Résumé
A spontaneous tension hemothorax due to the rupture of an intercostal artery aneurysm is a rare complication of type I neurofibromatosis. Until now, around 23 cases have been reported. The patient reported here presented with a spontaneous tension hemothorax. At the emergency department, we were faced with a rapidly aggravating hemodynamic compromise after chest tubing. An emergent thoracotomy revealed an actively bleeding huge intercostal artery aneurysm. We intended primarily to repair the bleeding aneurysm, but we failed with because of vascular fragility. Thus we present this case to share our terrible experience to other physicians.
Sujets)
Humains , Anévrysme , Artères , Service hospitalier d'urgences , Hémodynamique , Hémorragie , Hémothorax , Neurofibromatoses , Rupture , Thoracotomie , ThoraxRésumé
PURPOSE: Pneumonia is a common complication of organophosphate poisoning and increases the incidence of respiratory failure and the duration of mechanical ventilator support. Therefore, we investigated the clinical characteristics of pneumonia as a complication of organophosphate insecticide poisoning and then determined the factors related to the development of pneumonia. METHODS: A retrospective study was performed on patients with organophosphate insecticide poisoning, who were treated at our hospital with medical records and chest radiograph of patients. From January 1, 2001, to July 31, 2004, eighty five patients were included in this study. RESULTS: 1) Thirty-two (71% of the patients developing pneumonia) patients developed pneumonia later than 48 hours from admission and twenty-five (55.6% of the patients developing pneumonia) patients developed pneumonia later than 48 hours after mechanical ventilatory support. 2) The mean onset of pneumonia resistant to initial empirical antibiotics was 4.8 days from admission, and that of susceptible pneumonia was 3.7 days from admission. 3) Patients with pneumonia as a complication needed larger doses of atropine and more 2-pralidoxime injections, as well as longer mechanical ventilatory support, ICU admission, and total hospital admission. CONCLUSION: Most Pneumonia in organophosphate poisoning patients were nosocomial pneumonia & ventilator-associated pneumonia. Thus, to reduce the incidence of pneumonia complication in organophosphate poisoning patients, Physicians must take measures, such as hand-washing and careful periodic drainage of tubing condensate, etc., to reduce the incidence of nosocomial pneumonia. In selecting empirical antibiotics for pneumonia complicating organophosphate poisoning patients, physicians should take regional prevalence of nosocomial pathogens into consideration. In late-onset ventilator-associated pneumonia, physicians must consider pneumonia caused by organisms resistant to commonly used empirical antibiotics.
Sujets)
Humains , Antibactériens , Atropine , Drainage , Incidence , Dossiers médicaux , Intoxication aux organophosphates , Pneumopathie infectieuse , Pneumopathie de déglutition , Pneumopathie infectieuse sous ventilation assistée , Intoxication , Prévalence , Radiographie thoracique , Insuffisance respiratoire , Études rétrospectives , Respirateurs artificielsRésumé
PURPOSE: Paraquat is widely used non-selective contact herbicide. In spite of efforts to improve the outcome in paraquat poisoning, the mortality rate still remains high. The purpose of this study is to assess the predictive factors of prognosis by investigating initial laboratory data on paraquat poisoning. METHODS: The author retrospectively analyzed the clinical features, laboratory data, and outcomes for 130 paraquatpoisoning patients treated from June 1997 to September 2003 at the emergency medical center of Chonnam National University Hospital. RESULTS: The results were as follows: 1) The mortalities were significantly older than the survivors (49.3 years vs 37.6 years, p<0.05). Among the total 130 cases, the survivors numbered 50, and the deceased numbered 80. The mean age of all 130 cases was 44.8+/-16.9 years. 2) The white blood cell count and the levels of serum AST and ALT in the deceased were significantly higher than they were in the survivors. The levels of arterial pH, PaCO 2, base excess, HCO3 -, and serum potassium in the survivors were significantly higher than they were in the deceased. 3) A multivariate Cox-Regression analysis revealed that sex, serum potassium, and arterial HCO3 - were associated with the mortality rate. CONCILUSION: The above data reveal that the ingested amount, the result of the urine sodium dithionite test, and the initial state of laboratory parameters, including the white blood cell count, ABGA (pH, PaCO2, HCO3 -, base excess), serum potassium, AST, and ALT, can be used to predict the outcome of paraquat poisoning.
Sujets)
Humains , Dithionite , Urgences , Concentration en ions d'hydrogène , Numération des leucocytes , Mortalité , Paraquat , Intoxication , Potassium , Pronostic , Études rétrospectives , SurvivantsRésumé
Hydatid disease is a parasitic infection caused by the Echinococcal species. Humans are intermediate hosts and become infected directly by contact with canines or indirectly by contact with food, water, and contaminated objects. This disease involves multiple organs, including liver, lung, heart, muscle, bone, kidney, and brain. Rupture of a hydatid cyst, which is the most common complication of this disease, can cause serious sequelae, including allergic reaction, secondary infection, biliary obstruction, and metastasis. The hydatid disease occurs principally in areas of cattle and sheep ranching. In Korea, this disease is rare, and only a few cases have been reported. We report a case of hydatid disease with anaphylactic shock and suggest that hydatid cyst complications must be kept in mind when dealing with patients who have a history associated with an endemic region.
Sujets)
Animaux , Bovins , Humains , Anaphylaxie , Encéphale , Co-infection , Échinococcose , Coeur , Hypersensibilité , Rein , Corée , Foie , Poumon , Métastase tumorale , Rupture , Ovis , ChocRésumé
Percutaneous vertebroplasty is a safe and effective procedure for the treatment of benign and malignant lesions of the spine, but has been associated with some known complications. Most complications are related to the percutaneous approach, but more severe complications related to the unwanted migration of acrylic cement can occur. We report an unusual case of a fatal pulmonary embolism caused by acrylic cement. Known factors related to cement leakage are incorrect needle position, the consistency of the cement, and the vascularity of the lesion. Emergency physicians should consider acute pulmonary embolism as a diagnosis when evaluating a patient who is suffering from dysnea or chest pain after an orthopedic procedure performed with cement.
Sujets)
Humains , Douleur thoracique , Diagnostic , Urgences , Aiguilles , Procédures orthopédiques , Embolie pulmonaire , Rachis , VertébroplastieRésumé
No abstract available.