No abstract available.
Amniotic Fluid* ; Embolism, Air* ; Embolism, Amniotic Fluid* ; Female ; Pregnancy

This report describes a case of 88-year-old women who developed central venous catheter-related bilateral hydrothorax, in which left pleural effusion, while right pleural effusion was being drained. The drainage prevented accumulation of fluid in the right pleural space, indicating that there was neither extravasation of infusion fluid nor connection between the two pleural cavities. The only explanation for bilateral hydrothorax in this case is lymphatic connections. Although vascular injuries by central venous catheter can cause catheter-related hydrothorax, it is most likely that the positioning of the tip of central venous catheter within the lymphatic duct opening in the right subclavian-jugular confluence or superior vena cava causes the catheter-related hydrothorax. Pericardial effusion can also result from retrograde lymphatic flow through the pulmonary lymphatic chains.
Aged, 80 and over ; Central Venous Catheters ; Drainage ; Female ; Humans ; Hydrothorax* ; Lymphatic System ; Pericardial Effusion ; Pleural Cavity ; Pleural Effusion ; Vascular System Injuries ; Vena Cava, Superior

Although methidathion is an organophosphate insecticide, it is different from the other organophosphates in terms of toxicity. Because of its relatively high fat solubility, the apparent volume of methidathion distribution throughout the body is very high, indicating that hemoperfusion is not effective in removing this organophosphate from the body. Redistribution of methidathion from fat to blood can also occur when plasma levels diminish. Additionally, acetylcholinesterase aging, which is the loss of an alkyl side chain that prevents reactivation by oximes, is very rapid so that the effective reactivation by oximes is thwarted. Thus, methidathion's effect on acetylcholinesterase inhibition is long lasting, particularly with a high dose. In addition to its parasympatholytic effect and ability to induce muscle paralysis, methidathion poisoning is associated with a profound and long-lasting circulatory collapse due to sympathetic ganglion blockade. This report presents the case of a 55-year-old man who accidentally ingested a high dose of methidathion. He later developed enteroinvasive aspergillosis infection-induced multiple bowel perforations on two separate occasions while on mechanical ventilator support, resulting in a fatal outcome. The renin-angiotensin axis activated by sympathetic ganglion blockade may have reduced the patient's splanchnic blood flow, contributing to translocation of endotoxin. Also, the effect of excessive acetylcholine on non-neuronal acetylcholine receptors may have contributed to the development of fatal enteroinvasive aspergillosis in this patient.
Acetylcholine ; Acetylcholinesterase ; Aging ; Aspergillosis ; Fatal Outcome ; Ganglia ; Ganglia, Sympathetic ; Hemoperfusion ; Humans ; Middle Aged ; Organophosphate Poisoning ; Organophosphates ; Oximes ; Paralysis ; Parasympatholytics ; Plasma ; Poisoning* ; Receptors, Cholinergic ; Shock ; Solubility ; Ventilators, Mechanical

Anesthesia, General*

This report describes a case of 88-year-old women who developed central venous catheter-related bilateral hydrothorax, in which left pleural effusion, while right pleural effusion was being drained. The drainage prevented accumulation of fluid in the right pleural space, indicating that there was neither extravasation of infusion fluid nor connection between the two pleural cavities. The only explanation for bilateral hydrothorax in this case is lymphatic connections. Although vascular injuries by central venous catheter can cause catheter-related hydrothorax, it is most likely that the positioning of the tip of central venous catheter within the lymphatic duct opening in the right subclavian-jugular confluence or superior vena cava causes the catheter-related hydrothorax. Pericardial effusion can also result from retrograde lymphatic flow through the pulmonary lymphatic chains.
Aged, 80 and over ; Central Venous Catheters ; Drainage ; Female ; Humans ; Hydrothorax ; Lymphatic System ; Pericardial Effusion ; Pleural Cavity ; Pleural Effusion ; Vascular System Injuries ; Vena Cava, Superior

No abstract available.
Amniotic Fluid ; Embolism, Air ; Embolism, Amniotic Fluid ; Female ; Pregnancy

No abstract available.
Bronchial Spasm ; Pulmonary Edema

In community-acquired Klebsiella pneumoniae infection, pyogenic liver abscess is common as a primary site of infection, particularly in Asia, that can progress to bacteremia. Diabetes mellitus is a usual predisposing factor. Pneumonia as primary site of infection by community-acquired Klebsiella pneumoniae infection is not common but carries a poor outcome. Early administration of appropriate antibiotics is extremely important to avoid the development of bacteremia and septicemia. An infective endocarditis caused by community-acquired Klebsiella pneumoniae infection is very rare; particularly, such a case of endocarditis in which pneumonia was the primary site of infection has never been reported previously. In this report we described a case of community-acquired Klebsiella pneumoniae infection that started with pneumonia and progressed to bacteremia, leading to endocarditis, liver abscess, and other systemic septic complications. Delayed administration of appropriate antibiotics may have played a role in this case.
Abscess ; Anti-Bacterial Agents ; Asia ; Bacteremia ; Diabetes Mellitus ; Endocarditis ; Klebsiella ; Klebsiella pneumoniae ; Liver Abscess ; Liver Abscess, Pyogenic ; Pneumonia ; Sepsis ; Shock, Septic

Although methidathion is an organophosphate insecticide, it is different from the other organophosphates in terms of toxicity. Because of its relatively high fat solubility, the apparent volume of methidathion distribution throughout the body is very high, indicating that hemoperfusion is not effective in removing this organophosphate from the body. Redistribution of methidathion from fat to blood can also occur when plasma levels diminish. Additionally, acetylcholinesterase aging, which is the loss of an alkyl side chain that prevents reactivation by oximes, is very rapid so that the effective reactivation by oximes is thwarted. Thus, methidathion's effect on acetylcholinesterase inhibition is long lasting, particularly with a high dose. In addition to its parasympatholytic effect and ability to induce muscle paralysis, methidathion poisoning is associated with a profound and long-lasting circulatory collapse due to sympathetic ganglion blockade. This report presents the case of a 55-year-old man who accidentally ingested a high dose of methidathion. He later developed enteroinvasive aspergillosis infection-induced multiple bowel perforations on two separate occasions while on mechanical ventilator support, resulting in a fatal outcome. The renin-angiotensin axis activated by sympathetic ganglion blockade may have reduced the patient's splanchnic blood flow, contributing to translocation of endotoxin. Also, the effect of excessive acetylcholine on non-neuronal acetylcholine receptors may have contributed to the development of fatal enteroinvasive aspergillosis in this patient.
Acetylcholine ; Acetylcholinesterase ; Aging ; Aspergillosis ; Fatal Outcome ; Ganglia ; Ganglia, Sympathetic ; Hemoperfusion ; Humans ; Middle Aged ; Organophosphate Poisoning ; Organophosphates ; Oximes ; Paralysis ; Parasympatholytics ; Plasma ; Poisoning ; Receptors, Cholinergic ; Shock ; Solubility ; Ventilators, Mechanical