Subject(s)
Aneurysm, False/complications , Aneurysm, Infected/complications , Bacteremia/etiology , Bronchial Fistula/complications , Hemoptysis/etiology , Adult , Aneurysm, False/diagnosis , Aneurysm, Infected/diagnosis , Bronchial Fistula/diagnosis , Heart Injuries/complications , Heart Ventricles , Humans , Male , Wounds, Penetrating/complicationsABSTRACT
OBJECTIVE: To report the use of Fluosol in the management of a severe anemia and to review the literature regarding the use of Fluosol. CASE REPORT: A 40-year-old woman, at 40.5 weeks gestation, was admitted for induction of labor. Her hospital course was complicated by a postpartum hemorrhage and severe anemia. Because the patient was a Jehovah's Witness, she received non-blood products including hetastarch, iron dextran, and erythropoietin, and a total of 33 mL/kg of Fluosol, but she did not survive. DISCUSSION: Fluosol is an oxygen-carrying, perfluorochemical blood substitute. It was administered to our patient, who presented with the lowest hemoglobin (Hb) (11 g/L) and hematocrit (0.31 fraction of 1.00) of all reported cases. Almost all patients with an Hb < 20 g/L do not survive. CONCLUSIONS: Although the use of Fluosol as a blood substitute appears theoretically promising, its use in the management of severe anemia cannot be recommended.
Subject(s)
Anemia/drug therapy , Blood Substitutes/therapeutic use , Fluorocarbons/therapeutic use , Postpartum Hemorrhage/complications , Adult , Anemia/etiology , Christianity , Female , Fluorocarbons/administration & dosage , Humans , Infusions, Intravenous , Pregnancy , Treatment RefusalABSTRACT
An 81-year-old man, previously a shepherd in Italy, presented with recurrent Escherichia coli empyema over an 8-month period. His empyema was caused by an infected, nonviable hepatic Echinococcus cyst that eroded the diaphragm and led to intermittent spillage and pleural seeding. This case demonstrates that when dealing with Escherichia coli empyema, a subdiaphragmatic source ought to be suspected, and among immigrants from areas with prevalent hydatid disease, infected hepatic Echinococcus cyst might rarely be the cause.
Subject(s)
Echinococcosis, Hepatic/complications , Empyema, Pleural/etiology , Escherichia coli Infections/complications , Aged , Aged, 80 and over , Diaphragm , Echinococcosis, Hepatic/diagnostic imaging , Empyema, Pleural/diagnosis , Escherichia coli Infections/diagnosis , Fistula/etiology , Humans , Male , Recurrence , Tomography, X-Ray ComputedABSTRACT
The efficacy of corticosteroid treatment in the prophylaxis of the fat embolism syndrome was evaluated in a prospective, randomized, double-blind study of high-risk patients with long-bone fractures. Using a set of objective diagnostic criteria, we saw a significant difference in the incidence of the syndrome between corticosteroid- (0 of 21) and placebo-treated patients (9 of 41) (p less than 0.05). There were no complications related to corticosteroid treatment. No routine laboratory or physical findings reliably predicted the development of the fat embolism syndrome except petechial rash, which occurred only in 5 placebo-treated patients who developed the syndrome. Complement activation was present in all patients studied who had the syndrome (5 of 27) but also in many patients who did not meet our diagnostic criteria, suggesting a multifactorial cause. These data support the prophylactic value of corticosteroid treatment in patients at high risk for the fat embolism syndrome, particularly if several unfavorable predictors are present.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Embolism, Fat/drug therapy , Adolescent , Adult , Aged , Analysis of Variance , Clinical Trials as Topic , Embolism, Fat/etiology , Embolism, Fat/prevention & control , Extremities , Female , Fractures, Bone/complications , Fractures, Bone/drug therapy , Humans , Male , Methylprednisolone Hemisuccinate/therapeutic use , Middle Aged , Random AllocationABSTRACT
Four young healthy adults were studied physiologically after accidental inhalation of chlorine gas. All patients were symptomatic with cough, tightness in the chest, and shortness of breath. All had restrictive ventilatory defect with impaired diffusing capacity. There was evidence of some obstruction in small airways. There was inconsistent evidence of obstruction in large airways. All lung function impairment was temporary and cleared entirely within one month. There was no residual lung damage.
