ECMO usefulness in refractory shock secondary to Phenylephrine poisoning: About a case in a Pediatric subject

Introduction: Phenylephrine is an alpha-agonist with vasoconstrictor effect. Systemic absorption or adverse reaction can cause complications that can be lethal. In those cases of adverse drug reactions with failure to conventional management, the use of ECMO has been reported as a treatment modality. Clinical case: We report the case of a 13 years old teenager, who presented acute pulmonary edema and acute heart failure subsequent to the application of topical phenylephrine during the a rhino-septoplasty procedure, and that warranted placement of ECMO due to failure of conventional treatment. Discussion: Venoarterial ECMO was placed by central cannulation, with ventilatory and hemodynamic improvement, performing the explant successful 4th postoperative day. Conclusions: ECMO as a "bridge to recovery" may be an alternative in those cases of pulmonary or cardiac failure and refractory with a poor response to conventional treatment, as well as an option to save the life of these patients.

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Germline mutations of AIP gene in somatotropinomas resistant to somatostatin analogues

Acta Endocrinologica ◽

10.1530/eje-12-0457 ◽

2013 ◽

Vol 168 (1) ◽

pp. 9-13 ◽

Cited By ~ 41

Author(s):

Josep Oriola ◽

Tomás Lucas ◽

Irene Halperin ◽

Mireia Mora ◽

Ma José Perales ◽

...

Keyword(s):

Pituitary Adenomas ◽

Conventional Treatment ◽

Poor Response ◽

Germline Mutations ◽

Somatostatin Analogues ◽

Age At Diagnosis ◽

Somatostatin Analogue ◽

Endocrine Tumors ◽

Peg Treatment ◽

Aip Gene

ObjectiveMost cases of familial isolated pituitary adenomas with mutated aryl hydrocarbon receptor-interacting protein (AIP:HGNC:358) gene develop somatotropinomas. They are characterised by an aggressive clinical phenotype including early age at diagnosis, large tumours and frequent invasiveness. There is little information on AIP gene mutations' prevalence in isolated somatotropinomas characterised by poor response to somatostatin analogue treatment. The aim of this study was to investigate the prevalence of AIP mutations in non-familial cases of somatotropinomas with poor response to conventional treatment.Design and methodsFifty patients with acromegaly (22 males/28 females, age 51±18 years) and 60 controls were included in this study performed at eight University Hospitals in Spain. None had family history of pituitary adenomas or other endocrine tumors. All patients failed to respond to conventional treatment including surgery and somatostatin analogues. Some patients received adjuvant radiotherapy and most cases required pegvisomant (PEG) treatment for normalisation of IGF1. AIP analysis was performed in DNA extracted from peripheral leucocytes, using standardised PCR protocol in which the coding regions of exons 1, 2, 3, 4, 5 and 6 were amplified. Possible deletions/duplications were studied using multiplex ligation-dependent probe amplification.ResultsSequence changes of potential different significance that could be considered as mutations or variations of unknown significance (VUS) of the AIP gene were found in four patients (8%). In two cases, two different mutations previously described were found: p.Arg9Gln and p.Phe269Phe. Two other VUS were also found: c.787+24C>T in intron 5 and c.100-18C>T in intron 1. Age at diagnosis ranged from 21 to 50 years old, and in all patients, the tumor was a macroadenoma depicting IGF1 normalisation under PEG treatment.ConclusionsAIP germline mutations show a low, but non-negligible, prevalence in non-familial acromegaly patients with tumors resistant to treatment with somatostatin analogues.

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Pregnancy failure in patients with obstetric antiphospholipid syndrome with conventional treatment: the influence of a triple positive antibody profile

Lupus ◽

10.1177/0961203317692432 ◽

2017 ◽

Vol 26 (9) ◽

pp. 983-988 ◽

Cited By ~ 25

Author(s):

J O Latino ◽

S Udry ◽

F M Aranda ◽

S D A Perés Wingeyer ◽

D S Fernández Romero ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Antiphospholipid Syndrome ◽

Pregnancy Outcomes ◽

Conventional Treatment ◽

Poor Response ◽

Anticardiolipin Antibodies ◽

History Of ◽

Obstetric Antiphospholipid Syndrome ◽

The Impact

Conventional treatment of obstetric antiphospholipid syndrome fails in approximately 20–30% of pregnant women without any clearly identified risk factor. It is important to identify risk factors that are associated with these treatment failures. This study aimed to assess the impact of risk factors on pregnancy outcomes in women with obstetric antiphospholipid syndrome treated with conventional treatment. We carefully retrospectively selected 106 pregnancies in women with obstetric antiphospholipid syndrome treated with heparin + aspirin. Pregnancy outcomes were evaluated according to the following associated risk factors: triple positivity profile, double positivity profile, single positivity profile, history of thrombosis, autoimmune disease, more than four pregnancy losses, and high titers of anticardiolipin antibodies and/or anti-βeta-2-glycoprotein-I (aβ2GPI) antibodies. To establish the association between pregnancy outcomes and risk factors, a single binary logistic regressions analysis was performed. Risk factors associated with pregnancy loss with conventional treatment were: the presence of triple positivity (OR = 5.0, CI = 1.4–16.9, p = 0.01), high titers of aβ2GPI (OR = 4.4, CI = 1.2–16.1, p = 0.023) and a history of more than four pregnancy losses (OR = 3.5, CI = 1.2–10.0, p = 0.018). The presence of triple positivity was an independent risk factor associated with gestational complications (OR = 4.1, CI = 1.2–13.9, p = 0.02). Our findings reinforce the idea that triple positivity is a categorical risk factor for poor response to conventional treatment.

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High-Volume Hemofiltration as Adjuvant Therapy for Refractory Shock after Pericardiocentesis

The Heart Surgery Forum ◽

10.1532/hsf98.20111028 ◽

2011 ◽

Vol 14 (5) ◽

pp. 313

Author(s):

Romuald Lango ◽

Maciej M. Kowalik ◽

Piotr Siondalski ◽

Jan Rogowski ◽

Alicja Dabrowska-Kugacka

Keyword(s):

Cardiac Tamponade ◽

Inflammatory Mediators ◽

Experimental Studies ◽

High Volume ◽

Left Ventricular ◽

Sudden Increase ◽

Refractory Shock ◽

Hemodynamic Deterioration ◽

High Volume Hemofiltration ◽

Hemodynamic Improvement

Background: Pericardiocentesis for the treatment of chronic cardiac tamponade can occasionally result in acute pulmonary edema or biventricular failure. A sudden increase in heart filling pressures and right-to-left ventricular-output mismatch have been proposed underlying mechanisms.Case Report: We report the case of 16-year-old patient who underwent pericardiocentesis for chronic cardiac tamponade 6 weeks after undergoing a Bentall procedure. The patient developed circulatory shock 6 hours after pericardiocentesis. High-volume hemofiltration was used as a rescue therapy after treatment with positive inotropic drugs proved ineffective. An improvement in circulatory function observed after commencement of the hemofiltration treatment was followed by hemodynamic deterioration when the hemofiltration procedure was ceased.Discussion: The mechanism of the observed hemodynamic improvement is unclear. Hemodynamic recovery related in time to high-volume hemofiltration treatment indicates the possible removal of inflammatory mediators. Visceral vasoconstriction resulting from cardiac tamponade and subsequent improvement in gut perfusion after pericardiocentesis that led to washout of inflammatory mediators might have contributed to the development of acute heart failure. Cytokine removal by high-volume hemofiltration and the procedure's relationship to hemodynamic improvement have previously been demonstrated in clinical and experimental studies of septic shock.Conclusions: We conclude that high-volume hemofiltration can be helpful as an adjuvant treatment for refractory shock after pericardiocentesis for chronic cardiac tamponade. The mechanism of the observed hemodynamic improvement remains to be investigated.

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Emphysematous pyelonephritis treated with elective nephrectomy in a 75-year-old diabetic patient

Clinics and Practice ◽

10.4081/cp.2012.e14 ◽

2012 ◽

Vol 2 (1) ◽

pp. 14

Author(s):

Yayi He ◽

Bingyin Shi ◽

Xiaoyan Wu ◽

Peng Hou ◽

Yi Wang

Keyword(s):

Conventional Treatment ◽

Poor Response ◽

Diabetic Patients ◽

Progressive Decrease ◽

Emphysematous Pyelonephritis ◽

Quick Recovery ◽

Gas Formation ◽

Life Saving ◽

Tomography Scan

We present a case of 75-year-old man with type 2 diabetes and emphysematous pyelonephritis (EPN). The patient presented with abdominal pain, fever of undetermined origin and progressive decrease in urine output. Computerized tomography scan revealed gas formation in the left renal parenchyma and capsule. A left nephrectomy was performed. He made a quick recovery. EPN should be taken into consideration in diabetic patients with symptoms of pyelonephritis who show a poor response to conventional treatment. Elective nephrectomy may be life saving in some patients.

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THE MIMICKER OF MALADIES: A SUCCESS STORY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i5.1900 ◽

2021 ◽

Vol 5 (5) ◽

Author(s):

Aneesa Shahul S. ◽

Abhishek Singh Chauhan ◽

Dharmprakash Dwivedi ◽

Rajesh Kumar B ◽

Maheshdev G

Keyword(s):

Diabetic Patient ◽

Conventional Treatment ◽

Indian Subcontinent ◽

Poor Response ◽

Sputum Culture ◽

Success Story ◽

Loss Of Weight ◽

Bronchial Wash

Melioidosis is being diagnosed more frequently from Indian subcontinent in the recent days. It is a serious multisystem infection caused by Burkholderi pseudomallei. 1-2 We discuss the case of a 55 year old Diabetic patient, who presented with complaints of fever, cough, breathlessness and loss of weight of one month duration. Due to poor response to conventional treatment, he was further investigated – Bronchoscopy and CT Thorax was done. Bronchial wash and sputum culture confirmed Pulmonary Melioidosis. The patient received treatment with Inj. Ceftazidime and was continued on oral Cotrimoxazole. Treatment was successful with good clinic radiological resolution. The patient is under follow up and is asymptomatic. Keywords: burkholderia, diabetics, melioidosis, pneumonia

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