European journal of anaesthesiology
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A 21-year-old female weighing 55 kg was anaesthetized for facial reconstruction. After an initial bolus of pancuronium 5 mg and top-up doses of 2 mg at 135 min and 1 mg at 290 min and 335 min, no further relaxant was given for 130 min at which time neuromuscular transmission appeared fully recovered with a full train-of-four twitches and a sustained response to 50 Hz stimulation of the posterior tibial nerve. ⋯ The serum cholinesterase activity 12 h after surgery was 0.38 units mL-1 (normal range 0.65-1.0 units mL-1). There was no evidence of atypical cholinesterase.
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Case Reports
Hyperacute pneumonitis in a patient with overwhelming Strongyloides stercoralis infection.
The case of a 64-year-old man who was admitted to hospital with fever, general deterioration and anorexia is reported. For the past 4 years, the patient had been receiving corticosteroid therapy for a chronic inflammatory demyelinating polyradiculoneuropathy. Soon after admission the patient developed respiratory insufficiency as a result of a massive pneumonitis, with severe hypoxia, acute anaemia, acute renal failure and a systemic inflammatory response syndrome (SIRS) requiring admission to the Intensive Care Unit (ICU). ⋯ This nematode can produce an overwhelming hyperinfection syndrome, especially in patients showing deficient cell-mediated immunity. Strongyloides hyperinfection syndrome is frequently fatal but is potentially a treatable clinical condition. Patients undergoing immunosuppressive therapy or with suspected immunity deficiency (HIV infection, malnutrition, lymphomas, leukaemias or other neoplasia treated with systemic radiotherapy or chemotherapy) must be also monitored for opportunistic Strongyloides stercoralis infection, because clinical manifestation of the systemic hyperinfection syndrome can be rather non-specific.