1/23. Cerebral bacterial aneurysms in subacute bacterial endocarditis.Bacterial aneurysms are aneurysms which develop on a vascular wall weakened as a result of a bacterial infection. They can develop anywhere. This paper describes a female patient with subacute bacterial endocarditis and multiple cerebral aneurysms. Conservative treatment followed.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/23. Efficacy of long-term antibiotic suppressive therapy in proven or suspected infected abdominal aortic grafts.We have reviewed our experience of long-term antibiotic suppressive therapy in patients who underwent repair of an abdominal aortic aneurysm (AAA) and developed proven or strongly suspected infection of a graft. Five patients with abdominal aortic repair complicated by proven or suspected graft infections were treated with continuing antibiotic suppressive therapy based on microbiology culture reports. Two patients developed infection of an established graft, two patients had a graft inserted into an infected area and one patient was thought to be at high risk of developing infection of a recently placed graft. All patients had severe co-existent medical problems and were considered too ill to tolerate further definitive surgery. Response to therapy was monitored by absence of symptoms, fever, inflammatory markers and survival. All patients are alive with a median survival of 32 months, the longest having survived for 6 years. In selected patients with abdominal aortic graft infections, indefinite antibiotic suppressive therapy may be an acceptable alternative to further surgery.- - - - - - - - - - ranking = 0.14285714285714keywords = aneurysm (Clic here for more details about this article) |
3/23. Experience with infected aneurysms of the abdominal aorta.Seventeen consecutive patients with abdominal aortic aneurysms were treated during a 14-year period. Fever was the most common symptom first to appear (12 patients), either as fever of unknown origin or in association with other symptoms. Several factors raise the suspicion of an infected aneurysm: positive blood cultures, erosion of lumbar vertebrae, lack of aortic calcification, aneurysms found in female patients or after a prolonged illness of bacteremia. Staphylococci (41%) and salmonella (18%) were the most common organisms. Aneurysms with Gram negative organisms exhibited a greater tendency toward early rupture than those with Gram-positive organisms (84% vs 10%), and were associated with a higher mortality. Delay in making the diagnosis adversely affected the death rate. "Infected aneurysm" is suggested as a better term than "mycotic aneurysm," since fungi are rarely involved.- - - - - - - - - - ranking = 1.478635279349keywords = mycotic aneurysm, aneurysm (Clic here for more details about this article) |
4/23. Umbilical artery catheter use complicated by pseudoaneurysm of the aorta.We report a case of a large aortic mycotic pseudoaneurysm in a premature infant, a rare but serious complication associated with sepsis and umbilical artery catheter (UAC) use. Sonography is an appropriate first-line imaging modality for detection of aortic pseudoaneurysms. Increased awareness of this rare complication may lead to earlier diagnosis in the high-risk premature infant with a history of a UAC and sepsis.- - - - - - - - - - ranking = 0.85714285714286keywords = aneurysm (Clic here for more details about this article) |
5/23. Awake craniotomy for microsurgical obliteration of mycotic aneurysms: technical report of three cases.OBJECTIVE AND IMPORTANCE: Infectious (mycotic) aneurysms that do not resolve with medical treatment require surgical obliteration, usually requiring sacrifice of the parent artery. In addition, patients with mycotic aneurysms frequently need subsequent cardiac valve repair, which often necessitates anticoagulation. Three cases of awake craniotomy for microsurgical clipping of mycotic aneurysms are presented. Awake minimally invasive craniotomy using frameless stereotactic guidance on the basis of computed tomographic angiography enables temporary occlusion of the parent artery with neurological assessment before obliteration of the aneurysm. CLINICAL PRESENTATION: A 56-year-old woman presented with progressively worsening mitral valve disease and a history of subacute bacterial endocarditis and subarachnoid hemorrhage 30 years previously. A cerebral angiogram revealed a 4-mm left middle cerebral artery (MCA) angular branch aneurysm, which required obliteration before mitral valve replacement. The second patient, a 64-year-old woman with a history of rheumatic fever, had an 8-mm right distal MCA aneurysm diagnosed in the setting of pulmonary abscess and worsening cardiac function as a result of mitral valve disease. The third patient, a 57-year-old man with a history of fevers, night sweats, and progressive mitral valve disease, had an enlarging left MCA angular branch aneurysm despite the administration of antibiotics. Because of their location on distal MCA branches, none of the aneurysms were amenable to preoperative test balloon occlusion. INTERVENTION: After undergoing stereotactic computed tomographic angiography with fiducial markers, the patients underwent a minimally invasive awake craniotomy with frameless stereotactic navigation. In all cases, the results of the neurological examination were unchanged during temporary parent artery occlusion and the aneurysms were successfully obliterated. CONCLUSION: Awake minimally invasive craniotomy for an infectious aneurysm located in eloquent brain enables awake testing before permanent clipping or vessel sacrifice. Combining frameless stereotactic navigation with computed tomographic angiography allowed us to perform the operation quickly through a small craniotomy with minimal exploration.- - - - - - - - - - ranking = 3.1575259618081keywords = mycotic aneurysm, aneurysm (Clic here for more details about this article) |
6/23. Septic complications after cardiac catheterization and percutaneous transluminal coronary angioplasty.Septic complications after cardiac catheterization and percutaneous transluminal coronary artery angioplasty are distinctly uncommon. However, we have recently treated nine patients with sepsis and life-threatening complications after cardiac catheterization alone or after catheterization and subsequent percutaneous transluminal coronary angioplasty. The common denominator in all patients was either repeat puncturing of the ipsilateral femoral artery or leaving the femoral artery sheath in for 1 to 5 days after the procedure. Two patients died as a direct result of their septic complications. One death occurred in a patient in whom bacterial endocarditis with congestive heart failure developed, and the other patient had a large retroperitoneal hematoma that became secondarily infected. Infected aneurysms that were successfully treated developed in three patients. Our study suggests that colonization of the needle tract by skin flora predisposes to septic complications if repeat arterial punctures are required or if a femoral artery sheath is left in place for more than 24 hours. patients in whom sepsis develops after these procedures should be initially treated with antibiotics effective against gram-positive organisms. CT scanning or angiography should be considered for patients with persistent sepsis, septic emboli, and abdominal or flank pain. Infected aneurysms require resection or ligation because of the propensity of these aneurysms to rupture.- - - - - - - - - - ranking = 0.42857142857143keywords = aneurysm (Clic here for more details about this article) |
7/23. Impending rupture of nonaneurysmal bacterial aortitis: CT diagnosis.The CT appearance of mycotic abdominal aortic aneurysms leading to eventual rupture has been well described. On the other hand, ruptured nonaneurysmal bacterial aortitis has not been demonstrated in the CT literature. We present two cases with subsequent rupture documented on CT. The characteristic findings of periaortic density and adjacent gas collection should suggest the diagnosis of acute aortic infection. This may herald impending rupture, even in the absence of aneurysmal dilatation, and should direct therapy accordingly.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
8/23. Post-cannulation radial artery aneurysm--a rare complication.The following case report describes an expanding aneurysmal dilatation of the radial artery which developed 17 days following cannulation. Possible causes of this complication are: abnormal state of the vessel wall, multiple attempts at cannulation, and haematoma or infection at cannulation site. Other major and minor sequelae following arterial cannulation are reviewed.- - - - - - - - - - ranking = 0.71428571428571keywords = aneurysm (Clic here for more details about this article) |
9/23. The role of serial angiography in the management of bacterial and fungal intracranial aneurysms--report of two cases and review of the literature.The authors review 149 cases of bacterial and mycotic intracranial aneurysms reported since 1957 and describe two cases of bacterial aneurysms managed in their institution. The overall mortality rate was 39%. Bacterial aneurysms accounted for 0.49-4.3% of all intracranial aneurysms. Among the reported cases, the mortality rate for patients treated with antibiotics alone was high, whereas it was low among those who underwent elective surgery. The authors conclude the following: 1) Distal aneurysms should be treated with high-dose antibiotics and followed with serial cerebral angiography at 7 days, 14 days, 1 month, 3 months, and 1 year after the initiation of therapy; 2) proximal aneurysms should be treated with high-dose antibiotics, and surgery is rarely indicated; 3) any significant associated hematoma should be evacuated and the aneurysm resected, if possible; and 4) if serial angiography shows enlargement of an aneurysm, surgery should be considered. The clinical features and management of mycotic and bacterial aneurysms are discussed in detail.- - - - - - - - - - ranking = 1.8571428571429keywords = aneurysm (Clic here for more details about this article) |
10/23. Aneurysms of the abdominal aorta in the neonate and infant.We report a case of aneurysm of the infrarenal abdominal aorta from septic umbilical artery catheterization in a one-month old female infant. In spite of spontaneous thrombosis, the patient's course was uneventful. During the five-year follow-up period no further complications developed and operation was not required. Aneurysms of the aorta are rare in the very young and the infrarenal location is rarer. Sixteen other cases published in the literature are reviewed. Etiologic considerations and therapeutic modalities are discussed.- - - - - - - - - - ranking = 0.14285714285714keywords = aneurysm (Clic here for more details about this article) |
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