Showing papers by "CHU Ambroise Paré published in 2014"

Reverse Takotsubo cardiomyopathy after iatrogenic epinephrine injection requiring percutaneous extracorporeal membrane oxygenation

Abstract: Takotsubo cardiomyopathy is characterized by the sudden onset of reversible left ventricular dysfunction. Associated refractory cardiogenic shock is a rare occurrence and may require extracorporeal membrane oxygenation (ECMO). We report a case of a patient who, following the inadvertent injection of 1 mg of epinephrine, presented with reverse Takotsubo cardiomyopathy and refractory cardiogenic shock that required the implementation of a percutaneous ECMO. A 49-yr-old female patient presented with reverse Takotsubo cardiomyopathy in the operating room after an inadvertent injection of epinephrine. The development of refractory cardiogenic shock required emergent use of a mobile percutaneous ECMO system. It was possible to wean this support after four days, and the patient was later discharged without cardiac or neurological sequelae. The investigations performed confirmed the iatrogenic nature of this reverse Takotsubo cardiomyopathy. Takotsubo cardiomyopathy following an injection of epinephrine remains a rare but increasingly described occurrence. The severity of the symptoms appears to be patient dependent, but refractory cardiogenic shock may occur and require significant circulatory support. If this situation occurs in a hospital where this necessary equipment is lacking, a mobile ECMO unit appears to be a viable solution to optimize the patient’s chances of survival.

Huge Pneumoretroperitoneum as the First Sign of Colorectal Cancer

Abstract: Colorectal cancer is a common form of neoplasia, and it is a major source of morbidity and mortality in the elderly population. Surgery, whether palliative or curative, is often the only definitive management option. The incidence of carcinoma of the colon and rectum peaks in the seventh and eighth decades of life, with only 5 % recorded in those younger than 40 years. Up to 30% of colon cancers may present with an obstruction or perforation [1]. The incidence of colon cancer presenting with perforation is about 2.1–9.5 % of all cases [2]. The majority of patients with rectal cancer present with abdominal pain, weight loss, altered bowel habits, chronic blood loss or acute bleeding. Patient with perforated colon usually show signs of peritonitis, owing to intra-peritoneal perforation. Retroperitoneal perforation is less common, and frequently, abdominal signs and symptoms are minimal or atypical [2]. Late diagnosis and treatment could result in highmorbidity andmortality.We report the case of a woman admitted to hospital with no clear abdominal symptoms, but an important pneumoretroperitoneum at plain abdominal X-ray and CT scan.

Management of Autoimmune Systemic Diseases in the Intensive Care Unit

Abstract: The diagnosis of an autoimmune systemic disease (SD) and/or its management in the intensive care unit (ICU) is dependent on dialogue between the intensivist and specialists in these diseases. However, some clinical (syndromic associations) or biological signs should lead the intensivist to suspect these diseases. Several biological or histological investigations can be rapidly performed in the ICU to confirm the diagnosis. Both treatments of a potential flare-up of the suspected disease and a concurrent infectious complication need often to be started simultaneously. While waiting for the effects of these specific treatments, supportive treatment may include the initiation of non-invasive ventilation or, in severe specified cases, invasive mechanical ventilation with extra-corporeal supports like Renal Replacement Therapy (RRT) and extra-corporeal membrane oxygenation (ECMO). Referent centers should be asked for validation of the therapeutic options, especially when some drugs are used off-label for these severe patients. An integrative diagnostic and therapeutic approach is proposed to guide the intensivist in this complex management.

Neuropathic Pain and Its Management

Abstract: Neuropathic pain (NeP) is caused by a lesion to the somatosensory system, leading to pain in a body region related to the injured nervous structure. It leads to long-term changes in both peripheral and central neuronal networks and is associated with suffering and decreased quality of life. NeP can be diagnosed clinically and specific tests can confirm either the site of neuronal lesion or the topographical distribution of the deficit related to the pain. Different from nociceptive pain in which pain is caused by the activation of peripheral nerve endings, usually secondary to inflammation, NeP does not respond to usual analgesics. Its pharmacological treatment relies on the use of certain anticonvulsants and antidepressants that are able to decrease pain intensity and improve quality of life in a proportion of patients. Intensive research is being performed to better tailor treatment to individual patients and to develop more efficacious medications to relieve NeP in those who do not respond to current first-line therapy.