Adult ; Autonomic Nervous System Diseases ; complications ; Female ; Humans ; Hypotension ; etiology ; Severe Dengue ; complications

Ciguatera results when ciguatoxin-contaminated coral reef fish from tropical or subtropical waters are consumed. The clinical features that present in affected persons are mainly gastrointestinal, neurological, general, and much less commonly, cardiovascular. We report the case of a 50-year-old man who developed the characteristic combination of acute gastrointestinal and neurological symptoms after the consumption of an unidentified coral reef fish head. In addition to those symptoms, he developed dizziness, severe bradycardia (46 bpm) and prolonged hypotension, which required the administration of intravenous atropine and over three days of intravenous fluid replacement with dopamine infusion. Patients with ciguatera can develop severe bradycardia and prolonged hypotension. Physicians should recognise the possible cardiovascular complications of ciguatera and promptly initiate treatment with intravenous atropine, intravenous fluid replacement and inotropic therapy if such complications are observed.
Animals ; Bradycardia ; complications ; diagnosis ; Ciguatera Poisoning ; complications ; diagnosis ; therapy ; Ciguatoxins ; adverse effects ; Fishes ; Humans ; Hypotension ; complications ; diagnosis ; Male ; Middle Aged

BACKGROUND/AIMS: The mortality after pancretoduodenenctomy is decreased to less than 5 % in centers with experience. The morbidity, however, still remains high although the decrease has also been demonstrated. The aim of this study was to identify risk factors responsible for major complications following pancreatoduodenectomy. METHODS: Various features of forty nine consecutive patients who underwent pancreatoduodenectomy from 1990 to 1999 were statistically analyzed to determine risk factors for major postoperative complications. Anastomotic leakages, intraabdominal hemorrhage and intraabdominal abcess were categorized as major postoperative complication. RESULTS: In our series, postoperative mortality and morbidy rate were 6.1% and 51.0%, respectively. Seventeen major complications were found in 14 patients(28.6%): 7 cases with pancreaticojejuostomy leakage, 4 cases with biliojejunostomy leakage, 3 cases with intraabdominal hemorrhage and 1 case with intraabdominal abcess. The statistical analysis revealed that episode of intraoperative hypotension was the only independent risk factor for major postoperative complication.(Odds ratio: 25.4849, p=0.0048) CONCLUSION: Careful intraoperative management for maintenance of adequate blood pressure in hemodynamically unstable patients is important to reduce major complications after pancreatoduodenectomy.
Anastomotic Leak ; Blood Pressure ; Hemorrhage ; Humans ; Hypotension ; Mortality ; Pancreaticoduodenectomy* ; Postoperative Complications ; Risk Factors*

Glaucoma, Open-Angle ; etiology ; physiopathology ; Humans ; Intracranial Hypotension ; complications ; physiopathology ; Intraocular Pressure ; Male ; Middle Aged

BACKGROUND: Traumatic diaphragmatic rupture is not common, but it requires swiftly performing an emergency operation. This study was conducted to evaluate the prognostic factors for mortality after surgically treating traumatic diaphragmatic rupture. MATERIAL AND METHOD: From Jan 2001 to Dec. 2008, we experienced 37 cases of multiple traumas with diaphragmatic injuries that were confirmed by surgical procedures. We evaluated various factors, including the type of injury, the associated injuries, the preoperative vital signs, the ISS, the time until surgery and the rupture size. RESULT: There were 30 patients with blunt trauma and 7 patients with penetrating trauma. Thirty-four patients had associated injuries and the mean ISS was 20.8. Postoperative complications occurred in 11 patients and hospital mortalities occurred in 6 patients. The prognostic factors that had an influence on the postoperative mortalities were the preoperative intubation state, the patient who exhibited hypotension and a high ISS. CONCLUSION: Traumatic diaphragmatic rupture is just one part of multiple traumas. The postoperative mortalities might depend on not only on the diaphragmatic rupture itself, but also on the severity of the associated injuries.
Diaphragm ; Emergencies ; Hospital Mortality ; Humans ; Hypotension ; Intubation ; Multiple Trauma ; Postoperative Complications ; Prognosis ; Rupture ; Vital Signs

Postoperative respiratory complications following scoliosis surgery are high incidence. In this case, fifty year-old male patient was admitted for thoracolumbar screw fixations and developed postoperative pulmonary edema. This was most likely due to prolonged administration of nicardipine, which over time may inadvertently cause hypotension. As a result of volume overload, interstitial pulmonary edema and pleural effusion occurred. Moreover, pulmonary edema and pleural effusion appeared on the right side first and spread to the left. This phenomenon could be explained by the positioning of scoliosis patient. The cause of pulmonary edema was volume overload initiated by prolonged effect of nicardipine.
Humans ; Hypotension ; Incidence ; Male ; Nicardipine ; Pleural Effusion ; Postoperative Complications ; Pulmonary Edema ; Scoliosis

With the advancement of disease treatments, the number of patients undergoing surgery worldwide is increasing. However, many patients still experience severe perioperative complications. Perioperative hypotension is one of the common side effects during surgery. Physiologically, perioperative hypotension can lead to insufficient perfusion of important organs and result in acute and chronic irreversible organ injury, which cause serious consequences for the patient's postoperative hospitalization and even the long-term outcome. Therefore, in order to optimize perioperative circulation management and improve the quality of life for patients after surgery, it is of great importance to investigate the relationship between perioperative hypotension and postoperative myocardial injury, ischemic stroke, postoperative delirium, acute kidney injury, and postoperative mortality. Individualized circulation management and reasonable application of vasoactive drugs may be the key point to early prevention and correct treatment of perioperative hypotension, which is of great significance for reducing perioperative related morbidity and mortality and improving the prognosis for the surgical patients.
Acute Kidney Injury/etiology* ; Humans ; Hypotension/etiology* ; Postoperative Complications/etiology* ; Quality of Life

Bradycardia ; complications ; Carcinoma ; Carotid Sinus ; Head and Neck Neoplasms ; complications ; secondary ; Humans ; Hypotension ; complications ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; complications ; pathology ; Neoplasm Metastasis

Blood Pressure ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Hypertension ; complications ; drug therapy ; physiopathology ; Hypotension, Orthostatic ; complications ; drug therapy ; physiopathology ; Male ; Middle Aged ; Syncope ; complications ; drug therapy ; physiopathology

We experienced a patient with unilateral visual loss after cervical spine surgery in the prone position. During the initial postoperative period, we were not been able to identify the patient's visual loss because of severe conjunctival edema in both eyes. Three days after surgery, the patient complained of right visual loss and was examined by an ophthalmologist. Ophthalmic artery occlusion was taken to be the presumptive cause, based on fluorescein angiography (FAG) and other evidence. He had several risk factors of ophthalmic artery occlusion, such as; prone position, compression of the eye-balls, anatomic abnormality, cervical spine and a long duration operation, intraoperative bleeding, hypotension and smoking, and a diabetic history. We concluded that attention must always be paid to a patients' eyes throughout the perioperative and postoperative period to prevent such a catastrophic postoperative complication.
Edema ; Fluorescein Angiography ; Hemorrhage ; Humans ; Hypotension ; Ophthalmic Artery ; Postoperative Complications ; Postoperative Period ; Prone Position* ; Risk Factors ; Smoke ; Smoking ; Spine*