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1.
Pan Afr Med J ; 42: 260, 2022.
Article in English | MEDLINE | ID: mdl-36338555

ABSTRACT

The novelty described in this case report is the simultaneous development of arterial and venous thrombosis in a previously healthy Caucasian 37-year-old male with newly diagnosed warm autoimmune haemolytic anaemia (WA-AIHA). Clinical presentation included sensorimotor dysphasia, right arm paresis, abdominal pain, and swelling of the left leg. Computed tomography angiography showed partial occlusion of the left middle cerebral artery and multiple infarcts of the kidneys and spleen, while Doppler ultrasound revealed thrombosis of the left popliteal vein. A therapeutic dose of low-molecular-weight-heparin was instituted together with rituximab, leading to the complete serological and haematological remission. The exact thrombotic risk factors in WA-AIHA are still not completely identified and no generally accepted guidelines on thromboprophylaxis exist. The severe onset of the WA-AIHA might point towards a close association between haemolysis itself and thrombosis, raising the question of the necessity of prophylactic anticoagulation.


Subject(s)
Anemia, Hemolytic, Autoimmune , Thrombosis , Venous Thromboembolism , Venous Thrombosis , Male , Humans , Adult , Anemia, Hemolytic, Autoimmune/complications , Anemia, Hemolytic, Autoimmune/diagnosis , Anticoagulants/therapeutic use , Venous Thrombosis/etiology , Venous Thrombosis/complications
2.
Heart Lung ; 51: 17-21, 2022.
Article in English | MEDLINE | ID: mdl-34731692

ABSTRACT

BACKGROUND: Self-poisoning accounts for between 3 and 17% of intensive care unit (ICU) admissions. OBJECTIVES: To display the misused substances, intention, and outcome of patients admitted to the ICU due to self-poisoning. METHODS: A retrospective review of ICU admissions using an electronic patient database was performed. RESULTS: A total of 149 patients were admitted, accounting for 4.6% of ICU admissions. Self-poisoning with self-harm was more frequent than without self-harm intent (62.4% vs. 37.6%). 64.4% of ingested substances were misused prescribed drugs. Females used antipsychotics (X2 = 15, p< 0.05) and benzodiazepines (X2 =11.52, p< 0.05), and males ingested antipsychotics (X2 = 12, p< 0.05) with a self-harm intent. Antipsychotics were always used with a self-harm intent. Illicit drugs (X2 =9.14, p< 0.05) and ethanol (X2 =7.34, p< 0.05) were mostly used without self-harm intent. 102 patients (68.5%) continued treatment in a psychiatric clinic, more often women (X2 (1,N = 145)=7.94, p< 0.005). The readmission rate was low. Mortality was 2.6%. CONCLUSION: Self-poisoning is an infrequent cause of ICU admission. Prescribed psychotropic medications, including benzodiazepines, antipsychotics, and antidepressants were the most frequently misused substances. Psychiatric consultation before the ICU discharge and subsequent psychiatric treatment might lower the repetition and readmission rate.


Subject(s)
Antipsychotic Agents , Antipsychotic Agents/therapeutic use , Benzodiazepines , Female , Hospitalization , Humans , Intensive Care Units , Male , Prescriptions , Retrospective Studies
4.
Tohoku J Exp Med ; 235(1): 25-8, 2015 01.
Article in English | MEDLINE | ID: mdl-25744068

ABSTRACT

Mucinous cystadenoma is a rare benign neoplasm and is usually discovered incidentally. Pleuritis and pericarditis, inflammation of the pleura and pericardium, may represent manifestations of autoimmune disorders especially in female subjects. We report a patient with polyserositis that was resolved after removal of the mucinous cystadenoma. To the best of our knowledge, this is a first report describing pleuritis and pericarditis as an initial presentation of mucinous cystadenoma of an appendix. A forty-year-old Caucasian female patient with a history of pleuritis and recurrent pericarditis was admitted to the hospital due to acute abdomen. At that time she was taking indomethacin and colchicine due to pericarditis that was controlled only with the combination of these two drugs. The patient had elevated erythrocyte sedimentation rate (ESR), increased C-reactive protein (CRP) and normocytic anemia. Immunological tests, including antinuclear antibody, anti-neutrophil cytoplasmic antibody, rheumatoid factor, and anti-cyclic citrullinated peptide antibodies, were repeatedly negative. Emergency surgery revealed acute appendicitis with perforation and subsequent diffuse peritonitis. Histopathological examination showed acute appendicitis and mucinous cystadenoma. Following the surgery the patient did not take any drugs. Fourteen months later the patient was symptom free. Pleuritis and pericarditis in female patients are most often associated with autoimmune diseases. We assume that increased ESR and CRP with anemia detected in the patient may reflect the altered immunity that is due to mucinous cystadenoma. We believe that this report has a broader clinical impact, implying that benign tumor could alter immunity, which can lead to unusual presentation such as polyserositis.


Subject(s)
Appendiceal Neoplasms/surgery , Cystadenoma, Mucinous/surgery , Familial Mediterranean Fever/therapy , Adult , Appendicitis/complications , Female , Humans , Pericarditis/complications , Pleurisy/complications
6.
Intern Med ; 48(9): 711-5, 2009.
Article in English | MEDLINE | ID: mdl-19420819

ABSTRACT

Chromic acid is a strong metal acid and acute poisoning is very rare, but very serious with severe skin injury, renal and liver failure. The majority of published cases were suicide attempts with lethal outcomes. We describe the case of a 55-year-old man who had accidentally taken a sip of 20% chromic acid (estimated chromium intake: 2.3 g). Renal and liver failure were not present at presentation, but appeared later in the course of disease. He was treated with hemodialysis, no chelating agents or other methods for enhancing elimination were used. Liver and renal function improved over the next 30 days and the patient was discharged after 45 days of hospitalization with no need for dialysis. In the follow-up period of eight months his renal function remained depressed, but stable.


Subject(s)
Acute Kidney Injury/chemically induced , Acute Kidney Injury/diagnosis , Chromates/poisoning , Liver Failure/chemically induced , Liver Failure/diagnosis , Acute Disease , Acute Kidney Injury/therapy , Follow-Up Studies , Humans , Liver Failure/therapy , Male , Middle Aged , Renal Dialysis/methods , Survival
7.
Lijec Vjesn ; 129(1-2): 11-6, 2007.
Article in Croatian | MEDLINE | ID: mdl-17489512

ABSTRACT

Anorexia nervosa is an eating disorder which, in case of life threating complications, requires admission to the intensive care unit. Our experience shows that danger for these patients does not always stop upon the admission to the intensive care unit. Four young, vitally endangered patients with anorexia nervosa were described. Three of them had severe acute inflammation (2 pneumonias and peritonitis) and severe electrolyte imbalance which in one case resulted in cardiorespiratory arrest and the need for resuscitation. One of them died despite all measures taken in sepsis with multiple organ dysfunction syndrome. Prolonged electrolyte disturbances in anorexia nervosa, catabolism and insufficient immunity are main factors for developing an acute inflammation, as well as some other complications such as cardiorespiratory failure, nosocomial infection, and sepsis with multiple organ failure. Weak and totally exhausted body can not adapt in MODS and sepsis, so our recommendation is urgent admission to the hospital before it is too late.


Subject(s)
Anorexia Nervosa/complications , Adolescent , Adult , Anorexia Nervosa/metabolism , Anorexia Nervosa/therapy , Female , Humans , Intensive Care Units , Male , Multiple Organ Failure/etiology , Peritonitis/complications , Pneumonia/complications
8.
Acta Med Croatica ; 57(5): 433-6, 2003.
Article in Croatian | MEDLINE | ID: mdl-15011473

ABSTRACT

UNLABELLED: Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) are classical diseases characterized by thrombocytopenia and microangiopathic hemolytic anemia. Microangiopathic hemolytic anemia is also a part of clinical picture in patients with hemorrhagic fever with renal syndrome (HFRS). Some overlap in other elements of clinical picture between TTP and HFRS is possible, which could pose difficulties in differential diagnosis. Early treatment of patients with TTP is essential and significantly improves the outcome, whereas the treatment of HFRS is mainly supportive. In the last ten years, we treated 13 patients with TTP and 17 patients with HFRS. Two patients with HFRS were initially treated as TTP because it was not possible to exclude TTP on the basis of clinical picture. Further clinical course and serologic tests excluded TTP and suggested HFRS. CONCLUSION: Sometimes it is difficult to distinguish HFRS from TTP because thrombocytopenia and microangiopathic hemolytic anemia are present in both diseases and overlaps in other parts of clinical picture are possible. The serious consequences of delay in the efficacious treatment of patients with TTP could also influence the physicians' decisions.


Subject(s)
Hemorrhagic Fever with Renal Syndrome/diagnosis , Purpura, Thrombotic Thrombocytopenic/diagnosis , Adult , Diagnosis, Differential , Female , Hemorrhagic Fever with Renal Syndrome/therapy , Humans , Male , Purpura, Thrombotic Thrombocytopenic/therapy
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