INTRODUCTION: Purtscher-like retinopathy as a complication of acute pancreatitis is a disease which causes generalized retinal and macular oedema associated with retinal surface haemorrhage, which results in a permanent, sometimes partially reversible visual loss. CASE REPORT: The case report presented in this article refers to the case of a 36-year-old woman with severe acute pancreatitis. The pancreatitis led to the development of acute respiratory insufficiency with signs of septic shock and consequently, the patient was transferred to the critical care unit. The patient underwent a total of 8 surgical interventions with the revision of the abdominal cavity, necrectomy and application of the vacuum system into the abdominal cavity. Eye exams were conducted for impaired vision with the conclusion of Purtscher-like retinopathy associated with acute pancreatitis, occlusion of the central retinal artery of both eyes, confirmed by fluorescence angiography. After one year, alterations of the retina show no signs of improvement in this case; the loss of vision is permanent.Key words: acute pancreatitis Purtscher-like retinopathy.
- MeSH
- akutní nemoc MeSH
- dospělí MeSH
- fluoresceinová angiografie MeSH
- lidé MeSH
- nemoci retiny diagnóza etiologie MeSH
- okluze retinální arterie diagnóza etiologie MeSH
- pankreatitida komplikace MeSH
- respirační insuficience etiologie MeSH
- septický šok etiologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
UNLABELLED: Skin and Soft Tissue Infections (SSTIs) encompass a wide spectrum of inflammatory diseases of the skin, subcutis, fascia and muscles. Recent national trends indicate increasing rates of patients treated for these diagnoses at outpatient surgical department, but also of patients hospitalized with severe forms of SSTIs. Up to 90% fatality rates are reported in the literature for the most severe forms, resulting from underestimation of initial symptoms and therefore delayed onset of radical therapy only the phase of septic shock. The paper provides an interdisciplinary review of essential principles of the diagnosis and therapy of SSTIs, reflecting present knowledge supported by evidence-based medicine. KEY WORDS: skin and soft tissue infections - SSTIs - necrotizing fasciitis - diagnosis - therapy.
- MeSH
- časná diagnóza MeSH
- časná lékařská intervence MeSH
- infekce měkkých tkání komplikace diagnóza terapie MeSH
- infekční nemoci kůže komplikace diagnóza terapie MeSH
- lidé MeSH
- medicína založená na důkazech * MeSH
- progrese nemoci MeSH
- septický šok etiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Serious intraabdominal infections belong among life treating diseases. They are based on spreading infections from focal sources of inflammation in abdomen or damaged intestinal wall. METHODS AND RESULTS: Treatment strategies are surgical intervention, antimicrobial therapy, distributional shock treatment and accurate nutritional support (1). Glutamine and selenium supplementation may improve intestinal functions and restore antioxidant defence (2). Septic shock with multiple organ failure accompanied by serious catabolism and decrease of albumin had developed in a patient after endoscopic polypectomy. Infection source was not discovered by medical imaging examinations non surgical laparotomy. After distributive shock treatment, wide spectral antibiotics and enteral and parenteral nutrition the patients health improved. As adjuvant therapy intravenous supplementation was administered: glutamine in daily dose 2g and sodium selenite in continual infusion in daily dose 750 μg over 6 days. During intensive therapy, inflammatory markers decreased: C-reactive protein, procalcitonin, leukocyte count and neutrophils. Albumin levels increased. CONCLUSIONS: The paper describes therapeutic options during septic shock treatment and reversion possibilities in the catabolic phase of disease.Key words: colonoscopy, septic shock, multiorgan failure, enteral nutrition, parenteral nutrition.
We present a case of a 60-year old patient hospitalized at the Department of Infectious Diseases and Travel Medicine, Medical faculty of UPJS and L. Pasteurs University Hospital in Kosice with suspected gastroenteritis. The patient was admitted to an intensive care unit because of the signs of septic shock. Within one hour from admission, the patient was administered early goal directed therapy for septic shock. Subsequently, infectious endocarditis of stimulation electrodes and tricuspid valve was identified as the origin of the infection. The stimulation system was then explanted from a stabilized and afebrile patient at the Department of cardiac Surgery of Eastern Slovak Institute of Cardiac and Vascular Diseases in Kosice. This case should emphasise frequently atypical course of this serious disease and the need for early identification of severe sepsis to enable timely management to affect mortality.
- MeSH
- bakteriální endokarditida etiologie MeSH
- defibrilátory implantabilní škodlivé účinky MeSH
- infekce spojené s protézou etiologie mikrobiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- septický šok etiologie MeSH
- stafylokokové infekce etiologie MeSH
- Staphylococcus aureus * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- MeSH
- bakteriální endokarditida etiologie MeSH
- defibrilátory implantabilní škodlivé účinky MeSH
- infekce spojené s protézou etiologie MeSH
- lidé MeSH
- septický šok etiologie MeSH
- stafylokokové infekce etiologie MeSH
- Staphylococcus aureus * MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- komentáře MeSH
- úvodníky MeSH
The kidney is a common "victim organ" of various insults in critically ill patients. Sepsis and septic shock are the dominant causes of acute kidney injury, accounting for nearly 50 % of episodes of acute renal failure. Despite our substantial progress in the understanding of mechanisms involved in septic acute kidney injury there is still a huge pool of questions preclusive of the development of effective therapeutic strategies. This review briefly summarizes our current knowledge of pathophysiological mechanisms of septic acute kidney injury focusing on hemodynamic alterations, peritubular dysfunction, role of inflammatory mediators and nitric oxide, mitochondrial dysfunction and structural changes. Role of proteomics, new promising laboratory method, is mentioned.
- MeSH
- akutní poškození ledvin etiologie MeSH
- apoptóza MeSH
- lidé MeSH
- oxid dusnatý metabolismus MeSH
- proteomika metody MeSH
- renální oběh fyziologie MeSH
- septický šok etiologie MeSH
- zánět metabolismus MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- Názvy látek
- oxid dusnatý MeSH
Authors present the case of patient with perforation of atypicaly localised diverticula of small intestine. The most important in clinical picture of patient was the sudden progress of sepsis and symptoms of organ failure. This status was progreding after the first operative revision of abdominal cavity when no explanation for peritonitis was found. During the second operation revision we found the perforated diverticula of the mesenterial side of distal jejunum. In the period after operation several complications such as wound healing failure and organs failure were occurred.
- MeSH
- divertikl komplikace chirurgie MeSH
- lidé MeSH
- nemoci jejuna komplikace chirurgie MeSH
- perforace střeva etiologie chirurgie MeSH
- peritonitida etiologie MeSH
- senioři nad 80 let MeSH
- septický šok etiologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
AIM: The authors present a case of a patient with developed Fournièr gangrene and septic shock. Fournièr gangrene belongs to the group of local non-specific infection of soft tissues (NSTI). Its incidence is relatively low, but the infection is extraordinary aggressive with a possible lethal end. MATERIAL AND METHOD: 39 years old patient with 4 days history of Fournier gangrene's development was admitted in irreversible septic shock. The initial APACHE II score was 36. The delay in treatment was an important factor in the further course of illness with lethal end. RESULTS: Above the mentioned 39 years old patient died because of septic shock. The hemorrhagic cystitis was the original source of infection with further development of Fournièr gangrene according to the pathological record. CONCLUSION: We often come across all different kinds of stages of sepsis from the MODS to the septic shock for patients with Fournièr gangrene. Causal treatment should be started early. The local surgical excision and wide broad antibiotic administrations are basic treatments in the context of other treatment modalities according to the current patient's needs. The adjuvant hyperbaric oxygen treatment takes place in patients with Fournièr gangrene as well and is beneficial. The following factor even worsens the illness prognosis: delay in diagnostic, higher age, anorectal origin of infection, the amount of organ with dysfunction or failure, diabetes mellitus and significant immunodeficiency.
- MeSH
- dospělí MeSH
- fatální výsledek MeSH
- Fournierova gangréna komplikace MeSH
- lidé MeSH
- septický šok etiologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
The coupled plasma filtration adsorption (CPFA) was developed as an adsorptive hemopurification method aimed at nonselective removal of circulating soluble mediators potentially involved in the pathogenesis of sepsis. We hypothesized that this nonselective hemopurification could protect from detrimental consequences of long-term, volume-resuscitated porcine septic shock. In 16 anesthetized, mechanically ventilated, and instrumented pigs, the hyperdynamic septic shock secondary to peritonitis was induced by intraperitoneally inoculating feces and maintained for 22 h with fluid resuscitation and norepinephrine infusion as needed to maintain MAP above 65 mmHg. After 12 h of peritonitis, animals were randomized to receive either supportive treatment (control, n = 8) or CPFA treatment (CPFA, n = 8). Systemic, hepatosplanchnic, and renal hemodynamics; oxygen exchange; energy metabolism (lactate/pyruvate and ketone body ratios); ileal mucosal and renal cortex microcirculation; systemic inflammation (TNF-alpha, IL-6); nitrosative/oxidative stress (thiobarbituric acid reactive species, nitrates + nitrites); and endothelial/coagulation dysfunction (asymmetric dimethylarginine, von Willebrand factor, thrombin-antithrombin complexes, platelet count) were assessed before and 12, 18, and 22 h of peritonitis. Coupled plasma filtration adsorption neither delayed the development of hypotension nor reduced the dose of norepinephrine. The treatment failed to attenuate sepsis-induced alterations in microcirculation, surrogate markers of cellular energetics, endothelial injury, and systemic inflammation. Similarly, CPFA did not protect from lung and liver dysfunction and even aggravated sepsis-induced disturbances in coagulation and oxidative/nitrosative stress. In this porcine model of septic shock, the early treatment with CPFA was not capable of reversing the sepsis-induced disturbances in various biological pathways and organ systems. Both the efficacy and safety of this method require further rigorous experimental validation in clinically relevant models.
- MeSH
- energetický metabolismus MeSH
- hemodynamika MeSH
- hemofiltrace metody MeSH
- náhodné rozdělení MeSH
- peritonitida komplikace patofyziologie MeSH
- prasata MeSH
- septický šok etiologie metabolismus terapie MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVE: The role of haemofiltration as an adjunctive treatment of sepsis remains a contentious issue. To address the role of dose and to explore the biological effects of haemofiltration we compared the effects of standard and high-volume haemofiltration (HVHF) in a peritonitis-induced model of porcine septic shock. DESIGN AND SETTING: Randomized, controlled experimental study. SUBJECTS: Twenty-one anesthetized and mechanically ventilated pigs. INTERVENTIONS: After 12 h of hyperdynamic peritonitis, animals were randomized to receive either supportive treatment (Control, n = 7) or standard haemofiltration (HF 35 ml/kg per h, n = 7) or HVHF (100 ml/kg per hour, n = 7). MEASUREMENTS AND RESULTS: Systemic and hepatosplanchnic haemodynamics, oxygen exchange, energy metabolism (lactate/pyruvate, ketone body ratios), ileal and renal cortex microcirculation and systemic inflammation (TNF-alpha, IL-6), nitrosative/oxidative stress (TBARS, nitrates, GSH/GSSG) and endothelial/coagulation dysfunction (von Willebrand factor, asymmetric dimethylarginine, platelet count) were assessed before, 12, 18, and 22 h of peritonitis. Although fewer haemofiltration-treated animals required noradrenaline support (86, 43 and 29% animals in the control, HF and HVHF groups, respectively), neither of haemofiltration doses reversed hyperdynamic circulation, lung dysfunction and ameliorated alterations in gut and kidney microvascular perfusion. Both HF and HVHF failed to attenuate sepsis-induced alterations in surrogate markers of cellular energetics, nitrosative/oxidative stress, endothelial injury or systemic inflammation. CONCLUSIONS: In this porcine model of septic shock early HVHF proved superior in preventing the development of septic hypotension. However, neither of haemofiltration doses was capable of reversing the progressive disturbances in microvascular, metabolic, endothelial and lung function, at least within the timeframe of the study and severity of the model.
- MeSH
- energetický metabolismus MeSH
- hemodynamika fyziologie MeSH
- hemofiltrace metody MeSH
- mikrocirkulace fyziologie MeSH
- náhodné rozdělení MeSH
- oxidační stres fyziologie MeSH
- peritonitida komplikace patofyziologie MeSH
- prasata MeSH
- progrese nemoci MeSH
- septický šok etiologie terapie MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- práce podpořená grantem MeSH
