Fatal carbon dioxide embolism as a complication of endoscopic interventions

BACKGROUND: There is little information regarding full polysomnographic examination of infants for the evaluation of stridor or stertor. OBJECTIVE: To determine the usefulness of polysomnographic examination in the evaluation of airway disorders in infants. DESIGN: Case review series. SETTING: Tertiary pediatric care center and sleep disorders center. PATIENTS: Younger than 10 months. INTERVENTION: Full polysomnography and treatment with a positive-pressure assistive device or surgery if indicated. MAIN OUTCOME MEASURES: Electroencephalographic findings, amount and length of apnea, percentage of desaturation and carbon dioxide retention, sleep architecture, amount of hypopnea as well as sleep arousals, episodes of gastroesophageal reflux, and clinical follow-up. RESULTS: Of 60 full pediatric polysomnograms performed at our institution each year, only 17 were obtained in children younger than 10 months for determination of symptoms of stridor or stertor over the past 8 years. In several cases, interpretation of 4-channel studies led to the wrong conclusions and inadequate treatment. Diagnoses made using full polysomnography included 3 children with seizure disorders, 1 with disorganized brain activity, 2 with gastroesophageal reflux, and 7 with anatomical obstructions, 3 of whom were successfully treated with a positive-pressure assistive device and 4 of whom were treated surgically. CONCLUSIONS: Full polysomnography provides physiological data that complement anatomical data obtained via endoscopy and is a useful tool for evaluating the significance of airway disorders in infants.     

Fatal air embolism following gunshot wound of the lung

Air embolism following penetrating lung trauma has been reported infrequently and its existence is questioned. A death resulting from air embolism following a high-velocity gunshot wound is presented. Appropriate treatment and preventive measures are discussed.     

Fatal complication of paraffin plombage after half a century

Complications following thoracic plombage for treatment of tuberculosis can be observed more than 50 years after placement of the filling. The management of these late complications is challenging and frequently requires surgical intervention. We report a patient who received a plombage in 1947. She was admitted to hospital with subfebrile temperature and hoarseness. A computed tomography scan of the chest revealed transthoracic penetration of the paraffin plombage with intrusion into the overlying soft tissue. The patient underwent excision and debridement of the paraffin wax mass followed by thoracoplasty. She then developed septicaemia and died due to multiple organ failure 23 days after the surgical intervention. Early ablation of plombage should be considered in order to prevent late complications.     

Fatal intraoperative pulmonary embolism from a hepatic hydatid cyst

A 43-yr-old woman was operated for recurring hydatid cysts of the liver. One of the cysts was located in segment 8 adjacent to both inferior vena cava and right hepatic vein. During the operation, after application of traction on the liver the patient suddenly went into cardiac arrest. After applying open heart massage a Trendelenburg operation was performed, revealing a massive embolus of echinococcal material into the paracentral branches of the pulmonary artery. Resuscitation was unsuccessful. In the literature only four similar cases have been described. The conclusions from these deaths are that an adequate incision is mandatory, no traction on the liver should be necessary, and total vascular exclusion of the liver before cyst drainage and extracorporal bypass are necessary. Interventional techniques should be avoided.     

Fatal varicella-zoster encephalitis; a rare complication of herpes zoster

In a 82-year-old woman varicella zoster encephalitis was diagnosed, a rare complication of shingles. The case was remarkable for its rapid and fatal course in a patient without an underlying disease. At autopsy, the histological picture of an acute haemorrhagic encephalitis was seen, also a rare finding.     

Fatal pulmonary embolism after total hip arthroplasty: diurnal variations

From 1970 through 1986, a total of 18,104 Charnley low-friction arthroplasties were performed; of these, 122 deaths occurred from pulmonary embolism within 1 year of surgery. Diagnosis was confirmed by postmortem examination in 71% of cases. The exact time of the onset of the complication was recorded in 90 cases. In 74 (82%) cases, the time of collapse occurred during the 7-hour period from 9:00 AM to 4:00 PM, and in 16 (18%) cases, it occurred in the 17-hour period from 4:00 PM to 9:00 AM. The patient's activity at the time of collapse was recorded in 73 cases. Sixty (82%) were mobile, 3 were in the bathroom, and 10 (14%) were in bed. Sixty-six (70.2%) patients died within 1 hour of the onset of symptoms.     

The peripheral intravenous cannula: a cause of venous air embolism

Venous air embolism has been reported as a complication of invasive diagnostic and therapeutic procedures or accidental trauma. Little is known about the incidence of air embolism after minimal intravenous manipulations, such as the insertion of a peripheral intravenous cannula. Small air emboli in the central veins, central arteries, and cardiac chambers can be detected during electron-beam computed tomography studies of the chest. Electron-beam computed tomography of the chest was performed on 208 patients after the insertion of a peripheral intravenous cannula. The images were analyzed using a digital workstation. Small air embolism was visible in 10 of 208 (4.8%) patients in the following locations: the pulmonary trunk in 6 patients, the right ventricle in 2, the right atrium in 1, and the left brachiocephalic vein in 1. The embolism was asymptomatic in each patient. Although the potential risks in patients with septal defects and shunts remain unclear, caution should be taken with minimal intravenous manipulations.     

Failures to confirm the spatial-frequency hypothesis: Fatal blow or healthy complication?

Examined the validity of the hypothesis that the 2 cerebral hemispheres are differentially sensitive to the outputs of the spatial-frequency channels, using 12 male right-handed adults. Ss viewed digitized broad-pass, digitized low-pass, and coarsely quantized photographs that were presented to the left or the right of their point of fixation and were required to identify the faces as male or female. Results indicate that low spatial-frequency photographs were processed more efficiently by the right than by the left hemisphere, while higher frequency components benefited the left more than the right hemisphere. Exposure duration, spatial-frequency content, and practice effects appeared to influence the respective processing efficiency of the cerebral hemispheres. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A complication of pacemaker lead extraction: paradoxical embolism of a lead fragment in a leg artery

Extraction of three chronically implanted pacemaker leads was performed via the implant vein in a 71-year-old man. One of the leads broke in the subclavian scar tissue. The lead fragment migrated into the left peroneotibial trunk artery. Transesophageal echocardiography showed patent foramen ovale associated with right-to-left atrial shunt. This complication of lead extraction is discussed along with the role of echocardiography prior to lead removal.     

Fatal pulmonary embolism after endoscopic embolization of downhill esophageal varix

HISTORY AND CLINICAL FINDINGS: A 79-year-old man was admitted with a history of recent haematemesis and tarry stools. 4 years before he had undergone a subtotal thyroidectomy for hyperthyroidism. INVESTIGATIONS: He was anaemic (haemoglobin 7.2 g/dl, haematocrit 23%). At the transition between the upper and middle third of the oesophagus gastroscopy revealed a bleeding oesophageal varix. TREATMENT AND COURSE: The bleeding varix was sclerosed with polidocanol. 3 erythrocyte concentrates were administered. Massive bleeding 2 days later was controlled with intravaricose injection of cyanoacrylate (Histoacryl). The patient died 6 weeks later from progressive cardiovascular failure. Autopsy revealed the cause of death as right heart failure with extensive foreign-body pulmonary emboli identified as thrombotic material containing polymerized cyanoacrylate found in the previously injected oesophageal varix. Also discovered was a retrosternal goitre which had compressed the brachiocephalic vein. Cause of the "washing-out" of the cyanoacrylate embolus from the varix into the systemic circulation was an oesophago-varicose collateral circulation in a cranio-caudal direction; this had been formed by the pressure of the retrosternal goitre on the brachiocephalic vein. CONCLUSION: Cyanoacrylate injection into a varix above the lower third of the oesophagus should only be done under strict indication. A similar risk as that described in this case potentially exists in the treatment of acute bleeding from a portosystemic varicose circulation.     

Detection of site of air entry in venous air embolism: role of Valsalva maneuver

Venous air embolism in posterior fossa surgery is a well-documented complication. Various highly sensitive devices help in early detection of air embolism. In management of air embolism, sealing the site of air entry is an important step in preventing further episodes. Here we discuss the importance of inspiratory hold after lung inflation (Valsalva maneuver) in helping to localize the site of air entry and its role in the management of venous air embolism observed in two cases of posterior fossa mass, operated in sitting position.     

Peripheral intravenous infusion--another cause of air embolism

We report an unusual complication of intravenous infusion. A 4-week-old baby developed acute cardiopulmonary distress because of air embolism caused by improper preparation of peripheral intravenous set. The estimated amount of infused air was 12 ml (approximately 3.5 ml/kg). The infant recovered promptly after short supportive treatment.