Emergent Hip Arthroscopy: Life-saving Intervention for Septic Hip and Secondary Multiorgan Failure

We describe the case of a 49-year-old woman with a Tramadol intoxication associated with multiorgan failure. Veno-arterial femoro-femoral extracorporeal life support (VA-ECLS) and hemoperfusion (HP) were used as rescue treatments. The emergency medical service found a woman at home unconscious. Once in the hospital, she was intubated and catecholamines support was immediately started for a severe shock. Brain CT was normal, whereas EEG revealed a metabolic encephalopathy pattern. Toxic levels of Tramadol and Quetiapine were detected. VA-ECLS was implanted due to persistent multiorgan failure, and HP with a charcoal cartridge was set to increase the Tramadol clearance. To quantify the charcoal cartridge’s removal efficiency of Tramadol, Tramadol concentration was measured before and after the cartridge and before and after the treatment in the patient’s blood. The charcoal cartridge showed good extraction ratio during the treatment and no significant rebound effect. VA-ECLS and HP allowed the patient to be weaned from vasoconstrictors and the resolution of the organ failures. These treatments might be lifesaving in the Tramadol intoxication.

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Surgical Treatment of Early Postpartum Hemorrhage Caused by Lower Uterine Segment Atony

10.21203/rs.3.rs-316854/v1 ◽

2021 ◽

Author(s):

Dubravko Habek ◽

Ingrid Marton ◽

Matija Prka ◽

Ana Tikvica Luetić ◽

Mirjam Vitić ◽

...

Keyword(s):

Surgical Treatment ◽

Multiorgan Failure ◽

Lower Uterine Segment ◽

Fluid Replacement ◽

Balloon Tamponade ◽

Early Postpartum ◽

Life Saving ◽

Perinatal Center ◽

Inpatient And Outpatient Care ◽

Postpartum Hysterectomy

Abstract Purpose: Lower uterine segment atony is recently being recognized as one of the major reasons for early postpartum hemorrhage.Methods: We present our experience in surgical treatment of lower uterine segment atony patients that were delivered in our tertiary perinatal center during the 10 years period (2010-2019).Results: This particular study enrolled total number of 29 543 deliveries with 215 cases of early PPH (0,72%). LUSA was diagnosed in 44 cases or in 29,93% in all uterine atony cases. Exploration of the lower uterine segment accompanied by evacuation of the coagula was conducted in 5 cases (11,36%), haemostatic ligation procedures according to authors: Losickaja in 2 cases, Hebisch-Huch in 9 cases, Habek in 5 cases, Hebisch-Huch+Losickaja in 9 cases. Evacuation procedures were combined with ligation techniques in 7 cases, evacuation methods with ligation techniques and balloon tamponade in 2 cases, exploration combined with gauze tamponade in 1 case and ligation procedures with balloon tamponade in 3 cases. According to our results, haemostatic ligation procedures alone or combined with tamponade, have shown to be highly effective in 88,63%. Conclusion: Transvaginal approach for surgical treatment of lower uterine segment atony is accessible, feasible, successful and life saving. It can be easily performed in inpatient and outpatient care settings followed by administration of uterotonics, uterostiptics and tranexamic acid and fluid replacement. All of the above mentioned methods are of great importance in the prevention and treatment of obstetric hemorrhagic shock, development of coagulopathy, multiorgan failure, postpartum hysterectomy and finally vital for fertility preservation.

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PS02.244: PEDICLED FLAPS IN ESOPHAGEAL SURGERY: WHERE THORACIC-, PLASTIC- AND ENT- SURGEONS MEET

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.244 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 191-191

Author(s):

Elisabeth Gschwandtner ◽

Jörg Lindenmann ◽

Nicole Fink-Neuböck ◽

Melanie Fediuk ◽

Christian Porubsky ◽

...

Keyword(s):

De Novo ◽

Conflicts Of Interest ◽

Anastomotic Stricture ◽

Multiorgan Failure ◽

External Irradiation ◽

Muscle Flaps ◽

Myocutaneous Flaps ◽

Pedicled Flaps ◽

Surgical Closure ◽

Life Saving

Abstract Background Esophageal, esophago-hypopharyngeal and esophago-tracheobronchial fistulae or strictures arising either de novo or following therapeutic interventions constitute serious therapeutic challenges. If conservative measures fail, pedicled muscular or myocutaneous flaps are life-saving assets. Methods During the last 10 years we treated 13 patients (11 males, 2 females; mean age: 59; range: 44–82y) with complex esophageal/hypopharyngeal problems by using pedicled muscle flaps. Results All had but one case of lye ingestion had underlying malignant disease, all but two of the latter had had chemo- and or radiotherapy. At the time of the intervention eight patients were in a critical, septic condition. There were 5 esophago-tracheal, 2 esophago-bifurcational, one esophago-colo-bronchial, and one hypopharyngo-tracheal fistula, as well as one pharyngo-cutaneous fistula all following resection/reconstruction and/or attempts of surgical closure. One patient had stricture following external irradiation, another one anastomotic stricture. We applied a total of 17 pedicled flaps: 10 pectoralis major flaps (7 of them myocutaneous, three split flaps), 5 deltoideo-pectoral myocutaneous flaps and 2 sternocleidomastoideus flaps. In 11 patients additional intermittent stenting was used. In 6 patients the respective condition healed, 4 patients could be discharged but had minor recurrent fistulae that could be handled conservatively, in three cases persisting sepsis and multiorgan failure could not be overcome. Conclusion Muscle flaps can be life-saving in large fistulae of the esophagus and the hypopharynx and are useful for refractory cervical stenosis. In presence of multiorgan dysfunction, however, healing of flaps however initially vital, is often impaired. Disclosure All authors have declared no conflicts of interest.

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Dengue Infection Complicated by Hemophagocytic Lymphohistiocytosis: Experiences From 180 Patients With Severe Dengue

Clinical Infectious Diseases ◽

10.1093/cid/ciz499 ◽

2019 ◽

Vol 70 (11) ◽

pp. 2247-2255 ◽

Cited By ~ 9

Author(s):

Foong Kee Kan ◽

Cheng Cheng Tan ◽

Tatiana Von Bahr Greenwood ◽

Khairil E Khalid ◽

Premaa Supramaniam ◽

...

Keyword(s):

Risk Factors ◽

High Mortality ◽

Hemophagocytic Lymphohistiocytosis ◽

Multiorgan Failure ◽

Dengue Infection ◽

Severe Dengue ◽

Life Saving ◽

Independent Risk Factors ◽

Associated Risk Factors ◽

A Prospective Study

Abstract Background Globally, ~500 000 people with severe dengue (SD) require hospitalization yearly; ~12 500 (2.5%) die. Secondary hemophagocytic lymphohistiocytosis (sHLH) is a potentially fatal hyperinflammatory condition for which HLH-directed therapy (as etoposide and dexamethasone) can be life-saving. Prompted by the high mortality in SD and the increasing awareness that patients with SD may develop sHLH, our objectives were to (1) determine the frequency of dengue-HLH in SD, (2) describe clinical features of dengue-HLH, (3) assess mortality rate in SD and dengue-HLH, and (4) identify mortality-associated risk factors in SD. Methods A 5-year retrospective single-center study in all adult patients with SD admitted to a tertiary intensive care unit in Malaysia. Results Thirty-nine of 180 (22%) patients with SD died. Twenty-one of 180 (12%) had HLH defined as an HLH probability ≥70% according to histo score (HScore); 9 (43%) died. Similarly, 12 of 31 (39%) fulfilling ≥4 and 7 of 9 (78%) fulfilling ≥5 HLH-2004 diagnostic criteria died. Peak values of aspartate aminotransferase (AST), alanine aminotransferase, lactate dehydrogenase, and creatinine correlated to fatality (odds ratios [ORs], 2.9, 3.4, 5.8, and 31.9; all P < .0001), as did peak ferritin (OR, 2.5; P = .0028), nadir platelets (OR, 1.9; P = .00068), hepatomegaly (OR, 2.9; P = .012), and increasing age (OR, 1.2; P = .0043). Multivariable logistic regression revealed peak AST (OR, 2.8; P = .0019), peak creatinine (OR, 7.3; P = .0065), and SOFA (Sequential Organ Failure Assessment) score (OR, 1.4; P = .0051) as independent risk factors of death. Conclusions Be observant of dengue-HLH due to its high mortality. A prospective study is suggested on prompt HLH-directed therapy in SD patients with hyperinflammation and evolving multiorgan failure at risk of developing dengue-HLH.

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Severe leptospirosis complicated with multiorgan dysfunction successfully managed with plasma exchange: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-03135-3 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Manana Dewage Sankani Vishvara Kularathna ◽

Senanayake Abeysinghe Mudiyanselage Kularatne ◽

Manoji Pathirage ◽

Pala Thanthirige Madhushi Anuradha Nanayakkara

Keyword(s):

Plasma Exchange ◽

Multiorgan Failure ◽

Kidney Injury ◽

Severe Illness ◽

High Morbidity ◽

Dramatic Improvement ◽

Severe Thrombocytopenia ◽

Sri Lankan ◽

Life Saving ◽

Severe Leptospirosis

Abstract Background Leptospirosis is a common zoonotic infection caused by the spirochete Leptospira. The disease is more prevalent in the tropics, causing subclinical to severe illness leading to high morbidity and mortality. Case presentation A 77-year-old healthy Sri Lankan man presented to the Teaching Hospital Peradeniya with severe leptospirosis complicated with acute kidney injury, pulmonary hemorrhages, myocarditis, and severe thrombocytopenia. He was deteriorating despite treatment with intravenous antibiotics and methylprednisolone boluses. He made a dramatic improvement with two cycles of plasma exchange. Conclusion Therapeutic plasma exchange is a life-saving treatment modality in severe leptospirosis with multiorgan failure.

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Impairment Tutorial: Rating Tears of the Acetabular Labrum

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2006.novdec02 ◽

2006 ◽

Vol 11 (6) ◽

pp. 4-7

Author(s):

Charles N. Brooks ◽

Richard E. Strain ◽

James B. Talmage

Keyword(s):

Magnetic Resonance ◽

Hip Arthroscopy ◽

Age Groups ◽

Limited Range ◽

Labral Repair ◽

X Rays ◽

Joint Stability ◽

Acetabular Labrum ◽

Complete Excision ◽

Limited Range Of Motion

Abstract The primary function of the acetabular labrum, like that of the glenoid, is to deepen the socket and improve joint stability. Tears of the acetabular labrum are common in older adults but occur in all age groups and with equal frequency in males and females. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, is silent about rating tears, partial or complete excision, or repair of the acetabular labrum. Provocative tests to detect acetabular labrum tears involve hip flexion and rotation; all rely on production of pain in the groin (typically), clicking, and/or locking with passive or active hip motions. Diagnostic tests or procedures rely on x-rays, conventional arthrography, computerized tomography, magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and hip arthroscopy. Hip arthroscopy is the gold standard for diagnosis but is the most invasive and most likely to result in complications, and MRA is about three times more sensitive and accurate in detecting acetabular labral tears than MRI alone. Surgical treatment for acetabular labrum tears usually consists of arthroscopic debridement; results tend to be better in younger patients. In general, an acetabular labral tear, partial labrectomy, or labral repair warrants a rating of 2% lower extremity impairment. Evaluators should avoid double dipping (eg, using both a Diagnosis-related estimates and limited range-of-motion tests).

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