Brain Catastrophe presented with endocrine disruption

Pituitary Apoplexy (PA) is an acute critical endocrine condition that is infrequently encountered in daily medical practice. Its life-threatening condition that mandates prompt diagnosis and urgent treatment and may be neurosurgical intervention. Majority of cases are attributed to ischemic infarction or hemorrhage of the pituitary gland usually in the vicinity of pituitary adenoma, and in most cases could be the initial manifestation of these tumors! In reviewing the literatures there is conflicting evidence of which are the predominant, non-functional, or functional adenomas, some reports were showed that prolactin-secreting are at highest risk. There are recognizable risk factors that might precipitate this endocrine emergency like hypertension, medications, major surgery, head injury, radiation, or dynamic testing, but in majority of cases at presentation no identifiable risk factor could be detected. The typical clinical scenario includes persistent worsening headache, vomiting, and altered level of consciousness, visual defect or loss with extreme hormonal derangements which are shown by hemodynamic instability, adrenal crises with variable hormonal deficiencies.

Download Full-text

Celiac Crisis in a Young Woman: Raising Awareness of a Life-Threatening Condition

Middle East Journal of Digestive Diseases ◽

10.15171/mejdd.2019.154 ◽

2019 ◽

Vol 11 (4) ◽

pp. 230-233

Author(s):

Maryam Jameshorani ◽

Akram Pourshams ◽

Anahita Sadeghi ◽

Hiva Saffar ◽

Reza Malekzadeh

Keyword(s):

Celiac Disease ◽

Herbal Medicines ◽

Hemodynamic Instability ◽

Deficiency Anemia ◽

Electrolyte Disturbances ◽

Celiac Crisis ◽

Raising Awareness ◽

Clinical Presentations ◽

Threatening Condition ◽

Life Threatening

Celiac crisis is a rare, acute, and life-threatening presentation of celiac disease. Its clinical presentations consist of severe watery non-bloody diarrhea, electrolyte disturbances (i.e. hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, and metabolic acidosis), hypoproteinemia, and dehydration. Here we present a 33-year-old woman who referred with profuse diarrhea, weight loss, hemodynamic instability, hypokalemia, hypoproteinemia, ascites, pancytopenia, and iron deficiency anemia. She used herbal medicines for constipation and had severe weakness after her childbirth. The patient was diagnosed as having celiac disease through pathological and serological evaluations 10 months earlier. Diagnosis of celiac crisis after ruling out the other causes of resistant celiac was made and she was treated with steroids.

Download Full-text

Cardiac Tamponade

Cardiac Anesthesia: A Problem-Based Learning Approach ◽

10.1093/med/9780190884512.003.0008 ◽

2019 ◽

pp. 66-75

Author(s):

Todd Novak ◽

Silas Hoxie

Keyword(s):

Cardiac Tamponade ◽

Early Recognition ◽

Hemodynamic Instability ◽

Pericardial Fluid ◽

Anesthetic Techniques ◽

Physiological Changes ◽

Threatening Condition ◽

Life Threatening ◽

Cardiac Filling

Cardiac tamponade is a life-threatening condition that occurs when accumulating pericardial fluid results in impaired cardiac filling and hemodynamic instability. Most of the clinical features of tamponade are subtle and nonspecific and may not be appreciated until cardiovascular collapse is imminent. Understanding the physiological changes that occur during tamponade are essential for early recognition and intervention. While cardiac tamponade is a clinical diagnosis, echocardiography is the modality of choice in facilitating the prompt identification of extraneous pericardial contents and the determination of the hemodynamic significance. This chapter discusses the presentation, pathophysiology, and echocardiographic signs of tamponade, as well the differential diagnosis and confounding conditions most pertinent to the anesthesiologist. Both medical and surgical management are also addressed, including a review of perioperative and anesthetic techniques.

Download Full-text

The Potential Role of Extracorporeal Cytokine Removal in Hemodynamic Stabilization in Hyperinflammatory Shock

Biomedicines ◽

10.3390/biomedicines9070768 ◽

2021 ◽

Vol 9 (7) ◽

pp. 768

Author(s):

Fatime Hawchar ◽

Cristina Rao ◽

Ali Akil ◽

Yatin Mehta ◽

Christopher Rugg ◽

...

Keyword(s):

Critically Ill ◽

Hemodynamic Instability ◽

Pooled Analysis ◽

Organ Support ◽

Pubmed Database ◽

Threatening Condition ◽

Life Threatening ◽

Mean Differences ◽

The Impact

Hemodynamic instability due to dysregulated host response is a life-threatening condition requiring vasopressors and vital organ support. Hemoadsorption with Cytosorb has proven to be effective in reducing cytokines and possibly in attenuating the devastating effects of the cytokine storm originating from the immune over-response to the initial insult. We reviewed the PubMed database to assess evidence of the impact of Cytosorb on norepinephrine needs in the critically ill. We further analyzed those studies including data on control cohorts in a comparative pooled analysis, defining a treatment effect as the standardized mean differences in relative reductions in vasopressor dosage at 24 h. The literature search returned 33 eligible studies. We found evidence of a significant reduction in norepinephrine requirement after treatment: median before, 0.55 (IQR: 0.39–0.90); after, 0.09 (0.00–0.25) μg/kg/min, p <0.001. The pooled effect size at 24 h was large, though characterized by high heterogeneity. In light of the importance of a quick resolution of hemodynamic instability in the critically ill, further research is encouraged to enrich knowledge on the potentials of the therapy.

Download Full-text

May-Thurner syndrome – Are we aware enough?

VASA ◽

10.1024/0301-1526/a000775 ◽

2019 ◽

Vol 48 (5) ◽

pp. 381-388 ◽

Cited By ~ 6

Author(s):

Katalin Mako ◽

Attila Puskas

Keyword(s):

Contraceptive Use ◽

Iliac Vein ◽

Common Iliac Vein ◽

Vein Thrombosis ◽

Compression Syndrome ◽

Threatening Condition ◽

Life Threatening ◽

Iliac Vein Compression ◽

Iliac Vein Compression Syndrome ◽

The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

Download Full-text

Severe Alveolar Hemorrhage – What’s in it for the Gastroenterologist?

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.254.cut ◽

2016 ◽

Vol 25 (4) ◽

pp. 555-558

Author(s):

Alina Popp

Keyword(s):

Celiac Disease ◽

International Normalized Ratio ◽

Gluten Free Diet ◽

Alveolar Hemorrhage ◽

Severe Anemia ◽

Gluten Free ◽

Pulmonary Infiltrates ◽

Pulmonary Hemosiderosis ◽

Threatening Condition ◽

Life Threatening

Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist. Case presentation: We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were observed. Conclusion: Although the association is rare, celiac disease should be considered in a patient with idiopathic pulmonary hemosiderosis. In our case, severe anemia and alveolar infiltrates markedly improved with glucocorticoids and gluten-free diet. Abbreviations: APTT: activated partial thromboplastin time; BAL: bronchoalveolar lavage; CD: celiac disease; Cd: crypt depth; GFD: gluten-free diet; GI: gastrointestinal; IEL: intraepithelial lymphocyte; INR: international normalized ratio; IPH: idiopathic pu

Download Full-text

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY.

10.36106/ijsr/7502922 ◽

2019 ◽

Author(s):

Madan Goyal ◽

R K Goel

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Open Cholecystectomy ◽

Critical View Of Safety ◽

Recent Onset ◽

Conversion To Open Cholecystectomy ◽

Threatening Condition ◽

Life Threatening ◽

Fluid Collections ◽

A Prospective Study

Acute cholecystitis (AC) is a potentially life-threatening condition. LC was initially considered to be a relative contraindication for laparoscopic cholecystectomy (LC), but with increase in general expertise, early LC was recommended in selected patients1. Aprospective study of LC in grade 1 and 2 AC patients with mild to moderate inflammatory changes in the gallbladder and no significant organ dysfunction, was performed during October 2016 to July 2019. A total of 78 patients, out of 408 cholecystectomies performed during this period, were included in this study. Criteria for diagnosing AC was, recent onset of pain in right hypochondrium, fever, leucocytosis, pericholecystic fluid collections, subserosal oedema on ultrasound, pyocele and other pathological evidence of AC. Patients presented and operated within 4 days of onset of symptoms showed better results as compared to those who could be operated after 4 days and within 14 days. Five patients required conversion to open cholecystectomy because of complex adhesions in 2, critical view of safety was unachievable in 2 and in 1 for troublesome bleeding.

Download Full-text

PRO–CF–MED, Clinical Proof of concept for a RNA–targeting Oligonucleotide for a Cystic fibrosis–F508del MEDication, Horizon2020

Impact ◽

10.21820/23987073.2018.3.52 ◽

2018 ◽

Vol 2018 (3) ◽

pp. 52-54

Author(s):

Nicolas Lamontagne

Keyword(s):

Cystic Fibrosis ◽

Transmembrane Conductance Regulator ◽

Transmembrane Conductance ◽

Rna Targeting ◽

Threatening Condition ◽

Life Threatening ◽

Cftr Protein ◽

Disease Modifying ◽

Cystic Fibrosis Transmembrane ◽

Specific Challenge

Cystic fibrosis (CF) is a progressive life–shortening disease caused by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene leading to a dysfunctional CFTR protein. The disease affects over 70,000 patients worldwide and while many mutations are known, the F508del mutation affects 90% of all patients. The absence of CFTR in the plasma membrane leads to a dramatic decrease in chloride efflux, resulting in viscous mucus that causes severe symptoms in vital organs like the lungs and intestines. For CF patients that suffer from the life threatening F508del mutation only palliative treatment exist. PRO–CF–MED addresses the specific challenge of this call by introducing the first disease modifying medication for the treatment of the CF patients with F508del mutation. The PRO–CF–MED project has been designed to assess the potential clinical efficacy of QR–010, an innovative disease modifying oligonucleotide–based treatment for F508del patients. Partners within PRO–CF–MED have generated very promising preclinical evidence for QR–010 which allows for further clinical assessment of QR–010 in clinical trials. PRO–CF–MED will enable the fast translation of QR–010 towards clinical practice and market authorisation. PRO–CF–MED has the potential to transform this life–threatening condition into a manageable one.

Download Full-text

Advanced care planning: thinking ahead for parents, carers, children, and young people

10.1093/oso/9780198802136.003.0016 ◽

2018 ◽

Author(s):

Angela Thompson

Keyword(s):

Spiritual Needs ◽

Care Planning ◽

Best Interest ◽

Social Emotional ◽

Children And Young People ◽

Adult Services ◽

Active Approach ◽

Threatening Condition ◽

Life Threatening ◽

Advance Care

Advance care planning (ACP) in paediatrics applies from the diagnosis of a life-limiting/life-threatening condition onwards. It encompasses the management of intermittent potentially reversible episodes through to end-of-life care in keeping with the child’s best interest. It is an active approach to managing care and acknowledges the child’s and family’s broader social, emotional, and spiritual needs and keeps the child central and paramount to all planning. It requires transparent discussions and effectively documented agreements that are well communicated, readily accessible, and immediately identifiable. It is essential to regularly review and amend as necessary. They describe the care agreed at that point in time in the child’s best interest, in line with RCPCH guidance. Challenges may particularly occur at the time of transition to adult services.

Download Full-text

A Case of Exertional Heat Stroke Complicated by Hypoxic Hepatitis

Case Reports in Emergency Medicine ◽

10.1155/2020/8724285 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Bertram K. Woitok ◽

Shawki Bahmad ◽

Gregor Lindner

Keyword(s):

Supportive Care ◽

Liver Failure ◽

Acute Liver Failure ◽

Multiorgan Failure ◽

Heat Stroke ◽

Exertional Heat Stroke ◽

Hypoxic Hepatitis ◽

Threatening Condition ◽

Life Threatening ◽

Delayed Referral

Background.Exertional heat stroke is a life-threatening condition often complicated by multiorgan failure. We hereby present a case of a 25-year-old male presenting with syncope after a 10 km run in 28°C outside temperature who developed acute liver failure. Case Presentation. Initial temperature was found to be 41.1°C, and cooling measures were rapidly applied. He suffered from acute renal failure and rhabdomyolysis and proceeded to acute liver failure (ASAT 6100 U/l and ALAT 6561 U/l) due to hypoxic hepatitis on day 3. He did not meet criteria for emergency liver transplantation and recovered on supportive care. Conclusions. Acute liver failure due to heat stroke is a life-threatening condition with often delayed onset, which nevertheless resolves on supportive care in the majority of cases; thus, a delayed referral to transplant seems to be reasonable.

Download Full-text

Ultrasound diagnosis of dissecting thoracic aortic aneurysms: procedure with a handheld device and a video-illustrated case

Tropical Doctor ◽

10.1177/0049475520959906 ◽

2021 ◽

Vol 51 (1) ◽

pp. 10-15

Author(s):

Kenneth V Iserson ◽

Sri Devi Jagjit ◽

Balram Doodnauth

Keyword(s):

Aortic Dissection ◽

Correct Diagnosis ◽

Signs And Symptoms ◽

Aortic Aneurysms ◽

Thoracic Aortic Aneurysms ◽

Handheld Device ◽

Thoracic Aortic Dissection ◽

Threatening Condition ◽

Life Threatening ◽

Handheld Ultrasound

Acute thoracic aortic dissection is an uncommon, although not rare, life-threatening condition. With protean signs and symptoms that often suggest more common cardiac or pulmonary conditions, it can be difficult to diagnose. Ultrasound has proven useful in making the correct diagnosis. This case demonstrates that training gained using standard ultrasound machines can be easily and successfully adapted to newer handheld ultrasound devices. The examination technique using the handheld device is illustrated with photos and a video.

Download Full-text