Massive Edema Research Articles

Massive Upper-extremity Edema after Transaxillary Venoarterial-extracorporeal Membrane Oxygenation.

Massive Upper-extremity Edema after Transaxillary Venoarterial-extracorporeal Membrane Oxygenation.

Rare Cystic Hygroma of the Axilla and Breast in Adults, Case Report, Long-Term Follow-Up and Literature Review: An Experience from Saudi Arabia

Cystic hygroma (CH) in adults is a rare condition. Most CH cases are diagnosed at birth or during the first two years of life. Head and neck are the most common sites. There is scanty information about the natural history and follow-up of adult patients with axillary and breast CH. Hence, we present this case to shed some light on the natural history, complications, and a new suggested modality of treatment to deal with the complications. We report a case of a 39-year-old female who presented after ten years of excision of the right axillary CH with massive breast edema and recurrence of cysts in the ipsilateral breast and axilla. The insertion treated the edema of a breast-peritoneal shunt. The procedure was performed by inserting a normal V-P shunt catheter without a reservoir through a small incision in the inframammary fold toward the breast and another tiny incision at 10 of the clock in the right breast for fixation in the breast parenchyma. A catheter was inserted through a small incision on the right lumbar spine without intraperitoneal fixation after the catheter was inserted subcutaneously. This case report shows that adult CH can reoccur. To our knowledge, this is the second case of CH concomitantly involving the breast and axilla. The shunt of the edematous fluid to the peritoneal cavity can give hope for intractable breast edema treatment.

Challenges in administering immunosuppressive therapy in severe bacterial infection interfering crisis and refractory childhood systemic lupus erythematosus

Background: Childhood Systemic Lupus Erythematosus (cSLE) mostly come with severe manifestation compared to the adult. Infection aggravated the multisystem inflammation and interfering immunosuppressive agent protocol. Case: A 12-year-old girl was hospitalized for a month with massive edema and fever after being diagnosed with nephrotic syndrome and taken prednison for four weeks. The patient was completely bedridden, presented with hypertension, large erythematous striae across the trunk and limbs, and darkened skin. Further evaluation showed the EULAR/ACR classification criteria for SLE with score of 26. Cellulitis was suspected when a red, pinprick-sized papule appeared on the patient's right leg be increased significantly in size within two hours. Following the collection of a wound culture and blood culture specimen, triple antibiotics were given. Seven days after the wound has healed, administered of cyclophosphamide was started. Cyclophosphamide is used as an emergency treatment for lupus crises, as she experienced seizure and delirium. Seven days after cyclophosphamide administration, the wound was revived. Initial blood and wound cultures indicated an infection caused by Serratia marcescens; however, the second wound culture revealed infections caused by Klebsiella oxytoca and Enterobacter cloacae. We commenced Meropenem based on a sensitivity test to establish protection for the following administration of high-dose methylprednisolone with rituximab and cyclophosphamide. The lupus crisis was precipitated by an infection-induced inflammatory response. On day 17, after the calf and back wounds were completely healed, the antibiotic was withdrawn. In order to protect organ functionality, physiotherapy and nutritional support were employed. Conclusion: Clinicians need to be mindful and closely observe patient with severe SLE accompanied with infection to balancing intervention for immunosuppressant therapy and antibiotic.

Descemet’s Membrane Detachment Following Corneal Suture Removal: Case Report

Introduction: Descemet’s Membrane Detachment (DMD) is the separation of the descemet’s membrane from the overlying corneal stroma. It is a rare and a potential vision-threatening complication of cataract surgery, with incidence rates being reported at 0.044–0.5% after phacoemulsification and 2.5% after extra capsular extraction. In these cases, DMD is mostly seen during surgery or in the early post-operative period and it is associated to surgical technique, surgical equipment or genetic factors. It is one of the most serious complications of cataract surgery, leading to irreversible corneal decompensation. Small DMD may resolve spontaneously, but most large detachments require interventions such as pneumodescemetopexy. Case Report: We report a 70-year-old female patient, without any underlying disease, presented with the complaint of decreased vision in her pseudophakic right eye after a 15-weeks silent post-extra capsular cataract extraction period and two weeks after corneal suture removal. On slit-lamp examination, massive corneal edema was noticed on the temporal periphery with the involvement of the visual axis. Anterior segment optical coherence tomography revealed the presence of DMD in the superotemporal quadrant. To provide reattachment of DMD, we performed an anterior chamber tamponade with air. No complication associated with descemetopexy was noticed during recovery. Total Descemet’s membrane reattachment was achieved. Discussion: Among all intraocular surgeries, DMD is most commonly described after cataract surgery. It generally occurs in early- postoperative period and late-onset DMD have been reported less frequently. It presents as localized or diffuse corneal edema. Anterior segment optical coherence tomography examination can be clearly used for observation of the position and the range of DMD. There are several ways to manage DMD: medical treatment, pneumodescemetopexy, penetrating keratotplasty and endothelial keratoplasty. To the best of our knowledge, this is the first reported case of DMD after corneal suture removal. Conclusion: DMD after cataract surgery is associated with a variety of factors. Anterior segment optical coherence tomography examination can be used to find clear detachment of the descemet’s membrane. The position of detachment and surgical incision were found to be closely related. The location and the scope of detachment can be used to guide clinical treatments and improve prognosis of patients.

956: MASSIVE FLASH PULMONARY EDEMA FOLLOWING ANTIBODY-MEDIATED REJECTION THERAPY POST-LUNG TRANSPLANT

Introduction: Antibody-mediated rejection (AMR) is a complication of orthotopic lung transplantation (OLT) leading to allograft dysfunction through immune activation. We report a patient with bilateral OLT who received daratumumab for AMR and subsequently developed flash pulmonary edema and multisystem organ failure (MSOF) resulting in death. Description: An 18-year-old male with pulmonary veno-occlusive disease status-post remote bilateral OLT presented to a quaternary-care hospital for respiratory distress. Biopsy revealed AMR with elevated donor-specific-antibodies (DSAs). He was started on our institution-specific AMR protocol: systemic steroids, rituximab, a 5–7-day course of plasmapheresis, mepolizumab, and daratumumab. Following daratumumab, the patient developed tachycardia, tachypnea, hypertension, and altered mental status. He was transferred to the PICU in extremis and was emergently intubated. He had massive flash pulmonary edema with copious production of proteinaceous fluid (>1L/hr) impairing ventilation and oxygenation. His arterial pH remained < 7 and pCO2 > 100 mmHg. Echocardiogram demonstrated normal biventricular function, eliminating a cardiogenic source. He continued to have profound hypoxemic and hypercapnic respiratory failure, pulmonary edema, uncompensated shock, acute kidney injury with anuria, disseminated intravascular coagulation, and acute encephalopathy. Due to progressive MSOF, life-sustaining therapies were withdrawn. A unifying diagnosis to explain his MSOF and acute decompensation were never identified. Discussion: There are no reports of flash pulmonary edema after daratumumab administration, however it has been described with other monoclonal antibodies, including muromonab-CD3 (OKT3) [1]. Edema from OKT3 has been attributed to cytokine release syndrome (CRS) [1]. We postulate a similar pathophysiology. Daratumumab, a human CD-38-targeting antibody, induces cell-death via complement and antibody-dependent cytotoxicity, apoptosis, and phagocytosis [2]. We suspect a massive response of the infused monoclonal antibody with the pulmonary DSAs, resulting in localized cell death and lysis, cytokine release, pulmonary vascular inflammation, and uncontrollable pulmonary edema. We hope to gain further insight with immunohistological data on autopsy.

Traumatic acute retrobulbar haemorrhage complicated with central retinal artery occlusion

AbstractPurpose: To present the vascular complications of traumatic acute retrobulbar haemorrhage and describe its management through a case report.Methods: A case report of a patient having an acute retrobulbar haemorrhage complicated with central retinal artery occlusion (CRAO).Results: A 50‐year‐old male patient exposed to blunt orbital trauma two hours prior was referred to the emergency with complaints of pain and loss of vision in the left eye. The negative light perception was noted in this eye. A tense hematoma, proptosis, ophthalmoplegia, and a non‐reactive pupil were also noted. Biomicroscopic examination, revealed corneal edema, subconjunctival haemorrhage, and chemosis. The fundus examination was not possible. Intraocular pressure (IOP) was 60 mmHg. The patient was diagnosed with acute retrobulbar haemorrhage. Computerized tomography was performed immediately showing a fracture of the left medial orbital wall and haemorrhage within the retrobulbar space. Intravenous mannitol and topical dorzolamide‐timolol associated with oral corticosteroid were administered. IOP decreased to 30 mmHg, but the patient's visual acuity did not improve. The fundus examination revealed a total CRAO confirmed by the fluorescein angiography and OCT‐A showing massive ischemic edema and occluded perimacular arterioles with interruption to the choroidal blood flow. OCT images demonstrated an increased reflectivity and thickness of the inner retina and subretinal fluid, which corresponds to the acute phase of CRAO. The time of surgical treatment was missed, and as a result, the patient missed their chance for visual recovery.Conclusions: Retrobulbar haemorrhage is a complication from ocular trauma that may cause permanent vision loss. Retrobulbar haemorrhage can potentially lead to dangerous increases in intraorbital pressure, a condition that is also described as orbital compartment syndrome. This increase in pressure is sufficient to cause vision loss, whether through direct compression of the optic nerve leading to optic neuropathy, a central retinal artery occlusion, or compression of the vessels that provide nutrition to the optic nerve.

Postoperative Observation of Spaying with the Silicon Ring on the Ovaries in Heifers: A Retrospective Study in 28 Cases.

Although spaying prepubertal heifers has routinely been conducted to control cattle herd and improve meat quality, understandings of the postoperative changes following new spaying methods with the silicon ring on the ovaries via colpotomy remain limited. Therefore, as a retrospective study, 28 cases of spayed heifers were reviewed for postoperative changes after employing this method, with inclusion criteria including complete medical records for clinical observation, ultrasonography, measuring reproductive hormones, and tracking slaughter records. No mortality and heat signs at the pubertal age postoperatively occurred in spayed animals. On ultrasonography during rectal examination, the ovaries were enlarged without any folliculogenesis from one week, while massive ovarian edema appeared from two weeks, and ovaries were no longer palpable at four weeks post-surgery. In hormones, whereas estrogen and progesterone levels did not change from prepubertal to pubertal age in spayed animals, luteinizing hormone levels progressively increased during this period and reached a higher level at pubertal period than unspayed controls. Although carcass weight and yield were similar between groups upon slaughter at pubertal age, the spayed animals presented higher carcass quality (marbling degree) than that of controls. These results may contribute to develop herd management strategies, including control of estrus in cattle.

Autologous hematopoietic stem cell transplantation in Clarkson disease

Idiopathic systemic capillary leak syndrome (ISCLS) flares are frequently preceded by infections, particularly respiratory virus infections including coronavirus disease 2019.1,2 Hemodynamic collapse occurs at the onset of episodes, typically followed by massive peripheral edema resulting from intravenous (IV) fluid administration. Flares may be complicated by multiorgan dysfunction syndrome, vascular thrombosis due to hemoconcentration, and compartment syndrome.1 Indefinite monthly prophylaxis with high-dose intravenous immunoglobulins (IVIGs) induces disease remission but is expensive and inconvenient to administer.

Evaluation of the Rationality of Appropriate Doses of Corticosteroid Drugs in Patients With Nephrotic Syndrome in Hospitals

Nephrotic syndrome is a kidney disease in which symptoms include massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Nephrotic syndrome has first-line therapy using corticosteroids. The purpose of this study was to determine the accuracy of the dose in patients with nephrotic syndrome. The method used in this study is a qualitative descriptive method of retrospective data acquisition by taking a sample population of nephrotic syndrome patients at the Outpatient Installation of General Hospital of Ciamis District Period January-July 2020. Descriptive analysis includes the accuracy of the dose guided by the management of Kidney Disease: Improving Global Outcomes (KDIGO) which is presented in the form of tables and narratives. The results of this study indicate that the ratio between men and women is 3:1 with those under 15 years old. There were 18 cases of nephrotic syndrome using corticosteroid therapy. The most widely used corticosteroids were methylprednisolone 61.1% (11 patients) and prednisone 38.9% (7 patients). The use of the dose in 18 cases of nephrotic syndrome was stated to be the right dose (100%) and in accordance with the management recommendations.

Iatrogenic massive hemorrhagic edema of the tongue: a case report

BackgroundLingual edema is usually the result of infectious etiology, angioedema, and less commonly of traumatic etiology.As for the therapeutic approach, the first priority excluding airway compromise or ensuring airway safety. Antibiotic treatment should be administered for tongue swelling of inflammatory etiology while standard therapy with epinephrine, steroids, and antihistamines is recommended for cases of anaphylaxis. In addition, in case of injury causing lingual edema, one of the treatment options is surgical intervention.Aim of workThe aim of our work is to present a rare and simultaneously instructive case of traumatic hemorrhagic edema of the tongue, leading to airway obstruction.Case presentationWe report a case of hemorrhagic traumatic lingual edema, initially without symptoms of upper airway obstruction on admission. However, immediate intervention and airway securing was necessary due to rapid growth of the edema.Then, as long as patient was hemodynamically stable and airway patency was ensured, the diagnosis of iatrogenic tongue hematoma was confirmed. The challenge was to decide the appropriate treatment for the patient. Following, she was taken for 24 h to the ICU due to lactic acidosis while the bleeding was treated conservatively.Afterward, she was transferred to the clinic, hemodynamically stable, and was discharged uneventfully.ConclusionsHemorrhagic edema of the tongue may become a life-threatening condition. Its rapid growth can lead to obstruction of the upper respiratory way; therefore, special wariness in its management is required. Treatment can be conservative or surgical, depending on the size and tendency of hematoma to increase.

EP29.13: A case of massive and diffuse edema of umbilical cord associated with patent urachus

EP29.13: A case of massive and diffuse edema of umbilical cord associated with patent urachus

Massive Acute Pulmonary Edema and Cardiogenic Shock after Scorpion Envenomation in a Young Patient with No Cardiovascular Risk Factor

Massive Acute Pulmonary Edema and Cardiogenic Shock after Scorpion Envenomation in a Young Patient with No Cardiovascular Risk Factor

Hyper-acute pseudophakic macular edema vanishing within 72 hours: a case series.

To report three cases of massive pseudophakic macular edema occurring the day after uneventful cataract surgery and resolving in 24-72 hours. A 68-years woman affected by systemic lupus erythematosus and antiphospholipid syndrome displayed massive macular edema on OCT scan one day after uneventful cataract surgery. Routine postoperative topical eye drops (Chloramphenicol/Betamethasone QID and Bromfenac BID) were continued without additional medications. Three days later OCT showed a completely recovered, normal fovea. Two similar cases were documented. A 73-year-old man and a 53-year-old man underwent cataract surgery and started the mentioned topical postoperative therapy. Severe macular edema was diagnosed the day after surgery and resolved in 24 and 48 hours, respectively. Massive macular edema may occur immediately after uncomplicated cataract and then disappear within 1 to 3 days, without invasive therapies. This is a very significant event that may follow cataract surgery that was previously unreported.

SUPERIOR VENA CAVA SYNDROME SECONDARY TO THE LARGEST REPORTED THORACIC HYDATID DISEASE

TYPE: Case Report TOPIC: Lung Pathology INTRODUCTION: Pulmonary Hydatidosis makes up 25% of the cases of hydatid disease cases in endemic areas. We present here, a case of massive pulmonary hydatid disease presenting as tension hydatidothorax* and Superior Vena Cava (SVC) syndrome. *hydatidothorax: We introduce this term for describing the presence of hydatid cysts in the thoracic cavity. CASE PRESENTATION: A 25-year-old gentleman presented with progressive cough, dyspnea, dilation of facial, neck and arm veins and massive facial edema. Chest imaging showed multiple cystic lesions causing opacification of the right hemithorax with a massive mediastinal shift to the left while also compressing the SVC. The patient had refused treatment upon initial, less severe, presentation and only consented when the symptoms became unbearable. The combined size of the cysts was 183 X 209.5 X 333 mm– which we find to be the largest reported collection of hydatid cysts in the lungs. A surgical evacuation of the entire disease was performed and our 3-year post-operative evaluation showed no recurrence. DISCUSSION: SVC syndrome is a rare complication of hydatid disease and even though there is evidence of Cardiac hydatidosis presenting as such, our extensive literature search did not yield a case where pulmonary hydatid disease resulted in the typical presentation of SVC syndrome. Hence, this case expands on our understanding of the mechanical complications arising from the mass effect of progressively increasing hydatidothorax. CONCLUSIONS: Advanced stage of pulmonary hydatid disease can result in SVC syndrome and therefore should be considered in the differential diagnosis especially in patients hailing from endemic regions. DISCLOSURE: Nothing to declare. KEYWORD: Superior Vena Cava (SVC) Syndrome

Platelet-Rich Fibrin in Fat Grafts for Facial Lipofilling: A Randomized, Controlled Split-Face Clinical Trial.

ObjectivePrevious studies have reported that platelet-rich fibrin (PRF) may enhance the efficacy of fat grafts in facial lipofilling. However, these studies either lacked objective data or were not randomized, controlled trials. Thus, we aimed to objectively evaluate the efficacy of PRF in facial lipofilling.MethodsA controlled, split-face, randomized trial (January 2018 to May 2019) based on 18 patients who underwent fat grafts for bilateral temple lipofilling was performed. Each patient received a combination of an autologous fat graft and PRF on one side and a fat graft combined with an equal volume of saline on the other side. The effects of PRF were evaluated by comparing the remaining bilateral fat graft volumes through a digital three-dimensional reconstruction technique. Improvements in the appearance and recovery time of each temple were assessed by both a surgeon and patients who were blinded to the treatment assignment. Complications were also recorded.ResultsBilateral temple lipofilling showed no evidence of fat embolism, vascular/nerve injury, infection, massive edema, or prolonged bruising. Three-dimensional reconstruction data and the assessments from both the surgeon and patients revealed no significant differences in fat graft retention volume between the PRF-positive and PRF-negative lipofilling groups. However, recovery time in the PRF-positive lipofilling sites was significantly shortened compared with that of the PRF-negative lipofilling sites.ConclusionFacial filling with autologous fat grafts is effective and safe. Our results show that PRF does not markedly improve fat graft volume retention in the temple but significantly reduces postoperative recovery time.Trial Registration NumberChiCTR2100053663.

ROLE OF DECOMPRESSIVE CRANIECTOMY IN MIDDLE CEREBRAL ARTERY INFARCT – AN INSTITUTIONAL STUDY

The role of decompressive craniectomy in stroke victims is gaining popularity,as it is found to be beneficial in malignant infarction of middle cerebral artery (MCA) territory which results in massive edema and brain swelling.

Congenital Nephrotic Syndrome of the Finnish Type in a Dominican Newborn: An Overview and Case Report

Congenital nephrotic syndrome of the Finnish type (CNS-FT) is a rare genetic condition that causes massive proteinuria, hypoproteinemia, hypercholesterolemia, and edema that progresses to end-stage renal disease. Symptoms may manifest in utero as fetal hydrops or during the first few days to months of life. This article shares the case of a Dominican infant who presented with CNS-FT. It provides a comprehensive overview of CNS-FT including the underlying genetic cause, prenatal and postnatal diagnostic testing options, and treatment recommendations. It walks the reader through the diagnostic and initial and longer-term management of this infant and provides patient outcome at 10 months of age.

How I do it: decompressive hemicraniectomy supplemented with resection of the temporal pole and tentoriotomy for malignant ischemic infarction in the territory supplied by the middle cerebral artery

Malignant ischemic infarction in the territory supplied by the middle cerebral artery is an extremely severe form of ischemic stroke associated with development of massive uncontrollable postischemic edema of the affected cerebral hemisphere; the end result of which is development of transtentorial herniation and death.MethodThe surgical technique of performance of decompressive hemicraniectomy involves removal of an extensive bone flap in the fronto-temporo-parieto-occipital zone with resection of the temporal squama and of the greater wing of the sphenoid bone to visualize the level of entrance of the middle meningeal artery to the cranial cavity, which, in its turn, allows resection of the upright margin of the middle cranial fossa. Decompressive hemicraniectomy is supplemented with resection of the temporal pole and tentoriotomy.ConclusionPerformance of decompressive hemicraniectomy in combination with resection of the resection of the temporal pole and tentoriotomy is an effective surgical method of treatment of malignant ischemic stroke in the territory supplied by the middle cerebral artery, capable of reducing the lethality rate during the postoperative period.

STUDY ON RISK FACTORS FOR RELAPSE IN CHILDHOOD NEPHROTIC SYNDROME IN A TERTIARY CARE CENTRE OF EASTERN INDIA

Background: Nephrotic syndrome is a common renal disease in children characterised by massive proteinuria,hypoalbuminemia(serum albumin &lt;2.5g/dl),hyperlipidemia(serum cholesterol&gt;200mg/dl) and edema.It has high propensity for relapse.Approximately 80-90%of steroid sensitive nephrotic syndrome patients experience one or more relapses during their lifetime. So,the main problem in such disease is relapses and their association with complications of disease or side effects of drugs like steroid used in treatment.An understanding of risk factors that determine the course,is useful in taking decisions regarding therapy and counselling of parents.Ascarcity of reported data on risk factors for relapse from eastern India prompted to carry out this study in a tertiary care hospital. Aims And Objectives:To determine different risk factors for relapse in childhood nephrotic syndrome. Materials And Method: A retrospective analysis of medical records of children with steroid sensitive nephrotic syndrome of 1-12 years of age,with history of disease onset atleast 1 year back,attending inpatient and outpatient department of Pediatric medicine,IPGME&amp;R,Kolkata was carried out from February 2016 –July 2017 after obtaining ethical clearance from Instituitional Ethics committee and written informed consent from parents. Results: Records of 60 children with SSNS were reviewed.The mean age of the study population was7.3±2.7 years. Boys constituted 63.3% &amp; girls constituted 36.7% of total study population. 23 patients were included in FRNS/SDNS group,rest 37 patients were in IFRNS/No relapse group.Data were analyzed by using SPSS 20.0.1 programme and Graph Pad Prism version 5. Chi-square test &amp; Two-sample t-tests were used as statistical test &amp; p value &lt;0.05 was taken as signicant.Compared to IFRNS/No relapse,patients with FRNS/SDNS had signicantly more infections during 1st episode,more association with massive edema, more number of patients with inadequate duration of treatment (&lt;8weeks or irregular) and longer achievement of remission(14.3±2.7 days vs10±2.1),shorter steroid free time interval between completion of treatment of 1st attack &amp; onset of 1st relapse.FRNS group had signicantly less serum albumin(1.68±0.202 vs 2.05±0.17g/dl) during disease onset than IFRNS/No relapse group. Conclusion: Presence of infection &amp; massive edema during disease onset, inadequate initial treatment,prolonged achievement of remission,low serum albumin during disease onset ,short steroid free time interval between completion of treatment of 1st attack &amp;onset of 1st relapse were observed as statistically signicant risk factors for frequently relapse.These observations need to be validated by multicenter prospective study with larger sample size.

Imported malaria in adults: about a case of cerebral malaria

BackgroundMalaria is the first parasitic infection endemic in the world caused by parasites species of Plasmodium. Cerebral malaria (CM) is a rapidly progressive and severe form of Plasmodium falciparum infection, characterized by a greater accumulation of red blood cells parasitized by Plasmodium falciparum in the brain. The diagnosis of malaria is usually made in living patients from a blood sample taken in the course of a fever on return from an endemic country, whereas CM, often associated with fatal outcomes even in treated subjects, is usually diagnosed at autopsy.Case presentationWe present the case of a 36-year-old man who died a few days after returning from a business trip to the Ivory Coast. As a result of an unclear cause of death, a medicolegal autopsy was ordered. Autopsy findings revealed massive congestion and edema of the brain with no other macroscopic abnormalities at organ gross examination. Histology and laboratory tests were conducted revealing a Plasmodium falciparum infection, with numerous parasitized erythrocytes containing dots of hemozoin pigment (malaria pigment) in all examined brain sections and all other organs. Death was attributed to cerebral malaria with multiple organ failure.ConclusionsThis report summarizes several features for the diagnosis of malaria and how postmortem investigations, as well as histology and laboratory diagnosis, may lead to a retrospective diagnosis of a fatal complicated form with cerebral involvement.