Category Archives: JCCM 2020

Therapeutic Plasma Exchange: An Indispensable Therapy for Severe Neurological Conditions

Rodica Balasa

Neurology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/jccm-2020-0021

Therapeutic plasma exchange (TPE) is the most frequent therapeutic apheresis procedure used to remove the plasma, together with its high-molecular-weight agents such as immune complexes, antibodies, complement components, cytokines, different toxins and cryoglobulins, as well as to return of the majority of cellular components to the patients [1]. In the hands of an experienced specialist, TPE has been found by the American Academy of Neurology to be a very important and safe tool that can improve neurological disability in patients with numerous disorders [2]. [More]

Keywords: ,
Full text: PDF

The Diagnostic and Prognostic Role of Vascular Endothelial Growth Factor C in Sepsis and Septic Shock

Emoke Almasy1, Janos Szederjesi1, Bianca Liana Grigorescu2, Iudita Badea1,
Marius Petrisor3, Cristina Manasturean4, Valentina Negrea4, Agota-Evelyn Timar1,
Oana Coman1, Leonard Azamfirei1, Ario Santini5, Sanda Maria Copotoiu1

1 Anesthesiology and Intensive Care Clinic, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2 Discipline of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3 Department of Simulation Applied to Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4 Infectious Diseases Clinic, University Hospital Targu Mures, Romania
5 The University of Edinburgh, UK

DOI: 10.2478/jccm-2020-0020

Introduction: Variations in the expression of vascular endothelial growth factor (VEGF) could be used as a biomarker in critically ill patients with sepsis and septic shock. Inflammation potently upregulates VEGF-C expression via macrophages with an unpredictable response. This study aimed to assess one of the newer biomarkers (VEGF-C) in patients with sepsis or septic shock and its clinical value as a diagnostic and prognostic tool.
Material and methods: The study involved 142 persons divided into three groups. Group A consisted of fifty-eight patients with sepsis; Group B consisted of forty-nine patients diagnosed as having septic shock according to the Sepsis -3 criteria. A control group of thirty-five healthy volunteers comprised Group C. Severity scores, prognostic score and organ dysfunction score, were recorded at the time of enrolment in the study. The analysis included specificity and sensitivity of plasma VEGF-C for diagnosis of septic shock. Circulating plasma VEGF-C levels were correlated with the APACHE II, MODS and severity scores and mortality.
Results: The mean (SD) plasma VEGF-C levels in septic shock patients (1374(789) pg./m), on vasopressors at the time of admission to the ICU, were significantly higher 1374(789)pg./mL, compared the mean (SD) plasma VEGF-C levels in sepsis patients (934(468) pg./mL); (p = 0.0005, Student’s t-test.) Plasma VEGF-C levels in groups A and B were shown to be significantly correlated with the APACHE II (r = 0.21, p = 0.02; r = 0.45, p = 0.0009) and MODS score (r = 0.29, p = 0.03; r = 0.4, p = 0.003). There was no association between plasma VEGF-C levels and mortality [p = 0.1]. The cut-off value for septic shock was 1010 pg./ml.
Conclusions: VEGF-C may be used as a prognostic marker in sepsis and septic shock due to its correlation with APACHE II values and as an early marker to determine the likelihood of developing MODS. It could be used as an early biomarker for diagnosing patients with septic shock.

Keywords: , , ,
Full text: PDF

Non-Cardiogenic Pulmonary Oedema Following the Use of Gadolinium-Based Contrast Medium: A Case Report

Chilan Nguyen1, Tho Pham2

1 St George Hospital, Kogarah, NSW, Australia
2 Alfred Health, VIC, Australia

DOI: 10.2478/jccm-2020-0019

Non-cardiogenic pulmonary oedema can be life threatening and requires prompt treatment. While gadolinium-based contrast is generally considered safe with a low risk of severe side effects, non-cardiogenic pulmonary oedema has become increasingly recognised as a rare, but possibly life-threatening complication. We present a case of a usually well, young 23-year-old female who developed non-cardiogenic pulmonary oedema with a moderate oxygenation impairment and no mucosal or cutaneous features of anaphylaxis following the administration of gadolinium-based contrast. She did not respond to treatment of anaphylaxis but made a rapid recovery following the commencement of positive pressure ventilation. Our case highlights the importance of recognising the rare complication of non-cardiogenic pulmonary oedema following gadolinium-based contrast administration in order to promptly implement the appropriate treatment.

Keywords: , , , ,
Full text: PDF

The Use of Pistacia Lentiscus Chia Resin versus Omeprazole in Protecting Male Rats Peptic Mucosa against Cold Restraint Stress

Despoina Kakagia1, Apostolos Papalois2, Maria Lambropoulou3, Fotini Papachristou1, Gregory Trypsiannis4, Constantinos Anagnostopoulos5, Mike Pitiakoudis1, Alexandra Tsaroucha1

1 Democritus University of Thrace Faculty of Medicine Alexandroupolis, Greece
2 Elpen Research Centre, Elpen Pharmaceuticals, Greece
3 Department of Histology- Embryology, Democritus University of Thrace, Faculty of Medicine, Alexandroupolis, Greece
4 Department of Medical Statistics, Democritus University of Thrace, Faculty of Medicine, Alexandropoulis, Greece
5 Department of Biochemistry, Democritus University of Thrace, Faculty of Medicine, Alexandroupolis, Greece

DOI: 10.2478/jccm-2020-0018

Introduction: Peptic mucosal damage induced by acute stress is a serious cause of morbidity and mortality in critically ill patients. The study aimed to investigate the protective, antioxidant and anti-inflammatory effects of pre-treatment with Chios mastic gum (CMG), a traditionally consumed herbal resin naturally deriving from the trunk of Pistacia Lentiscus var. Chia compared to Omeprazole, a standard medication used in the prevention and treatment of gastritis, against the effects of cold restraint stress (CRS) in rat gastric and colonic mucosa.
Methods: Twenty-one male Wistar rats were randomly assigned to three groups: Control (C), Omeprazole (O), and CMG (M), according to the pre-treatment regime, and were subjected to CRS at 4oC for 3 hours. The gastric and colonic mucosal lesions were histologically assessed. ELISA measured blood concentrations of TNF-α, IL-1β, peroxidase, superoxide dismutase (SOD) and total antioxidant capacity (TEAC).
Results: In both groups, O and M, gastric mucosal hyperemia, haemorrhagic infiltration and mucosal oedema, as well as colonic mucosal hyperaemia and haemorrhagic infiltration were significantly reduced compared to the controls (p<0.05). No significant differences were observed between Groups O and M. TNF-α levels were significantly lower in group M compared to Group O (p=0.013). IL-1β levels were significantly depressed in groups M and O compared to control (p≤ 0.001). The activity of both peroxidase and SOD enzymes decreased in group M compared to group O (p= 0.043 and p=0.047 respectively) and the control (p=0.018 and p< 0.001 respectively). Conclusions: The natural Chios mastic gum is a promising nutritional supplement with protective properties to the peptic mucosa against CRS, exerting anti-inflammatory and antioxidant effects.

Keywords: , , , , ,
Full text: PDF

Catastrophic Caustic Ingestion: A Case Report

Kerri L Bouchard

University of Maryland Medical Center, Baltimore, USA

DOI: 10.2478/jccm-2020-0017

Introduction: The majority of oral ingestion of caustic material by adults is intentional, and the aftermath varies widely with potentially fatal results. Injuries range from superficial burns of facial and oropharyngeal structures to extensive necrosis of the gastrointestinal tract. Management focuses on the identification of the ingested substance and prompt treatment and supportive care of the multiple complications stemming from the ingestion. Complications following caustic ingestion include both immediate and long term.
Case presentation: A fifty-seven-year-old man presented following intentional ingestion of drain cleaner. The patient was intubated and underwent emergent esophagogastroduodenoscopy [EGD], which revealed extensive damage to his oesophagus and stomach. He survived his initial injury but had a prolonged hospital course and ultimately died after developing tracheoesophageal and bronchooesophageal fistulas which were too extensive for surgical repair.
Conclusion: The sequelae of caustic ingestion can be minor or severe, both immediate and delayed. Despite appropriate prompt management and supportive care, patients may die as a result of the initial injury or subsequent complications.

Keywords: , , ,
Full text: PDF

An Intentional Aconite Overdose: A Case Report

Christopher Wood1, James Coulson2, John Thompson2, Stephen Bonner1

1 James Cook University Hospital, Middlesbrough, United Kingdom
2 National Poisons Information Service, United Kingdom

DOI: 10.2478/jccm-2020-0016

Background: Aconite is one of the most toxic known herbs, widely used for centuries as an essential Chinese medicine, but also for deliberate poisoning throughout history. Clinically indicated in herbal medicine for a range of ailments from headaches to muscle spasm, unfortunately, the narrow therapeutic window may lead to a range of toxic presentations. The mechanism of action of the pharmacologically active compounds in Aconite relate to the activation of voltage-gated sodium channels within a range of tissue including myocardial, neuronal and smooth muscle leading to persistent cellular activity.
Case presentation: We report on a rare case of a fifty-year-old male with intentional aconite overdose presenting with refractory cardiovascular instability from persistent life-threatening arrhythmias, respiratory failure, and seizure activity.
Conclusion: An overview of Aconite, its history, pharmacological effects, treatment of overdose and outcomes is presented.

Keywords: ,
Full text: PDF

Drug Thrombus Resulting in Superior Vena Cava Syndrome: A Case Report

Stijn Vanstraelen1, Jeroen Vandenbrande2, Alaaddin Yilmaz2

1 Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
2 Jessa Hospital, Hasselt, Belgium

DOI: 10.2478/jccm-2020-0015

Introduction: Superior vena cava syndrome is one of the more serious complications of central venous catheter insertion. Drug interactions of administered drugs used in association with these catheters can lead to formation of precipitations and consequently thrombus formation. These interactions can be either anion-cation or acid-base based and more commonly present in clinical practice than expected.
Case presentation: The case of a 31-year old female who was admitted to an intensive care unit with an intracranial haemorrhage, is presented. Occlusion of the superior vena cava was caused by a drug-induced thrombus, formed by the precipitation and clotting of total parenteral nutrition and intravenous drugs. Given the nature of the thrombus and a recent intracranial haemorrhage, the patient was treated with a central thrombectomy supported by a heparin-free extracorporeal membrane oxygenation.
Conclusion: Knowledge of drug interactions is crucial in order to heighten awareness for the dangers of concomitant drug administration, especially in combination with total parenteral nutrition in critically ill patients.

Keywords: , ,
Full text: PDF

The Use of Extracorporeal Life Support in a Patient Suffering from Venlafaxine Intoxication. A Case Report

Christoph Marquetand1, Harald F. Langer1, Jan Philipp Klein2, Tobias Graf1

1 Department of Cardiology, Angiology and Intensive Care, Medicine Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
2 Lübeck University, Department of Psychiatry and Psychotherapy, Lübeck, Germany

DOI: 10.2478/jccm-2020-0014

Very few reports exist on serious cardiac complications associated with intake of serotonin-noradrenaline reuptake inhibitors. This paper describes and discusses the case of a patient who ingested a dose of 17.5 g venlafaxine. She developed a full serotonergic syndrome leading to multi-organ failure, including refractory cardiovascular shock, which was managed by early implantation of an extracorporeal life support (ECLS) system as a bridging strategy. This intervention was successful and resulted in full recovery of the patient.

Keywords: , , , ,
Full text: PDF

Associate Professor Silviu-Cosmin Moldovan (1975 – 2020)

Leonard Azamfirei

“George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș

“George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureş has been deeply affected by the untimely death of Associate Professor Silviu-Cosmin Moldovan, Vice-Dean of the Faculty of Medicine in English.
Associate Professor Silviu-Cosmin Moldovan (PhD) was born on August 9 1975, in Târgu-Mureș, and graduated from the Faculty of Medicine, University of Medicine and Pharmacy of Târgu-Mureș, in 1999.
After graduation, in 2000, he started to work as an intern, and in 2004 he began his residency in pathological anatomy at the Emergency County Hospital of Târgu-Mureș and continued his professional activity as medical specialist and then as senior physician in pathological anatomy at the Emergency County Hospital of Târgu-Mureș. [More]

Keywords:
Full text: PDF

Anaesthesia for Liver Transplantation: An Update

Lavinia Nicoleta Brezeanu1, Radu Constantin Brezeanu2, Mircea Diculescu1,3, Gabriela Droc1,3

1 Fundeni Clinical Institute, Bucharest, Romania
2 “Bagdasar-Arseni” Emergency Hospital, Bucharest, Romania
3 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

DOI: 10.2478/jccm-2020-0011

Liver transplantation (LT) is a challenging surgery performed on patients with complex physiology profiles, complicated by multi-system dysfunction. It represents the treatment of choice for end-stage liver disease. The procedure is performed under general anaesthesia, and a successful procedure requires an excellent understanding of the pathophysiology of liver failure and its implications. Despite advances in knowledge and technical skills and innovations in immunosuppression, the anaesthetic management for LT can be complicated and represent a real challenge. Monitoring devices offer crucial information for the successful management of patients. Hemodynamic instability is typical during surgery, requiring sophisticated invasive monitoring. Arterial pulse contour analysis and thermo-dilution techniques (PiCCO), rotational thromboelastometry (RO-TEM), transcranial doppler (TCD), trans-oesophageal echocardiography (TEE) and bispectral index (BIS) have been proven to be reliable monitoring techniques playing a significant role in decision making. Anaesthetic management is specific according to the three critical phases of surgery: pre-anhepatic, anhepatic and neo-hepatic phase. Surgical techniques such as total or partial clamping of the inferior vena cava (IVC), use of venovenous bypass (VVBP) or portocaval shunts have a significant impact on cardiovascular stability. Post reperfusion syndrome (PRS) is a significant event and can lead to arrhythmias and even cardiac arrest.

Keywords: , ,
Full text: PDF