Medicine
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Review Case Reports
The clinical spectrum of retroperitoneal hematoma in anticoagulated patients.
Bleeding into the retroperitoneal space is a serious complication of anticoagulation. The incidence may be on the rise due to the increasing number of patients prescribed anticoagulants for atrial fibrillation and other disorders. ⋯ Thus, an adequate index of suspicion is needed to reverse anticoagulation rapidly and initiate other therapeutic measures. We reviewed the cases diagnosed at our institution and reported in the literature to delineate the clinical manifestations and course of this process.
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Review Case Reports
Assessing the relationship between the use of nonsteroidal antiinflammatory drugs and necrotizing fasciitis caused by group A streptococcus.
Group A streptococcal (GAS) necrotizing fasciitis is a rapidly progressive soft tissue infection. Elderly and chronically ill individuals are at greatest risk, particularly when skin breakdown is present. Reports suggest that nonsteroidal antiinflammatory drugs (NSAIDs) increase the risk of developing GAS necrotizing fasciitis, impede its timely recognition and management, and accelerate the course of infection. ⋯ However, prospective studies do not support a risk of developing GAS necrotizing fasciitis as a result of NSAID therapy, or a worsening of established streptococcal infection. To avoid the application of NSAIDs in lieu of aggressive medical and surgical management of streptococcal fasciitis, clinicians must understand the early symptoms of GAS necrotizing fasciitis that precede visible soft tissue necrosis. A rational approach to patients presenting with localized soft tissue pain will enhance detection and therapy of this rapidly progressive, life-threatening disease.
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Review
Torsade de pointes due to noncardiac drugs: most patients have easily identifiable risk factors.
Numerous medications, including drugs prescribed for noncardiac indications, can lead to QT prolongation and trigger torsade de pointes. Although this complication occurs only rarely, it may have lethal consequences. It is therefore important to know if patients with torsade de pointes associated with noncardiac drugs have risk factors that are easy to identify. ⋯ Other risk factors were frequently present (18%-41%). Virtually all patients had at least 1 of these risk factors, and 71% of patients had 2 or more risk factors. Our study suggests that almost all patients with torsade de pointes secondary to noncardiac drugs have risk factors that can be easily identified from the medical history before the initiation of therapy with the culprit drug.