Acute renal failure and rhabdomyolysis in a patient with infectious mononucleosis: a case report

We report a very rare case of acute renal failure and rhabdomyolysis in an Intensive Care treated 20-years-old male with upper airway obstruction due to Epstein-Barr infection. In our opinion this was a manifestation of the very rare and potentially lethal propofol infusion syndrome and not a direct complication of the underlying infection, although renal biopsy was not performed in our patient

Recurrent Jarisch-Herxheimer reaction in a patient with Q fever pneumonia: a case report

Q fever is a zoonotic disease caused by coxiella burnetii. The Jarisch-Herxheimer reaction (JHR) is associated with the antibiotic treatment of certain bacterial infections. We report a very rare case of a 36-year-old male with Q fever pneumonia that resulted in recurrent ARDS and presented the JHR during his treatment. The patient was admitted for treatment of community acquired pneumonia. He developed ARDS, was intubated and placed on mechanical ventilation. Doxycycline was empirically added to his antibiotic regiment. The patient presented an acute rise in temperature, tachycardia, tachypnea, hypoxia, hypotension and a temporary deterioration of his chest x-ray. The same 6-hour-long reaction which is known as JHR was presented another 3 times. Cultures were negative but antibodies against coxiella burnetii were positive. This case reminds us that any deterioration of a patient treated in the ICU should not be considered as a new septic episode and time should be allowed for the antibiotic regiments

Serotonin Toxicity Syndrome in Pregnancy: Could the Values of Blood Gases be Affected?

Serotonin toxicity syndrome is a potentially life-threatening condition caused by excessive serotonergic activity in the nervous system. It is characterized by mental status changes, autonomic instability, and neuromuscular hyperactivity. Critically ill patients may require neuromuscular paralysis, sedation, and intubation. If serotonin syndrome is recognized and complications are managed appropriately, the prognosis is favorable. In the presented case clinical presentation and outcome of the serotonin syndrome which was developed in a 30-year-old pregnant woman with a medical history of depression managed by selective serotonin-noradrenaline reuptake inhibitors is discussed. This case is presented to inform physicians about our observations regarding the results of blood gases and to discuss our possible explanation

Diagnosis and surgical approach of popliteal artery entrapment syndrome: a retrospective study

Stavros Gourgiotis1, John Aggelakas1, Nikolaos Salemis1, Charalabos Elias2, Charalabos Georgiou11Second Surgical Department, 401 General Army Hospital of Athens, Greece; 2Second Surgical Department, 417 NIMTS Veterans General Hospital of Athens, GreeceBackground: Popliteal artery entrapment syndrome (PAES) is a rare but potentially limb threatening peripheral vascular disease occurring predominantly in young adults. This study is a retrospective review of 49 limbs in 38 patients with PAES treated surgically over an 8-year period.Patients and methods: From 1995 to 2002, 38 patients with a mean age of 21 years (range, 18–29 years) underwent surgery for PAES at a single institution. The patients’ demographic data and clinical features are recorded. The preoperative diagnosis of PAES was made based on various combinations of investigations including positional stress test, duplex ultrasonography, computed tomography, computed tomographic angiography, and angiography. Results: Nine, 33, and 7 patients had Delaney’s type I, II, and III PAES respectively. The surgical procedures consisted of simple release of the popliteal artery in 33 limbs (67.3%), autogenous saphenous vein (ASV) patch angioplasty with or without thromboendarterectomy (TEA) in 5 limbs (10.2%) and ASV graft interposition or bypass in 11 limbs (22.5%). At a median follow up of 34 months (range, 8–42 months), there were no postoperative complications and all the patients were cured of their symptoms.Conclusions: PAES is an unusual but important cause of peripheral vascular insufficiency especially in young patients. Early diagnosis through a combined approach is necessary for exact diagnosis. Popliteal artery release alone or with vein bypass is the treatment of choice when intervention is indicated for good operative outcome and to prevent limb loss.Keywords: popliteal artery, entrapment syndrome, diagnosis, surgery, treatmen

Cavernous Hemangioma of the Rib: A Rare Diagnosis

Hemangioma of the rib is an uncommon benign vascular tumour. A case of rib hemangioma in a 29-year-old woman is presented. Chest roentgenogram and computed tomography revealed a mass along the inner surface of the 7th left rib with bone destruction. She underwent resection of the 7th rib. The pathologic diagnosis was cavernous hemangioma. Hemangiomas of the rib are rare tumours but should be kept in mind in the differential diagnosis of rib tumours

Calcium Channel Blockers and Esophageal Sclerosis: Should We Expect Exacerbation of Interstitial Lung Disease?

Esophageal sclerosis is the most common visceral manifestation of systemic sclerosis, resulting in impaired esophageal clearance and retention of ingested food; in addition, co-existence of lung fibrosis with esophageal scleroderma is not uncommon. Both the progression of generalized connective tissue disorders and the damaging effect of chronic aspiration due to esophageal dysmotility appear to be involved in this procedure of interstitial fibrosis. Nifedipine is a widely prescribed calcium antagonist in a significant percentage of rheumatologic patients suffering from Raynaud syndrome, in order to inhibit peripheral vasospasm. Nevertheless, blocking calcium channels has proven to contribute to exacerbation of gastroesophageal reflux, which consequently can lead to chronic aspiration. We describe the case of severe exacerbation of interstitial lung disease in a 76-year-old female with esophageal sclerosis who was treated with oral nifedipine for Raynaud syndrome

Preoperative diagnosis of obscure gastrointestinal bleeding due to a GIST of the jejunum: a case report

Gastrointestinal stromal tumours (GISTs) are rare mesenchymal neoplasms affecting the digestive tract or nearby structures within the abdomen. We present a case of a 66-year-old female patient who presented with obscure anemia due to gastrointestinal bleeding and underwent exploratory laparotomy during which a large GIST of the small intestine was discovered. Examining the preoperative results of video capsule endoscopy, computed tomography, and angiography and comparing them with the operative findings we discuss which of these investigations plays the most important role in the detection and localization of GIST. A sort review of the literature is also conducted on these rare mesenchymal tumours

Compliance with evidence-based clinical guidelines in the management of acute biliary pancreatitis: the MANCTRA-1 study protocol.

Despite existing evidence-based practice guidelines for the management of biliary acute pancreatitis (AP), the clinical compliance with recommendations is overall poor. Studies in this field have identified significant discrepancies between evidence-based recommendations and daily clinical practice. The most commonly reported gaps between clinical practice and AP guidelines include the indications for CT scan, need and timing of artificial nutritional support, indications for antibiotics, and surgical/endoscopic management of biliary AP. The MANCTRA-1 (coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis) study is aiming to identify the areas for quality improvement that will require new implementation strategies. The study primary objective is to evaluate which items of the current AP guidelines are commonly disregarded and if they correlate with negative clinical outcomes according to the different clinical presentations of the disease. We attempt to summarize the main areas of sub-optimal care due to the lack of compliance with current guidelines to provide the basis for introducing a number of bundles in AP patients' management to be implemented during the next years. The MANCTRA-1 study is an international multicenter, retrospective cohort study with the purpose to assess the outcomes of patients admitted to hospital with a diagnosis of biliary AP and the compliance of surgeons worldwide to the most up-to-dated international guidelines on biliary AP. ClinicalTrials.Gov ID Number: NCT04747990, Date: February 23, 2021. Protocol Version V2.2