Multiorgan dysfunction syndrome due to high-dose cantharidin poisoning:A case report

BACKGROUND This report delves into the diagnostic and therapeutic journey undertaken by a patient with high-dose cantharidin poisoning and multiorgan dysfunction syndrome(MODS).Particular emphasis is placed on the comprehensive elucidation of the clinical manifestations of high-dose cantharidin poisoning,the intricate path to diagnosis,and the exploration of potential underlying mechanisms.CASE SUMMARY A patient taking 10 g of cantharidin powder orally subsequently developed MODS.The patient was treated with supportive care,fluid hydration and antibiotics,and hemoperfusion and hemofiltration therapy for 24 h and successfully recovered 8 d after hospital admission.Cantharidin poisoning can cause lifethreatening MODS and is rare clinically.This case underscores the challenge in diagnosis and highlights the need for early clinical differentiation to facilitate accurate assessment and prompt intervention.CONCLUSION This article has reported and analyzed the clinical data,diagnosis,treatment,and prognosis of a case of high-dose cantharidin poisoning resulting in MODS and reviewed the relevant literature to improve the clinical understanding of this rare condition.

Acute diquat poisoning case with multiorgan failure and a literature review:A case report

BACKGROUND With the withdrawal of paraquat from the market,diquat is widely used,so the treatment of diquat poisoning has become one of the focuses of emergency poisoning diagnosis and treatment.CASE SUMMARY We studied the case of a 17-year-old male patient who drank 200 mL(20 g/100 mL)of diquat solution two hours before arriving at the hospital.Despite the use of treatments such as gastric lavage,hemoperfusion,continuous hemodialysis,glucocorticoids,and organ support,the patient’s condition rapidly progressed to multiorgan failure,and he died 23.5 h after admission.CONCLUSION We summarized the clinical characteristics and treatment strategies of diquat poisoning through this case and performed a literature review to provide a basis and direction for clinical treatment.

Chronic pancreatitis:a sequela of acute fatty liver of pregnancy

BACKGROUND: Chronic pancreatitis following acute fatty liver of pregnancy is rarely reported.METHODS: We treated a 34-year-old woman who developed acute fatty liver of pregnancy (AFLP) after delivery by caesarean section at 32 weeks of gestation. AFLP was complicated by acute pancreatitis and multiple organ failure. The management of the disease was primarily supportive. She recovered from acute fulminant liver failure and multi-organ failure, apart from the development of symptomatic chronic pancreatitis thereafter. RESULTS: Investigations failed to identify any other causes of chronic pancreatitis. The patient responded very well to pancreatic enzyme supplement for the treatment of steatorrhoea.CONCLUSION: To our knowledge, this is the first report of chronic pancreatitis as a consequence of multi-organ dysfunction caused by AFLP.

Multiorgan chronic inflammatory hepatobiliary pancreatic murine model deficient in tumor necrosis factor receptors 1 and 2

AIM: To provoke persistent/chronic multiorgan inflammatory response and to contribute to stones formation followed by fibrosis in hepatobiliary and pancreatic tissues. METHODS: Tumor necrosis factor receptors 1 and 2(TNFR1/R2) deficient mice reared in-house were given dibutyltin dichloride(DBTC) twice within 10 d by oral gavage delivery. Sham control animals received vehicle treatment and na?ve animals remained untreated throughout the study. Animals were monitored daily for symptoms of pain and discomfort. The abdominal and hindpaw hypersensitivity were assessed with von Frey microfilaments. Exploratory behaviors were recorded at the baseline, after initiation of treatment, and before study termination. Histopathological changes were examined postmortem in tissues. Collagen accumulation and fibrosis were confirmed with Sirius Red staining. RESULTS: Animals lost weight after oral administration of DBTC and developed persistent inflammatory abdominal and hindpaw hypersensitivity compared to sham-treated controls(P < 0.0001). These pain related secondary mechanical hypersensitivity responses increased more than 2-fold in DBTC-treated animals. The drastically diminished rearing and grooming rates persisted after DBTC administration throughout the study. Gross as well as micropathology at one month confirmed that animals treated with DBTC developed chronic hepatobiliary injuries evidenced with activation of stellate cells, multifocal necrosis, fatty degeneration of hepatocytes, periportal infiltration of inflammatory cells, and prominent biliary ductal dilation. The severity of hepatitis was scored 3.7 ± 0.2(severe) in DBTC-treated animals vs score 0(normal) in shamtreated animals. Fibrotic thickening was extensive around portal ducts, in hepatic parenchyma as well as in lobular pancreatic structures and confirmed with Sirius Red histopathology. In addition, pancreatic microarchitecture was presented with distortion of islets, and parenchyma, infiltration of inflammatory cells, degeneration, vacuolization, and necrosis of acinar cells and distention of pancreatic ducts. Extent of pancreatic damage and pancreatitis were scored 3.6 ± 0.4(severe) for DBTC-treated in contrast to score 0(normal) in sham-treated animals. The gall bladder became expanded with ductal distention, and occasional bile stones were detected along with microscopic hepatic lesions. DBTC-treated animals developed splenic hypertrophy with increased weight and length(P < 0.01) along with thymic atrophy(P < 0.001). Finally, colitic lesions and colitis were prominent in DBTC-treated animals and scored 3.4 ± 0.3(moderately severe) vs 0(normal) for the sham-treated animals. CONCLUSION: This is the first report of chronic inflammatory multiorgan hepatobiliary pancreatitis, along with fibrosis and calculi formation induced reliably utilizing oral DBTC administration in TNFR1/R2 deficient mice.

Therapeutic plasma exchange and continuous renal replacement therapy for severe hyperthyroidism and multi-organ failure:A case report

BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.

EB病毒感染后瑞氏综合征伴多器官功能障碍的一例重症病例（英文）

A 20-month-old male infant with multiorgan dysfunction after Epstein-Barr virus(EBV)infection developed Reye’s syndrome.He also suffered from acute liver failure,life-threatening cerebral edema,severe disseminated intravascular coagulation(DIC),and myocardial involvement.EBV infection aggravated the progress of Reye’s syndrome,leading to death despite full supportive and symptomatic therapy.This critical case suggested that pediatricians should pay attention to multiorgan involvement of severe EBV infection.

Multiple Organ Dysfunction Syndrome (MODS): Is It Preventable or Inevitable?

Multiple organ dysfunction syndrome (MODS) is a systemic, dysfunctional inflammatory response that requires long intensive care unit (ICU) stay. It is characterized with high mortality rate depending on the number of organs involved. It has been recognized that organ failure does not occur as an all-or-none rule, but rather a range of organ dysfunction exists resulting in clinical organ failure. In the absence of a gold standard scoring or tool for early diagnosis or prediction of MODS, a novel bio-clinical scoring is mandatory. Moreover, understanding the pathophysiology of MODS in medical, surgical and trauma, ICUs should take a priority to achieve a favorable outcome. Herein we reviewed the literatures published in English language through the research engines (MEDLINE, Scopus, and EBASE) from 1982 to 2011 using key words: “multiorgan dysfunction”, “organ failure”, “intensive care units” to highlight the definition, mechanism, diagnosis and prediction of MODS particularly at its earliest stages. Bring up new bio-clinical scoring to a stage where it is ready for field trials will pave the way for implementing new risk-stratification strategy in the intensive care to reduce the morbidity and mortality and save resources. Prospective studies are needed to answer our question and to shift MODS from an inevitable to a preventable disorder.

Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion

BACKGROUND For advanced gastric cancer patients with pancreatic head invasion,some studies have suggested that extended multiorgan resections(EMR)improves survival.However,other reports have shown high rates of morbidity and mortality after EMR.EMR for T4b gastric cancer remains controversial.AIM To evaluate the surgical approach for pT4b gastric cancer with pancreatic head invasion.METHODS A total of 144 consecutive patients with gastric cancer with pancreatic head invasion were surgically treated between 2006 and 2016 at the China National Cancer Center.Gastric cancer was confirmed in 76 patients by postoperative pathology and retrospectively analyzed.The patients were divided into the gastrectomy plus en bloc pancreaticoduodenectomy group(GP group)and gastrectomy alone group(GA group)by comparing the clinicopathological features,surgical outcomes,and prognostic factors of these patients.RESULTS There were 24 patients(16.8%)in the GP group who had significantly larger lesions(P<0.001),a higher incidence of advanced N stage(P=0.030),and less neoadjuvant chemotherapy(P<0.001)than the GA group had.Postoperative morbidity(33.3%vs 15.3%,P=0.128)and mortality(4.2%vs 4.8%,P=1.000)were not significantly different in the GP and GA groups.The overall 3-year survival rate of the patients in the GP group was significantly longer than that in the GA group(47.6%,median 30.3 mo vs 20.4%,median 22.8 mo,P=0.010).Multivariate analysis identified neoadjuvant chemotherapy[hazard ratio(HR)0.290,95%confidence interval(CI):0.103–0.821,P=0.020],linitis plastic(HR 2.614,95%CI:1.024–6.675,P=0.033),surgical margin(HR 0.274,95%CI:0.102–0.738,P=0.010),N stage(HR 3.489,95%CI:1.334–9.120,P=0.011),and postoperative chemoradiotherapy(HR 0.369,95%CI:0.163–0.836,P=0.017)as independent predictors of survival in patients with pT4b gastric cancer and pancreatic head invasion.CONCLUSION Curative resection of the invaded pancreas should be performed to improve survival in selected patients.Invasion of the pancreatic head is not a contraindication for surgery.

Multiorgan retrieval and preservation of the thoracic and abdominal organs in Maastricht III donors

This editorial describes the indications and technical aspects of the simultaneous retrieval of thoracic and abdominal organs in Maastricht III donors as well as the preservation of such organs until their implantation.

Role of epigenetic abnormalities and intervention in obstructive sleep apnea target organs

Obstructive sleep apnea(OSA)is a common condition that has considerable impacts on human health.Epigenetics has become a rapidly developing and exciting area in biology,and it is defined as heritable alterations in gene expression and has regulatory effects on disease progression.However,the published literature that is integrating both of them is not sufficient.The purpose of this article is to explore the relationship between OSA and epigenetics and to offer better diagnostic methods and treatment options.Epigenetic modifications mainly manifest as post-translational modifications in DNA and histone proteins and regulation of non-coding RNAs.Chronic intermittent hypoxia-mediated epigenetic alterations are involved in the progression of OSA and diverse multiorgan injuries,including cardiovascular disease,metabolic disorders,pulmonary hypertension,neural dysfunction,and even tumors.This article provides deeper insights into the disease mechanism of OSA and potential applications of targeted diagnosis,treatment,and prognosis in OSA complications.

Pyogenic liver abscess as initial presentation in locally advanced right colon cancer invading the liver,gallbladder,and duodenum

Locally advanced colorectal cancer complicated with adjacent organic invasion may remain confined to the local area with minimal metastasis.In the present paper,we report on a patient with advanced right colon cancer,including liver,gallbladder,and duodenal invasion behind the scene of liver abscess.En bloc resection was performed on the patient,with right-hemicolectomy,cholecystectomy,partial duodental resection,and hepatectomy.Postoperative management was administered,including nutritional support in the early postoperative period,effective anti-infection treatment,and adjuvant chemotherapy(FOLFOX4).The patient survived for 16 months after the operation.Common clinical manifestations of colorectal cancer were digestive symptoms and changes in defecation.However,the clinical manifestation of locally advanced colon cancer was extremely complicated.Extended or multivisceral resection may offer patients a chance to survive an acute crisis and allow for treatment with adjuvant therapy.