1/168. 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 = 1keywords = near (Clic here for more details about this article) |
2/168. Acute necrotizing otitis media in an infant: a case report.Acute necrotizing otitis media (ANOM), an uncommon but severe form of bacterial otitis media, frequently causes distressing sequelae if not properly diagnosed and treated. A four-month-old female infant initially became ill with intermittent fever, followed by left facial nerve paralysis and left otorrhea four days later. Microscopic examination of the left ear revealed congestion and swelling of the external ear canal, perforation of the eardrum and erosions on the malleus. culture of pus from the otic lesion grew pseudomonas aeruginosa. The patient's condition did not improve despite systemic administration of antibiotics; thus, surgical intervention was arranged. During the operation, near-total perforation of the eardrum, a dislodged incus, cholesteatoma-like matrix around the stapes, and granulation tissue occupying the middle ear and mastoid cavities were noted. Radical mastoidectomy was conducted and pathologic examination of the surgical specimen disclosed necrotic changes in both soft and bony tissues. The patient recovered soon after surgery. Her fever subsided one day after surgery and the patient was discharged in a stable condition 12 days later. However, she still had left facial nerve paralysis six months later.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/168. Acute pulmonary edema associated with placement of waist-high, custom-fit compression stockings.Compression stockings are a safe, noninvasive treatment for patients with symptomatic orthostatic hypotension due to autonomic nervous system dysfunction. In this report, we describe a 75-year-old man who had development of pulmonary edema approximately 45 minutes after placement of compression stockings on the first postoperative day following a carotid endarterectomy. No sudden changes were noted on an electrocardiogram or echocardiogram or in the cardiac isoenzymes associated with the pulmonary edema. The patient had a history of coronary artery disease, diabetes mellitus-induced autonomic nervous system dysfunction, and recent surgery near the carotid baroreceptor. All these factors may have limited his ability to compensate for a rapid increase in central blood volume. The temporal relationship of the patient's respiratory distress to the placement of the compression stockings, in the absence of laboratory findings of primary cardiac dysfunction, make stocking-related fluid shift the likely precipitating event in the formation of acute pulmonary edema. This case suggests that compression stockings should be used with caution in patients with limited cardiac reserve.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/168. Acute orbital compartment syndrome after lateral blow-out fracture effectively relieved by lateral cantholysis.PURPOSE: To report the observation of an acute traumatic orbital compartment syndrome in an 80-year-old man. methods: Lateral canthotomy and cantholysis. Computed x-ray tomography. RESULTS: Unilateral proptosis, blindness, a frozen globe and a dilated pupil developed within one hour after a blunt trauma to the left orbital region. Surgery two hours later resulted in normal orbital tension and near-complete recovery of functions. An orbital hematoma was found overlying a lateral blow-out fracture. CONCLUSION: Under favorable conditions, the orbital compartment syndrome can be effectively relieved by lateral canthotomy and cantholysis. The present and previous reports suggest that two hours of orbital ischemia is near the critical time limit for recovery of full visual function.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
5/168. Acute sacroiliitis as a manifestation of calcium pyrophosphate dihydrate crystal deposition disease.While radiographic lesions of the sacroiliac joint (SIJ) are common in patients with calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, they are rarely accompanied by clinical symptoms. We report the case of a 69-year-old woman who presented with an acute sacoiliitis and a linear calcification in the right SIJ on CT scan. The patient recovered well after intra-articular steroid injections.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/168. kerosene-induced severe acute respiratory failure in near drowning: reports on four cases and review of the literature.OBJECTIVE: The purpose of this study is to present an unusual respiratory and cardiovascular course after intoxication and near drowning in a river contaminated with kerosene. DESIGN: case reports and review of the literature. SETTING: intensive care unit of a university-affiliated hospital. patients: Four patients after near drowning. INTERVENTION: Supportive only. RESULTS: The four patients developed acute respiratory failure. Cardiomyopathy was present in three patients and a persistent hypokalemia in two patients. The onset of the symptoms was delayed, which led to underestimation of the severity of their illness. Two of the four patients died. The diagnosis of hydrocarbon intoxication was based on bronchoalveolar lavage results, neutrophilic alveolitis with the presence of lipid-laden macrophages, and evidence of lipoid pneumonia from the autopsy performed on one victim. One patient who clinically deteriorated and another who developed a severe restrictive pulmonary disorder were treated with corticosteroids, which were effective only in the latter patient. CONCLUSIONS: Acute kerosene intoxication in a near-drowning event often results in severe respiratory and cardiac failure, with a high fatality rate. Treatment with corticosteroids may lead to a rapid improvement in lung function.- - - - - - - - - - ranking = 7keywords = near (Clic here for more details about this article) |
7/168. Use of mechanical thrombolysis via microballoon percutaneous transluminal angioplasty for the treatment of acute dural sinus thrombosis: case presentation and technical report.OBJECTIVE AND IMPORTANCE: Although conventional superselective chemical thrombolysis is frequently successful for the treatment of severe acute dural sinus thrombosis, the technique has limitations and risks. This prompted us to develop a supplemental technique for achieving more rapid recanalization, using coronary microballoon percutaneous transluminal angioplasty catheters. We describe a successful application of this technique and technology that has not been previously reported. CLINICAL PRESENTATION: After several days of severe headaches, photophobia, and vomiting, a 29-year-old woman presented with rapidly progressive neurological deficits secondary to complete occlusion of the superior sagittal sinus (SSS) and right transverse/sigmoid sinus complex. Owing to her rapid neurological decline, she was referred for emergency endovascular intervention. TECHNIQUE: Initially, superselective chemical thrombolysis of the SSS was performed using urokinase. However, because of the extensive nature of the thrombus and lack of initial therapeutic response, we elected to attempt mechanical thrombolysis with various coronary percutaneous transluminal angioplasty microballoon catheters. This was accomplished by initial coaxial positioning of the device into an occluded segment, followed by gentle inflation and retraction of the device along the course of the right transverse sinus and/or SSS. These maneuvers were repeated with balloons of increasingly large diameter. Near-complete restoration of venous outflow was obtained within the SSS with preferential runoff into the left transverse sinus. The right transverse sinus was only partially recanalized. Despite the patient's rapid neurological decline on presentation, she experienced a dramatic clinical recovery with near-complete reversal of neurological deficits within 24 hours of intervention. CONCLUSION: This report shows the feasibility of performing safe and effective mechanical thrombolysis with percutaneous transluminal angioplasty coronary balloon microcatheters within the major dural sinuses. This technique can probably accelerate clot disruption and thrombolysis, possibly resulting in a more rapid restoration of venous flow.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/168. MRI-induced retrocalcaneal bursitis.This case report describes a patient with acute retrocalcaneal bursitis, which developed after MRI examination of the ankle. The sagittal T2*-weighted gradient echo sequence revealed an extensive susceptibility artifact in the area surrounding the achilles tendon near its insertion at the os calcis. This artifact was caused by postsurgical metallic particles. We postulate that these particles were mechanically stimulated by the magnetic field and induced the inflammatory response.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/168. Enlargement of ulcer-like projections after repair of acute type A aortic dissection.We treated two cases of enlargement of ulcer-like projections in the descending thoracic aorta, which were recognized after emergency graft replacement from the ascending aorta to the aortic arch for acute type A aortic dissection. The intimal tear, which was near the left subclavian artery, was resected during the initial operation. Graft replacement of the descending thoracic aorta was successful.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
10/168. Near-tetraploid minimally differentiated acute myeloid leukemia with extensive erythrophagocytosis by leukemic blasts.Numerical change of chromosomes is common in acute myeloid leukemia (AML). However, a chromosome number as high as near-tetraploidy is very rare, especially in minimally differentiated AML (AML-M0). Erythrophagocytosis by reactive or malignant histiocytes is common in malignant hematological diseases; however, erythrophagocytosis by leukemic blasts is also very rare, especially in AML-M0. We report here the first case of AML-M0 with both of these unique characteristics: a near-tetraploid karyotype and erythrophagocytosis by leukemic blasts.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
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