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  • ISSN: 2373-9819
    Volume 6, Issue 3
    Case Series
    Irene Cortes Verdasca*, Marta Rebelo, and Eduarda Carmo
    CD infection is considered when a clinical picture is associated with the presence of CD producing toxins. To characterize a set of CD cases in a sample of patients admitted to the intensive care unit. Retrospective study of 10 years. Data on demographic variables, clinical severity, ALOS and MR were collected. 33 cases of CD were found. From these, 15 cases were severe, classified as pseudo membranous colitis, with a mean age of 69 and higher prevalence in female patients. The severity scores APACHE and SAPS II, were, on average, 29.7 and 63.6 (SD of 7 and 21.9). ALOS was 21.1 (SD 19.2) with MR of 60%.
    As serious complicated infection emerged 5 cases of toxic megacolon, with higher prevalence in males and mean age of 71. APACHE and SAPS II were 25.6 and 48.4 (SD 5.5 and 13.7). ALOS was 20.1 (SD 17.9), with MR of 60%.
    The rest presented mild infection, with higher prevalence in females and mean age of 69. However, APACHE and SAPS II were 27.8 and 46.5 (SD 11.5 and 20.3). ALOS was 15.2 (SD 10.7) and MR 54%.
    Irene Cortes Verdasca*, Gabriela Almeida, and Eduarda Carmo
    Introduction: SAH is a relevant health problem. The poor prognosis might be even changed by factors influenced by therapeutic interventions and management procedures.
    Case description: 85-year-old man admitted to the ER for prostration, headache and left hemiparesis. Head CT showed right anterior SAH and CT angiography revealed aneurysm of the right posterior communicating artery. Under went aneurysm embolization and started nimodipine and NA for BP control. Head CT control showed acute hydrocephalus with midline deviation and therefore placed external ventricular drainage. At day 3 post-event presented septic shock with marked abdominal. Performed abdominal CT that revealed mesenteric ischemia. Given the irreversibility of the latest complication there was no surgical indication. Death occurred on the 4th day post-event.
    Another case of a 79-year-old woman admitted for prostration, disorientation and left hemiparesis. Head CT and angiography documented bilateral frontal acute SAH and saccular aneurysm of the anterior communicating artery, respectively. Initiated nimodipine and NA and underwent aneurysm embolization. Head CT control showed worsening of cerebral edema and frontoparietal craniotomy with subtotal drainage was performed. At day 4 post-event developed abdominal distension and increased hemodynamic instability with NA. Abdominal CT showed diffuse intestinal ischemia. Given the poor prognosis there was no surgical indication. Death occurred on the 21st day post-event.
    Discussion: The association of 2 acute events is rare and the underlying mechanism is not yet established. Prolonged use and increasing doses of NA may be considered as a contribution.
    Muhammad Ali Tariq*, Usama Nasir, Neha Waqas, Atif Ameer, Asad Ali, Saad Wasiq, and Maira Nusrat
    Chest pain is among the most common presentations in the Emergency Department. It encompasses an expansive and varied list of differentials. At initial presentation in the emergency department, our attention is mainly focused on determining if this pain is cardiac or pulmonary in origin as these are the most life-threatening scenarios that merit acute care delivery. However, once these have been ascertained and ruled out, it is very important to consider other less common causes of the chest pain. Here, we present a case of a 52 years old Intravenous drug abuser with the chief complaint of chest pain. A chest CT scan suggested underlying sternal osteomyelitis. Further investigations concluded that the gram-negative organism, Pseudomonas aeruginosa was the etiological agent implicated P. aeruginosa is a rather rare cause of sternal osteomyelitis as compared to Staphylococcus aureus.
    Thomas Busch*, Esra Bayram, Kirk Sheplay, and Mohamad Aziz
    A 69-year-old female with history of breast carcinoma presented with a large non-obstructive soft tissue mass in the small bowel radiologically suggestive of sarcoma. She also had multiple hepatic cystic lesions, bilateral adrenal masses, a blastic iliac bone lesion and a left lung mass consistent with metastases. The lung mass was biopsied and revealed a spindle cell tumor positive for vimentin, smooth muscle actin (SMA) and BCL-2. History of prior breast carcinoma was investigated and it was found to have been reported as metaplastic carcinoma with prominent spindle cell sarcomatous component. Pathological analysis of the small bowel tumor was consistent with multiple metastases. Metaplastic breast carcinoma is more aggressive than ductal carcinoma, with larger tumor size, higher grade, more distant metastases and poor prognosis. These tumors are usually negative for mucin, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2), complicating diagnosis and management. It is important to distinguish metaplastic breast carcinoma and initiate an individualized treatment protocol to avoid a devastating outcome.
    Ioannis Stamatatos*, Georgios Meimaris, Dimitrios Lioumpas, and Isaak Dimitriadis
    Background-Aim: Femoral artery pseudoaneurysms (PSA) typically result from percutaneous access for the purpose of angiography and other interventions. PSAs can be asymptomatic or manifest as a pulsatile mass or thrill. Rarely, they rupture leading to a life-threatening shock. We report the case of a 98 year-old woman who suffered a life-threatening superficial femoral artery pseudoaneurysm rupture after an extra-capsular fracture osteosynthesis that was treated with thrombin injection.
    Methods: We have received written consent from the patient and the institution review committee to present this case for scientific purposes.
    Results: Although uncomplicated femoral PSA can be treated with ultrasound-guided compression with 70-100% efficacy, thrombin injections guided by ultrasound have become the treatment of choice with the success rates ranging from 93-100%. This is the first case to our knowledge of ruptured iatrogenic femoral pseudoaneurysm treated with thrombin infusion.
    Conclusions: Rupture of the pseudoaneurysm comprises a vascular emergency while clinical suspicion and imaging techniques are the cornerstones of timely diagnosis and appropriate management of the condition. Ultrasound-guided thrombin injection should always be considered after the diagnosis of a ruptured femoral pseudoaneurysm, before emergency surgery is performed.
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