1/38. Lower limb exsanguination and embolism.We report a case of fatal pulmonary embolism during lower limb exsanguination in orthopaedic surgery. A 76-year-old woman underwent an open fixation of an external femoral condyle fracture one day after injury. Subarachnoidal anaesthesia was performed and Esmarch compression bandages were applied in preparation for tourniquet ischaemia. At this time, the patient lost consciousness, became apneic and collapsed. resuscitation procedures were instituted and transoesophageal echocardiography revealed pulmonary embolism. In spite of haemodynamic support and thrombolytic therapy, the patient died. Postmortem examination revealed multiple thromboemboli of recent origin in the right heart cavities, in the pulmonary arteries and in the popliteal and tibial veins of the injured leg. Preventive, diagnostic and therapeutic options of this catastrophic event and indications of pulmonary embolectomy are discussed.- - - - - - - - - - ranking = 1keywords = embolism (Clic here for more details about this article) |
2/38. Pulmonary fat embolism: a complication of fracture.Medical personnel must be aware of the possibility of fat embolism as a complicating factor of fractures. Ambulance, emergency room, orthopedic, and intensive-care personnel may frequently be involved in the care of these patients. Fat embolism should be suspected any time a patient exhibits bizarre mental, pulmonary, or circulatory symptoms following a fracture. Prevention may be achieved by as near immobilization of a fracture as possible. When fat embolism does occur, the course of the illness may or may not be complex. The treatment is supportive and the patient should be made as comfortable as possible.- - - - - - - - - - ranking = 1.1666666666667keywords = embolism (Clic here for more details about this article) |
3/38. Transcranial doppler detection of fat emboli.BACKGROUND AND PURPOSE: The fat embolism syndrome (FES) is characterized by the simultaneous occurrence of pulmonary and neurological symptoms as well as skin and mucosal petechiae in the setting of long-bone fractures or their surgical repair. Its pathophysiology is poorly understood, and effective treatments are lacking. We present 5 patients with long-bone fractures in whom in vivo microembolism was detected by transcranial Doppler. methods: Five patients with long-bone fractures were monitored with transcranial Doppler for microembolic signals (MESs) after trauma. Two patients also had intraoperative monitoring. A TC-2020 instrument equipped with MES detection software was used. Detected signals were saved for subsequent review. Selected signals satisfied criteria defined previously and were categorized as large or small. RESULTS: Cerebral microembolism was detected in all 5 patients and was transient, resolving within 4 days of injury. Intraoperative monitoring revealed an increase in MESs during intramedullary nail insertion. The characteristics of MESs after injury varied among patients, with large signals being more frequent in the only patient with a patent foramen ovale. CONCLUSIONS: Cerebral microembolism after long-bone fractures can be detected in vivo and monitored over time. These findings may have potential diagnostic and therapeutic implications.- - - - - - - - - - ranking = 0.66666666666667keywords = embolism (Clic here for more details about this article) |
4/38. An unusual cause of thigh pain in colonic cancer. Inflammatory oncotaxis?Colonic carcinoma metastasis in order of frequency to the liver, lung, bone and brain. Metastases elsewhere are unusual. We report a very rare case of metastatic spread to skeletal muscle and skin. There follows a review of the theories of anomalous metastatic localization. Inflammatory oncotaxis is offered as the most likely explanation of this phenomenon. The importance of good history taking in colorectal cancer follow up clinics is emphasised.- - - - - - - - - - ranking = 1.3421278984622E-5keywords = brain (Clic here for more details about this article) |
5/38. Fatal fat embolism syndrome: a case report.Fat embolism syndrome is a dire complication of long bone trauma. It is usually associated with neurological, hematological and respiratory involvement, the latter being the major cause of death. We present a case of severe fat embolism syndrome occurring 3 hours after a long bone injury, leading to permanent vegetative state and death without any respiratory signs. The diagnosis was confirmed by cytology of the bronchoalveolar lavage fluid. Clinical presentation of the puzzling fat embolism syndrome and diagnostic tests in suspected fat embolism syndrome are reviewed.- - - - - - - - - - ranking = 1.3333333333333keywords = embolism (Clic here for more details about this article) |
6/38. child abuse in an infant presenting as unexplained acute systemic hypertension.hypertension in the infant is uncommon and is usually associated with renal vascular or parenchymal disease, coarctation or thrombosis of the aorta, or chronic lung disease. A 3-month-old infant who presented with unexplained acute systemic hypertension was subsequently discovered to have an undiagnosed femoral fracture secondary to child abuse. Undiagnosed fractures, which are often associated with child abuse, should be considered in the differential diagnosis of an infant presenting with unexplained systemic hypertension.- - - - - - - - - - ranking = 0.0012766159734446keywords = thrombosis (Clic here for more details about this article) |
7/38. Cerebral autoregulation before and after blood transfusion in a child.The authors present the case of an anemic 22-month-old child undergoing lower extremity surgery in whom the lower limit of cerebral autoregulation was shifted to the right.- - - - - - - - - - ranking = 0.00033059093615125keywords = cerebral (Clic here for more details about this article) |
8/38. Paradoxical fat embolism after intramedullary rodding: a case report.Following intramedullary rodding of two long-bone fractures, a twenty-year-old woman developed the clinical picture of fat embolism syndrome with severe neurological involvement. Corroborating evidence suggested paradoxical embolization of fat as the precipitating cause of this neurologic deterioration. The suspected pathophysiology of this event is discussed.- - - - - - - - - - ranking = 0.83333333333333keywords = embolism (Clic here for more details about this article) |
9/38. Endovascular closure of a patent foramen ovale in the fat embolism syndrome: changes in the embolic patterns as detected by transcranial Doppler.BACKGROUND: The posttraumatic fat embolism syndrome (FES) is characterized by petechiae and pulmonary and cerebral dysfunction. A patent foramen ovale (PFO) could worsen the prognosis of FES by allowing larger emboli to reach the systemic circulation. Transcranial Doppler ultrasonography can be used to diagnose and monitor cerebral microembolism in FES. OBJECTIVE: To describe a case of successful percutaneous closure of PFO in a patient with posttraumatic FES with excellent clinical outcome. PATIENT AND methods: A 17-year-old girl presented with a posttraumatic long-bone fracture complicated by typical severe FES. Transcranial Doppler disclosed multiple microembolic signals over both middle cerebral and basilar arteries. A large PFO was diagnosed by transesophageal echocardiogram. A brain magnetic resonance image with diffusion-weighted sequences showed multiple bilateral areas of abnormal diffusion in watershed territories. Percutaneous PFO closure with a buttoned device was successfully performed. RESULTS: Closure of PFO was associated with marked reduction in the number and intensity of microembolic signals. Subsequent surgical repair of the fracture with the patient under transcranial Doppler monitoring was uneventful. There was excellent correlation between clinical course and microembolic signal load by transcranial Doppler. CONCLUSIONS: Cerebral fat embolism after long-bone fractures can be detected in vivo and monitored over time with the use of transcranial Doppler techniques. If a PFO is present, its closure before surgical manipulation of the fracture is feasible and could have important protective effects against massive systemic embolization.- - - - - - - - - - ranking = 1.1676718607541keywords = embolism, cerebral, brain (Clic here for more details about this article) |
10/38. Ectopic calcification around joints of paralysed limbs in hemiplegia, diffuse brain damage, and other neurological diseases.Mechanical deformity associated, with neurological disease is commonly encountered in the form of contractures, or pre-existing arthritis. Less common is the occurrence of ectopic calcification around the joints of a paralysed limb. Two forms of this are presented in a series of twenty patients. Para-articular calcification with the appearance of myositis ossificans around large joints of the affected limbs occurred most often. The interior of the joints was not affected, nor was there evidence of bony injury. In some cases, however, the excessive outgrowth of bone around the joint eventually resulted in a functional ankylosis by a uniting bar of bone outside the joint. The second form of calcification was periosteal, which unlike the first type was resorbed and left an area of cortical bony thickening.- - - - - - - - - - ranking = 5.368511593849E-5keywords = brain (Clic here for more details about this article) |
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