A Fatal Case of Community Acquired Cupriavidus Pauculus Pneumonia

Introduction: Cupriavidus pauculus is a rarely isolated non-fermentative, aerobic bacillus, which occasionally causes severe human infections, especially in immunocompromised patients. Strains have been isolated from various clinical and environmental sources

Neutrophil Gelatinase-Associated Lipocalin as a Marker for Renal Dysfunction Detection in Critically Ill Patients with Increased Intraabdominal Pressure

Introduction: Elevated intraabdominal pressure (IAP) it is known to have an impact on renal function trough the pressure transmitted from the abdominal cavity to the vasculature responsible for the renal blood flow. Intraabdominal pressure is found to be frequent in intensive care patients and also to be a predictor of mortality. Intra-abdominal high pressure is an entity that can have serious impact on intensive care admitted patients, studies concluding that if this condition progresses to abdominal compartment syndrome mortality is as high as 80%

The Role of Angiopoietine-2 in the Diagnosis and Prognosis of Sepsis

Introduction: Angiopoietin-2 (ANG-2) is a new biomarker whose blood-serum values increase in sepsis and its expression is elevated in line with the severity of the degree of inflammation. The aim of this study was to identify the diagnostic role of ANG-2 in patients with non-surgical sepsis addmitted to an intensive care unit

Influence of Ventilation Parameters on Intraabdominal Pressure

Introduction: Intraabdominal pressure monitoring is not routinely performed because the procedure assumes some invasiveness and, like other invasive procedures, it needs to have a clear indication to be performed. The causes of IAH are various. Mechanically ventilated patients have numerous parameters set in order to be optimally ventilated and it is important to identify the ones with the biggest interference in abdominal pressure. Although it was stated that mechanical ventilation is a potential factor of high intraabdominal pressure the set parameters which may lead to this diagnostic are not clearly named

Emergency surgery and epidermolysis: an unusual fatal association

Scopul lucrării. Epidermoliza poate reprezenta o urgență medico-chirurgicală, cu risc crescut de deces. Scopul studiului a fost prezentarea rolului chirurgului și anestezistului, respectiv al patologului, în managementul terapeutic și elucidarea patomecanismului decesului, la pacienții cu epidermoliză instalată rapid. Materiale și metode. Pentru elaborarea prezentei lucrări, am selectat cele mai reprezentative cazuri cu epidermoliză, la care autopsiile au fost efectuate la cererea chirurgului sau a medicului anestezist. Rezultate. În cadrul Serviciului de Anatomie patologică al Spitalului Județean de Urgență Târgu-Mureș efectuăm peste 200 de autopsii anual dar sub 5% sunt efectuate la cererea medicul clinician. În ultimii doi ani, am efectuat astfel de autopsii la trei pacienți cu epidermoliză, la care cauza instalării și a evoluției fulminante nu au fost elucidate. Pacienții decedați erau o femeie de 34 de ani și doi bărbați de 59 ani. La toți pacienții decesul s-a instalat sub 48 ore de la internare, fiecare fiind supus unei intervenții chirurgicale sau proceduri invazive. La pacienta tânără, obezitatea și insuficiența renală au fost co-factorii care au contribuit la insuficiența multiplă de organe. La unul dintre bărbați, ciroza decompensată și un șoc hemoragic au fost elementele principale iar celălalt pacient era diagnosticat și tratat pentru mielom multiplu. Nu am identificat o legătură directă între leziunile menționate și epidermoliză. Concluzii. Deși cauzele epidermolizei rămân neelucidate, apariția neașteptată și în scurt timp a acesteia, urmată de deces, poate reprezenta o provocare pentru echipa interdisciplinară. Sunt necesare studii aprofundate pentru a înțelege patomecansimul instalării epidermolizei și a îmbunătăți managementul terapeutic al acestor cazuri.Aim of study. Epidermal necrolysis is a severe life-threatening condition which can be installed in a short time and the causes are far to be understood. The aim of this study is to present the challenges encountered by the surgeons, anesthesiologists and pathologists in management of cases with suddenly installed epidermolysis. Materials and methods. For this paper, we chose the most representative cases with epidermolysis from our database, for which autopsy was done at the request of the surgeon or anesthesiologist. Results. In the Department of Pathology there are over 200 cases per year for which autopsies are done. However, only few of them (below 5%) are done as per the request of the clinicians. In the last two years, in three unusual deaths the post-surgery/postinterventional autopsy was asked to elucidate the cause of epidermolysis and sudden death. It is about one 34-year-old female and two 59-year-old males. In all of them, epidermolysis was installed in fewer than 48 hours. In the young female, the only predisposing factors were represented by the obesity and renal insufficiency and death was installed as result of multiorgan failure syndrome. In another patient, decompensated cirrhosis and hemorrhagic shock was decided to be the cause of the death. In the third one, multiple myeloma was the main disorder. No specific link was found between any of these diseases and epidermolysis. Conclusions. Although further data needs to elucidate the causes of epidermolysis, their occurrence and fatal evolution ask for deeper research, for future better management of such cases

Reduction of Intra-abdominal Hypertension Is Associated with Increase of Cardiac Output in Critically Ill Patients Undergoing Mechanical Ventilation

Objective: To demonstrate the relationship between intra-abdominal hypertension (IAH) and cardiac output (CO) in mechanically ventilated (MV), critically ill patients

An Evaluation of Serum Procalcitonin and C-Reactive Protein Levels as Diagnostic and Prognostic Biomarkers of Severe Sepsis

Background: Recommendations have been made, following the multicenter Surviving Sepsis Campaign study, to standardize the definition of severe sepsis with reference to several parameters such as haemodynamic stability, acid-base balance, bilirubin, creatinine, International Normalized Ratio (INR), urine output and pulmonary functional value of the ratio between arterial oxigen partial pressure and inspiratory oxigen concentration. Procalcitonin (PCT) is considered to be a gold standard biomarker for the inflammatory response, and recent studies have shown that it may help to discover whether a seriously ill person is developing sepsis. C-reactive protein (CRP) is also used as a marker of inflammation in the body, as its blood levels increase if there is any inflammation in the body. The aim of this study was to evaluate serum procalcitonin and C-reactive protein levels as diagnostic and prognostic biomarkers of severe sepsis