European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study Clinical Trial Controlled Clinical Trial
Very low monocytic HLA-DR expression indicates high risk of infection--immunomonitoring for patients after neurosurgery and patients during high dose steroid therapy.
In patients with disturbed immunoreactivity caused by trauma or immunosuppressive therapy infections are still a severe problem. To determine whether measurement of monocytic HLA-DR expression is useful for identifying patients with a high risk of infection after elective neurosurgery, blood was obtained from 57 patients during the first 3 days after surgery. HLA-DR expression was lower in 14 patients who developed infection, compared with patients with an uncomplicated postoperative course (p < 0.0001). ⋯ Likewise, monitoring of dermatological patients (n = 10) who received high dose systemic steroids revealed a very low HLA-DR expression in those patients who later developed infection. Our studies show that very low HLA-DR expression indicates high risk of infection. We recommend the measurement of this parameter for immunomonitoring.
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Case Reports
Reversible cardiac failure in an adolescent after prolonged exposure to carbon monoxide.
We describe the case of an adolescent who developed a severe but fully reversible cardiac dysfunction with low blood levels of carboxy haemoglobin (COHb = 10%) after a prolonged exposure to carbon monoxide. A 15-year-old male was admitted with a Glasgow Coma Scale of 8/15 with suspected postictal state and postanoxic encephalopathy. ⋯ The patient fully recovered without neurological deficit. A low blood COHb concentration is a poor safety indicator since high tissue levels of accumulated carbon monoxide can be associated with coma and fulminant cardiorespiratory failure requiring advanced life support facilities.
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Sudden non-traumatic death in young people (< 30 years old) has been discussed both in systematic studies and anecdotal reports. After presenting three remarkable cases, a global survey of the incidence with special reference to the Belgian CPCR database, ethiopathogenesis and prognosis of sudden non-traumatic death in this specific age group is given. ⋯ The involvement of drugs or other toxins has to be excluded in the first place. Apart from transoesophageal echocardiography and coronary angiography, electrophysiological testing, serological exams, myocardial biopsy and magnetic resonance imaging should be considered.
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In a prospective study of 4234 patients with acute poisoning in the Emergency Department of the University Hospital of Gent in Belgium between 1983 and 1990, we observed a decline in the number of poisonings from 665 in 1983 to 424 in 1990. This was due to a decrease in the number of deliberate self-poisonings. Fifty-six per cent of patients were female and the most prevalent age group was 20 to 24 years. ⋯ With regard to treatment, a reduction in gastric lavage was observed. The patients were transferred to the intensive care unit (29.2%), the psychiatry ward (23.6%) or discharged home (27.8%). Only 0.3% of the patients died in the Emergency Department.