scholarly journals Perioperative management of a patient with primary hypoparathyroidism and severe hypocalcaemia for lumbar spine surgery

2016 ◽  
Vol 03 (01) ◽  
pp. 049-051
Author(s):  
Deepak Madankar ◽  
Sheetal Samel ◽  
Abhay Ganar ◽  
Neelesh Mathankar
Keyword(s):  
Perioperative Management ◽  
Muscle Power ◽  
Lumbar Discectomy ◽  
Medical Emergency ◽  
Lumbar Spine Surgery ◽  
Rare Entity ◽  
Ionised Calcium ◽  
Life Threatening ◽  
Severe Hypocalcaemia ◽  
Intravenous Calcium

AbstractPrimary hypoparathyroidism and consequent hypocalcaemia in the absence of iatrogenic cause are a rare entity. Serum ionised calcium concentrations < 0.50 mmol l−1 are more frequently associated with life-threatening complications and constitute a medical emergency that necessitates intravenous calcium therapy. The anaesthesiologist should carefully look for the effects of hypocalcaemia on the heart, circulation, muscle power and blood coagulation. We report perioperative management of a case of hypoparathyroidism and associated hypocalcaemia posted for lumbar discectomy in prone position and its anaesthetic implications.

scholarly journals A Cough Deteriorating Gross Hematuria: A Clinical Sign of a Forthcoming Life-Threatening Rupture of an Intraparenchymal Aneurysm of Renal Artery (Wunderlich's Syndrome)

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Ioannis Anastasiou ◽  
Ioannis Katafigiotis ◽  
Christos Pournaras ◽  
Evangelos Fragkiadis ◽  
Ioannis Leotsakos ◽  
...  
Keyword(s):  
Renal Artery ◽  
Artery Aneurysm ◽  
Final Diagnosis ◽  
Medical Emergency ◽  
Renal Artery Aneurysm ◽  
Rare Entity ◽  
Gross Hematuria ◽  
Macroscopic Hematuria ◽  
Unstable Patient ◽  
Life Threatening

Macroscopic hematuria regards the 4% to 20% of all urological visits. Renal artery aneurysms (RAAs) are detected in approximately 0.01%–1% of the general population, while intraparenchymal renal artery aneurysms (IPRAAs) are even more rarely detected in less than 10% of patients with RAAs. We present a case of a 58-year-old woman that came into the emergency room (ER) complaining of a gross hematuria during the last four days. Although in the ER room the first urine sample was clear after a cough episode, a severe gross hematuria began which led to a hemodynamically unstable patient. Finally, a radical nephrectomy was performed, and an IPRAA was the final diagnosis. A cough deteriorating hematuria could be attributed to a ruptured intraparenchymal renal artery aneurysm, which even though constitutes a rare entity, it is a life-threatening medical emergency.

Perioperative management for functional ganglioneuroma in a 2-year-old child with multiple congenital defects and COVID-19: A case report (Preprint)

2021 ◽  
Author(s):  
Pragadeshwaran Rajendran ◽  
Habib Karim ◽  
Vikramjit Singh ◽  
Shruti Bias
Keyword(s):  
Decision Making ◽  
Perioperative Management ◽  
Septal Defect ◽  
Hormone Secretion ◽  
Perioperative Period ◽  
Congenital Defects ◽  
Rare Entity ◽  
Palpable Mass ◽  
Life Threatening ◽  
Surgical Manipulation

UNSTRUCTURED Unlike neuroblastoma, ganglioneuroma is a rare entity in children younger than seven years of age. Further, these tumors are mostly inactive endocrinologically and present as abdominal pain or palpable mass. Unfortunately, when functional, they mimic or occasionally co-exist with pheochromocytoma. While perioperative management of pheochromocytoma has evolved a lot, very little is known for the management of functioning ganglioneuroma. Hormone secretion due to surgical manipulation and anesthesia can precipitate life-threatening complications. The risk further increases when associated with other congenital comorbidities. Furthermore, corona pandemic as well as COVID-19 infection in the perioperative period is another new challenge. We report perioperative management and outcome of a functioning retroperitoneal ganglioneuroma in a 2-year-old child, having a ventricular septal defect, spina bifida occulta, and COVID-19. The case also highlights decision-making challenges during the COVID-19 pandemic.

A Review on the Use of Reversal Agents of Direct Oral Anticogulant Drugs in Case of Gastrointestinal Bleeding

2020 ◽  
Vol 15 ◽  
Author(s):  
Veronica Ojetti ◽  
Angela Saviano ◽  
Mattia Brigida ◽  
Luisa Saviano ◽  
Alessio Migneco ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Medical Emergency ◽  
Management Approach ◽  
Emergency Setting ◽  
Reversal Agents ◽  
Life Threatening ◽  
Andexanet Alfa

Background : Major bleeding is a life-threatening condition and a medical emergency with high mortality risk. It is often the complication of anticoagulant’s intake. Anticoagulants are commonly used for the prevention and the treatment of thrombotic events. The standard therapy with vitamin K antagonist (warfarin) has been frequently replaced by direct oral anticoagulants (DOACs). The latter agents (rivaroxaban, apixaban, edoxaban, dabigatran, betrixaban) showed a better efficacy and safety compared to standard warfarin treatment and they are recommended for the reduction of ischemic stroke. Literature data reported a high risk of gastrointestinal bleeding with DOACs, in particular with dabigatran and rivaroxaban. In case of life-threatening gastrointestinal bleeding, these patients could benefit from the use of reversal agents. Methods: We performed an electronic search on PUBMED of the literature concerning reversal agents for DOACs and gastrointestinal bleeding in the Emergency Department from 2004 to 2020. AIM: This review summarizes the current evidences about three reversal agents idarucizumab, andexanet alfa and ciraparantag, and the use of the first two in the emergency setting in patients with an active major bleeding or who need urgent surgery to offer physicians indications for a better management approach in order to increase patient’s safety. Conclusion: Although these agents have been marketed for five years (idarucizumab) and two years (andexanet alfa) respectively, and despite guidelines considering antidotes as first-line agents in treating life-threatening hemorrhage when available, these antidotes seem to gain access very slowly in the clinical practice. Cost, logistical aspects and need for plasma level determination of DOAC for an accurate therapeutic use probably have an impact on this phenomenon.. An expert multidisciplinary bleeding team should be established so as to implement international guidelines based on local resources and organization.

Acute pericardial tamponade: The initial manifestation of systemic lupus erythematosus with Graves’ hyperthyroidism

Lupus ◽  
2021 ◽  
pp. 096120332110047
Author(s):  
Muming Yu ◽  
Yulei Gao ◽  
Heng Jin ◽  
Songtao Shou
Keyword(s):  
Myocardial Infarction ◽  
Systemic Lupus Erythematosus ◽  
Female Patient ◽  
Lupus Erythematosus ◽  
Pericardial Tamponade ◽  
Medical Emergency ◽  
Systemic Lupus ◽  
Initial Manifestation ◽  
Life Threatening ◽  
Obstructive Shock

Acute pericardial tamponade, which can cause obstructive shock, is a serious life-threatening medical emergency that can be readily reversed by timely identification and appropriate intervention. Acute pericardial tamponade can occur for a number of reasons, including idiopathic, malignancy, uremia, iatrogenic, post-myocardial infarction, infection, collagen vascular, hypothyroidism, and others. Systemic lupus erythematosus (SLE) and hyperthyroidism associated with pericardial tamponade are rarely reported. Here, we report the case of a 20-year-old female patient was final diagnosed of SLE with Graves’ hyperthyroidism.

scholarly journals Linical efficacy of percutaneous endoscopic lumbar discectomy for the treatment of lumbar spinal stenosis in elderly patients: a retrospective study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Hua Li ◽  
Yufu Ou ◽  
Furong Xie ◽  
Weiguo Liang ◽  
Gang Tian ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lumbar Discectomy ◽  
Lumbar Spine Surgery ◽  
Decompression Surgery ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Pain Scores ◽  
Endoscopic Lumbar Discectomy ◽  
Lumbar Spinal

Abstract Background Although percutaneous endoscopic lumbar discectomy (PELD) is increasingly being used to treat lumbar degenerative disease, the treatment of elderly patients with lumbar spinal stenosis (LSS) involves considerable uncertainty. The purpose of this study was to evaluate the safety and effectiveness of PELD for the treatment of LSS in elderly patients aged 65 years or older. Methods In this retrospective review, 136 patients aged 65 years or older who underwent PELD to treat LSS were evaluated. The patients were divided into two groups, group A (ages 65–74) and group B (age ≥ 75), and perioperative data were analyzed. The Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and MacNab classification were used to evaluate postoperative clinical efficacy. Results All patients successfully underwent the operation with satisfactory treatment outcomes. Compared to preoperative scores, the self-reported scores or pain while performing daily activities were significantly improved in both treatment groups (P < 0.05). No statistically significant between-group differences were observed in operation time, intraoperative blood loss, postoperative bed rest, and postoperative hospital stay (P > 0.05). The overall postoperative complication rate was similar between the two groups. Moreover, no statistically significant differences in VAS-back pain scores, VAS-leg pain scores, JOA scores, and MacNab classification were found between the groups at the 3-month and 1.5-year follow-up examinations (P > 0.05). Conclusion PELD is safe and effective for the treatment of LSS in elderly patients. Age is not a contraindication for decompressive lumbar spine surgery. PELD has advantages such as reduced trauma, fewer anesthesia-related complications, and a fast postoperative recovery. Elderly patients should be considered good candidates for lumbar decompression surgery using minimally invasive techniques.

scholarly journals Myelodysplastic Syndrome Clinically Presenting with the “Classic TTP Pentad”

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Santiago Fabián Moscoso Martínez ◽  
Evelyn Carolina Polanco Jácome ◽  
Elizabeth Guevara ◽  
Vijay Mattoo
Keyword(s):  
Myelodysplastic Syndrome ◽  
Clinical Presentation ◽  
Renal Involvement ◽  
Medical Emergency ◽  
Complete Blood Cell Count ◽  
Blood Cell Count ◽  
Thrombocytopenic Purpura ◽  
Life Saving ◽  
Threatening Condition ◽  
Life Threatening

The clinical presentation of myelodysplastic syndrome (MDS) is not specific. Many patients can be asymptomatic and can be detected only due to an abnormal complete blood cell count (CBC) on routine exam or for other reasons while others can be symptomatic as a consequence of underlying cytopenias. Thrombotic thrombocytopenic purpura (TTP) usually is suspected under the evidence of microangiopathic hemolytic anemia (MAHA) and thrombocytopenia and because it is a life-threatening condition (medical emergency) immediate initiation of plasmapheresis could be life-saving. The following case illustrates an unusual presentation of MDS in a patient who came in to the emergency room with the classic TTP “pentad” of fever, renal involvement, MAHA, mental status changes, and thrombocytopenia. We will focus our discussion in the clinical presentation of this case.

scholarly journals A forgotten life-threatening medical emergency: myxedema coma

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
Elisa Pizzolato ◽  
Alberto Peano ◽  
Letizia Barutta ◽  
Emanuele Bernardi ◽  
Elena Maggio ◽  
...  
Keyword(s):  
Life Support ◽  
Neurological Status ◽  
Medical Emergency ◽  
Myxedema Coma ◽  
Emergency Department Stay ◽  
Life Threatening ◽  
Appropriate Therapy ◽  
Alithiasic Cholecystitis ◽  
The Right ◽  
Tomography Scan

Nowadays myxedema coma is a rare medical emergency but, sometimes, it still remains a fatal condition even if appropriate therapy is soon administered. Although physical presentation is very non-specific and diversified, physicians should pay attention when patients present with low body temperature and alteration of neurological status; the presence of precipitating events in past medical history can help in making a diagnosis. Here we discuss one such case: an 83-year-old female presented with abdominal pain since few days. Laboratory tests and abdomen computed tomography scan demonstrated alithiasic cholecystitis; she was properly treated but, during the Emergency Department stay she experienced a cardiac arrest. Physicians immediately started advance cardiovascular life support algorithm and she survived. Later on, she was admitted to the Intensive Care Unit where doctors discovered she was affected by severe hypothyroidism. Straightway they started the right therapy but, unfortunately, the patient died in a few hours.

scholarly journals Intensive Care Management of Multiorgan Dysfunction and Hypoxic Brain Injury Secondary to Refractory Status Epilepticus

2021 ◽  
Vol 2 (4) ◽  
pp. 3
Author(s):  
Sanum Kashif
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Medical Emergency ◽  
High Grade Fever ◽  
Refractory Status ◽  
Hypoxic Brain Injury ◽  
Hypoxic Brain ◽  
Threatening Condition ◽  
Life Threatening ◽  
Permanent Brain Damage

Refractory Status Epilepticus (RSE) is a medical emergency that may lead to permanent brain damage or death.Mortality rate is 16-39%. It is the life threatening condition in which continuous fits occur, despite treatmentwith benzodiazepines and one antiepileptic drug.A 25-year-old female, brought in emergency department with high-grade fever and frequent fits. GlasgowComa Scale (GCS) was 3/15 with unstable hemodynamics. Resuscitation started immediately and managed asstatus epilepticus. Patient was in multi organ failure on arrival. On the basis of history and examination, hypoxicbrain injury was diagnosed initially. Later on, refractory status epilepticus (RSE) with multi organ dysfunctionsyndrome (MODS) was diagnosed, after necessary investigations and treatment. Patient was managed as ateam with multidisciplinary approach and after continuous effort of 2 weeks, patient was successfullydischarged to home.

UNEXPLAINED DELIRIUM : THINK OF THYROID STORM

2021 ◽  
pp. 23-25
Author(s):  
Soni Namita ◽  
Shruti A ◽  
Soni Anand ◽  
Nikalje A ◽  
Bharadwaj M
Keyword(s):  
Ventricular Tachycardia ◽  
Thyroid Storm ◽  
Rare Entity ◽  
Thyroid Medication ◽  
Malignant Arrhythmia ◽  
Life Threatening ◽  
Systemic Condition ◽  
Very High ◽  
Serum Tsh

Background: Thyroid storm is a life-threatening Endocrine emergency with an incidence rate of 1% to 2% all over the world. It is a systemic condition leading to increased production of Thyroid Hormone and its release leading to Thermoregulatory, Adrenergic, Neuropsychiatric, Cardiovascular, and Abdominal Manifestations. Thyroid storm with Malignant Arrhythmia and delirium both together is rare entity, but the mortality rate is very high. The presentation of Malignant Arrhythmias and delirium together in the initial phase of the disease is much less common with only a few isolated cases described in the scientic literature. Objective: To present a case in which a patient had two simultaneous complication of thyroid storm i.e. delirium and ventricular tachycardia. Case Study: We report a 65 years-year-old man who came with complaints of Diarrhea, Fever, Breathlessness and psychosis. His serum tsh was <0.015 and anti tpo antibodies was 83. He was diagnosed to be in Thyroid storm and later had complications including Ventricular Tachycardia and delirium in an undiagnosed case of Hyperthyroidism. He was started on anti thyroid medication and slowly as his condition improved he was discharged. Conclusion: Patients with Thyrotoxicosis need to be closely monitored for complications since its early diagnosis and treatment may save lives.

scholarly journals Paroxysmal Cold Hemoglobinuria in an Adult with Respiratory Syncytial Virus

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Ryan Leibrandt ◽  
Kenneth Angelino ◽  
Monique Vizel-Schwartz ◽  
Ilan Shapira
Keyword(s):  
Respiratory Syncytial Virus ◽  
Upper Respiratory Tract ◽  
Rare Entity ◽  
Rare Form ◽  
Cold Temperatures ◽  
Tertiary Syphilis ◽  
Life Threatening ◽  
Upper Respiratory ◽  
Syncytial Virus ◽  
Paroxysmal Cold Hemoglobinuria

Paroxysmal cold hemoglobinuria (PCH) is a rare form of cold autoimmune hemolytic anemia first discovered in the early 20th century in adults with tertiary syphilis. Today, it is more commonly seen in children as a life-threatening anemia during a viral upper respiratory tract infection (URI). Although respiratory syncytial virus (RSV) has previously been reported to cause PCH in a child, herein we present the first documented case in an adult. The Donath–Landsteiner (DL) test, the diagnostic test for PCH, was positive on two separate occasions. The patient was treated successfully with warming and avoidance of cold temperatures. To facilitate identification of this rare entity by clinicians, we include a discussion about the pathophysiology, diagnosis, and treatment of PCH.

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