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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a case of a 77-year-old female patient who died 4 days after a closed colles-fracture of the right wrist because of secondary emerged necrotising fasciitis. At the time of visiting our emergency department, the patient reports about untypical pain and progressive swelling of the entire right arm 3 days following a fall onto the outstretched hand where she sustained a closed distal radius fracture. Within 6 h, the patient developed hypotension and fever leading to cardiac and respiratory failure. The emergent-induced diagnostic presented a severe septic situation in the laboratory examination of the blood samples, an apparent before unknown diabetes mellitus and an unknown bronchial carcinoma with part of post-stenosis pneumonia of the right lung. After initial CPR and stabilisation, the patient underwent an urgent and aggressive surgical debridement with fasciotomies of the muscle compartments of the entire right upper extremity. The microbiological investigation of the intraoperative taken specimens presented plentiful group-A-beta-haemolytic streptococcus. Despite a broad spectrum intravenous antibiotic therapy, intensive care support and a second look operation 12 h later with exarticulation of the right arm in the shoulder joint, the patient died of septic shock and multiorgan failure 34 h after admission.
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PMID:Complication of a closed Colles-fracture: necrotising fasciitis with lethal outcome. A case report. 1893 52

Patients with diabetes mellitus have an increased risk of developing infections and sepsis. In this issue of Critical Care Esper and colleagues report on a large survey, involving 12.5 million sepsis cases, that examined the impact of pre-existing diabetes on organ dysfunction during sepsis. Their main conclusion was that diabetes patients, relative to non-diabetics, were less likely to develop respiratory failure and more likely to develop renal failure during the course of sepsis.
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PMID:Diabetes and sepsis outcomes--it is not all bad news. 1921 80

Lung transplantation has become a viable option for those cystic fibrosis (CF) patients with end-stage lung disease. Despite the challenges that the CF patients present, the survival seen after lung transplantation is more favorable than seen in patients with chronic obstructive pulmonary disease and pulmonary fibrosis. Although the CF patients with severe respiratory disease usually are infected with organisms that display in vitro resistance to the commonly used antibiotics, these patients usually have successful outcomes with transplantation. The other challenges include the presence of nontuberculous mycobacteria, the significant incidence of liver involvement, the development of an ileus or the development of the distal intestinal obstruction syndrome, and the presence of gastroesophageal reflux. Most of the patients have metabolic bone disease, even preoperatively, that warrants treatment, especially with the significant loss of bone density seen in the first year after transplant, thought to be related, in part, to the high dose of corticosteroids. Diabetes mellitus and its consequences are not uncommon. The malabsorption of fat seen in the pancreatic-insufficient patients complicates the absorption kinetics of the anti-rejection drugs. In May 2005 the United Network of Organ Sharing instituted a lung-allocation score to better distribute the donated lungs to those patients who would achieve the most benefit. This score uses several variables to balance the likelihood of the patients living one year with a transplant versus one year without a transplant. With this change in the allocation of organs, the median waiting times have significantly decreased, the mortality on the waiting list has decreased, and the number of CF patients transplanted has not changed. With substantial experience, more programs are now transplanting patients who require constant mechanical ventilation or patients who have undergone previous pleural procedures, especially in the treatment of a pneumothorax. The limiting factor now in lung transplantation is the number of organs available. Efforts to increase the donor pool, such as alveolar recruitment strategies to improve gas exchange, have been effective in allowing more patients to be transplanted. Lung transplantation is now an accepted form of therapy in those patients who are developing progressive respiratory failure.
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PMID:Lung transplantation in cystic fibrosis. 1946 64

A 60-year-old-man with diabetes mellitus was admitted to our hospital because of pyrexia of up to 40 degrees and dyspnea. Chest radiograph revealed ground glass infiltrates in both lung fields. Legionella pneumonia was diagnosed as a consequence of the urinary examination performed for Legionella antigen detection; further, we initiated intravenous pazufloxacin administration. Despite an antibiotic, sivelestat sodium, and mechanical ventilation, the condition of the patient worsened and he died of respiratory failure 5 days following admission. Pulse-field gel electrophoresis (PFGE) was performed to investigate the route of infection: this technique was applied to patient sputum samples and water from the humidifier in the room of the patient. The same DNA pattern as Legionella pneumophilla serogroup 1 was identified via analysis with PFGE.
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PMID:[Case of Legionella pneumonia caused by a household humidifier]. 1951

Epigastric hernia, apparently minor injury, neglected can reach impressive sizes, with major un-esthetic effect. In an unfavorable clinically context (morbid obesity, chronic respiratory failure, ground cancer, diabetes, heart failure) complications occur (incarceration, strangulation) with a complex picture. We present three clinical observations, including a low occlusion by fixed transverse colon necrosis in a strangulated epigastric hernia with pyo-stercoral phlegmon.
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PMID:[Voluminous complicated epigastric hernia]. 1960 68

The mechanism of dead-in-bed syndrome (DBS), a rare but devastating condition that mainly affects young type 1 diabetes patients, remains mysterious. A new theory is proposed to explain this syndrome. This theory suggests that repeated episodes of hypoglycaemia-induced adaptation in orexin-A neurons cause (i) defective awakening and (ii) hypotonia of upper airway muscles during sleep. Consequently, due to the combined effect of these factors, long-term exposure of intermittent hypoxia occurs, leading to a combination of factors - such as depression of ventilation, increase in sympathetic tone, fluctuations in intrathoracic pressure and cardiac arrhythmias - these in conjunction with an underlying cardiovascular pathology (genetically inherited or acquired) cause cardio-respiratory failure and thus sudden death during sleep. This mechanism can be generalized to explain other cases of sudden unexplained nocturnal deaths including sudden infant deaths (SIDs).
Curr Diabetes Rev 2009 Nov
PMID:The mechanism of dead-in-bed syndrome and other sudden unexplained nocturnal deaths. 1960 34

This was a study of the pre-operative factors that influence quality of life (QoL) in patients with coronary artery disease and the relationship between pre-operative QoL and early outcome after coronary artery bypass surgery (CABG). Using the WHOQOL-BREF questionnaire, 283 patients who underwent isolated coronary artery bypass surgery were interviewed and scores were obtained for the physical, psychological, social and environmental components. The study found that the independent physical component predictors for higher QoL included male gender and diabetes mellitus, while the independent psychological component predictors were male gender and high ejection fraction. Males, diabetics and patients with low education levels had higher social well-being than others. Among the postoperative complications, only respiratory failure was found to have a relationship with physical and psychological components. Women with coronary artery disease who were candidates for CABG had lower scores than the men in respect of all components of QoL. Furthermore, a lower pre-operative psychological score in patients undergoing CABG can influence postoperative complications, especially respiratory failure.
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PMID:Quality of life-associated factors among patients undergoing coronary artery bypass surgery as measured using the WHOQOL-BREF. 1990

Recently, the World Health Organization declared a pandemic mediated by the novel A H1N1 influenza virus. Soon after the first report from Mexico, the disease arrived in Chile, where it spread quickly from south to north, mimicking cold weather progression through the country. Between May and September 2009, 366,624 cases of H1N1 were reported; 12,248 were confirmed by real-time reverse-transcription polymerase chain reaction and 1562 were hospitalized. One hundred thirty-two deaths were attributable to the infection, creating a death rate of 0.78 per 100,000 inhabitants. Common comorbidities were present in 59%, including obesity, chronic obstructive pulmonary disease, hypertension, type II diabetes, and congestive heart failure. Nine percent were pregnant. Severe disease developed early; the median time to admittance was 5 days, and the most common clinical manifestations were cough, fever, dyspnea, and myalgia. Mean acute physiology and chronic health evaluation II and sequential organ failure assessment scores were 14 and 5, respectively. Highlighted laboratory data were lactate dehydrogenase and creatine kinase elevation, leukocytosis in 50%, elevated creatinine in a 25%, and thrombocytopenia in 20%. Severe respiratory failure requiring high-frequency oscillatory ventilation and extracorporeal membrane oxygenation as sophisticated modes of respiratory support was seen in 17%. Acute renal failure occurred in 25% of the intensive care unit patients, with death rates near 50%. Health systems reinforced outpatient guards with extra staff and extension of the duty schedules. Antivirals were supplied free for medically diagnosed cases. Admissions for severe cases were prioritized, reconverting hospital beds into advanced care ones; a central coordination station rationed their assignment. Recommendations for small hospitals include adding ventilators, using videoconferences, providing tutorial activity from experts, developing guidelines for disease management, and outlining criteria for transport.
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PMID:Influenza A pandemics: clinical and organizational aspects: the experience in Chile. 1993 12

Coronary artery bypass grafting (CABG) has been widely used for the treatment of patients with coronary artery disease. Patients with low ejection fraction (EF) are at a higher risk for postoperative complications and mortality. Our objective was to assess the effect of low EF on clinical outcomes of CABG. We analyzed 1156 patients, who have undergone CABG in our department between 2002 - 2009 years. Patients were stratified into I of II EF groups: I Group - EF< or = 35% (100 patients) and II Group - EF > 35 % (1056 patients). EF was estimated by left ventriculography preoperatively and by echocardiography postoperatively. Surgical treatment was carried out only in cases, where the target coronary arteries were of relatively good diameter, to achieve complete revascularization. Group I experienced a higher incidence of postoperative respiratory failure. intraoperative mortality - 0, postoperative mortality- 4 (4%), reoperation - 0. Postoperative survival data were available for 73 patients. These data were obtained from our own medical records. This follow up manifested, that long term survival was 95, 8%. EF significant improvement (EF >40%) was in 82% and EF unimportant improvement only in 13% of cases. Multivariate analysis showed previous myocardial infarction, congestive heart failure, age, diabetes mellitus and arterial hypertension as independent significant predictors of in-hospital complications. Patients with low EF have higher incidence of postoperative complications, as well as preoperative sickness and risk factors, than patients with normal EF. Therefore CABG remains a viable option in selected patients with low EF. In patients with compromised left ventricular function and low EF, caused by atherosclerotic cardiosclerosis, lyal factors of CABG are angina and qualitative coronary arteries.
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PMID:Coronary artery bypass grafting in patients with low ejection fraction. 1999 96

The study compared cardiovascular risks factors, morbidity and in-hospital mortality following coronary artery bypass graft (CABG) surgery in Australian patients of different ethnic backgrounds including Aboriginal (AB), Italian (IT), Indian (IA), British Caucasians (BC), and Chinese (CH). These groups AB (n = 20), CH (n = 12), IT (n = 104), BC (n = 493), and IA (n = 16) all had first-time isolated CABG surgery at St. Vincent's Hospital, Melbourne from March 2001 to March 2007. AB patients were current or past smokers with the highest prevalence of preoperative diabetes (P = 0.001) and mostly had nonelective CABG surgery (P = 0.018). AB patients had higher incidences of postoperative respiratory failure (P = 0.001) compared with the other groups. In contrast, past history of MI (P = 0.012) was associated with IA patients. Both IA and AB groups had significantly higher acute renal failure rates requiring temporary dialysis (P = 0.025), longer ICU (P = 0.003) and hospital stays (P = 0.03) compared to BC, IT and CH groups. All groups had similar 30-day (P = 0.59) in-hospital mortality. The higher incidences of in-hospital morbidity observed in IA and AB compared to BC, IT, and CH groups suggests that ethnic lifestyle may be a strong risk factor. Larger confirmatory studies are required to verify incidents and elucidate reasons why ethnic-associated perioperative complications exist.
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PMID:Ethnicity and adverse operative outcomes among Australian patients undergoing first-time isolated coronary artery bypass graft surgery. 2008 46


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