Treatment with lipid therapy to resuscitate a patient suffering from toxicity due to local anesthetics

Recently, although without a universal recognition, the use of lipid emulsions as a rescue therapy for the bupivacaine cardiac toxicity has been proposed. In this article we report a successful resuscitation of a patient after the injection of bupivacaine in emergency room and a commented review of the related literature. The patient is a 73 years old man that, after a subcutaneous injection of bupivacaine (0.5%, i.e. 0.5 mL/h), developed circulatory arrest. After the failure of the initial treatment based on the advanced life support protocol, we have successfully performed a therapy with lipid emulsion. The bupivacaine intravascular injection, together with its interaction with amitriptyline and carbamazepine, could lead to cardiac depression, severe arrhythmias, hypotension, and/or cardiac arrest. In the case of failure of traditional life support treatment, intravenous lipid emulsion proves to be the best therapy to treat bupivacaine systemic toxicity

Epicardial fat, gender, and cardiovascular risk

Epicardial fat (EF) is considered an important risk factor and an active player in the pathogenesis of cardiovascular and metabolic diseases. EF is an endocrine organ that releases hormones and mediators, including the circulating C-reactive protein (CRP), and plays a vital role in modifying the vascular endothelial function and promoting the growth of coronary atherosclerosis. This study aimed to investigate the relationship between CRP concentrations and EF in a cohort of patients with metabolic syndrome at risk for coronary artery disease. In our study, carried out in primary prevention, we enrolled 36 subjects (M/F: 21/15; age: 59.3±0.79 yrs) diagnosed with metabolic syndrome. We have classified the patients into two groups: Men and Women. Besides anthropometric characterization and screening laboratory tests, the subjects performed a multidetector computed tomography scan, which allowed the EF quantification. Mean EF was 115.1 cc in the study population. The average EF of women was 111 cc; the average EF of men was 118 cc (P=0.18). CRP levels were strongly positively correlated with EF area in women (P=0.01), while the correlation was not found in men (P=0.4). Our findings suggest that, in women, the EF produces a greater amount of acute-phase proteins and increases the pro-inflammatory state in the epicardial region. For this reason, we can hypothesize, in women, a different role in the development of atherosclerotic plaque of the epicardial fat compared to men

A strange case of Evans syndrome

Evans syndrome is a rare autoimmune disease presenting hemolytic anemia, thrombocytopenia and/or neutropenia. It may be associated with other autoimmune or lymphoproliferative diseases. It can have an extremely serious disease course and, in rare cases, this can even be life-threatening. First-line treatment consists of steroids and/or immunoglobulin. Further therapy with rituximab, vincristine, cyclophosphamide and other immunosuppressive drugs can be considered in unresponsive patients. We report a case of Evans syndrome in a 54-year old woman admitted to the Emergency Department (ED) for asthenia. Etiopathogenic, clinical, therapeutic and evolutive aspects are discussed. In contrast to many cases described in the literature, our patient had a satisfactory response to corticoids. We also discuss how to make a specific diagnosis, even in a suburban ED with limited resources, in order to admit patients to the appropriate hospital department and allow the correct therapy to be started as early as possible

New evidences about the strict relationship between the epicardial fat and the aerobic exercise

Background/aims: In this study, we report some experimental results about the strong correlation between the physical activity and the cardiovascular prevention that has been confirmed by many epidemiological studies. In particular, we examined the epicardial fat (EF) behavior in order to investigate its direct role in coronary disease through vasocrine and paracrine cytokines secretions. The purpose of this study was the determine the effects of aerobic exercise on epicardial fat volume in patients with metabolic syndrome. Methods: We have studied, in primary prevention, 54 non-diabetic patients, 23 female and 31 male, mean age of 60 ± 15 years, affected by metabolic syndrome. Patients performed a multi detector computed tomography (MDCT) scan, a non-invasive approach for epicardial fat (EF) quantification Results: Our findings show that sedentary patients exhibit an EF volume very high compared to subjects with moderate/intensive exercise training. These results, obtained in patients affected by metabolic syndrome, demonstrate sedentary patients to have an epicardial fat volume statistically higher compared to non-sedentary patients. Conclusion: This study confirms that lifestyle, and in particular aerobic exercise, plays a fundamental role in the cardiovascular risk prevention

A dangerous adverse event in the use of dabigatran

Not availabl

A strange case of Evans syndrome

Evans syndrome is a rare autoimmune disease presenting hemolytic anemia, thrombocytopenia and/or neutropenia. It may be associated with other autoimmune or lymphoproliferative diseases. It can have an extremely serious disease course and, in rare cases, this can even be life-threatening. First-line treatment consists of steroids and/or immunoglobulin. Further therapy with rituximab, vincristine, cyclophosphamide and other immunosuppressive drugs can be considered in unresponsive patients. We report a case of Evans syndrome in a 54-year old woman admitted to the Emergency Department (ED) for asthenia. Etiopathogenic, clinical, therapeutic and evolutive aspects are discussed. In contrast to many cases described in the literature, our patient had a satisfactory response to corticoids. We also discuss how to make a specific diagnosis, even in a suburban ED with limited resources, in order to admit patients to the appropriate hospital department and allow the correct therapy to be started as early as possible

A strange case of Evans syndrome

Evans syndrome is a rare autoimmune disease presenting hemolytic anemia, thrombocytopenia and/or neutropenia. It may be associated with other autoimmune or lymphoproliferative diseases. It can have an extremely serious disease course and, in rare cases, this can even be life-threatening. First-line treatment consists of steroids and/or immunoglobulin. Further therapy with rituximab, vincristine, cyclophosphamide and other immunosuppressive drugs can be considered in unresponsive patients. We report a case of Evans syndrome in a 54-year old woman admitted to the Emergency Department (ED) for asthenia. Etiopathogenic, clinical, therapeutic and evolutive aspects are discussed. In contrast to many cases described in the literature, our patient had a satisfactory response to corticoids. We also discuss how to make a specific diagnosis, even in a suburban ED with limited resources, in order to admit patients to the appropriate hospital department and allow the correct therapy to be started as early as possible