4FI conference

1
4FI conference

• A 58y/o male patient with POEMS syndrome

Ri???/VS???
2
Brief history(1)

• 58y/o male, with
• DM under OHA
• BPH
• Hypertension
• POEMS syndrome, first diagnosed in 1994/10,
  controlled under regular OPD follow-up

3
Brief history(2)

• Progression of POEMS syndrome
• initial manifestation of weakness and numbness of
  distal parts of four limbs
• Receive regular OPD follow-up? admitted to 5D
  three times, had tried chemotherapy and plasma
  exchange therapy
• 3. In 2005/12, condition worsening? increasing
  dysesthesia rigidity, poor appetite, dizziness,
  nausea, vomiting after food intake, and abdominal
  fullness

4
Brief history(3)

• 2006/01
• CT? gallstones, ascites, and left renal cysts,
• Panendoscopy? GERD congestive gastropathy
• Abdominal echo ? suspect liver cirrhosis
  ascites
• ?paracentesis2
• 2006/05/16? admitted to 12D for rapid
  deterioration of neuropathy

5
Brief history(4)

• In 5D?
• NCV and SSEP?degenerative axonopathy
• Serum eletrophoresis ?IgG1310 mg/dl, IgA320
  mg/dl, IgM77 mg/dl , no monoclonal protein
• Ascites tapping?1000 mL clear yellowish fluid ,
  albumin of 2.3 g/dL, LDH of 122 mg/dL, glucose of
  115 mg/dL
• CSF protein level?120 mg/dL ?plasmapheresis7
  ?muscle power increased significantly

6
Brief history(5)

• In 5D, abdominal echo was performed
• ?hepatosplenomegaly with massive ascites
• ?Laparoscopic wedge resection of liver on
  2006/6/2
• op findings ?
• Massive ascites, 2500ml, yellow clear
• liver ?graish-whitish change
• 3. Reddish fibrin like substance over abdomen
  cavity

7
Brief history(6)

• Post-op in ICU ?
• Hemodynamic unstable, Hb ?11.1 on 6/1, 7.8 on
  6/3
• WBC?, Plt?
• ?continuous blood transfusion
• ?Hb, Plt still drop after PRBC, FFP usage WBC
  level still higher, abdominal fullness occurred
• ?exploratory laparotomy was performed on 06/05
• ?massive ascites 3600cc and diffuse oozing around
  LUQ port site without any active bleeder.

8
Brief history(7)

• Post-op in 4FI ?
• Vital sign ?
• BT36.2, BP144/89, PR120
• Respiratory ?
• 1 ETT intubation , under ventilator support
• -- Mode SIMVPS(8) , RR 21/8 Vt554 PEEP