蜂蛰伤并发多脏器功能障碍综合征危险因素分析

目的 探讨蜂蛰伤后并发多脏器功能障碍综合征(MODS)的危险因素.方法 回顾性分析皖南医学院附属黄山市人民医院急诊科2015年8月至2020年12月收治的95例蜂蜇伤患者的临床资料.13例蜂蛰伤后并发MODS为MODS组,82例蜂蛰伤后未出现MODS者为非MODS组.比较两组的白细胞(WBC)、血红蛋白(HGB)、血小...     

Acute respiratory distress syndrome following multiple wasp stings treated with extracorporeal membrane oxygenation: A case report

BACKGROUNDIt is necessary for clinicians to be aware of a rare but possible acute respiratory distress syndrome (ARDS) complication caused by multiple wasp stings. Severe ARDS has a high mortality rate but no specific pharmacotherapies have been identified to date. This case study presents the first case of severe ARDS caused by multiple wasp stings, treated successfully with extracorporeal membrane oxygenation (ECMO). It also emphasizes the effectiveness of early ECMO treatment for severe ARDS with persistent hypoxemia.CASE SUMMARYA 24-year-old woman was admitted to the emergency department after being stung by more than 10 wasps within a 30-min period, with clinical symptoms of multiple rashes, dizziness, chest tightness, nausea, and vomiting. On the 2^nd day of admission, the patient developed progressive dyspnea. The patient was diagnosed with ARDS based on clinical manifestations and lung computed tomography (CT) scan. Because of the progressive dyspnea, the intensive care unit physician performed endotracheal intubation and continued to provide ventilator support, but the patient’s respiratory distress worsened, as indicated by the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen. Veno-venous ECMO was initiated for 6 d. On day 7 of admission, ECMO was stopped. On the 11^th day of admission, CT scan of the lungs revealed significant reduction of ground-glass opacities and consolidations. After about 2 wk, the patient recovered completely from ARDS and was discharged to home. At the 2-mo follow-up, the patient was in good health with no recurrence of dyspnea nor chest tightness.CONCLUSIONARDS complication caused by multiple wasp stings may be fatal when mechanical ventilation becomes dangerous due to persistent hypoxemia and despite optimization of ARDS management. We propose that the early implementation of ECMO is a relatively effective treatment, although the evidence is relatively limited.     

杂合肾脏替代治疗在蜂蜇伤致急性肺水肿合并急性肾损伤中的应用

目的 本研究旨在分析杂合肾脏替代治疗(hybrid renal replacement therapy,HRRT)在蜂蜇伤致APE合并AKI中的应用.方法 前瞻性分析四川大学华西医院2007年至2010年收治的9例蜂蜇伤致急性肺水肿(acute pulmonary edema,APE)合并急性肾损伤(acute kidney injury,AKI)的患者,HRRT采用持续静静脉血液滤过(continuous veno-venous hemofiltration,CVVH)联合血浆置换(plasma exchange,PE)及持续缓慢低效血液透析(sustained low-efficiency dialysiS,SLED)的方式.CVVH机型为百特Accura、贝朗Diapact,滤器选择贝朗Diacap Acute M,血流量180～250 ml/min,置换液速度3000 ml/h,应用枸橼酸或低分子肝素抗凝,碳酸氧盐置换液采用前稀释方法输入,治疗时间至少72 h;入院第1 d及第2 d给予PE治疗(置换量:新鲜冰冻血浆2000～2500 ml/次);患者病情稳定后使用SLED隔日治疗8～12 h,透析量150 ml/min.于此同时,给予局部生理盐水冲洗湿敷伤口,给予糖皮质激素、保护肝功能、营养支持,必要时给予红细胞生成素、输血及输注人血白蛋白.结果 1例患者入院2 h后猝死,8 h后行尸体解剖提示死亡原因为蜂毒致多器官急性严重中毒性损伤及功能衰竭而死亡.余8例患者经HRRT后,氧合指数均显著改善,(5.3±2.6)d后复查胸部CT发现肺水肿显著改善,机械通气的5例患者均在2～7 d后成功脱离呼吸机.8例患者的B型尿钠肽(B-type natriuretic peptide,BNP)、肌酸激酶(creatine kinase,CK)、肌红蛋白(myoglobin,Myo)、乳酸脱氢酶(lactate dehydrogenase,LDH)经治疗后显著下降,均在入院(18±7)d后进入多尿期,(29±12)d后肾功能均完全恢复,(37±21)d后血红蛋白水平恢复至正常水平.随访(92±68)d未发现器官功能损伤.结论 APE合并AKI是蜂蜇伤严重并发症,早期积极的HRRT(CVVH+PE+SLED)干预能获得满意疗效.     

Herbal incense-related sudden death: case report

Currently, there are over 100 legally available synthetic cannabimimetics (SCBs). Serious adverse effects and deaths have been related to use of these substances. Despite their known hazards, many of them are still not banned for use in Croatia and grow in popularity among drug users. We report the case of a young man who suffered a cardiorespiratory arrest and eventually died several hours after smoking herbal incense containing a sprayed mixture of SCBs and consuming alcohol. He had no history of health problems and the autopsy revealed no pathological findings. We discuss hazards related to herbal incense smoking and draw attention to the rise in a number of cases related to use of SCBs in our community.     

A honey bee can threat ear: Sudden sensorineural hearing loss

Sudden sensorineural hearing loss is an otologic emergency. Many etiological factors can lead to this pathology. Honey bee (Apis mellifera) sting may lead to local and systemic reactions due to sensitization of the patient. In this paper we described a sudden sensorineural hearing loss occurred after honey bee sting.     

Huffing and twist: Fatal Torsade de pointes associated with Tetrafluoroethane Inhalation and amphetamine use

Many volatile chemicals inhaled for a recreational high have a chemical structure similar to chloroform and may lead to Ikr blockade and subsequent torsades de pointes. This is one potential mechanism of action for huffing‐associated sudden death.     

Japanese encephalitis following liver transplantation: A rare case report

BACKGROUND Japanese encephalitis(JE) is a serious public health concern with a high mortality rate in many Asian countries. For many years, JE virus(JEV) was considered the major cause of viral encephalitis in Asia. Although most JE cases are asymptomatic, the case fatality rate approaches 30%, and approximately 30%–50% of survivors have long-term neurological sequelae. To the best of our knowledge, JEV infection has never been reported following liver transplantation.CASE SUMMARY We report a case of a woman who underwent liver transplantation for autoimmune liver disease but presented with fever and neurological symptoms 13 d after transplantation. Magnetic resonance imaging revealed JEV infection,and positive immunoglobulin M antibody to JEV in blood and cerebrospinal fluid confirmed JE. The patient was treated with antiviral agents, immune regulation,and organ function support. No neurological sequelae were present after 1 year of follow-up.CONCLUSION Imaging and lumbar puncture examination should be performed as soon as possible in patients with fever and central nervous system symptoms after liver transplantation, and the possibility of atypical infection should be considered,which is helpful for early diagnosis and improved prognosis.     

Spontaneous dissecting aneurysm of the coronary artery. A rare cause of myocardial infarction and sudden death

Spontaneous dissecting aneurysm of the coronary artery (SDACA) not associated with aortic aneurysm or trauma is a very rare cause of myocardial ischemia. It has a higher prevalence in otherwise healthy women, especially in the peri- and postpartum period. In 80-90% of cases the diagnosis of SDACA is confirmed at autopsy, as the majority of patients present with acute myocardial infarction or sudden death. We describe the case of a 47-year-old Caucasian woman who died suddenly without any previous sign of cardiac disease. She had no clinical signs of Marfan's syndrome or arterial hypertension, she used no oral contraceptives and she was not in the peri- or postpartum period. At autopsy we found a recent dissecting aneurysm of the right coronary artery. Histology showed a hematoma between the media and adventitia of the coronary artery, flattening and occluding the lumen. Acute myocardial infarction was present in the posterior wall of the left cardiac ventricle. SDACA is an unpredictable condition and prompt diagnosis and life-saving procedures--either surgical or conservative--are rarely successful. We report a very rare disease documented in only 108 cases according to the English-language literature accessible to us.     

A Cause of Sudden Death: Rupture of Thoracic Aortic Aneurysm

Sudden death occurred during antihypertcnsive therapy of a Stanford type A dissecting aortic aneurysw. Hemodynamic and electrocardiograpbic events were recorded including deterioration of ventricular fibrillation 4 minutes after rupture.     

Fatal visceral disseminated varicella-zoster virus infection in a renal transplant recipient: A case report

BACKGROUNDVisceral disseminated varicella-zoster virus (VZV) infection is a rare but life-threatening disease. In transplant recipients with VZV infection, visceral dissemination may develop without skin eruptions, which leads to the failure of early diagnosis.CASE SUMMARYThe patient was a 33-year-old male renal recipient who was referred to our hospital with severe upper abdominal pain of 3-d duration. On admission, the patient rapidly developed septic shock and multiple organ dysfunction syndrome with liver dysfunction and acute kidney injury. Next-generation sequencing of peripheral blood yielded 39224 sequence reads of VZV, and real-time polymerase chain reaction for VZV was positive, with 1.2 × 10⁷ copies/mL. The final diagnosis was visceral disseminated VZV infection. Acyclovir and supportive therapy were started, but the patient died of severe visceral organ damage 16 h after admission.CONCLUSIONVisceral disseminated VZV infection is possible in renal transplant recipients presenting abdominal pain and rapidly-evolving organ damage without skin involvement.     

Postpausal Ventricular Fibrillation Analyzed by Holter-ECG: A Case Report

A 70-year-old male patient with a myocardial infarction, 3 months previously, happened to be wearing a Holter monitor at cardiac arrest during micturition. The patient had ventricular fibrillation (VF) and was successfully resuscitated by means of defibrillation. Analysis of the Holter tape revealed atrial fibrillation and secondary ventricular premature beats (VPB), i.e., VPBs dependent upon a relatively long interval between the two preceding heartbeats. The VF was preceded by an especially long R-R interval (1.45 sec) following a run of especially short R-R intervals implying the sharpest deceleration of the ventricular rate during 1 hour Holter recording preceding the cardiac arrest. A peculiar large alteration of the T wave configuration was also found to precede the VF.     

Brugada Syndrome: A Primer for Nurse Practitioners

Brugada syndrome (BrS) is a less known cardiac condition which falls into the category of a channelopathies. BrS has been diagnosed for more than 2 decades. Currently BrS remains a major cause of sudden cardiac death in young adults who have no known abnormal heart structure. Nurse practitioners’ awareness of the clinical presentation, diagnosis, treatment, and ongoing care is essential for maximizing patient outcomes.     

Fatal herpetic hepatitis in adult following short corticotherapy: a case report

Herpes simplex virus hepatitis (HSV hepatitis) is an uncommon and severe complication of HSV type 1 and HSV type 2 infection. HSV hepatitis affects mostly immunocompromised patients. We report the case of a young man without any previous known immunodeficiency who developed fatal HSV hepatitis in the first 8 days of oral corticotherapy given for ulcerative colitis. A prompt diagnosis was possible because HSV was recovered from peripheral blood leukocytes. Received: 22 May 1998 Accepted: 15 January 1999     

Risk Assessment and Risk Stratification in Sudden Cardiac Death: A Biostatistician's View

Determining individual probabilities of developing lethal arrhythmia over time (risk assessment) and grouping individuals by that probability (risk stratification) are similar to, yet differ in purpose from, screening, diagnosis, risk factor identification, and prognostic staging. Methods of handling bias, use of multiple predictors, and evaluation of results provide challenges. A key purpose of risk assessment and stratification is examined. The role of operational definitions of predictors and events and of methods that account for multiple predictors and known confounding factors is analyzed. Constructed examples illustrate potential pitfalls in assessment and how multivariate techniques can deal with multiple predictors. A trial design to evaluate risk stratification for the identified purpose is elaborated and potential results are interpreted. Bias from predictors regressing to the mean can be minimized either by averaging a number of measurements or by equalizing the bias in comparison groups. An analysis of two predictors and two risk strata illustrates how the discrimination of combined predictors may be greater than the sum of the individual variables' discrimination. Risk stratification can be evaluated in trials that randomize competing interventions within different risk strata. Results of such trials indicate whether the risk strata adequately distinguish individuals by their responsiveness to particular intervention. Potential pitfalls, not easily recognized in risk stratification, can be avoided in the methods and in studies for evaluating those methods. Multivariate techniques maximize the discrimination of multiple predictors, but may increase complexity. Randomized trials of treatment provide evidence for utility of risk stratification.     

ICD Implantation in Noncompaction of the Left Ventricular Myocardium: A Case Report

Isolated noncompaction of the ventricular myocardium (INVM) is an uncommon cardiomyopathy characterized by the persistence of fetal myocardium with prominent trabecular meshwork and deep intertrabecular recesses, often associated with systolic dysfunction and ventricular dilatation. A 23-year-old man from Burkina Faso was referred to our operative unit with a diagnosis of INVM, made with echocardiogram and magnetic resonance imaging and nonsustained ventricular tachycardia. The literature reports the incidence of malignant ventricular arrhythmias in as many as 47% of the patients and sudden cardiac death in almost 50% of them and this supported our decision to perform implantable cardioverter-defibrillators implantation.     

Preexcitation in Hypertrophic Cardiomyopathy: A Case of a Fasciculoventricular Mahaim Fiber

STELLBRINK, C., et al .: Preexcitation in Hypertrophic Cardiomyopathy: A Case of a Fasciculoventricular Mahaim Fiber . A patient with hypertrophic cardiomyopathy (HCM) who presented with preexcitation pattern on the surface ECG suggestive of the Wolff-Parkinson-White (WPW) syndrome is described. Intracardiac electrophysiological study revealed a fixed anomalous QRS complex and a short fixed His-ventricular interval indicating a fasciculoventricular Mahaim fiber. As this specific form of accessory connection does not cause reentrant tachycardias, no treatment was required. It is important to distinguish this entity from atriofascicular or nodoventricular Mahaim fibers or the WPW syndrome in patients with HCM showing a preexcitation pattern in the surface ECG, as these may cause life-threatening arrhythmias in this patient population.