scholarly journals Fatal Heat Stroke in a Schizophrenic Patient

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
María Jesús Gómez Ramos ◽  
Francisco Miguel González Valverde ◽  
Carmen Sánchez Álvarez ◽  
Lisa Ortin Katnich ◽  
Francisco Pastor Quirante
Keyword(s):  
Supportive Care ◽  
Multiorgan Failure ◽  
Heat Stroke ◽  
Best Supportive Care ◽  
Histological Evaluation ◽  
Life Threatening ◽  
History Of ◽  
Body Cooling ◽  
Salt And Water Balance ◽  
Obesity Hypertension

Objective. The case of a patient who developed a fatal post-exertional heat stroke is reported.Case Report. A 20-year-old man with a history of morbid obesity, hypertension, and schizophrenia was admitted to our intensive care unit because of multiorgan failure due to severe heat stroke. He had been working under the sun. Treatment included aggressive body cooling but, in spite of the best supportive care, the patient succumbed in a few hours. We concluded that the adverse event was possibly associated with his obesity and the use of antipsychotics. Histological evaluation revealed lesions consistent with severe hyperthermia and shock.Conclusions. Heat stroke is an uncommon clinical entity characterized by systemic heat and loss of the body's normal mechanisms for dealing with heat stress, such as sweating and temperature control. When heat stroke is diagnosed early and supportive care begins promptly the prognosis is optimal but it becomes a life-threatening disease when treatment is delayed. Lack of physical acclimatization and the use of certain medications that interfere with salt and water balance can impair thermoregulation under conditions of high environmental temperature. Health professionals must be adequately prepared to prevent, recognise, and treat them urgently.

scholarly journals A Case of Exertional Heat Stroke Complicated by Hypoxic Hepatitis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Bertram K. Woitok ◽  
Shawki Bahmad ◽  
Gregor Lindner
Keyword(s):  
Supportive Care ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Multiorgan Failure ◽  
Heat Stroke ◽  
Exertional Heat Stroke ◽  
Hypoxic Hepatitis ◽  
Threatening Condition ◽  
Life Threatening ◽  
Delayed Referral

Background.Exertional heat stroke is a life-threatening condition often complicated by multiorgan failure. We hereby present a case of a 25-year-old male presenting with syncope after a 10  km run in 28°C outside temperature who developed acute liver failure. Case Presentation. Initial temperature was found to be 41.1°C, and cooling measures were rapidly applied. He suffered from acute renal failure and rhabdomyolysis and proceeded to acute liver failure (ASAT 6100 U/l and ALAT 6561 U/l) due to hypoxic hepatitis on day 3. He did not meet criteria for emergency liver transplantation and recovered on supportive care. Conclusions. Acute liver failure due to heat stroke is a life-threatening condition with often delayed onset, which nevertheless resolves on supportive care in the majority of cases; thus, a delayed referral to transplant seems to be reasonable.

Malignant catatonia and neuroleptic malignant syndrome: How different/similar are they?

2016 ◽  
Vol 33 (S1) ◽  
pp. S640-S640 ◽  
Author(s):  
P. Sales ◽  
M. Bernardo ◽  
A. Lopes ◽  
E. Trigo
Keyword(s):  
Supportive Care ◽  
Neuroleptic Malignant Syndrome ◽  
Specific Treatment ◽  
Hemodynamic Instability ◽  
Psychotic Symptoms ◽  
Muscle Rigidity ◽  
Life Threatening ◽  
History Of ◽  
Competing Interest ◽  
Malignant Catatonia

IntroductionCatatonia is a neuropsychiatric syndrome that appears in medical, neurological or psychiatric conditions. There are presentation variants: “malignant catatonia” (MC) subtype shares many characteristics with the neuroleptic malignant syndrome (NMS), possibly reflecting common pathophysiology.Objectives/methodsWe present a clinical vignette and review the literature available on online databases about MC/NMS.ResultsWe present a man, 41-years-old, black ethnicity, with no relevant medical history. He had two previous episodes compatible with brief psychosis, the last one in 2013, and a history of adverse reactions to low doses of antipsychotics. Since the last episode he was asymptomatic on olanzapine 2.5 mg id. He acutely presented to the Emergency Room with mutism, negativism, immobility and delusional speech, similar to the previous episodes mentioned and was admitted to a psychiatric infirmary, where his clinical condition worsened, showing muscle rigidity, hemodynamic instability, leukocytosis, rhabdomyolysis and fever. Supportive care was provided, olanzapine was suspended and electroconvulsive therapy (ECT) was initiated. After two months, he was discharged with no psychotic symptoms. He is still under ECT and no antipsychotic medication was reintroduced.Discussion/conclusionMany studies suggest that clinical or laboratory tests do not distinguish MC from NMS and that they are the same entity. These two conditions are life-threatening and key to treatment is a high suspicion level. There is no specific treatment; supportive care and stopping involved medications are the most widely used measures. ECT is a useful alternative to medication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Esophageal Cancer

2008 ◽  
Vol 6 (9) ◽  
pp. 818 ◽  
Author(s):  
_ _
Keyword(s):  
Esophageal Cancer ◽  
Supportive Care ◽  
High Body Mass Index ◽  
The United States ◽  
Best Supportive Care ◽  
Major Health Problem ◽  
Major Health ◽  
Caucasian Race ◽  
History Of ◽  
Recent Version

Upper gastrointestinal (GI) tract cancers originating in the esophagus, gastroesophageal (GE) junctions, and stomach constitute a major health problem worldwide; esophageal cancer is the eighth most common cancer worldwide. An estimated 16,470 new cases of and 14,280 deaths from esophageal cancer will occur in the United States in 2008. Risk factors associated with development of esophageal cancer include age, male gender, Caucasian race, high body mass index, Barrett's esophagus, and history of gastroesophageal reflux disease. Important updates for the 2009 guidelines include a new page on “Principles of Best Supportive Care” that gives specific recommendations for esophageal cancer best supportive care throughout the guidelines. To view the NCCN Clinical Practice Guidelines in Oncology on Gastric Cancers, please visit the NCCN Web site at www.nccn.org. For the most recent version of the guidelines, please visit NCCN.org

Chemotherapy for Advanced Pancreatic Cancer: The History is Changing

1998 ◽  
Vol 84 (3) ◽  
pp. 308-311 ◽  
Author(s):  
Francesco Graziano ◽  
Giuseppina Catalano ◽  
Stefano Cascinu
Keyword(s):  
Pancreatic Cancer ◽  
Natural History ◽  
Supportive Care ◽  
Advanced Disease ◽  
Advanced Pancreatic Cancer ◽  
Best Supportive Care ◽  
Physical Conditions ◽  
History Of

Until recently, chemotherapy was considered ineffective in pancreatic cancer and these patients received best supportive care only. Now, there is evidence that chemotherapy may influence the natural history of the disease by prolonging survival and there are data on its role as an effective tool for the improvement of physical conditions in patients with advanced disease. The results are far from conclusive, and only partially satisfying but they represent a step forward.

Reversal of ‘the dying’ diagnosis

2021 ◽  
Vol 14 (6) ◽  
pp. e240133
Author(s):  
Maimoona Ali ◽  
Andrew Goddard ◽  
Eleanor Smith
Keyword(s):  
Palliative Care ◽  
Intensive Care ◽  
Supportive Care ◽  
End Of Life Care ◽  
Surgical Intervention ◽  
Best Supportive Care ◽  
Lower Limbs ◽  
Life Care ◽  
Incision And Drainage ◽  
History Of

A 75-year-old woman was admitted with sepsis and treated with broad-spectrum antibiotics until examination of her lower limbs noted necrotising wounds. Surgical intervention was advised by the plastic surgeons; however, she was deemed unsuitable for intensive care. She underwent incision and drainage of the necrotic area and biopsies were taken. She deteriorated clinically and the decision was made for best supportive care and was therefore transferred to the inpatient palliative care unit for end-of-life care. However, she stabilised, and based on culture sensitivities, antibiotics were restarted. It was also noted that the patient had a 3-month history of loose stools, which had not been addressed previously. The biopsies were suggestive of pyoderma gangrenosum, prompting a dermatology review, and prednisolone and doxycycline were started. The wounds and her loose stools improved, and with ongoing rehabilitation, she made a full recovery. Referral to gastroenterology was made.

scholarly journals Best supportive care for idiopathic pulmonary fibrosis: current gaps and future directions

2018 ◽  
Vol 27 (147) ◽  
pp. 170076 ◽  
Author(s):  
Giovanni Ferrara ◽  
Fabrizio Luppi ◽  
Surinder S. Birring ◽  
Stefania Cerri ◽  
Antonella Caminati ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Supportive Care ◽  
Symptom Control ◽  
Best Supportive Care ◽  
Current Evidence ◽  
Future Directions ◽  
Improve Symptom ◽  
History Of

Best supportive care (BSC) is generally defined as all the interventions and the multiprofessional approach aimed to improve and optimise quality of life (QoL) in patients affected by progressive diseases. In this sense, it excludes and might be complementary to other interventions directly targeting the disease. BSC improves survival in patients with different types of cancer. Patients with idiopathic pulmonary fibrosis (IPF) experience a vast range of symptoms during the natural history of the disease and might have a beneficial effect of BSC interventions. This review highlights the current evidence on interventions targeting QoL and gaps for the clinical assessment of BSC in the treatment of IPF patients. Very few interventions to improve QoL or improve symptom control are currently supported by well-designed studies. Sound methodology is paramount in evaluating BSC in IPF, as well as the use of validated tools to measure QoL and symptom control in this specific group of patients.

Cholangiokarzinome

Praxis ◽  
2002 ◽  
Vol 91 (34) ◽  
pp. 1352-1356
Author(s):  
Harder ◽  
Blum
Keyword(s):  
Supportive Care ◽  
Evidence Based Medicine ◽  
Best Supportive Care ◽  
Evidence Based ◽  
Systemische Chemotherapie ◽  
Chirurgische Resektion ◽  
Multimodale Therapiekonzepte ◽  
Based Medicine

Cholangiokarzinome oder cholangiozelluläre Karzinome (CCC) sind seltene Tumoren des biliären Systems mit einer Inzidenz von 2–4/100000 pro Jahr. Zu ihnen zählen die perihilären Gallengangskarzinome (Klatskin-Tumore), mit ca. 60% das häufigste CCC, die peripheren (intrahepatischen) Cholangiokarzinome, das Gallenblasenkarzinom, die Karzinome der extrahepatischen Gallengänge und das periampulläre Karzinom. Zum Zeitpunkt der Diagnose ist nur bei etwa 20% eine chirurgische Resektion als einzige kurative Therapieoption möglich. Die Lebertransplantation ist wegen der hohen Rezidivrate derzeit nicht indiziert. Die Prognose von nicht resektablen Cholangiokarzinomen ist mit einer mittleren Überlebenszeit von sechs bis acht Monaten schlecht. Eine wirksame Therapie zur Verlängerung der Überlebenszeit existiert aktuell nicht. Die wichtigste Massnahme im Rahmen der «best supportive care» ist die Beseitigung der Cholestase (endoskopisch, perkutan oder chirurgisch), um einer Cholangitis oder Cholangiosepsis vorzubeugen. Durch eine systemische Chemotherapie lassen sich Ansprechraten von ca. 20% erreichen. 5-FU und Gemcitabine sind die derzeit am häufigsten eingesetzten Substanzen, die mit einer perkutanen oder endoluminalen Bestrahlung kombiniert werden können. Multimodale Therapiekonzepte können im Einzellfall erfolgreich sein, müssen jedoch erst in Evidence-Based-Medicine-gerechten Studien evaluiert werden, bevor Therapieempfehlungen für die Praxis formuliert werden können.

scholarly journals Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 205
Author(s):  
Nicola Tarantino ◽  
Domenico G. Della Rocca ◽  
Nicole S. De Leon De La Cruz ◽  
Eric D. Manheimer ◽  
Michele Magnocavallo ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Individual Factors ◽  
Substantial Part ◽  
Arrhythmogenic Substrate ◽  
Life Threatening ◽  
History Of ◽  
Anatomic Distribution ◽  
Artery Disease ◽  
Surveillance Analysis

A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete’s age, and the operator’s expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation.

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