A&A practice
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Anaphylaxis is a life-threatening, systemic, hypersensitivity reaction, manifested by urticaria, hypotension, and respiratory symptoms. Antigens that are cleared renally may have protracted exposure in patients with impaired renal function, resulting in prolonged and refractory anaphylactic shock. ⋯ The patient was treated with continuous, short-term, veno-venous hemodiafiltration. Initiating this therapy in patients with refractory anaphylactic shock and anuria due to an antigen that is excreted renally can expedite recovery.
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A 67-year-old man presented with severe 9 of 10 intractable pain of the left shoulder joint after arthroplasty and revision surgeries, with associated weakness, atrophy, and limited range of motion in all directions. Dorsal root ganglion stimulation (DRG-S) at the left C4, C5, and C6 levels was used after failed conservative and interventional measures, resulting in significant improvement in pain, function, and quality of life measures through 6 months postimplantation. Larger studies should examine if DRG-S is effective in treating chronic arthritic joint pain as well as chronic postsurgical pain of the shoulder that is not predominantly neuropathic.
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Recently, denervation therapies have drawn attention as a promising treatment, and cooled radiofrequency has been proposed as the best option to capture most of the genicular nerves. We present a rare case of synovial knee fistula after radiofrequency and its management. ⋯ One week later, the fistula was closed, and 14 months later, the procedure was repeated without complications. Genicular radiofrequency ablation is an emerging technique, and providers should be aware of the reported complications to counsel patients and manage potential risks appropriately.
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Case Reports
Posterior Reversible Encephalopathy Syndrome and Eclampsia in the Setting of Magnesium Toxicity: A Case Report.
Posterior reversible encephalopathy syndrome (PRES) is a rare neurologic condition and a feared complication of eclampsia. It is evidenced by acute neurologic dysfunction secondary to cerebral edema and is typically reversible in nature. ⋯ We present a case wherein a 24-year-old parturient developed PRES and eclampsia in the setting of symptomatic hypermagnesemia, requiring management with lorazepam after seizures developed. Here we detail her clinical course, including the unique challenges of treating eclampsia and PRES in the setting of magnesium toxicity.
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Physiologic changes of pregnancy are poorly tolerated in patients with pulmonary arterial hypertension (PAH), and peripartum maternal mortality is high. We present a case of a 31-year-old G3P0020 patient at 35 weeks' gestation with severe World Health Organization group I PAH who underwent cesarean delivery followed by percutaneous right ventricular assist device placement. Risks and benefits of the mode of delivery, neuraxial versus general anesthesia, and mechanical circulatory support are reviewed.