ABSTRACT
INTRODUCTION: Vaso-occlusive crisis (VOC) is the most frequent complication of sickle-cell disease and is associated with significant acute bone pain. OBJECTIVE: To evaluate the feasibility and efficacy of hyperbaric oxygen therapy (HBOT) for severe VOC. METHODS: We report our retrospective experience with HBOT in VOC in nine patients and 15 HBOT sessions. RESULTS: All nine patients had received appropriate conventional treatment prior to HBOT. Pain scores using a Visual Analog Scale (0 to 10) determined whether HBOT was effective or not in improving symptoms. While no change in pain score occurred before the HBOT session, pain scores fell significantly from 3.3 prior to HBOT to 1.9 24 hours after HBOT (P = 0.002). While morphine dosage increased before HBOT (median morphine dose 23 mg per day and 35.95 mg per day respectively on Day -2 and Day -1, P = 0.04), the median morphine dose one day after HBOT (Day +1 23 mg per day) tended to be lower than Day -1 (P = 0.08), and decreased to zero 2 days after HBOT (P = 0.004). Two patients had ear pain during compression, requiring rapid interruption of the HBOT session, although neither patient had any sequelae. CONCLUSION: HBOT is feasible in sickle cell disease and appears to be effective in reducing the pain of VOC rapidly.
Subject(s)
Anemia, Sickle Cell/complications , Hyperbaric Oxygenation/methods , Pain Management/methods , Adolescent , Analgesics, Opioid/therapeutic use , Feasibility Studies , Female , Humans , Hyperbaric Oxygenation/adverse effects , Male , Morphine/therapeutic use , Pain Measurement , Retrospective Studies , Young AdultABSTRACT
Three patients with extensive necrotizing pneumonia due to Panton-Valentine leukocidin-positive Staphylococcus aureus strains and with aggravating factors (leukopenia count of less than 3x10(9)/liter in all three cases and hemoptysis in two cases) were successfully treated with toxin-suppressing agents introduced rapidly after hospital admission.
Subject(s)
Antitoxins/therapeutic use , Bacterial Toxins/antagonists & inhibitors , Exotoxins/antagonists & inhibitors , Immunoglobulins, Intravenous/therapeutic use , Leukocidins/antagonists & inhibitors , Necrosis/therapy , Pneumonia, Staphylococcal/therapy , Staphylococcus aureus/drug effects , Virulence Factors/antagonists & inhibitors , Adult , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Hemoptysis/microbiology , Humans , Infant , Leukopenia/immunology , Male , Microbial Sensitivity Tests , Necrosis/complications , Necrosis/microbiology , Pneumonia, Staphylococcal/complications , Pneumonia, Staphylococcal/microbiology , Radiography, Thoracic , Staphylococcus aureus/isolation & purification , Tomography , Treatment OutcomeABSTRACT
INTRODUCTION: Mesenteric venous thrombosis is a rare disease but potentially severe because of the prognosis of intestinal infarction with high mortality rate (60%). OBSERVATION: We report the case of a 55 year-old man who presented with an upper mesenteric venous thrombosis related to a familial resistance to C reactive protein through factor V Leiden mutation. COMMENTS: The discovery of a mesenteric venous thrombosis requires aetiological research that is usually multifactorial. Among the most frequent genetic coagulation abnormalities observed resistance to C reactive protein due to G202110A prothrombin gene mutation is the most common. Although factor V Leiden mutation is less frequent, it requires anticoagulation therapy for life in the case of the appearance of a thrombosis.
Subject(s)
Activated Protein C Resistance/genetics , Factor V/genetics , Mesenteric Vascular Occlusion/genetics , Mutation/genetics , Thrombosis/genetics , Activated Protein C Resistance/diagnosis , Disease Progression , Genetic Carrier Screening , Heparin/administration & dosage , Humans , Infarction/diagnosis , Infarction/genetics , Infarction/surgery , Intestine, Small/blood supply , Male , Mesenteric Vascular Occlusion/diagnosis , Mesenteric Vascular Occlusion/surgery , Mesenteric Veins , Middle Aged , Thrombosis/diagnosis , Thrombosis/surgery , Tomography, X-Ray ComputedSubject(s)
Facial Injuries/complications , Facial Injuries/diagnosis , Glasgow Coma Scale , Multiple Trauma/complications , Multiple Trauma/diagnosis , Skull/injuries , Biomechanical Phenomena , Brain Injuries/etiology , Cerebral Hemorrhage/etiology , Emergency Medical Services/methods , Facial Injuries/classification , Facial Injuries/epidemiology , Humans , Magnetic Resonance Imaging , Medical History Taking , Multiple Trauma/classification , Multiple Trauma/epidemiology , Physical Examination , Prognosis , Respiratory Insufficiency/etiology , Risk Factors , Shock, Hemorrhagic/etiology , Tomography, X-Ray ComputedABSTRACT
A case of a patient who was admitted to hospital in Paris, France, in February 2001 with autoimmune haemolytic anaemia, probably due to artemether-lumefantrine therapy, is presented. Such a complication has previously been observed in patients receiving drugs containing aryl-amino-alcohols but never before in a patient receiving lumefantrine and may be associated with the increase in episodes of blackwater fever seen in recent years.
Subject(s)
Anemia, Hemolytic, Autoimmune/chemically induced , Antimalarials/adverse effects , Artemisinins/adverse effects , Ethanolamines/adverse effects , Fluorenes/adverse effects , Malaria, Falciparum/drug therapy , Sesquiterpenes/adverse effects , Artemether , Drug Combinations , Humans , Lumefantrine , Male , Middle AgedABSTRACT
Traumatic extrathoracic lung herniation is an exceptional complication of blunt chest trauma. We report the case of a 46-year-old man who was involved in a motorcycle accident and who suffered a left clavicle fracture-dislocation associated with multiple rib fractures and massive herniation of the left upper lobe through an upper anterior chest wall defect. Immediate surgical repair through an atypical transcostal vertical thoracotomy resulted in full recovery of pulmonary function at 1 year.
