Intensive Medical Treatment Research Articles

노인성우울증에 대한 한방 집중치료 프로그램의 효과

Received: November 30, 2014 Revised: December 9, 2014 Accepted: December 9, 2014 Objectives: As the elderly population grows and the prevalence of depression increases, the incidence of geriatric depression disorder will continue to increase. The effect of an intensive Korean medicine treatment program on geriatric depression disorder was studied. Methods: Geriatric depression disorder patients who received treatment over a period of three years were reviewed, with the geriatric depression score (GDS) used as the primary outcome. The intensive Korean medical treatment program applied to the geriatric depression disorder patients consisted of herbal medicine, acupuncture, pharmacopuncture, moxibustion, meditation, qigong exercises, and reminiscence therapy. Results: The GDS scores of patients who received the intensive Korean medical treatment program decreased from an average of 19.57 (±5.52) to 15.76 (±6.99) and there was a significant difference. Conclusions: When the intensive Korean medical treatment program was applied to geriatric depression disorder patients, the symptoms of depression improved. This treatment program will be helpful for improving symptoms in patients and can be applied by trained clinicians.

Effects of Korean Medical Combination Treatment for Herniated Intervertebral Lumbar Disc Patients: An Observational Study

Objectives : Lumbar disc herniations are common conditions which induce severe pain and disability. We assessed the clinical effectiveness of Korean medical combination treatment. Methods : This is an observational study. We reviewed the medical records of 46 patients with lumbar disc herniations, who attended intensive Korean medical combination treatments at Mokhuri Neck and Back Hospital, Korea during March, 2012 to October, 2012. All the patients took combination treatments of acupuncture, Chuna and herbal medicines during the hospitalization treatments. Zero to ten pain numerating rating scale(NRS) of pain and SF-36 were assessed before and after treatments. Results : During the period, 46 patients with lumbar disc herniation participated in the treatments, respectively. Average admission duration were 20.32 days(SD 9.67) in lumbar disc patients. For lumbar patients, low back pain NRS decreased from 5.84 ± 2.58 to 2.12 ± 1.74(p<0.001) and radiating pain from 6.25 ± 2.30 to 2.59 ± 1.97(p<0.001). Total SF-36 score increased significantly after treatment in lumbar disc patients(p<0.001). Conclusions : Korean medical combination treatment might be effective in reducing pain and improving life quality of patients with lumbar disc herniation.

Postmortem distribution of PV9, a new cathinone derivative, in human solid tissues in a fatal poisoning case

In our previous study, we identified PV9 [1-phenyl-2-(pyrrolidin-1-yl)octan-1-one] in human blood and urine in a fatal poisoning case. The victim was an 18-year-old woman. After ingesting “aroma liquid” solution, the victim showed various symptoms including low levels of consciousness, and was taken to a hospital emergency department. Although the victim received intensive medical treatment including an intravenous drip infusion of a large volume of transfusion solution, she was pronounced dead about 20 h after admission. In this study, we carefully examined the postmortem distribution of PV9 in nine solid tissues of the victim collected at forensic autopsy. The extraction of PV9 and internal standard (IS) PV8 [1-phenyl-2-(1-pyrrolidinyl)-1-heptanone] was performed by acetonitrile deproteinization, followed by modified QuEChERS dispersive solid-phase extraction and filtration through Captiva ND Lipids cartridges. Anaysis was performed by liquid chromatography–tandem mass spectrometry. Because this study dealt with various kinds of human matrices, we used the standard addition method to overcome matrix effects. After thorough validations, such as checking the product ion mass spectra, selected reaction monitoring chromatograms, linearity of the standard addition calibration curves, the intraday and interday repeatability, matrix effects, and recovery rates for the method, the concentrations of PV9 in nine solid tissue specimens were measured using PV8 as IS. The highest level of PV9 was found in the kidney at 907 ± 19.5 ng/g followed by the skeletal muscle, pancreas, adipose tissue, liver, lung, spleen, heart muscle, and brain. The lowest level of PV9 in the brain was 212 ± 11.9 ng/g. The high level of PV9 in the kidney suggests that this drug tends to be rapidly excreted into urine via the kidney as was the case for α-pyrrolidinovalerophenone. The low concentration of PV9 in the brain was unexpected, because this drug is a psychotropic drug with a long hydrophobic side chain, and is considered to cross the blood–brain barrier very easily. To our knowledge, this is the first demonstration of the distribution of the new pyrrolidinophenone derivative PV9 in human solid tissues in a poisoning case.

Incidence of Adrenal Insufficiency in Patients with Multiple Myeloma during High Dose Chemotherapy and Autologous Stem Cell Transplant

▪Background High dose chemotherapy (HDC) followed by autologous stem cell transplant (ASCT) is considered the standard of care for patients with multiple myeloma (MM). With most patients receiving induction therapy that includes corticosteroids. The combined effect of prior therapy for myeloma and ASCT related complications may result in hypotension and require intensive medical treatment. To date the incidence of adrenal insufficiency in the setting of ASCT is unknown. The effects of this underlying disorder in regards to post transplant outcome remain unknown as well. We set out to compare the outcomes of patients with multiple myeloma who underwent ASCT with adrenal insufficiency compared to those with sufficient adrenal function.Methods We undertook a prospective study in 13 consecutive patients with Multiple Myeloma admitted for high dose chemotherapy and autologous stem cell transplant at Henry Ford Hospital between February 2014 through June 2014, with the first patient sample being obtained in on 2/14/2014 and last sample recorded in 6/23/2014. Random cortisol levels were obtained on the day of admission or day -2 (figure 1), prior to the start of high dose chemotherapy. All prior therapies included corticosteroids and consisted of the following RVD, DCEP, RD, VD, DT-PACE. Patients were classified into two groups those with cortisol levels > 5 and those patients who had cortisol levels <5. Endpoints analyzed included hypotension, septic shock, and duration of antibiotic therapy.Results Of the 13 patients analyzed the median age was 60 years old (range 53-78), gender 8 male patients 5 female. All patients underwent high dose chemotherapy with Melphalan and Autologous stem cell transplant. Of the 13 patients in which data was obtained 3/13 23% had adrenal insufficiency prior to high dose Melphalan and ASCT. With a median cortisol level of 3.2 in the patient cohort who were found to be adrenal insufficient. The incidence of hypotension was 2/3 66% in the adrenal insufficient patients compared 1/10 10% in the cohort with sufficient adrenal function. Septic shock occurred in 2/3 66% of the adrenal insufficient compared to 0/10 in the adrenal sufficient group. The median duration of antibiotic therapy was 5 days in the adrenal insufficient cohort compared to 2 days in the patients with adequate adrenal function.Conclusion In this small cohort of consecutive patients from a single center, we found that there was a high incidence of adrenal insufficiency 23% in patients undergoing ASCT. The treatment regimens varied in the study group with all patients receiving corticosteroid therapy in there induction regimen. Given the unexpectedly high incidence of adrenal insufficiency a consideration should be given to check a random cortisol level prior to the initiation of HDC. Supplemental therapy or treatment should be considered in this high risk group to avoid unnecessary complications and prolonged antibiotic use and supportive care in this patient cohort. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Extensive cervicofacial necrotizing fasciitis of odontogenic origin: case report and literature review

Necrotizing fasciitis is a potentially fatal soft tissue infection characterized by generalized necrosis and gas formation in the subcutaneous tissues and fascia. It is rarely seen in the head and neck area. This report presents the case of a 62-year-old diabetic female patient with generalized cervicofacial necrotizing fasciitis extending to the front chest wall. The cause of the disease was the extraction of the infected second molar tooth. Debridement was performed on the generalized necrotic fascia, subcutaneous tissue, and the skin extending from the preauricular area to the front chest wall and nipples. A series of debridement procedures were necessary because of generalized necrosis. The patient received intensive medical supportive treatment. Following the debridement procedures, the defective area from the neck to the front chest wall was closed up with split-thickness skin graft. Abscessed tooth extraction can lead to cervicofacial necrotizing fasciitis. Necrotizing fasciitis still remains as a potentially fatal disease. Early diagnosis, early radical surgical debridement, and a multidisciplinary approach constitute the significant factors in preventing mortality in such patients.

Arterial stiffness in atherosclerotic renovascular hypertension.

Arterial stiffness is an independent cardiovascular risk factor. Aging, high blood pressure and increased renin-angiotensin system activity contribute to increased arterial stiffness in patients with atherosclerotic renovascular hypertension (aRVH). A literature search failed to identify any study related to this topic. Therefore, our aim was to determine the arterial stiffness in patients with aRVH and analyze whether stenting in addition to multifactorial drug therapy has beneficial effects on markers of stiffness and the clinical course. In this 6-month longitudinal study, 37 patients with refractory hypertension and unilateral aRVH were enrolled. After stenting, all patients received multifactorial dug therapy including 80 mg of telmisartan. Arterial stiffness indices were determined using Arteriograph. The control group consisted of 44 patients with essential hypertension. There were no differences in brachial blood pressure values between the two groups (P > 0.05). At baseline, adjusted pulse wave velocity (PWV) was higher in aRVH patients than that of essential hypertensive patients (12.8 ± 0.4 vs. 11.6 ± 0.3 m/s; P = 0.029). In the aRVH group, at the end of the follow-up, a significant decrease in the aortic augmentation index (37.7 ± 9.9 vs. 33.7 ± 11.4; P = 0.02) without changes in PWV was observed (P > 0.05). This study is the first to show that arterial stiffness is higher in patients with refractory aRVH than in those with essential hypertension. Multifactorial therapy based on stenting and intensive medical treatment reduced central blood pressure and augmentation index. Failure to obtain PWV reduction is likely a consequence of the present irreversible structural vessel changes. Longer follow-up might enable us to resolve whether arterial stiffness indices have better predictive ability in patients with aRVH than brachial blood pressure.

Patient Attitudes to Intensive Care and Life-Sustaining Technology

We used a validated questionnaire to explore the views of patients regarding receiving intensive care and life-sustaining technology. Data was obtained from 38 patients. A score was obtained for ‘general attitude towards use of life-sustaining/prolonging technology’ that varied from 18.9 to 48.5 out of 52, the higher score reflecting a more positive attitude. There was no significant difference between men and women or correlation with age or ASA score. A score for ‘personal desire for life support’ was also obtained, ranging from zero to a maximum possible score of eight, which reflected the most positive view. The median score was 0.5. Women had a significantly lower median score of zero vs 1.5 for men (p=0.022). There was no significant correlation with age or ASA score. There was considerable heterogeneity of views regarding the use of life-sustaining technology. In this study, women were less likely to want intensive medical treatment than men.

En la estenosis carotídea asintomática, salvo excepciones, el tratamiento médico es el más adecuado

Asymptomatic carotid stenosis (ACS) has a high prevalence and a small possibility of stroke. Its treatment involves the application of the so-called, intensive medical treatment (IMT) of the arteriosclerosis, and in selected cases, carotid surgery, either by endarterectomy (TEA) or a Stent (CAS). The current indications are based on old clinical trials in which the current medical treatment was not applied, and the only selection criterion relating to the lesion was the grade of stenosis. With the application of IMT, the stroke rate in patients with ACS is currently similar to that obtained in the surgical arm of the clinical trials, results that are better than in normal practice. If there is a sub-group of patients who could benefit from surgery, then they are those with an unstable plaque despite the IMT. For all this, we should be cautious when performing a surgical intervention in patients with ACS. Randomised clinical trials are needed to compare CAS, TEA, and the improved medical treatment in patients with ACS.

Aggressive behavior problems in children with autism spectrum disorders: Prevalence and correlates in a large clinical sample

Aggressive behavior problems (ABP) are frequent yet poorly understood in children with autism spectrum disorders (ASD) and are likely to co-vary significantly with comorbid problems. We examined the prevalence and sociodemographic correlates of ABP in a clinical sample of children with ASD (N=400; 2–16.9 years). We also investigated whether children with ABP experience more intensive medical interventions, greater impairments in behavioral functioning, and more severe comorbid problems than children with ASD who do not have ABP. One in four children with ASD had Child Behavior Checklist scores on the Aggressive Behavior scale in the clinical range (T-scores≥70). Sociodemographic factors (age, gender, parent education, race, ethnicity) were unrelated to ABP status. The presence of ABP was significantly associated with increased use of psychotropic drugs and melatonin, lower cognitive functioning, lower ASD severity, and greater comorbid sleep, internalizing, and attention problems. In multivariate models, sleep, internalizing, and attention problems were most strongly associated with ABP. These comorbid problems may hold promise as targets for treatment to decrease aggressive behavior and proactively identify high-risk profiles for prevention.

Identification and quantitation of a new cathinone designer drug PV9 in an “aroma liquid” product, antemortem whole blood and urine specimens, and a postmortem whole blood specimen in a fatal poisoning case

A couple bought “aroma liquid” and “bath salt” type drugs at a dubious drug shop. Both of them orally took the liquid type drug; although the male subject showed no symptoms, the female subject suffered shivering, convulsions, and low levels of consciousness. The woman was taken to an emergency hospital to receive intensive medical treatment, but died about 20 h after admission. The aroma liquid solution, and the antemortem blood and urine collected during medical treatment at the hospital were brought to our laboratory by the police for analysis of the causative drug(s). In addition, a sample of postmortem femoral vein blood was collected from the cadaver. After some screening tests, we finally identified PV9 (α-POP) in all specimens by gas chromatography–mass spectrometry and liquid chromatography–tandem mass spectrometry (LC–MS–MS). The concentration of PV9 was 18.3 mg/ml in the aroma liquid solution, 45.7 ng/ml in the antemortem blood, 20.3 ng/ml in the antemortem urine, and 180 ng/ml in the postmortem femoral vein blood. The concentrations in antemortem blood and urine and in postmortem blood were greatly lowered by dilution during the intensive medical treatment, including intravenous drip infusion of a large volume of solution. The probable coexistence of a β-hydroxyl metabolite was also investigated by mass chromatography and analysis of fragment ions of the product ion spectrum obtained by LC–MS–MS. To our knowledge, this is the first reported identification and quantitation of PV9 in human specimens in a fatal PV9 poisoning case.

Five-year medical and pharmacy costs after a medically supervised intensive treatment program for obesity.

The financial impact of intensive medical interventions for weight loss has not been fully studied. A randomized pragmatic clinical trial. Seven primary care clinics and one research center in Louisiana. Severely obese individuals (body mass index 40-60 kg/m(2)) randomized to usual care (n = 190) or intensive medical management (n = 200). Forty-seven percent of participants completed year 2 follow-up and were included in the analyses. Physician-monitored intervention with recommendations for 12 weeks of liquid diet followed by 4 months of group behavioral therapy, structured diet, and option of pharmacotherapy, and an additional 16 months of maintenance strategies. Two-year preintervention and 5-year postintervention measures were computed from claims data and included (1) medical costs excluding pharmacy, (2) pharmacy costs only, (3) total medical and pharmacy costs, and (4) medical and pharmacy subcategory costs. Differential categories for preintervention and postintervention were created using total sample 75th percentiles. Chi-square tests were employed to compare the intervention groups both preintervention and postintervention with respect to the proportion of subjects above the 75th percentile for each of the cost categories. Medical costs excluding pharmacy did not differ between groups. The intensive medical intervention group had a significantly smaller percentage of subjects above the 75th percentile for pharmacy costs only (p = .0125), and for antidiabetic agents (p = .0464), antihypertensives (p = .0075), and dyslipidemic subcategories (p = .0197). An intensive medical intervention may reduce pharmaceutical expenditures in severely obese individuals. These results must be viewed with caution given the high attrition of study participants.

Orbital abscess after peribulbar anesthesia in a frontoethmoidal mucocele

Clinic casePeribulbar anesthesia is used in daily practice during cataract surgery. It is a safe technique, but not without complications. We present the case of a man who had an orbital abscess secondary to peribulbar anesthesia that led to the perforation of an unknown frontoethmoidal mucocele. DiscussionOrbital abscess secondary to an iatrogenic mucocele perforation after anesthesia is a periorbital complication not described. The detection of the orbital process, intensive medical treatment and monitoring for signs of deterioration are vital in preventing serious complications.

THU0248 Three-Year Sustained Remission in Early RA: Predictors and Structural Outcomes. Analysis of Longitudinal Observational Data in Two Multicentre UK Inception Cohorts over 25 Years

BackgroundAchieving sustained remission in Rheumatoid Arthritis (RA) is more important than achieving point remission, albeit more challenging, and likely to have greater impact on long-term outcomes of disease such as...

Our experience in the treatment of patients with severe dilatative cardiomyopathy and amiodarone — induced thyrotoxicosis

E mail: matias.trbusic@gmail.com Amiodarone-induced thyrotoxicosis (AIT) is a serious medical problem especially in patients with dilatative cardiomyopathy because of a substantial rate of morbidity and mortality. Patients usually present as worsening of arrhythmias and congestive heart failure. Two forms of AIT have been described. Type I occurs in patients with a preexisting adenomatous goiter and results from the excessive hormone production secondary to iodine excess. Type II is found in patients without a preexisting thyroid disease and results from the chemical-induced thyroiditis which causes the follicular damage and release of preformed hormone. AIT develops in 2-3% of patients in iodine sufficient areas such as Croatia. AIT can be managed medically or surgically. Available medical treatment regimens are complex, not uniform and do not consistently provide success. Thyroidectomy was previously considered to be the last treatment option, when medical therapy failed. However, in new reports, thyroidectomy is considered to be an initial treatment option despite the operative risk. We represent two cases of AIT in patients with previously diagnosed dilatative cardiomyopathy with severe systolic dysfunction of the left ventricle who were taking amiodarone because of the documented non-sustained ventricular tachycardia. Dominant symptoms include refractory congestive heart failure with symptoms of hypo-perfusion and recurrence of arrhythmias (non-sustained ventricular tachycardia in both patients and atrial fibrillation with rapid ventricular response despite the medical treatment in one patient). Both patients did not have the preexisting thyroid disease and AIT type II (or “mixed”) was presumed. Echocardiography showed the impairment of the left and right ventricular ejection fraction and atrioventricular regurgitations. Prolonged treatment with high doses of dobutamin was needed to establish hemodynamic stabilization. AIT was treated by discontinuation of the drug, moderate doses of metyl-prednisolon (40 mg/day) and propiltiouracil (300 mg/day). After 4-6 weeks of the treatment, an improvement was achieved and the patients could wean off dobutamin. Free T4 and T3 started to decline in controls. The patients were discharged from the hospital after 2 and 3 months after the treatment in stable condition, in functional class NYHA II/III, as before AIT developed. Conclusion: AIT in patients with congestive heart failure is a challenging problem, but with aggressive and intensive medical treatment surgery it can be avoided.

Management of patients during hunger strike and refeeding phase

ObjectiveHunger strikers resuming nutritional intake may develop a life-threatening refeeding syndrome (RFS). Consequently, hunger strikers represent a core challenge for the medical staff. The objective of the study was to test the effectiveness and safety of evidence-based recommendations for prevention and management of RFS during the refeeding phase. MethodsThis was a retrospective, observational data analysis of 37 consecutive, unselected cases of prisoners on a hunger strike during a 5-y period. The sample consisted of 37 cases representing 33 individual patients. ResultsIn seven cases (18.9%), the hunger strike was continued during the hospital stay, in 16 episodes (43.2%) cessation of the hunger strike occurred immediately after admission to the security ward, and in 14 episodes (37.9%) during hospital stay. In the refeed cases (n = 30), nutritional replenishment occurred orally, and in 25 (83.3%) micronutrients substitutions were made based on the recommendations. The gradual refeeding with fluid restriction occurred over 10 d. Uncomplicated dyselectrolytemia was documented in 12 cases (40%) within the refeeding phase. One case (3.3%) presented bilateral ankle edemas as a clinical manifestation of moderate RFS. Intensive medical treatment was not necessary and none of the patients died. Seven episodes of continued hunger strike were observed during the entire hospital stay without medical complications. ConclusionsOur data suggested that seriousness and rate of medical complications during the refeeding phase can be kept at a minimum in a hunger strike population. This study supported use of recommendations to optimize risk management and to improve treatment quality and patient safety in this vulnerable population.

Intracranial Internal Carotid Artery Angioplasthy and Stenting in Giant Cell Arteritis

We report the case of a 59-year-old woman who presented with several episodes of transient ischemic attack (TIA) caused by pathologically confirmed giant cell arteritis. She continued suffering from TIAs during admission despite immunosuppressant and antithrombotic therapy. Sudden neurological deterioration with paraparesis and cognitive impairment developed. A brain magnetic resonance (MR) imaging showed bilateral watershed ischemic lesions. MR angiography demonstrated severe stenosis of both intracranial internal carotid arteries (ICAs). Angioplasty and stenting on the left ICA were performed, with evident clinical improvement occurring within 24 hours. Endovascular therapy may be an alternative option to treat severe GCA with symptomatic intracranial large vessel disease not responsive to intensive conventional medical treatment.

Active video games to promote physical activity in children with cancer: a randomized clinical trial with follow-up

BackgroundLow levels of physical activity, musculoskeletal morbidity and weight gain are commonly reported problems in children with cancer. Intensive medical treatment and a decline in physical activity may also result in reduced motor performance. Therefore, simple and inexpensive ways to promote physical activity and exercise are becoming an increasingly important part of children’s cancer treatment.MethodsThe aim of this study is to evaluate the effect of active video games in promotion of physical activity in children with cancer. The research is conducted as a parallel randomized clinical trial with follow-up. Patients between 3 and 16 years old, diagnosed with cancer and treated with vincristine in two specialized medical centers are asked to participate. Based on statistical estimates, the target enrollment is 40 patients. The intervention includes playing elective active video games and, in addition, education and consultations for the family. The control group will receive a general recommendation for physical activity for 30 minutes per day. The main outcomes are the amount of physical activity and sedentary behavior. Other outcomes include motor performance, fatigue and metabolic risk factors. The outcomes are examined with questionnaires, diaries, physical examinations and blood tests at baseline and at 2, 6, 12 and 30 months after the baseline. Additionally, the children’s perceptions of the most enjoyable activation methods are explored through an interview at 2 months.DiscussionThis trial will help to answer the question of whether playing active video games is beneficial for children with cancer. It will also provide further reasoning for physical activity promotion and training of motor skills during treatment.Trial registrationClinicalTrials.gov identifier: NCT01748058 (October 15, 2012).

Prognostic relevance of KRAS genotype in metastatic colorectal cancer patients unfit for FIr-B/FOx intensive regimen

First-line triplet chemotherapy plus bevacizumab (FIr-B/FOx) can improve efficacy of metastatic colorectal cancer (MCRC), KRAS wild-type and mutant. Prognostic relevance of KRAS genotype was evaluated in patients unfit for FIr-B/FOx, treated with conventional medical treatments. Consecutive MCRC patients not eligible for FIr-B/FOx regimen due to age (≥75 years) and/or comorbidities were treated with tailored conventional first-line treatments. KRAS codon 12/13 mutations were screened by direct sequencing. Activity and efficacy were evaluated and compared according to medical treatments, age (non-elderly and elderly ≥65 years), comorbidity stage (Cumulative Illness Rating Scale), metastatic extension (liver-limited and other/multiple metastatic), and KRAS genotype, using log-rank. Selected first line treatments were medical in 37 patients (92.5%), and surgical in 3 patients (7.5%). Medical treatment regimens: triplet, 18 (45%); doublet, 15 (37.5%); mono-therapy, 4 (10%). At median follow-up of 8 months, objective response rate (ORR) was 37%, median progression-free survival (PFS) 7 months, liver metastasectomies 8% (liver-limited disease 37.5%), median overall survival (OS) 13 months. Triplet regimens failed to significantly affect clinical outcome, compared to doublet. According to KRAS genotype, ORR, PFS and OS were, respectively: wild-type 50%, 8 months, 13 months; mutant 25%, 6 months, 9 months. KRAS genotype wild-type compared to mutant significantly affected PFS, while not OS. KRAS c.35 G>A mutation (G12D) significantly affected worse PFS and OS compared to wild-type and/or other mutations. KRAS genotype, specifically the c.35 G>A KRAS mutation, may indicate poor prognosis in MCRC patients unfit for intensive medical treatments.

Self-limiting left ventricular wall rupture following myocardial infarction: a case report and literature review

We report the case of a 62-year-old woman presenting with symptoms and findings of myocardial infarction and a left ventricular free wall rupture.Coronary angiography revealed a critical stenosis in the middle right coronary artery. A contrast left ventriculogram revealed extravasation of contrast through the inferolateral wall of the left ventricle.Left ventricular free wall rupture is a rare complication of acute myocardial infarction, occurring in approximately 2% of cases. It is often fatal because of the development of haemopericardium and tamponade.Some patients, like the one described in this case, may present with small leaks that might close spontaneously by epicardial fibrin deposits, thus selflimiting, without requiring surgical intervention. This patient received only intense medical treatment. Indeed, blood clots at the endocardial and theepicardial site of the rupture have often been identified, suggesting protection for further rupture.

Septic shock due to community-acquired Pseudomonas aeruginosa necrotizing fasciitis: A case report and literature review.

Necrotizing fasciitis is a rare but fatal infection, characterized by the rapid progression of necrosis of the fascia, skin, soft tissue and muscle. The most common bacteria associated with necrotizing fasciitis is group A streptococcus, although other pathogens have also been implicated. In the present study, a case of community-acquired necrotizing fasciitis, complicated with septic shock and multiple organ dysfunction syndromes due to Pseudomonas aeruginosa, is presented. Despite intensive medical treatment, the condition of the patient deteriorated rapidly and the patient subsequently succumbed to multiple organ failure. In view of the rapid progression and high mortality rate of this disease, early surgery, as well as novel therapeutic approaches for septic shock are required to improve the outcome for patients.