A Rare Case of Ruptured Infrarenal Aortic Aneurysm Infected with <i>Haemophilus influenzae</i> Type B
Notice bibliographique
Résumé
CASE PRESENTATION A 56-year old woman presented to the emergency department with a vague history of abdominal pain that had persisted for five days. A long-standing smoker, she was otherwise healthy with no previously diagnosed chronic medical conditions, and had no recent exposure to any sick contacts; she did admit to having a short episode of an upper respiratory tract infection two weeks previously that self-resolved. There was also no recent history of travel. On examination, she was tachycardic (110 beats/min to 115 beats/min), hypertensive (169/110 mmHg) and afebrile, and had a soft but tender abdomen. White blood cell count was in the 20×109/L range. Computed tomography (CT) angiography of the abdomen and pelvis revealed a 4 cm infrarenal aortic aneurysm extending to the aortic bifurcation with an associated 6.4 cm × 10 cm periaortic hematoma suggestive of rupture (Figure 1). The renal arteries and visceral vessels displayed mild atheromatous changes; other intra-abdominal structures were unremarkable. The patient’s relatively young age and female sex, coupled with the relatively small size and inflammatory appearance of the ruptured aneurysm on CT scan, were highly suggestive of a mycotic aneurysm. Blood cultures were drawn and ciprofloxacin and cefazolin were initiated. The patient was brought to the operating room for emergent open repair through a midline transperitoneal approach. Intraoperatively, note was made of an edematous retroperitoneum and an adherent duodenum. There were significant inflammatory changes in the aorta, extending distally into the iliac arteries. The periaortic fluid was noted to be nonpurulent; a sample of this was sent for Gram stain, and was reported as “moderate polymorphs with no organisms seen”. Given these nonspecific findings, the aneurysm was repaired with an in situ aorto-bi-iliac 12 mm × 7 mm Hemashield graft. The patient was then transferred to the intensive care unit (ICU) for postoperative care and continued on ciprofloxacin and cefazolin. Recovery was complicated, however, with acute occlusion of the graft. The patient underwent a second surgery with extensive thrombectomy of both limbs of the graft, as well as a left iliofemoral bypass due to consistently poor flow. The patient continued to decline, requiring increasing pressors to maintain hemodynamics. Antibiotics were broadened to include meropenem, vancomycin and fluconazole to treat her sepsis, despite negative blood cultures drawn at the time of the initial presentation. Additional complications included the need for hemodialysis for renal failure.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».