1/9. Primary percutaneous transluminal coronary angioplasty performed for acute myocardial infarction in a patient with idiopathic thrombocytopenic purpura.A 72-year-old female with idiopathic thrombocytopenic purpura (ITP) complained of severe chest pain. electrocardiography showed ST-segment depression and negative T wave in I, aVL and V4-6. Following a diagnosis of acute myocardial infarction (AMI), urgent coronary angiography revealed 99% organic stenosis with delayed flow in the proximal segment and 50% in the middle segment of the left anterior descending artery (LAD). Subsequently, percutaneous transluminal coronary angioplasty (PTCA) for the stenosis in the proximal LAD was performed. In the coronary care unit, her blood pressure dropped. Hematomas around the puncture sites were observed and the platelet count was 28,000/mm3. After transfusion, electrocardiography revealed ST-segment elevation in I, aVL and V1-6. Urgent recatheterization disclosed total occlusion in the middle segment of the LAD. Subsequently, PTCA was performed successfully. Then, intravenous immunoglobulin increased the platelet count and the bleeding tendency disappeared. A case of AMI with ITP is rare. The present case suggests that primary PTCA can be a useful therapeutic strategy, but careful attention must be paid to hemostasis and to managing the platelet count.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/9. Penile strangulation treated with the modified string method.Penile strangulation by a nonmetallic or thin metallic ring is easily overcome by severing the object, but a heavy metal ring causing penile strangulation is very difficult to sever. Here we report 2 cases of penile strangulation by metal rings, involving a 38-year-old man and a 44-year-old man, both of whom were treated with the modified string method and glandular puncture.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
3/9. diagnosis and management of traumatic ventricular septal defect.Four cases of ventricular septal defect secondary to stab wounds of the heart are presented. One of three patients arriving at the Emergency Department in shock and who were resuscitated required an emergency thoracotomy. These patients had immediate repair of their external cardiac wounds in the Operating Room. Cases 1 and 3 developed heart failure and loud systolic murmur postoperatively. Case 4 was treated with chest tube for a left hemothorax and developed heart failure after discharge. In Cases 1, 2, and 3, 2-D echocardiography detected and located a VSD. In Case 3 Doppler measurement showed elevated RV pressure (45 mm Hg) and decreased peak tricuspid to mitral flow ratio (0.36, normal = 0.6). All patients underwent cardiac catheterization. In Case 4 there was associated mitral regurgitation. Cases 1 and 3 had pulmonary to systemic flow ratios greater than 3:1. Cases 1, 3, and 4 underwent operative repair. In Case 1 the VSD was closed with a dacron patch, and in Cases 3 and 4 it was sutured with Teflon pledgets. In Case 4 a puncture wound of the mitral valve annulus was simultaneously repaired. All patients are alive but in Case 1 postoperative 2-D echocardiography demonstrated partial dehiscence of the patch which has not required reoperation and in Case 3 post-repair 2-D echocardiography and Doppler flow studies have shown an intact VSD repair. This series of post-traumatic VSD demonstrates its varying clinical presentation and the diagnostic and followup benefits offered by 2-D echocardiography, especially when combined with Doppler flow measures.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
4/9. subarachnoid hemorrhage presenting as acute chest pain: a variant of le coup de poignard.A 39-year-old woman presented to the emergency department with symptoms of acute knifelike chest pain and was discharged with a diagnosis of musculoskeletal pain syndrome. One day later, she returned with a complaint of persistent chest pain. physical examination disclosed meningismus, this led to a lumbar puncture and the subsequent diagnosis of subarachnoid hemorrhage. Angiography later revealed findings consistent with dissection of the vertebral artery. This case illustrates an unusual presentation and cause of spinal subarachnoid hemorrhage, a potentially treatable emergency condition.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
5/9. Rat bite fever: report of a fatal case.Two days following a rat bite, a 3-month-old boy presented to the ED with a temperature of 40 C and several puncture wounds on his right hand. He died after a fulminating illness. Postmortem examination revealed endocarditis, interstitial pneumonia, hepatic and splenic congestion, and arthritis. Blood cultures revealed the presence of streptobacillus moniliformis. Rat bite fever is rare in the united states, occurring most commonly in children and laboratory personnel.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
6/9. Emergency reduction of paraphimosis.paraphimosis in uncircumcised or incompletely circumcised children is a serious and painful condition requiring prompt reduction to prevent possible necrosis of the glans or urinary obstruction. Techniques described to reduce oedema distal to the constricting ring include application of ice packs, compressive elastic bandages, and making a dorsal slit which necessitates later circumcision. We have used a simple "puncture" technique to treat successfully an uncircumcised 12-year-old boy with severe paraphimosis. An 18 gauge hypodermic needle was used to puncture the oedematous foreskin at multiple sites, followed by gentle manual compression. This resulted in rapid diminution of the swelling, permitting easy manual reduction of the prepuce. Circumcision can then be performed if so desired.- - - - - - - - - - ranking = 2keywords = puncture (Clic here for more details about this article) |
7/9. Response of headaches to nonnarcotic analgesics resulting in missed intracranial hemorrhage.The differential diagnosis of headache is broad, ranging from immediately life-threatening to benign etiologies. Currently, headaches can be treated successfully with various nonnarcotic analgesics. Three cases are presented in which patients with headaches were treated in an emergency department with nonnarcotic analgesics which relieved their headaches; subsequently, these patients returned to be diagnosed with intracranial hemorrhage. Some nonnarcotic analgesics may relieve symptoms of intracranial hemorrhage through their recognized mechanisms of action. Avoiding such occurrences requires that the diagnosis of headache be made with careful consideration of the patient's history. A patient presenting with a new onset of severe headache or a headache that is different from those experienced in the past deserves a thorough diagnostic work-up including a computed tomography scan followed by lumbar puncture if indicated. Diagnostic decisions regarding headache should not be based on a patient's response to any analgesic, nonnarcotic or narcotic.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
8/9. Peripheral arterial thrombosis in the nephrotic syndrome.Peripheral arterial thrombosis is a rare complication of nephrotic syndrome that occurs in conjunction with a hypercoagulable state and results in a high rate of limb loss and death. We report a case of brachial artery thrombosis in a pediatric patient with nephrotic syndrome, antithrombin iii deficiency, and antecedent vessel trauma. An extensive review of the literature is presented. We conclude that management of arterial thrombosis requires aggressive replenishment of antithrombin III and adequate heparinization in addition to the traditional surgical management. Moreover, arterial puncture should be avoided because of the high risk of thrombosis in these patients.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
9/9. Failed emergency transtracheal ventilation through a 14-gauge intravenous catheter.We encountered two patients who could be neither ventilated nor intubated after induction of anesthesia. In both cases, transtracheal ventilation failed after emergent cricothyroid membrane puncture with a 14-gauge intravenous (i.v.) catheter. In the first case, two catheters placed in rapid succession kinked, preventing gas exchange. In the second case, absence of a plunger on the needle-over-catheter assembly prevented confirmation of intratracheal placement. Both patients required emergent tracheal access by the surgeon. We suggest that transtracheal ventilation via standard i.v. catheters as a primary emergent rescue technique be reassessed.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |