1/62. ovarian cysts in childhood.This is a review of cases of ovarian cyst encountered in childhood in the Manchester children's hospitals. The patients presented with acute or recurrent abdominal pain or an abdominal or pelvic mass. The commonest cyst found was a teratoma, which was discovered because of its size or because of a complication. All but one of the girls with teratomas had not reached puberty. After puberty the cysts were follicular or luteal in type, although there was one case of cystadenoma. Complications in the form of torsion, rupture which haemoperitoneum or haemorrhage into the cyst were common. Treatment consisted of ovarian cystectomy, oophorectomy or salpingo-oophorectomy, and the results were satisfactory.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/62. Emergency and elective surgical treatment of portal hypertension. A review of 23 years' experience.A retrospective review of surgical treatment for portal hypertension during a 23-year period in a regional unit is reported and the immediate and subsequent management of patients with bleeding oesophageal varices is discussed. Fifty-four patients with recurrent varix haemorrhage uncontrolled by conservative methods have been treated by oesophageal transection with a mortality of 22.2% (26.6% for cirrhotic patients). Thirty-two per cent of the cirrhotics were alive after 2 years. Only a minority (12%) of the survivors were considered suitable for a subsequent shunt procedure. Therapeutic portacaval anastomosis has been performed on 65 patients with a 51.2% 5-year survival (43-5% for cirrhotic patients). Further haemorrhage due to shunt thrombosis occurred in 5-3% of cases. The frequent occurrence of portal-systemic encephalopathy, increasing with duration of time following a shunt, is emphasized. The high morbidity and mortality in the poor-risk cirrhotic indicated that this type of patient is unsuitable for a portal-systemic shunt and is better treated by medical means.- - - - - - - - - - ranking = 2keywords = haemorrhage (Clic here for more details about this article) |
3/62. Ambulance transport of obstetric emergencies.Ninety-eight patient records from obstetric flying squad calls were reviewed. The reasons for call-out and the effect of transport on maternal and foetal cardiovascular parameters were analysed. The main reason for calling the flying squad is now antepartum haemorrhage. Transporting the patient to hospital has little effect on the cardiovascular state.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
4/62. Paradoxical embolism-report of a case involving four organ systems.Paradoxical embolism through a patent foramen ovale (PFO) can involve multiple organs simultaneously. The most commonly involved sites are the cerebrum and the extremities. Paradoxical embolism to coronary arteries or upper extremities is relatively uncommon. We report a case of acute pulmonary embolism and paradoxical embolism through a patent foramen ovale involving the left upper extremity, brain, and coronary artery. early diagnosis in the emergency department was made by a trans-esophageal echocardiogram, and the patient was successfully treated with intravenous t-PA and heparin. patients with acute pulmonary embolism or deep venous thrombosis who also develop signs of systemic embolism should be evaluated for a patent foramen ovale.- - - - - - - - - - ranking = 0.00038020456539276keywords = brain (Clic here for more details about this article) |
5/62. Tardive dystonia of the larynx in a quadriplegic patient: an unusual cause of stridor.We describe a case of a quadriplegic brain-damaged man with severe upper airway obstruction. A diagnosis of tardive dystonia affecting the vocal folds was made and confirmed by flexible nasopharyngoscopy. Emergency tracheotomy was required. The tardive movement disorder resolved with discontinuation of thioridazine. This case serves to heighten awareness of potentially serious airway complications associated with the use of anti-psychotics and anti-emetics particularly in those with organic brain disease.- - - - - - - - - - ranking = 0.00076040913078553keywords = brain (Clic here for more details about this article) |
6/62. Unusual arachnoid cyst of the quadrigeminal cistern in an adult presenting with apneic spells and normal pressure hydrocephalus--case report.A 67-year-old woman was admitted to our clinic with symptoms of normal pressure hydrocephalus, lower cranial nerve pareses, and pyramidal and cerebellar signs associated with respiratory disturbances. Computed tomography (CT) and magnetic resonance imaging revealed a 4.7 x 5.4 cm quadrigeminal arachnoid cyst causing severe compression of the tectum and entire brain stem, aqueduct, and cerebellum, associated with moderate dilation of the third and lateral ventricles. Emergency surgery was undertaken due to sudden loss of consciousness and impaired breathing. The cyst was totally removed by midline suboccipital craniotomy in the prone position. Postoperatively, her symptoms improved except for the ataxia and impaired breathing. She was monitored cautiously for over 15 days. CT at discharge on the 18th postoperative day revealed decreased cyst size to 3.9 x 4.1 cm. Histological examination confirmed the diagnosis of the arachnoid cyst of the quadrigeminal cistern. The patient died of respiratory problems on the 5th day after discharge. Quadrigeminal arachnoid cysts may compress the brain stem and cause severe respiratory disturbances, which can be fatal due to apneic spells. patients should be monitored continuously in the preoperative and postoperative period until the restoration of autonomous ventilation is achieved.- - - - - - - - - - ranking = 0.00076040913078553keywords = brain (Clic here for more details about this article) |
7/62. Emergency endovascular treatment of thoracic aortic rupture in three accident victims with multiple injuries.PURPOSE: To report an experience with emergency endovascular treatment of traumatic thoracic aortic ruptures in multi-injured patients. case reports: Three victims of motor vehicle accidents with multiple head, chest, and abdominal injuries in addition to fractures were treated urgently for thoracic aortic lacerations with transluminal placement of an endovascular graft during the initial emergent laparotomy. In all cases, ruptured visceral organs were treated first and the abdomen closed. femoral artery access was gained through a cutdown, and the endografts were delivered with no systemic heparinization. The endovascular component of the surgical session took approximately 50 minutes. All patients survived to discharge. Two patients are alive at 5 and 12 months with sustained endovascular exclusion of the pseudoaneurysm, but one patient with severe brain damage died 9 months after treatment from respiratory insufficiency. CONCLUSIONS: Acute endovascular treatment of thoracic aortic ruptures is feasible and has the advantage of avoiding thoracotomy in otherwise severely injured patients.- - - - - - - - - - ranking = 0.00038020456539276keywords = brain (Clic here for more details about this article) |
8/62. Subarachnoid haemorrhage: a clinical overview.Subarachnoid haemorrhage affects up to 9,000 people a year in the UK (Lindsay and Bone 1997) and is a devastating condition. Although many patients make a good physical recovery, some are left with cognitive and perceptual deficits. Early rehabilitation and support is essential, and caring for these patients and their families is a major challenge for nurses.- - - - - - - - - - ranking = 5keywords = haemorrhage (Clic here for more details about this article) |
9/62. Posterior fossa decompression for life-threatening tonsillar herniation in patients with gliomatosis cerebri: report of three cases.OBJECTIVE AND IMPORTANCE: Gliomatosis cerebri (GC) is a rare type of primary brain tumor that diffusely infiltrates more than two lobes of the brain while the normal cerebral architecture is maintained. To the best of our knowledge, the association between an acquired tonsillar herniation and GC has never been reported. In this article, we describe three patients with progressive gliomatosis of the cerebellar hemispheres who subsequently showed signs and symptoms secondary to tonsillar herniation. Early recognition of this potentially life-threatening complication allowed us to recommend prompt surgical intervention. CLINICAL PRESENTATION: One patient with primary, or Type I, GC presented with suboccipital headaches, and two patients with secondary, or Type II, GC presented with the signs and symptoms of progressive myelopathy. Serial imaging studies demonstrated progressive involvement of the cerebellum, descent of the cerebellar tonsils through the foramen magnum, and cervicomedullary spinal cord compression. INTERVENTION: Once the tonsillar herniation was recognized, all three patients underwent posterior fossa decompression, a cervical laminectomy to the lowest level of the tonsillar herniation, and duraplasty. All three patients experienced immediate improvement in their conditions. CONCLUSION: Early recognition of tonsillar herniation, a possibly overlooked cause of death in patients with GC, allows for early surgical intervention as a potentially lifesaving procedure and significant improvement in the patient's condition.- - - - - - - - - - ranking = 0.00076040913078553keywords = brain (Clic here for more details about this article) |
10/62. Intracranial migration of Foley catheter--an unusual complication.Profuse nasal bleeding in cases of severe head injury is mostly associated with facial and skull base fractures and various methods have been tried to control such bleeding. Anterior nasal packing, producing a tamponade effect with a Foley catheter and other inflatable balloon devices are time proven methods. We describe a case of severe head injury with such fractures where a Foley catheter tamponade was attempted to control the severe nasal bleeding and the CT brain scan revealed inadvertent malposition of the catheter into the cranial cavity. This rare entity is described to highlight the potential danger associated with a proven method of controlling severe nasal bleeding and suggestions are outlined as to how to avoid such a mishap, along with a brief review of the literature.- - - - - - - - - - ranking = 0.00038020456539276keywords = brain (Clic here for more details about this article) |
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