midwest Affiliate (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota & Wisconsin). Change in Biomarker Levels at 24 hours of Milrinone Therapy

scholarly journals Influence of nicotine on healing of vesical sutures in rabbits

2007 ◽  
Vol 22 (6) ◽  
pp. 479-484 ◽  
Author(s):  
Christiano Machado ◽  
Eduardo Wei Kin Chin ◽  
Sérgio Ossamu Ioshii ◽  
Renato Tâmbara Filho ◽  
Aline Von Bathen
Keyword(s):  
Tensile Strength ◽  
Statistical Difference ◽  
Saline Solution ◽  
Healing Process ◽  
Bladder Wall ◽  
Inflammatory Cells ◽  
Strength Test ◽  
Control Group ◽  
Time Intervals ◽  
Tensile Strength Test

PURPOSE: To study the effects of nicotine on inflammatory cells, deposition of collagen and its interference on the strength of tissue in vesical sutures in rabbits. METHODS: Twenty New Zealand rabbits were used, randomized into two groups: group N, consisting of 10 animals, to which nicotine was administered in the dose of 2mg/kg of weight as a subcutaneous injection, diluted in 1ml of saline solution at 0.9% in a daily administration during the 28 days prior to the surgery; and group C, consisting of 10 animals, to which saline solution at 0.9% was administered in the same conditions and time intervals of the nicotine group. All the animals underwent cystotomy and suture of the bladder wall 28 days after the administration of nicotine or saline solution. The measurements were performed on the fourth and seventh day in each group after cystectomy and euthanasia of the animals. A fragment of bladder was removed and sent for a tensile strength test to evaluate the tissue strength and another fragment underwent a histological analysis of inflammatory process and deposition of collagen. RESULTS: There was a decrease of neutrophils on the fourth postoperative day (p=0.079) and an increase of plasmocytes on the seventh postoperative day (p=0.053) in the animals that were given nicotine, without statistical difference in relation to the control group. In the analysis of the proliferation of fibroblasts, deposition of collagen and tensile strength test, there was no statistical difference in relation to the control group. CONCLUSION: The administration of nicotine in rabbits did not influence the healing process of vesical suture in relation to the inflammatory cells, deposit of collagen and tissue strength of the suture.

Critical care for patients with congenital abnormalities of the coronary arteries

2015 ◽  
Vol 25 (8) ◽  
pp. 1561-1566 ◽  
Author(s):  
Saul Flores ◽  
Ryan A. Moore ◽  
Christopher J. Statile ◽  
Erik C. Michelfelder ◽  
Shawna G. Wanstrath ◽  
...  
Keyword(s):  
Critical Care ◽  
Coronary Arteries ◽  
Care Management ◽  
Myocardial Injury ◽  
Congenital Abnormalities ◽  
Structural Heart Disease ◽  
Neurological Status ◽  
Cardiac Lesions ◽  
Critical Care Management ◽  
Significant Support

AbstractCongenital abnormalities of the coronary arteries in the absence of structural heart disease account for a small but interesting percentage of cardiac lesions in children. Their presentation may vary from incidental identification to aborted/sudden cardiac death. Patients with aborted sudden death episodes will require significant support if they develop extensive ischaemic myocardial injury. Ultimately, surgical repair should be carried out as soon as haemodynamic stability is attained and the neurological status is evaluated. The aims of this article were to provide a review of congenital abnormalities of the coronary arteries most commonly seen in children in the ICU as well as to review the current critical-care management thereof.

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