1/27. Acute coagulopathy following infusion of prothrombin complex concentrate.An acute coagulopathy developed in a 49 year old woman with severe liver disease after she received an infusion of prothrombin complex concentrate. The concentrate used in the infusion was subsequently studied by observing the effect of the concentrate on the partial thromboplastin times of various plasmas. The evidence suggests that activated coagulation factors, including activated factor X, were present in the concentrate, and probably played a role in initiating the acute change in the patient's coagulation status. Mechanisms whereby liver disease predisposes toward the development of such a coagulopathy are discussed. It would appear that prothrombin complex concentrates should be used in patients with liver disease only with utmost caution.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/27. Migration of a K-wire from the distal radius to the heart.K-wires and Steinmann pins are used to provide internal fixation for fractures or osteotomies. In some instances, removal of the implant is planned and the implant is left long to facilitate its removal. In other instances, implant removal is not planned and the implant is cut off at the level of the bone. Migration of these implants to solid organs or body cavities has been reported. Extravascular migration may occur along tissue planes assisted by muscle motion. Large vessel penetration can occur and has been reported with subsequent migration of the implant to the heart. This case report documents the loosening of a K-wire used in the distal radius to supplement the fixation of a complex intra-articular fracture, migration of the implant along tissue planes, penetration into a peripheral vein, and continued migration of the implant to the heart. There are multiple reports documenting wandering bullets, venous catheter tips, and invasive monitoring devices in the extremities. This is only the second case report that the authors are aware of that confirms migration of an implant from the distal extremity to the heart.- - - - - - - - - - ranking = 0.16666666666667keywords = complex (Clic here for more details about this article) |
3/27. Multiple primary malignancies in patients with alcoholic liver disease. A report of two cases.Two patients, each with three primary malignant neoplasms are presented. In an effort to identify a possible common denominator of induction of these tumors, it was found that both patients were alcoholics with liver disease, and that both had impaired delayed hypersensitivity reactions. The possibility of an increased susceptibility to cancer among alcoholics with liver disease is noted and the need for careful follow-up of these patients is suggested.- - - - - - - - - - ranking = 0.03069426025277keywords = neoplasm (Clic here for more details about this article) |
4/27. Alcohol abuse: an important cause of severe hyperhomocysteinemia.Alcohol has complex direct effects on homocysteine metabolism, which are incompletely understood, and indirect effects mediated by interactions with vitamin metabolism and other factors. Both transmethylation and transsulfuration pathways are affected. Alcohol abuse is a common cause of hyperhomocysteinemia that often fluctuates and is sometimes severe. The causative role of alcohol in hyperhomocysteinemia is often overlooked by clinicians when evaluating patients and by investigators when conducting surveys. A married couple with severe hyperhomocysteinemia owing to surreptitious alcohol abuse, a case study illustrating many of these issues, is presented. A steep rise in s-adenosylhomocysteine as well as homocysteine levels was demonstrated with increased alcohol ingestion, with a decreased s-adenosylmethionine:s-adenosylhomocysteine ratio. Both patients had severe neurologic symptoms as well as macrocytic red blood cells, which, along with the high homocysteine levels, were misattributed to cobalamin deficiency, in one case despite serum cobalamin levels that were normal.- - - - - - - - - - ranking = 0.16666666666667keywords = complex (Clic here for more details about this article) |
5/27. The MICA Case Conference Program at Tewksbury Hospital, Mass.: an integrated treatment model.This report describes the MICA (Mentally Ill Chemically Abusing) Program at the Tewksbury Hospital campus in Tewksbury, massachusetts. Several campus facilities collaborate in the MICA Program. Through Expert Case Conferences, principles of integrated psychosocial treatment with dual diagnosis patients are demonstrated. An expert clinician focuses on the interplay between psychological pain, characterological traits, defenses, and the patient's drug of choice. patients who have participated in the program have reported positive experiences. The staff reported that the program has resulted in facility improvement in assessment and treatment of complex dual diagnosis patients.- - - - - - - - - - ranking = 0.16666666666667keywords = complex (Clic here for more details about this article) |
6/27. pellagra encephalopathy following B-complex vitamin treatment without niacin.pellagra is caused by nicotinic acid deficiency; it is rarely encountered in developed countries, and it is mainly related to poverty and malnutrition, as well as with chronic alcoholism. We report the case of an alcoholic patient who was diagnosed with pellagra and administered B-complex vitamin tablets that did not contain niacin. A few weeks later, the patient developed nervousness, irritability, insomnia and, consequently, delusional ideas and hallucinations, for which he had to be hospitalized. After his admission, the patient manifested loss of consciousness and myoclonus. All of his symptoms (cutaneous, neurological, and psychiatric) resolved fully with treatment with niacin in combination with other B-complex vitamins. All undiagnosed encephalopathies in alcoholic patients should be treated with multiple vitamin therapy, including nicotinic acid.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
7/27. Irrational fear of AIDS associated with suicidal behavior.This article concerns patients who have an irrational conviction that they have AIDS, despite medical evidence to the contrary, and who, despite medical reassurance, go on to complete suicide or make serious suicide attempts. patients with such irrational convictions often develop this symptom complex in the setting of extramarital affairs and subsequent feelings of guilt and shame. Two case reports are presented, one of completed suicide and one of serious attempted suicide. Both patients were on inpatient chemical dependency wards at the time of their suicidal acts. A comparison is made to syphilophobia. The literature on the irrational fear of AIDS and syphilophobia is reviewed. Although such cases are not common and suicidality among such patients is not common, it is helpful for clinicians to be aware of the potential risk for serious suicidal acts in patients who develop this irrational belief system.- - - - - - - - - - ranking = 0.16666666666667keywords = complex (Clic here for more details about this article) |
8/27. Recurrent rupture of a mycotic ascending aortic aneurysm: a surgical and medical challenge.infection in the vascular tree remains one of the greatest challenges for vascular surgeons. Despite technical advances and newer antibiotics, the morbidity and mortality remain high. The following case report underlines the complex factors encountered in a 62-year-old alcoholic patient presenting with a "classical" history of mycotic aneurysmal disease who suffered from recurrent rupture of the aneurysm of the ascending aorta. In situ reconstruction of the ascending aorta was performed with patch of xenopericardium. As demonstrated in this case, aggressive surgical management and long-term triple antibiotic therapy can salvage patients even with multiple complications in the early postoperative period.- - - - - - - - - - ranking = 0.16666666666667keywords = complex (Clic here for more details about this article) |
9/27. Long-term behavioural changes after unilateral stereotactic cingulotomy in a case of therapy-resistant alcohol dependence.We report the case of a female patient who had undergone a unilateral stereotactical anterior cingulotomy (AC) 20 years previously because of refractory alcohol dependence. After AC, the drinking behaviour switched from a chronic to an episodic one with fast losses of control accompanied by abnormal oral impulse-control behaviour. Relapses were stress- but not cue-induced and followed by long-term intervals of abstinence. In addition to an intended lesion of the left dorsal anterior cingulate cortex (ACC), MR images showed additional lesions within the left caudate body and the dorsal medial thalamic nucleus. Applying a neuropsychological test battery, we found disturbed divided attention and impaired executive function. From this, we conclude that the complex lesion pattern may contribute to some of the behavioural changes seen in our patient after AC. This hypothesis is supported by the neuropsychological deficits and the fact that the neuronal circuits, impaired by the lesions, are involved in addiction-specific behaviour. This case report further emphasizes the key role of the ACC and its connections in the maintenance of dependent behaviour.- - - - - - - - - - ranking = 0.16666666666667keywords = complex (Clic here for more details about this article) |
10/27. Subacute encephalopathy with seizures in alcoholics (SESA syndrome): report of an unusual case.Subacute encephalopathy with seizures in alcoholics (SESA syndrome) is a rare neurologic disorder complicating the chronic abuse of alcohol. This acute or subacute condition is characterized by transient neurologic deficits, seizures and severe lateralized abnormalities on the electroencephalogram (EEG). Our case demonstrates that in SESA syndrome, convulsive (generalized tonic-clonic) and nonconvulsive (complex partial) seizures may coexist.- - - - - - - - - - ranking = 0.16666666666667keywords = complex (Clic here for more details about this article) |
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