Publications (5)11.46 Total impact
Conference Paper: Hemophagocytic Lymphohystiocytosis In Miliary TuberculosisAmerican Thoracic Society 2010 International Conference, May 14-19, 2010 • New Orleans; 05/2010
- Journal of Cardiac Failure 08/2009; 15(6). DOI:10.1016/j.cardfail.2009.06.031 · 3.05 Impact Factor
- Chest 10/2008; 134(4_MeetingAbstracts). DOI:10.1378/chest.134.4_MeetingAbstracts.s14004 · 7.48 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: There are multiple reports in the literature of serious and at times fatal complications after cervical spine manipulation therapy (CSMT), even though CSMT is considered by some health providers to be an effective and safe therapeutic procedure for head and neck pain syndromes. We report a case of a young female with cervicalgia and headache with fatal posterior circulation cerebrovascular accident after CSMT. Serious complications are infrequent, with a reported incidence between one per 100,000 to one in 2 million manipulations. The most frequent injuries involve artery dissection or spasm. Stroke as a complication of cervical manipulation and dissection of the vertebral arteries (VAD) is a rare but well recognized problem. Neck pain, headache, vertigo, vomiting and ataxia are typical symptoms of VAD, but this vascular injury also can be asymptomatic. The most common risk factors are migraine, hypertension, oral contraceptive pills and smoking. Stroke following CSMT is more common than the literature reports. The best values derive from retrospective surveys. The lack of identifiable risk factors place those who undergo CSMT at risk of neurologic damage. Accurate patient information and early recognition of the symptoms are important to avoid catastrophic consequences.Southern Medical Journal 03/2007; 100(2):201-3. DOI:10.1097/SMJ.0b013e31802ed21f · 0.93 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The prevalence of acute kidney injury (AKI) in patients with acute pancreatitis (AP) has been reported to be 15%, with mortal-ity from cases complicated by AKI close to 80% compared with 7% among patients with acute pancreatitis but without AKI. Hemolytic Uremic Syndrome (HUS) is a disorder consisting of AKI accompanied by non-immune hemolytic anemia and throm-bocytopenia most commonly seen in children. Thrombocytopenic Thrombotic Purpura (TTP) shares many clinical similarities with HUS but affects mainly adults. TTP/HUS among adults is associ-ated with infections, transplants, autoimmune diseases, drugs and neoplastic diseases. Pancreatitis as a result of TTP/HUS is rare, affecting only 2% of adults with TTP/HUS. Pancreatitis as the cause of TTP/HUS has only been described in a few case reports. We describe the case of a 25-year-old man with history of alcohol abuse who was readmitted with a diagnosis of AP and who developed progressive worsening of his renal function, de-spite fluid resuscitation, associated with thrombocytopenia. Fur-ther laboratory evaluations confirmed findings of microangiopathic hemolysis consistent with the diagnosis of TTP/HUS. The patient was started on therapeutic plasma ex-changes with improvement of his renal function 24 to 48 hours after initiating therapy. In this patient with AP, the renal failure was part of TTP/HUS spectrum. The exact mechanism that leads to the development of TTP/HUS in patients with AP is not clear, some hypotheses point toward endothelial injury as the inciting factor that leads to the microangiopathic process mediated by pancreatic autoantibodies, interleukin-1, tumor necrosis factor-a or modified Von Willebrand factor. Exchange transfusion of fresh frozen plasma remains the cornerstone of treatment for classic TTP/HUS. Among adult patients, it is important that physicians recognize TTP/HUS as one of the potential causes of AKI in cases of AP, especially when there is concomitant thrombocy-topenia, because the early initiation of plasma exchange has a major impact on survival and long term renal function. INTRODUCTION AND BACKGROUND Hemolytic uremic syndrome (HUS), thrombotic thrombocy-topenic purpura (TTP) and disseminated intravascular coagula-tion are classified into a group of disorders called thrombotic microangiopathies (TMA) (1). The term HUS was coined by Gas-ser et al. in 1955 and describes an illness consisting of acute renal failure accompanied by non-immune hemolytic anemia and throm-bocytopenia (2). The first case of TTP was described in 1924 by Dr. Eli Moschcowitz in a young woman who presented with microangiopathic hemolytic anemia, fever, bleeding, neurologic and renal abnormalities(1). HUS is most commonly seen in chil-dren, but cases among adults have also been described associ-ated with infections, transplants, autoimmune diseases, drugs and neoplasms (1,3,4). Pancreatitis as a result of TTP or HUS is rare, affecting only 2% of adults with TTP/HUS (5). Pancreatitis causing TTP/HUS has only been described in a few case reports (5-8). Here we report a case of TTP/HUS that developed as a complication of acute pancreatitis (AP) and which was treated successfully with plasma exchange after early recognition.