Fatal Course of Cutaneous Cholesterol Embolization Syndrome: A Case Report

2021 ◽  
pp. 153473462110585
Author(s):  
B.A.W. van den Beukel ◽  
A. Poot ◽  
R. Beuk
Keyword(s):  
Skin Necrosis ◽  
Aortic Wall ◽  
Lower Extremities ◽  
Excision Biopsy ◽  
Rapid Progression ◽  
Arterial Revascularization ◽  
Abdominal Organs ◽  
Short Period ◽  
Fatal Course ◽  
Vascular Status

Cholesterol embolization syndrome is an increasing but underestimated problem after endovascular intervention or after the start of thrombolytic therapies. Embolies from the aortic wall involves abdominal organs and the skin of the lower extremities or buttocks. In our case a progressive ulceration and necroses occurs spontaneously. Endovascular treatment of the lower extremities was successful for a short period. Due to the progression of necrosis, both legs were amputated. Biopsies were taken from the skin were initially no directions to the diagnosis of Cholesterol embolization syndrome. After a second elliptical excision biopsy the diagnosis of cholesterol embolization syndrome was confirmed. Because the rapid progression of skin necroses despite the treatment of prednisone, patient died due to sepsis and renal failure. This case shows when arterial revascularization is performed and progression in skin necrosis occurs despite optimal arterial vascular status the diagnosis CES should be considered and treated in an early state of disease.

scholarly journals A Patient of Using Presepsin to Diagnose Streptococcal Toxic Shock Syndrome during Anticancer Drug Treatment

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Gaku Takahashi
Keyword(s):  
Blood Culture ◽  
Toxic Shock Syndrome ◽  
Lower Leg ◽  
Rapid Progression ◽  
Streptococcal Toxic Shock Syndrome ◽  
Toxic Shock ◽  
Anticancer Chemotherapy ◽  
Successful Recovery ◽  
Short Period ◽  
Infection Focus

Background. Streptococcal toxic shock syndrome (STSS) is a rapidly progressive infection, with potentially rapid patient deterioration in a very short period. We experienced a rare case of STSS during anticancer chemotherapy, and we continuously measured presepsin (P-SEP) and evaluated its usefulness. Case Presentation. A 60-year-old woman with pulmonary metastasis from cervical cancer began anticancer chemotherapy. A fever of >40°C and right lower leg swelling developed on day 3. Symptoms worsened despite cefmetazole treatment (1.0 g/day). Blood culture was performed without suspecting STSS. On day 5, symptoms worsened and acute disseminated intravascular coagulation (DIC) and sequential organ failure assessment (SOFA) scores increased. C-reactive protein (CRP) increased from 28.8 mg/dl to 35.5 mg/dl and P-SEP also increased from 1,635 to 2,350 pg/mL. STSS was suspected due to the rapid progression of brown discoloration of the entire right lower leg. Ceftriaxone 2 g/day and clindamycin 1,200 mg/day were begun. On the evening of day 5, blood culture revealed rapidly progressive group A streptococci. After that, symptoms improved rapidly with treatment, and SOFA and DIC scores also decreased. While CRP remained at about 0.5 mg/dl, P-SEP remained slightly elevated at about 400 pg/mL. A residual infection focus was suspected. Contrast-enhanced computed tomography (CT) revealed a capsule-enclosed abscess in the right lower leg soleus muscle on day 32. Debridement was performed and antibiotics were continued until P-SEP was 88 pg/mL. CT confirmed the disappearance of the abscess. Conclusion. Prompt diagnosis by blood culture and a sufficiently early, appropriate change in antibiotic therapy led to successful recovery from STSS during anticancer chemotherapy without lower limb amputation. P-SEP was useful in assessment of the residual infection focus and suspending treatments.

scholarly journals Malignant phyllodes tumor of the breast with rapid progression: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Hajime Abe ◽  
Atsuko Teramoto ◽  
Yumiko Takei ◽  
Yoshihito Tanaka ◽  
Genichiro Yoneda
Keyword(s):  
Therapeutic Strategy ◽  
Muscle Flap ◽  
Skin Grafting ◽  
Phyllodes Tumor ◽  
Rapid Progression ◽  
Total Mastectomy ◽  
Latissimus Dorsi Muscle Flap ◽  
Case Presentation ◽  
Dorsi Muscle ◽  
Short Period

Abstract Background Malignant phyllodes tumors (PTs) of the breast occur infrequently and are difficult to treat with adjuvant therapy. Here, we present a case of a female patient with a huge malignant PT with rapid progression in a short period. Case presentation A 44-year-old woman presented to our hospital with a rapid growth mass in her right breast, measuring 20 cm. She was initially diagnosed as having a borderline phyllodes tumor by core needle biopsy and underwent total mastectomy and artificial dermis was grafted, 20 days later, latissimus dorsi muscle flap and free skin grafting were performed. Two courses of doxorubicin–ifosfamide therapy were administered because of recurrence, but the patient died 4 months after the mastectomy. Conclusions A standard therapeutic strategy for malignant PTs is needed in urgently to reduce the risk of tumor recurrence.

scholarly journals Intra-Alveolar Hemorrhage in Certain Orphan Lung Diseases in Children (Lecture)

2020 ◽  
pp. 72-80
Author(s):  
O.L. Tsymbalista ◽  
Keyword(s):  
Kidney Failure ◽  
Clinical Course ◽  
Pulmonary Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Rapid Progression ◽  
Goodpasture Syndrome ◽  
Pulmonary Hemosiderosis ◽  
Short Period ◽  
Pulmonary Pathology ◽  
Idiopathic Pulmonary Hemosiderosis

The theme is relevant due to the diagnostic difficulties, severe clinical course and prognosis of idiopathic pulmonary hemosiderosis and Goodpasture syndrome. Idiopathic pulmonary hemosiderosis and Goodpasture syndrome are severe, life-threatening immunopathologic diseases due to alveolar hemorrhage and a hundred percent mortality within a short period of time after the onset of clinical manifestations. Idiopathic pulmonary hemosiderosis generally occurs in children at the age of 3–8 years as a separate condition, or as a stage of Goodpasture syndrome. It manifests itself as shortness of breath, pneumonia, prune juice sputum, hemoptysis, hemorrhage. During exacerbation, the patients' condition is determined by the degree of pulmonary hemorrhage, pulmonary heart disease, acute posthemorrhagic anemia. The exacerbation lasts from a few hours to 1–2 weeks. The duration of each episode and remission varies among patients being unpredictable. Each new exacerbation is more severe. In Goodpasture syndrome, predominant pulmonary and renal vascular lesions of autoimmune nature are observed. It affects young males more frequently; is rare in children. Hemorrhagic alveolitis as a form of lung damage develops first; then, the kidneys are involved, and anemia occurs. Glomerulonephritis (GN) manifests itself as nephrotic syndrome with rapid progression of kidney failure. In case of the predominant pulmonary pathology, recurrent hemoptysis and pulmonary hemorrhage are observed; in end-stage disease with cardiopulmonary failure manifestations, rapidly progressive GN and kidney failure develop. The second variant of Goodpasture syndrome is characterized by relatively slow progression of pulmonary changes and renal lesions. Goodpasture syndrome is rarely accompanied by GN from the onset to the end of the disease and pulmonary pathology manifests itself at the terminal phase of the disease. The treatment of both diseases includes lifetime therapy with glucocorticoids, cytostatics. Pulse therapy using these preparations, discrete plasma exchange and intravenous immunoglobulin administration, syndromic treatment are carried out. No conflict of interest was declared by the authors. Keywords: children, idiopathic pulmonary hemosiderosis, Goodpasture syndrome, clinical course, therapy.

scholarly journals Calciphylaxis Involving Both the Upper and Lower Extremities

2004 ◽  
Vol 47 (4) ◽  
pp. 277-279
Author(s):  
Tulay Ozer ◽  
Ali Borazan ◽  
Mubin Hosnuter ◽  
Eksal Kargi ◽  
Ahmet Savranlar ◽  
...  
Keyword(s):  
Type Ii Diabetes ◽  
Lower Extremities ◽  
Type Ii Diabetes Mellitus ◽  
Rapid Progression ◽  
Small Vessels ◽  
Upper And Lower Extremities ◽  
Phosphate Product ◽  
Stage Renal Disease ◽  
End Stage ◽  
Very High

Calciphylaxis is an uncommon complication of end stage renal disease (ESRD) and secondary hyperparathyroidism. It characterized by cutaneous necrosis with mural calcifications and thrombosis in the small vessels of dermis. It is important to diagnose and treat, because of mortality rate from calciphylaxis is very high. We present the case of a patient with ESRD and type II diabetes mellitus developing calciphylaxis of the both upper and lower extremities had normal corrected calcium-phosphate product level. After amputation, necrosis was showed rapid progression resulting in death in one month.

Rapid Progression of Aortic Wall Vegetation

2008 ◽  
Vol 21 (3) ◽  
pp. 297.e1-297.e2 ◽  
Author(s):  
Ali Reza Moaref ◽  
Reza Mollazadeh ◽  
Mahmood Zamirian ◽  
Mohammed Bagher Sharifkazemia
Keyword(s):  
Aortic Wall ◽  
Rapid Progression

scholarly journals DIAGNOSTIC AND TREATMENT OF COMBINED DAMAGES OF LARGE BONES OF THE LIMBS AND ORGANS OF THE ABDOMINAL CAVITY IN CHILDREN

2019 ◽  
Vol 22 (1) ◽  
pp. 33-37
Author(s):  
Y. M. Yahyaev ◽  
M. I. Izrailov ◽  
I. A. Aliyev ◽  
M. -A. Magomedov ◽  
A. M. Aliskandiev
Keyword(s):  
Traffic Accident ◽  
Abdominal Cavity ◽  
Economic Effect ◽  
Lower Extremities ◽  
Upper Extremities ◽  
Lower Limbs ◽  
Diagnosis And Treatment ◽  
Multiple Injuries ◽  
Control Group ◽  
Abdominal Organs

The experience of the management of 141 victim cases aged from 1 year to 15 years with fractures of the large bones of the extremities associated with injuries of the abdominal organs is presented. The cause of injury in 56% of cases was a traffic accident with boys to prevalent to suffer. In 141 victims, 184 injuries of the abdominal organs were diagnosed with predominant damage in isolated injuries of the spleen (40%), in case of multiple injuries, a combination of damage to the spleen and liver (41.9%). In 47.6% of patients, fractures of the lower limbs were observed, fractures of the bones of the upper extremities were found in 41.8%, with predominant damage to the bones of the lower extremities with open fractures (65%). The use of the developed algorithm for diagnosis and treatment, providing for a differentiated approach to diagnosis and treatment at different periods of combined trauma, allowed obtaining more beneficial results in the main group (97.4%) compared with the control group (93.9%) with an economic effect of 28%.

scholarly journals COVID-19. An update for orthopedic surgeons

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 24 ◽  
Author(s):  
Mohammad Kamal Abdelnasser ◽  
Mohamed Morsy ◽  
Ahmed E. Osman ◽  
Ayman F. AbdelKawi ◽  
Mahmoud Fouad Ibrahim ◽  
...  
Keyword(s):  
Orthopedic Surgery ◽  
Operative Management ◽  
Relevant Information ◽  
Health Care Facilities ◽  
Medical Community ◽  
Rapid Progression ◽  
Short Period ◽  
Number Of Publications ◽  
Meta Analyses ◽  
The Impact

The COVID-19 pandemic has affected our world in a short period of time, and the orthopedic surgery practice was not an exclusion. Elective care was deferred in most health care facilities and emergency care was continued with strict precautions. With rapid progression of the pandemic, the response of the medical community is also rapidly changing in all aspects of delivering care. This led to a large number of publications with reports, guidelines, measures, ways to react to the crisis, and post-pandemic predictions and speculations. In this review we aimed at summarizing all the relevant information to the orthopedic surgery community. To do this, a comprehensive search was performed with all related terms on two scientific search engines, PubMed and SCOPUS, and the results were filtered by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The result was 72 articles that were further reduced to 33 articles after full text reading. The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. This review represents the most up to date information published in the literature that is a must-know to every orthopedic surgeon.

The Origin of the Moon and its Relationship to the Origin of the Solar System

1962 ◽  
Vol 14 ◽  
pp. 133-148 ◽  
Author(s):  
Harold C. Urey
Keyword(s):  
Solar System ◽  
The Moon ◽  
The Past ◽  
The Earth ◽  
Short Period ◽  
Origin Of The Moon

During the last 10 years, the writer has presented evidence indicating that the Moon was captured by the Earth and that the large collisions with its surface occurred within a surprisingly short period of time. These observations have been a continuous preoccupation during the past years and some explanation that seemed physically possible and reasonably probable has been sought.

the effects of resonance with Jupiter in the system of short-period comets

1974 ◽  
Vol 22 ◽  
pp. 193-203
Author(s):  
L̆ubor Kresák
Keyword(s):  
Structural Effects ◽  
Order Resonance ◽  
Mean Motion ◽  
Short Period ◽  
The Mean ◽  
Compound Effect ◽  
Low Order

AbstractStructural effects of the resonance with the mean motion of Jupiter on the system of short-period comets are discussed. The distribution of mean motions, determined from sets of consecutive perihelion passages of all known periodic comets, reveals a number of gaps associated with low-order resonance; most pronounced are those corresponding to the simplest commensurabilities of 5/2, 2/1, 5/3, 3/2, 1/1 and 1/2. The formation of the gaps is explained by a compound effect of five possible types of behaviour of the comets set into an approximate resonance, ranging from quick passages through the gap to temporary librations avoiding closer approaches to Jupiter. In addition to the comets of almost asteroidal appearance, librating with small amplitudes around the lower resonance ratios (Marsden, 1970b), there is an interesting group of faint diffuse comets librating in characteristic periods of about 200 years, with large amplitudes of about±8% in μ and almost±180° in σ, around the 2/1 resonance gap. This transient type of motion appears to be nearly as frequent as a circulating motion with period of revolution of less than one half that of Jupiter. The temporary members of this group are characteristic not only by their appearance but also by rather peculiar discovery conditions.

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