Southern medical journal
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Southern medical journal · Sep 2002
Case ReportsPosterior ischemic optic neuropathy related to profound shock after penetrating thoracoabdominal trauma.
Ischemic optic neuropathy is a rare cause of blindness reported most commonly in association with collagen-vascular diseases, infectious processes, and systemic hypotension related to massive exsanguinating hemorrhage. We report what we believe to be the first case of posterior ischemic optic neuropathy due to perioperative hypotension in a patient who had a penetrating thoracoabdominal injury with massive hemorrhage, severe hypotension, massive microcapillary circulatory leak, multiple system organ failure, and acute respiratory distress syndrome. Although the incidence of postoperative visual loss is low (-0.002%), awareness of this entity must be raised within the trauma surgical community.
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We describe a case of primary aortoenteric fistula (PAEF) in a patient with upper gastrointestinal bleeding. Primary aortoenteric fistula is a rare but clinically important cause of catastrophic gastrointestinal bleeding. ⋯ Primary aortoenteric fistula should be considered in any patient known to have an abdominal aortic aneurysm who presents with upper gastrointestinal bleeding when no identifiable source of bleeding is found on upper endoscopy. Computed tomography may confirm the diagnosis and emergency exploratory laparotomy should be done as soon as the diagnosis is considered clinically.
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Citalopram is the newest selective serotonin reuptake inhibitor (SSRI) available in the United States. It is currently approved by the Food and Drug Administration for the treatment of major depression. However, a number of studies have found it to be effective in the treatment of panic disorder as well. ⋯ We present the case of a 61-year-old woman who had frank panic attacks after her citalopram dose was increased. She had had no history of anxiety symptoms. Anxiety abated completely upon discontinuance of citalopram therapy.
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Southern medical journal · Sep 2002
Case ReportsNecrotizing fasciitis of the upper extremity resulting from a water moccasin bite.
Aeromonas hydrophila infection has been described as the cause of necrotizing fasciitis in patients with suppressed immune systems, burns, or trauma in an aquatic setting. We report a case in which severe necrotizing fasciitis involving hand, arm, chest, and lateral side of trunk, along with toxic shock, developed after the patient was bitten by a venomous snake. Mixed aerobic and anaerobic bacteria, including A hydrophila, were isolated from the wound culture. ⋯ After the application of skin grafts, the wound completely healed. This case illustrates that a venomous snakebite may result in infection with A hydrophila and can cause severe necrotizing fasciitis. Early and aggressive surgical intervention should be implemented as soon as the necrotizing fasciitis is diagnosed.