Rhabdomyolysis Advances In Diagnosis And Treatment Pdf
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- 2017, Number 5
- What's to know about rhabdomyolysis?
- Rhabdomyolysis: advances in diagnosis and treatment
- What's to know about rhabdomyolysis?
2017, Number 5
During recent years, we have witnessed many technological advances in electronic publication. The accessibility and wide diffusion of on-line publication will provide the opportunity for our scientific colleagues, not only in Latin America, but throughout the world, to share the knowledge and skills of our Mexican surgical community, as well as to provide authors from other countries with a forum for participating in our Journal, in order that we may gain knowledge of surgical specialties throughout the world.
Manuscripts will be accepted in Spanish and in English, and will be translated to English or Spanish for on-line publication. Guidelines for manuscript submission can be accessed in this website.
We are confident that this evolution in publication will serve the needs of the international community, as well as to provide our Mexican scientists with greater visibility throughout the global community. The Mexican Academy of Surgery is pleased to offer this on-line publication without fees or subscription. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years.
SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. Rhabdomyolysis is defined as skeletal muscle necrosis. Ultrasound assessment has recently become a useful tool for the diagnosis and monitoring of muscle diseases, including rhabdomyolysis.
A case is presented on the ultrasound findings in a patient with rhabdomyolysis.. To highlight the importance of ultrasound as an essential part in the diagnosis in rhabdomyolysis, to describe the ultrasound findings, and review the literature.. A 30 year-old with post-traumatic rhabdomyolysis of both thighs. Ultrasound was performed using a Philips Sparq model with a high-frequency linear transducer 5—10 MHz , in low-dimensional scanning mode 2D , in longitudinal and transverse sections at the level of both thighs.
The images obtained showed disorganisation of the orientation of the muscle fibres, ground glass image, thickening of the muscular fascia, and the presence of anechoic areas.. Ultrasound is a useful tool in the evaluation of rhabdomyolysis.. Rhabdomyolysis is secondary to necrosis of the skeletal muscle, and the resulting release of its structural components into the circulation.
These include electrolytes, myoglobin and sarcolemma proteins creatine kynase, aldolase, lactate dehydrogenase, alanine amino transferase and aspartate aminotransferase. Simultaneously there is major depletion of ATP created by dysfunction of the ionic interchange pumps, which leads to a persistent increase in calcium levels at sarcoplasmic level, continuous contraction of the muscle fibres, activation of protease and phospholipases, destruction of myofibrillar proteins of the cytoskeleton disintegrating the myocyte 1—3 Fig.
The upper part summarises hereditary and acquired causes of rhabdomyolysis. Massive muscle necrosis manifests clinically as myalgia, muscle weakness and pigmentation of urine with no haematuria.
Acute renal injury is the most serious potential complication of rhabdomyolysis, and is considered a marker of poor prognosis. Rhabdomyolysis is a complex entity, for which an appropriate initial approach is essential, as is follow-up monitoring of its progression in order to make correct and timely treatment decisions and avoid the serious associated complications.
Early diagnosis requires high clinical suspicion and the relevant laboratory tests. Magnetic resonance is the best imaging method for diagnosing rhabdomyolysis, due to its high sensitivity and specificity in assessing the muscle. Its disadvantage is the cost, the inherent risks in transferring critically ill patients to the imaging room and time usage. Diagnosis is facilitated because the ultrasound findings, such as muscle disorganisation, are correlated with clinical symptoms and muscle insonation is used to evaluate the day-to-day progress of the rhabdomyolysis patient for purposes of comparison.
The objective of this study is to describe the advantages of ultrasound and its principle findings in the diagnosis and evaluation of rhabdomyolysis. We present the case of a year-old male patient, with no chronic degenerative diseases relevant to his current disease. The disorder started during an abseiling activity, when he was left hanging and only attached at the waist by one harness for approximately 6 h, in an arched position, and his lower limbs were immobilised.
After rescue, he presented pain in his spine, with induration and loss of sensitivity in the pelvic limbs and pigmented urine. A presumptive diagnosis was made of rhabdomyolysis and compartment syndrome of the pelvic limbs, due to the presence of induration of the limbs with loss of sensitivity, with levels up to 5 times higher than the reference CPK level, and with pigmented urine and acute renal function disturbance.
The patient underwent dermofasciectomy of both thighs and was admitted to the intensive care unit. Ultrasound insonation was performed with a Philips Sparq model with a high-frequency linear transducer 5—10 MHz , in low-dimensional scanning mode 2D , in longitudinal and transverse sections at the level of both thighs.
The images obtained were as follows: ground glass-like or cloudy image reduced echogenicity , thickening of muscular fascia Fig. Vascularisation was preserved in the periphery depicted by the external circumflex artery with preserved flow velocities. B Ultrasound image of the left rectus femoris muscle with rhabdomyolysis, showing muscle fascia thickening F , loss of orientation of the muscle fascicles with reduction of echogenicity and anechoic areas E.
Ultrasound image in 2D of the left rectus femoris muscle showing hyperechoic intramuscular areas and disorganised distribution of the muscle fascicles arrows.
The femoral, popliteal and pedal veins and arteries were assessed and flow was not seen to be compromised, which is a relevant finding in this case, since compartment syndrome was ruled out Fig. Rhabdomyolysis is a syndrome caused by necrosis of the skeletal muscle and the resulting release of muscle cell content. Various factors have caused this disorder to present more frequently recently in the hospital environment, 9 with the increasing incidence of severe trauma, medications, and strenuous exercise in patients lacking in physical fitness.
Steeds et al. Shan et al. Su et al. The clinical features observed in these patients were ground glass-like or cloudy image, uneven anechoic areas in the muscular and intramuscular periphery, irregular and heterogeneous muscle fibres; in patients with rhabdomyolysis and compartment syndrome, the striated muscle volume increased and the flow velocity in the distal arteries decreased. Finally, Chiu et al.
The ultrasound scan showed diminished echogenicity, increased muscle thickness and disorganisation of the muscle fibres of the external abductor. In line with the documented evidence, various ultrasound patterns are seen in patients with rhabdomyolysis.
These include, a reverse image where the muscle septa are shown as distended and hypoechoic and the muscle fibres appear relatively hyperechoic with a ground glass-like image, irregular anechoic areas in the muscular and intramuscular periphery, with no signals of blood flow compatible with fluid and loss of muscle integrity in the affected muscle; the latter being the most representative echographic feature of rhabdomyolysis.
Reduced echogenicity can be associated with local inflammation, oedema and bleeding. They are thought to originate from muscle fibre hypercontractility, in the acute phase of the injury. In our case we found the following ultrasound images: 1 reduction in echogenicity ground glass-like or cloudy image , 2 muscular disorganisation; 3 increased diameter of the muscle fascia, 4 intramuscular hyperechoic areas, 5 uneven anechoic areas in the muscular and intramuscular periphery, with no signals of blood flow compatible with oedema, and 6 normal vascularisation with preservation of waves and flow velocities.
The ultrasound findings observed in this report are similar to those reported in the international literature. Ultrasound in rhabdomyolysis and compartment syndrome provides vitally important information for the diagnosis, treatment and follow-up of patients with this disorder.
It is an easy-to-use, technological tool that can be used at the patient's bedside. To date, there are no studies that assess ultrasound as a diagnostic tool for rhabdomyolysis. However, given the scientific evidence, it is positioning itself as a non-invasive procedure to employ in emergencies where early diagnosis is of great importance. It is worth mentioning that this document constitutes the first evidence reported in our environment, highlighting the importance of ultrasound and its findings in rhabdomyolysis.
The authors declare that no experiments were performed on humans or animals for this study. The authors declare that they have followed the protocols of their work center on the publication of patient data. The authors declare that no patient data appear in this article. The authors have no conflict of interests to declare. Cir Cir. ISSN: Follow us:. Previous article Next article.
Issue 6. Pages November - December Download PDF. Corresponding author. Toriello Guerra, C. This item has received. Under a Creative Commons license. Article information. Show more Show less. Background Rhabdomyolysis is defined as skeletal muscle necrosis.
A case is presented on the ultrasound findings in a patient with rhabdomyolysis. Objective To highlight the importance of ultrasound as an essential part in the diagnosis in rhabdomyolysis, to describe the ultrasound findings, and review the literature. Clinical case A 30 year-old with post-traumatic rhabdomyolysis of both thighs.
The images obtained showed disorganisation of the orientation of the muscle fibres, ground glass image, thickening of the muscular fascia, and the presence of anechoic areas.
Conclusions Ultrasound is a useful tool in the evaluation of rhabdomyolysis. Palabras clave:. Background Rhabdomyolysis is secondary to necrosis of the skeletal muscle, and the resulting release of its structural components into the circulation. Figure 1. Figure 2. Figure 3. Figure 4. Rhabdomyolysis: a review of the literature. Neth J Med, 67 , pp. Giannoglou, Y. Chatzizisis, G.
The syndrome of rhabdomyolysis: pathophysiology and diagnosis. Eur J Intern Med, 18 , pp. Med Int Mex, 29 , pp. Bosch, E. Poch, J. N Engl J Med, , pp.
What's to know about rhabdomyolysis?
THE relationship between hypermetabolic exertional stress injuries and malignant hyperthermia MH has been a topic of debate for almost 30 yr. Central to this debate is the idea that some MH susceptible MHS patients may develop awake nonanesthesia-related manifestations similar to that seen in porcine stress syndrome. An individual is identified as MHS if he or she has a well-documented clinical episode consistent with MH during exposure to any of the known anesthetic triggering agents, or if he or she has undergone a skeletal muscle biopsy with a positive diagnostic contracture test. However, none of the published reports of patients who presented first with ER and who were subsequently identified as MHS by a positive contracture test ever developed documented clinical MH episodes involving anesthesia. First, it is the only documented case of an individual who presented first with ER, followed by a clinical MH episode during anesthesia, and then by a positive contracture test. This report provides clinical evidence for an association between ER and MH and discusses the possible role for synergistic action among rare variants in the genes encoding proteins crucial to skeletal muscle calcium regulation. A physically fit, muscular, yr-old, kg African American presented to the emergency department with intense bilateral calf pain after a 2.
Vascular injury is a rare complication of femoral shaft fractures, and rupture of the deep femoral artery is more difficult to diagnose because of its anatomical location and symptoms. Despite its low incidence, deep femoral artery rupture can lead to life-threatening outcomes, such as compartment syndrome, making early identification and diagnosis critical. A year-old male patient was admitted to our hospital due to right lower limb trauma in a car accident, with complaints of severe pain and swelling on his right thigh. X-ray demonstrated a right femoral shaft fracture. During preparation for emergency surgery, his blood pressure and blood oxygen saturation dropped, and sensorimotor function was lost.
Rhabdomyolysis is a common cause of acute kidney injury, featuring muscle pain, weakness and dark urine and concurrent laboratory evidence of elevated muscle enzymes and myoglobinuria. Rhabdomyolysis is often seen in elderly and frail patients following prolonged immobilization, for example after a fall, but a variety of other causes are also well-described. What is unknown to most physicians dealing with such patients is the fascinating history of rhabdomyolysis. Cases of probable rhabdomyolysis have been reported since biblical times and during antiquity, often in the context of poisoning. Equally interesting is the link between rhabdomyolysis and armed conflict during the 20th century. Salient discoveries regarding the pathophysiology, diagnosis and treatment were made during the two world wars and in their aftermath.
daviesscountyarc.org pdf). When the patient arrived, he was alert; heart rate was 89 bpm, rhabdomyolysis is early detection and treatment with aggressive Rhabdomyolysis: advances in diagnosis and treatment.
Rhabdomyolysis: advances in diagnosis and treatment
Rhabdomyolysis is a condition in which skeletal muscle tissue dies, releasing substances into the blood that cause kidney failure. Rhabdomyolysis is usually caused by a specific event. This is most commonly injury, overexertion, infection, drug use, or the use of certain medications. The condition is fairly rare, with roughly 26, new cases in the United States each year. In most cases, the first recommended line of treatment is giving fluids directly through the veins.
It was created in December with the purpose of disseminating scientific information derived from primary and secondary research and presenting cases coming from the practice of Rheumatology in Latin America. Since its foundation, the Journal has been characterized by its plurality with subjects of all rheumatic and osteomuscular pathologies, in the form of original articles, historical articles, economic evaluations, and articles of reflection and education in Medicine. It covers an extensive area of topics ranging from the broad spectrum of the clinical aspects of rheumatology and related areas in autoimmunity both in pediatric and adult pathologies , to aspects of basic sciences.
Rhabdomyolysis is a potentially life-threatening condition caused by a breakdown of skeletal muscle and the release of the intracellular contents into the circulatory system. There are many possible causes, including crush injury, excessive muscular activity, medications, infections, and varied metabolic, connective tissue, rheumatologic, and endocrine disorders.
What's to know about rhabdomyolysis?
Key words:. Update review of the acute porphyrias. Br J Haematol ; 4 Role of genetic testing in the management of patients with inherited porphyria and their families. Ann Clin Biochem ;50 Pt 3 The incidence of inherited porphyrias in Europe. J Inherit Metab Dis ;36 5
During recent years, we have witnessed many technological advances in electronic publication. The accessibility and wide diffusion of on-line publication will provide the opportunity for our scientific colleagues, not only in Latin America, but throughout the world, to share the knowledge and skills of our Mexican surgical community, as well as to provide authors from other countries with a forum for participating in our Journal, in order that we may gain knowledge of surgical specialties throughout the world. Manuscripts will be accepted in Spanish and in English, and will be translated to English or Spanish for on-line publication. Guidelines for manuscript submission can be accessed in this website. We are confident that this evolution in publication will serve the needs of the international community, as well as to provide our Mexican scientists with greater visibility throughout the global community. The Mexican Academy of Surgery is pleased to offer this on-line publication without fees or subscription.
Rhabdomyolysis: advances in diagnosis and treatment. Emerg Med Pract. ;. –15, quiz Address for correspondence to: Qiaoxia Tong, Union Hospital.
Revista Colombiana de Reumatología (English Edition)
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Конечно. Алгоритм, не подающийся грубой силе, никогда не устареет, какими бы мощными ни стали компьютеры, взламывающие шифры. Когда-нибудь он станет мировым стандартом. Сьюзан глубоко вздохнула. - Да поможет нам Бог, - прошептала .