RESUMO
Acute necrotizing esophagitis (AEN), also called "black esophagus," is a rare disorder with an unknown pathogenesis. Endoscopic findings generally show black pigmentation throughout the esophagus. This case also offered rare views of the gross anatomy of this disorder. Histological examination revealed that the mucosal and submucosal layers of the esophagus were involved in the severe necrotizing inflammation. The chief manifestation of this disease is hematemesis from hemorrhage of the upper gastrointestinal tract with a typically multifactorial etiology. AEN is also characterized by a clear boundary at the gastroesophageal junction where the necrosis stops. In this study, we report an autopsy case of a 61-year-old man with necrotizing inflammation throughout the esophagus and esophageal necrosis from the laryngopharynx to the gastroesophageal junction. The patient was a disabled person with a history of alcohol abuse who was also diagnosed with mild coronary arteriosclerosis and fatty liver on the basis of the underlying diseases. In this case, the main etiology for poor perfusion from the distal esophageal area was likely underlying illness, history of alcoholism, and malnutrition.
Assuntos
Humanos , Pessoa de Meia-Idade , Alcoolismo , Autopsia , Doença da Artéria Coronariana , Pessoas com Deficiência , Esofagite , Junção Esofagogástrica , Esôfago , Fígado Gorduroso , Hematemese , Hemorragia , Hipofaringe , Inflamação , Desnutrição , Necrose , Perfusão , Pigmentação , Trato Gastrointestinal SuperiorRESUMO
Ketamine is a rapidly acting dissociative anesthetic that can be administered as a sole agent, an induction agent, or a supplement to low potency anesthetic agents.It is usually used for the minor surgery or outpatient surgery in pediatric anesthesia because of the undesirable psychotomimetic side effects of ketamine are less common in the children. We report that a pediatric patient had experienced a profound paralytic ileus after ventilation tube insertion with ketamine anesthesia.
Assuntos
Criança , Humanos , Procedimentos Cirúrgicos Ambulatórios , Anestesia , Íleus , Pseudo-Obstrução Intestinal , Ketamina , Procedimentos Cirúrgicos Menores , VentilaçãoRESUMO
Ketamine is a rapidly acting dissociative anesthetic that can be administered as a sole agent, an induction agent, or a supplement to low potency anesthetic agents.It is usually used for the minor surgery or outpatient surgery in pediatric anesthesia because of the undesirable psychotomimetic side effects of ketamine are less common in the children. We report that a pediatric patient had experienced a profound paralytic ileus after ventilation tube insertion with ketamine anesthesia.
Assuntos
Criança , Humanos , Procedimentos Cirúrgicos Ambulatórios , Anestesia , Íleus , Pseudo-Obstrução Intestinal , Ketamina , Procedimentos Cirúrgicos Menores , VentilaçãoRESUMO
Patients with diabetes or chronic renal failure may develop profound hypotension after anesthesia induction. In a patient with chronic renal failure, inappropriate dialysis may aggravate the hypotension. Combined autonomic neuropathy in diabetes mellitus is the main cause of the undesirable changes in blood pressure after anesthesia induction. We report a case of hypotension refractory to fluid replacement and inotropes in a patient with chronic renal failure for 10 years and diabetes mellitus for 5 years. The patient received hemodialysis on the day before surgery and had developed various symptoms suggestive of autonomic neuropathy (i.e., dizziness on standing, esophageal spasm, intermittent diarrhea).