[Consensus conference on the management of hepatopulmonary syndrome. Complications of portal hypertension: how to treat pleuropulmonary complications].
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We are reporting the case of a female patient who had to undergo splenectomy after she suffered splenic rupture as a result from "kinetic therapy" during the treatment for pulmonary failure secondary to sepsis. Four years later the patient was again admitted with a clinical picture consistent with sepsis. Two blood cultures were positive for pneumococci confirming the diagnosis of pneumococcal sepsis. This paper discusses the potential risks of kinetic therapy in patients with ARDS. After splenectomy there is increased risk of infection with certain bacteria, funghi, viruses and protozoa. The most common bacterial pathogen is pneumococcus. A polyvalent vaccine is available for prophylaxis. Although penicillin G is still commonly used as an antibiotic therapy for pneumococcal infection, increased resistance of pathogens to penicillin must be anticipated. Alternative antibiotic regimens are demonstrated.
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We describe a patient with unusual echocardiographic features of prosthetic aortic valve endocarditis. Transesophageal echocardiography in this patient demonstrated a large multiloculated aortic root abscess extending to mitral-aortic intervalvular fibrosa, a high acquired ventricular septal defect, paravalvular aortic regurgitation caused by aortic valve dehiscence, and anterior mitral valve leaflet perforation.
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Six weeks after presumptive acute synovial rupture at the knee, a patient was admitted with cutaneous induration over the medial calf. Roentgenograms showed gas shadows within the involved area. A fluctuant area at the center of the indurated mass yielded a Corynebacterium species.
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This paper sets out to bring together recurrent themes in the understanding and care of patients with Chronic/End Stage Renal Failure centering on the key issue of loss. A multi-disciplinary conceptual framework is proposed based on three perspectives--Systemic, Existential and Narrative. The integrated framework for understanding the complexity of grief issues for dialysis and pre-dialysis patients focuses on the perception of self and the inter-relationship with others directly involved in their care.
The neuropathological findings in six patients who developed neurological signs after the onset of "septic shock" caused by Gram-negative septicaemia are described. The changes in the brains were characteristic of acute haemorrhagic leucoencephalitis, and there was evidence, particularly in the kidneys, of disseminated intravascular coagulation with tubular necrosis and, in some, appearances indistinguishable from membrano-proliferative glomerulonephritis. It is agreed that acute haemorrhagic leucoencephalitis is another manifestation of a generalised Shwartzman reaction, and it is suggested that activation of complement is the final common pathway that produces tissue damage in the brain and kidney.
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