1/1356. Severe panarteritis associated with drug abuse.A case of panarteritis with purpura fulminans, mononeuritis multiplex, gastrointestinal manifestation and presumably cardiac involvement in a previously healthy 22-year-old man with a history of drug abuse including cocaine, cannabinoids and methamphetamines is described. Histopathological examination of the gut led to the diagnosis of panarteritis without immune deposits. Antineutrophil antibodies were negative. Besides the drugs, no other possible cause of vasculitis was found. The patient recovered completely after 1 year. Drug abuse is a thus possible cause of severe extracerebral disabling vasculitis.- - - - - - - - - - ranking = 1keywords = cardiac (Clic here for more details about this article) |
2/1356. Carotid endarterectomy and intracranial thrombolysis: simultaneous and staged procedures in ischemic stroke.PURPOSE: The feasibility and safety of combining carotid surgery and thrombolysis for occlusions of the internal carotid artery (ICA) and the middle cerebral artery (MCA), either as a simultaneous or as a staged procedure in acute ischemic strokes, was studied. methods: A nonrandomized clinical pilot study, which included patients who had severe hemispheric carotid-related ischemic strokes and acute occlusions of the MCA, was performed between January 1994 and January 1998. Exclusion criteria were cerebral coma and major infarction established by means of cerebral computed tomography scan. Clinical outcome was assessed with the modified Rankin scale. RESULTS: Carotid reconstruction and thrombolysis was performed in 14 of 845 patients (1.7%). The ICA was occluded in 11 patients; occlusions of the MCA (mainstem/major branches/distal branch) or the anterior cerebral artery (ACA) were found in 14 patients. In three of the 14 patients, thrombolysis was performed first, followed by carotid enarterectomy (CEA) after clinical improvement (6 to 21 days). In 11 of 14 patients, 0.15 to 1 mIU urokinase was administered intraoperatively, ie, emergency CEA for acute ischemic stroke (n = 5) or surgical reexploration after elective CEA complicated by perioperative intracerebral embolism (n = 6). Thirteen of 14 intracranial embolic occlusions and 10 of 11 ICA occlusions were recanalized successfully (confirmed with angiography or transcranial Doppler studies). Four patients recovered completely (Rankin 0), six patients sustained a minor stroke (Rankin 2/3), two patients had a major stroke (Rankin 4/5), and two patients died. In one patient, hemorrhagic transformation of an ischemic infarction was detectable postoperatively. CONCLUSION: Combining carotid surgery with thrombolysis (simultaneous or staged procedure) offers a new therapeutic approach in the emergency management of an acute carotid-related stroke. Its efficacy should be evaluated in interdisciplinary studies.- - - - - - - - - - ranking = 16.69844778915keywords = infarction (Clic here for more details about this article) |
3/1356. prognosis of acute poststreptococcal glomerulonephritis in childhood: prospective study and review of the literature.Serial, clinical, clinicopathologic and histologic studies performed simultaneously following onset of PS-AGN in children for a period of up to 144 months revealed no evidence of progression to chronic glomerulonephritis. Although acute morphologic changes were more severe in renal tissue obtained from patients with AGN following streptococcal upper respiratory infection than following pyoderma, the acute manifestations in both groups subsided 6 to 12 weeks after onset. Cumulative morphologic healing occurred in 20% of patients at 24 months, in 43% at 48 months after onset of PS-AGN; 1 patient who was unhealed at 49 months was lost to follow-up. In 2 patients (6%), acute histologic exacerbations without clinical signs occurred within 24 months after onset. Subsequent healing was documented histologically. Addis counts remained abnormal in a high percentage of patients throughout the 12 years of observation and did not correlate with the histologic findings of renal biopsy tissue. The occasional demonstration of renal vascular disease and/or hypertension may merely reflect the early development of spontaneous essential hypertension although the possibility of a relationship to the previous attack of PS-AGN is intriguing. This question cannot be answered at this time. Renal biopsy studies are more dependable than Addis counts in assessing the course of PS-AGN. The significance of persistence of immunofluorescent and/or electron microscopic changes (subepithelial dense deposits) many years after onset in 58% of 12 patients studied, at a time when a majority of patients (84%) revealed healing by light microscopy, remains to be assessed.- - - - - - - - - - ranking = 2.79240731341keywords = attack (Clic here for more details about this article) |
4/1356. Postpartum onset of acute heart failure possibly due to postpartum autoimmune myocarditis. A report of three cases.autoimmune diseases, especially autoimmune thyroid disease, frequently develop after delivery due to the immune rebound mechanism. Most cases have transient dysfunction of affected organs. Cardiac dysfunction developed after delivery is called postpartum or peripartum cardiomyopathy. However, the aetiology of the disease is not clarified yet. Here we report three cases that developed acute heart failure in the postpartum period. One was complicated with an atrioventricular block and postpartum autoimmune thyroiditis. All patients recovered to normal cardiac function or pre-attack condition after 1 month of therapy with conventional drugs and bed rest. All three had positive antiheart antibody detected by indirect immunofluorescence assay, and one had antibody to heart myosin detected by enzyme-linked immunosorbent assay. Moreover, one of two patients examined revealed lymphocytic infiltration by endomyocardial biopsy. antibodies to 26 viruses were not elevated significantly during the first 2 weeks after admission in any case. It is strongly suggested that heart failure is induced by postpartum autoimmune myocarditis, and thus clinicians should be aware of this disease.- - - - - - - - - - ranking = 7.8366455614448keywords = attack, cardiac, heart (Clic here for more details about this article) |
5/1356. Atrial tamponade causing acute ischemic hepatic injury after cardiac surgery.A patient developed late cardiac tamponade after aortic valve replacement and coronary artery bypass grafting. nausea and dramatic elevations of serum aminotransferases were the initial clinical manifestations of cardiac tamponade. Severe acute ischemic hepatic injury secondary to isolated compression of both atrial cavities by two loculated thrombi was diagnosed.- - - - - - - - - - ranking = 6keywords = cardiac (Clic here for more details about this article) |
6/1356. Intrapericardial yolk sac tumor associated with acute myocarditis.An occult intrapericardial yolk sac tumor occurred in a 3-year-old girl with a fatal outcome. At autopsy, a 5.5-cm mass surrounded the base of the heart and compressed the left atrium posteriorly. Histologically, the tumor was a pure yolk sac tumor. Postmortem chemical analyses of the blood revealed an alpha-fetoprotein level greater than 7000 microg/L. Acute myocarditis of both ventricles was also found.- - - - - - - - - - ranking = 0.50552978100435keywords = heart (Clic here for more details about this article) |
7/1356. Postoperative pulmonary edema.BACKGROUND: Noncardiogenic pulmonary edema may be caused by upper airway obstruction due to laryngospasm after general anesthesia. This syndrome of "negative pressure pulmonary edema" is apparently well known among anesthesiologists but not by other medical specialists. methods: We reviewed the cases of seven patients who had acute pulmonary edema postoperatively. RESULTS: There was no evidence of fluid overload or occult cardiac disease, but upper airway obstruction was the most common etiology. Each patient responded quickly to therapy without complications. CONCLUSIONS: Of the seven patients with noncardiogenic postoperative pulmonary edema, at least three cases were associated with documented laryngospasm causing upper airway obstruction. This phenomenon has been reported infrequently in the medical literature and may be underdiagnosed. Immediate recognition and treatment of this syndrome are important. The prognosis for complete recovery is excellent.- - - - - - - - - - ranking = 1keywords = cardiac (Clic here for more details about this article) |
8/1356. Ventricular rhythms in acute myocardial infarction.Ectopic ventricular activity in acute myocardial infarction is considered to be benign if it is slow and regular (accelerated idioventricular rhythm), but ominous when rapid (ventricular tachycardia). However, it has been observed in an increasing number of reports that these two types may coexist in the same patient, altering thereby the clinical significance of both. In the present study electrocardiograms were analyzed of 55 patients hospitalized for acute myocardial infarction, in whom idioventricular rhythm occurred. It was found that three major types of ventricular rhythms could be identified: a regular-stable rhythm, an irregularunstable one, and a third variant which was a combination of these two types. The stable ventricular rhythm was self limited and harmless. The unstable and combined types which were characterized by random coupling times and varying interbeat intervals, were frequently associated with re-entrant beats and fast ventricular rates and therefore a potentially ominous prognosis. It is suggested that the Ca dependent slow diastolic depolarization may be the mechanism responsible for the unstable ventricular rhythm, and the reasons for this assumption are discussed. A therapeutic approach based on the above considerations is described.- - - - - - - - - - ranking = 379.83050053114keywords = myocardial infarction, infarction (Clic here for more details about this article) |
9/1356. Observations on the treatment of dissection of the aorta.The results are presented of treatment in twenty-three patients with dissection of the thoracic aorta, in four of whom it was acute (less than 14 days' duration), and in nineteen chronic (more than 14 days' duration). Sixteen patients had Type I and II dissection (involving the ascending aorta) and five Type III (descending aorta at or distal to the origin of the left subclavian artery); in two, dissection complicated coarctation of the aorta in the usual site. Thirteen patients had aortic regurgitation. Three of the patients with acute dissection were treated medically; two, both with Type I dissection, died, and the third, with Type III, survived. The remaining acute patient was treated surgically and also died. Of the patients with chronic dissection, eight were treated medically and eleven surgically. None of the medical group died in hospital; three died between 3 months and 1 year, and five have survived from periods of 12-72 months. Eleven patients with chronic dissection were treated surgically; four died in hospital at or shortly after operation; and the remaining seven lived for periods of 12-84 months. The presentation, indications for surgical treatment and results are discussed. It is concluded that surgical treatment of chronic dissection may carry a higher initial mortality than medical, but that there may be slightly better overall long term results in the former. As this series was not selected randomly, because patients with complications were selected for surgery, and there are only a few patients in each group, the results do not permit firm conclusion regarding the relative merits of medical and surgical treatment. It is suggested that all patients should initially be treated medically but that surgical treatment should be considered if the dissection continues, if aortic regurgitation is severe, if an aneurysm develops or enlarges, if cardiac tamponade develops or there is evidence of progressive involvement of the branches of the aorta. attention is drawn to the important syndrome of chronic dissecting aneurysm of the ascending aorta with severe aortic regurgitation which requires definitive surgical treatment and aortic valve replacement. The importance of adequate visualization of the origin and extent of the dissection as a preliminary to surgical treatment is stressed.- - - - - - - - - - ranking = 1keywords = cardiac (Clic here for more details about this article) |
10/1356. Acute embolic carotid occlusion after cardiac catheterization: effect of local intra-arterial urokinase thrombolysis.A 64-year-old woman developed a severe embolic cerebral attack with total left hemiplegia approximately 30 hours after cardiac catheterization for mitral stenosis. She underwent intra-arterial thrombolysis of the right internal carotid artery four and one-half hours after the onset of neurologic deficit with subsequent recanalization of the occluded vessel and near complete neurologic recovery.- - - - - - - - - - ranking = 7.79240731341keywords = attack, cardiac (Clic here for more details about this article) |
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