1/16. Peripheral arterial occlusion in acute promyelocytic leukemia.A 16-year-old Caucasian teenager developed fatigue, abdominal pain, pneumonia, and subsequently acute vascular occlusion of the left superficial femoral artery. Vascular assessment and heparin therapy lead to bone marrow aspiration and a diagnosis of acute promyelocytic leukemia. Treatment with chemotherapy prevented loss of limb and avoided further vascular surgery. Young patients with acute vascular occlusion require an in-depth assessment including attention to hematological disorders. Clots obtained on thromboembolectomy should be sent for pathological assessment and not discarded, especially in an unusual-age patient for arterial embolus.- - - - - - - - - - ranking = 1keywords = leukemia (Clic here for more details about this article) |
2/16. basilar artery occlusion due to mucormycotic emboli, preceded by acute hydrocephalus.A rare case of brain stem infarction caused by mucormycotic emboli, preceded by acute hydrocephalus, is reported. The patient, who had suffered from leukemia and had undergone bone marrow transplantation several months before, presented initially with seizure and persistent disturbance of consciousness. A head CT scan revealed marked ventricular dilation and diagnosed as acute hydrocephalus. The patient received emergent ventricular drainage. Despite the aggressive treatment, the patient did not survive. autopsy revealed systemic mucormycosis occluding and invading various arteries including basilar artery and its branches, causing fatal brainstem infarction. Although early diagnosis remains difficult in the cases of systemic mucormycosis, prompt initiation of treatment is mandatory; one must have in mind the possibility of presence of fungal infection when treating patients with acute neurological deterioration who have underlying debilitating diseases, even though fungi themselves are hard to detect in most cases.- - - - - - - - - - ranking = 0.2keywords = leukemia (Clic here for more details about this article) |
3/16. Presentation and revascularization outcomes in patients with radiation-induced renal artery stenosis.This study analyzed the initial presentation and revascularization outcomes of patients with radiation-induced renal artery stenosis, a rare complication of therapeutic irradiation. Of 11 patients with renal artery stenosis after irradiation, 7 patients fulfilled the following criteria: normotension before irradiation, radiation dose greater than 25 grays delivered to the renal arteries, associated perirenal radiation-induced lesions, and absence of arterial disease outside the radiation field. The median age at irradiation was 30 years, and the median local irradiation dose was 40 grays. The median time from irradiation to referral was 13 years. All patients were hypertensive at referral, with a median blood pressure (BP) of 171/102 mm Hg and median treatment score of two. The median glomerular filtration rate was 67 mL/min. Two patients had bilateral stenoses and 1 patient had stenosis affecting a single kidney. Stenoses were proximal in 6 patients and truncal in 1 patient, and all had the appearance of atherosclerotic stenosis. Percutaneous transluminal renal artery angioplasty (PTRA) was successful in 5 patients, but required multiple insufflations. PTRA failed in 1 patient, who subsequently underwent an aortorenal bypass. After a median follow-up of 36 months, 2 patients had died of noncardiovascular causes and 4 patients remained hypertensive, with a median BP of 136/85 mm Hg and median treatment score of two. No restenosis occurred, but aneurysms developed at the site of angioplasty in 1 patient. If hypertension occurs even decades after irradiation, a radiation-induced renal artery stenosis should be sought in patients who have undergone abdominal irradiation.- - - - - - - - - - ranking = 812.83164132031keywords = radiation-induced (Clic here for more details about this article) |
4/16. radiation-induced arteriopathy. A report of two cases.radiation is a rare cause of occlusive arterial disease. It can manifest with a variety of symptoms. The pathophysiology of radiation-induced arterial injury has not been clearly elucidated. Surgically correctable cases pose a technical challenge and there appears to be high incidence of late graft infection in areas of irradiated tissue. Two case reports and a brief review of the literature are presented.- - - - - - - - - - ranking = 116.1188059029keywords = radiation-induced (Clic here for more details about this article) |
5/16. ophthalmic artery occlusion secondary to radiation-induced vasculopathy.A 35-year-old man with neurofibromatosis type 1 (NF1) had a left ophthalmic artery occlusion that caused no light perception OS 28 years after having been treated with external beam radiation therapy for a presumed glioma of the right optic nerve and chiasm. Clinical and imaging findings were consistent with radiation-induced cerebral vasculopathy. This ophthalmic complication has never been reported, despite the common occurrence of severe carotid-ophthalmic artery junction stenosis after radiation in NF1 patients. Even though modern radiation techniques limit collateral damage, this modality should be used with discretion in NF1 patients, given the vulnerability of their immature cerebral vasculature to radiation.- - - - - - - - - - ranking = 580.59402951451keywords = radiation-induced (Clic here for more details about this article) |
6/16. Primary stenting of bilateral radiation-induced external iliac stenoses.radiation-induced arteritis is a described rare complication of radiotherapy, particularly in patients with cancer. We report bilateral radiation-induced arteritis leading to stenoses in the external iliac arteries, which was treated with primary percutaneous arterial stenting, and review the current literature on the topic.- - - - - - - - - - ranking = 580.59402951451keywords = radiation-induced (Clic here for more details about this article) |
7/16. Central retinal vein occlusion: a prospective histopathologic study of 29 eyes in 28 cases.The clinical and histopathologic features of 29 eyes from 28 patients with central retinal vein occlusion (CRVO) are reported. A fresh or a recanalized thrombus was observed in each eye. This study considers the temporal aspects of the cases, and it notes the different morphologic features of the occlusion. These observations explain most of the variability of the changes observed in previous reports. We believe these different features representthe various stages in the natural evolution of such a thrombus. The interval between CRVO and histopathologic study in our series ranged from six hours to more than ten years. Local and systemic factors were reviewed and were found to be important in the pathogenesis of thrombus formation. Local diseases with a predisposing effect on CRVO included: glaucoma, papilledema, subdural hemorrhage, optic nerve hemorrhage, and drusen of the optic nerve head. Associated systemic diseases included: hypertension, cardiovascular and cerebrovascular disease, diabetes mellitus, and leukemia with thrombocytopenia. A fresh thrombus in the CRVO was observed in three (10.3%), and a recanalized thrombus in 26 eyes (89.7%). Endothelial-cell proliferation was a conspicuous feature in 14 (48.3%) of the eyes. Chronic inflammation in the area of the thrombus and/or vein wall or perivenular area was observed in 14 (48.3%) of the eyes. Arterial occlusive disease was observed in seven eyes (24.6%). Cystoid macular edema was found in 26 (89.7%) of the eyes.- - - - - - - - - - ranking = 0.2keywords = leukemia (Clic here for more details about this article) |
8/16. Acute myelocytic leukemia with acute aortic occlusion as presenting symptom.In a 42-year-old Caucasian female, acute myelocytic leukemia (M2) presented as occlusion of the distal aorta and right iliac artery. She died after 10 days of respiratory failure. At postmortem examination the aortic wall contained multiple thrombi composed of fibrin and leukemic cells. There was no evidence of diffuse intravascular coagulation. Thromboplastic activity of the blast cells could have played a role in the formation of thrombi in the large vessels of this patient.- - - - - - - - - - ranking = 1keywords = leukemia (Clic here for more details about this article) |
9/16. Percutaneous transluminal angioplasty of nonatherosclerotic lesions.Percutaneous transluminal angioplasty (PTA) was attempted on 16 nonatherosclerotic lesions in 14 patients. dilatation was initially successful in 4/4 cases with renal artery stenosis due to fibromuscular dysplasia (three) and takayasu arteritis (one); all patients became normotensive and remain normotensive on no antihypertensive medications, at up to 12 months follow-up. PTA was technically successful in 4/5 transplant renal artery stenosis; these four patients remain normotensive or almost normotensive on no or markedly reduced antihypertensive medications, at up to 14 months followup. Initial success was obtained in 3/3 lesions involving vascular grafts; in one, the patient became and remained asymptomatic for the remaining 5 months he lived; in another, occlusion of the dilated segment and the graft occurred 8 months after PTA; and in the third, symptoms and signs of the limb ischemia returned within 24 hr of PTA. PTA was initially successful in a patient with recurrent celiac artery stenosis after surgery for median arcuate ligament syndrome; she has remained free of symptoms for 18 months. In a patient with three radiation-induced stenoses, PTA was initially successful; this patient is asymptomatic at 20 months follow-up. The medial type of fibromuscular dysplasia dilates most easily, suggesting a concentric stretching and some shearing of the fibrous tissue, which then heals in its dilated state. Intimal fibroplasia may be eccentric, and concentric stretching during dilatation may not be possible, leading to less satisfactory results. radiation-induced stenosis involves periarterial fibrosis and arterial wall thickening, and the results in PTA of many of these lesions may be less satisfactory than reported here. The responsiveness of graft stenoses will vary with the cause; anastomotic stenoses will probably dilate easily, for they involve either concentric intimal proliferation, or a small degree of periarterial fibrosis; graft stenoses surrounded by dense fibrous tissue may respond initially to PTA, but the long-term results will probably be poor due to recurrent graft constriction.- - - - - - - - - - ranking = 116.1188059029keywords = radiation-induced (Clic here for more details about this article) |
10/16. Acute lymphoblastic leukemia manifested as aortic occlusion.A 36-year-old black man is described who presented with occlusion of the distal aorta and common iliac arteries by thrombus composed of fibrin and leukemic cells. On the basis of a review of the literature, this may be the first report of acute leukemia presenting in this manner.- - - - - - - - - - ranking = 1keywords = leukemia (Clic here for more details about this article) |
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