1/83. 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 = coronary (Clic here for more details about this article) |
2/83. Long-term patency of a Cook stent without anticoagulation.In recent years intracoronary stenting has been proven to be an effective bail out for acute and threatened closure during and after coronary angioplasty. Initial enthusiasm has been hampered by significant anticoagulation related vascular and bleeding problems. We report a patient with intracoronary stent whose stent remained patent despite lack of any anticoagulation.- - - - - - - - - - ranking = 0.42857142857143keywords = coronary (Clic here for more details about this article) |
3/83. Odynophagia in a woman with known coronary artery disease and ischemia on electrocardiogram.Esophageal intramural hematoma can mimic other causes of chest pain. When the patient is known to have coronary artery disease, the diagnosis may be difficult. Moreover, the course may be complicated and may harm the patient if antiplatelet drugs, thrombolytics, and anticoagulants are used. The presence of odynophagia should alert the clinician to the possibility of an esophageal origin, even in a patient with known coronary artery disease. We present a case in which early recognition of the clinical presentation prevented potential iatrogenic complications.- - - - - - - - - - ranking = 0.85714285714286keywords = coronary (Clic here for more details about this article) |
4/83. Biportal endoscopic removal of a primary intraventricular hematoma: case report.Primary intraventricular hematomas account for approximately 6% of all intracerebral hematomas. If the clot blocks cerebrospinal fluid (CSF) pathways, surgical intervention, which may be of different types, can be life-saving. In the case reported here, after careful preoperative planning the use of two rigid endoscopes permitted the removal of most of the intraventricular clot and restoration of CSF circulation by creation of a 3rd ventriculostomy within the same procedure and no later treatment was necessary. Repeated CT scans proved that only a small portion of the intraventricular clot remained in the ventricular system. The ventricular size normalised, and the patency of the artificial hole in the floor of the 3rd ventricle was demonstrated both by the rapidly improving clinical picture of the patient and by flow-sensitive MRI studies. For individuals who suffer primary intraventricular hemorrhage and later develop occlusive hydrocephalus, endoscopic removal of the clot and 3rd ventriculostomy might offer a more adequate treatment option than external ventricular drainage.- - - - - - - - - - ranking = 0.0055215323821252keywords = circulation (Clic here for more details about this article) |
5/83. Aortic intramural hematoma during coronary angioplasty: insights into the pathogenesis of intramedial hemorrhage.We report a case of a 74-year-old woman who had an aortic intramural hematoma as a complication of percutaneous coronary angioplasty. Transesophageal echocardiography enabled the diagnosis of aortic intramural hematoma and was very useful in the patient's management and follow-up.- - - - - - - - - - ranking = 0.71428571428571keywords = coronary (Clic here for more details about this article) |
6/83. Thalamic hematoma from a ruptured posterior cerebral artery aneurysm.BACKGROUND: The location of parenchymal hemorrhage often indicates the site of the aneurysm in subarachnoid hemorrhage. CASE REPORT: We present the first case of a thalamus hematoma associated with a small ruptured (P1) posterior cerebral artery aneurysm with rapid washout of subarachnoid blood mimicking a ganglionic hemorrhage. CONCLUSION: thalamus hematoma with subarachnoid hemorrhage points at a ruptured proximal posterior circulation aneurysm.- - - - - - - - - - ranking = 0.0055215323821252keywords = circulation (Clic here for more details about this article) |
7/83. Recombinant VIIa concentrate in the management of bleeding following prothrombin complex concentrate-related myocardial infarction in patients with haemophilia and inhibitors.prothrombin complex concentrates (PCCs) and, more recently, activated prothrombin complex concentrates (APCCs), are widely used for the treatment of active bleeding in haemophiliacs with inhibitors. myocardial infarction (MI), associated with the use of these concentrates, is a well-recognized, but uncommon, complication. We review the 14 previous cases published in the literature and describe two additional patients. MI related to the use of activated and non-activated PCCs predominantly affects young patients who often have no preceding history of, or risk factors for, MI and tends to be associated with large cumulative doses of concentrate. The most frequent pathological finding is myocardial haemorrhage, with no evidence of coronary artery atheroma or thrombosis. The management of further bleeding in these patients is difficult. We have safely used recombinant factor viia to treat bleeding in the immediate and long-term period following PCC-related MI.- - - - - - - - - - ranking = 0.14285714285714keywords = coronary (Clic here for more details about this article) |
8/83. A case of coronary artery fistula draining into the pericardium causing hematoma.A 28-yr old female patient admitted to our clinic because of dyspnea and chest pain. Her transesophageal echocardiography demonstrated a huge mass on the anterolateral wall of the left ventricle causing dysfunction of the myocardium. coronary angiography demonstrated left anterior descending artery fistula draining into the pericardial cystic mass. Hydatic cyst was suspected and ELISA and hemagglutinin tests were both negative for echinococcus granulosus. Magnetic resonance image of the heart showed a mass thought to be a hematoma inside the cyst. She underwent surgery. The cystic lesion with a pure hematoma inside, was excised, and the fistula between left anterior descending artery and the mass was ligated without any complications. To our knowledge, this is the first case of a pericardial hematoma due to a coronary artery fistula, in the English literature.- - - - - - - - - - ranking = 0.71428571428571keywords = coronary (Clic here for more details about this article) |
9/83. Adventitial hematoma triggering coronary spasm during percutaneous coronary intervention.During percutaneous coronary intervention of the left anterior descending coronary artery, a lumen narrowing was observed proximal to the stent just deployed. Intravascular ultrasound showed a hematoma localized outside the trilaminar wall structure in absence of a dissection flap or evidence of compression of the lumen. The luminal narrowing resolved after intracoronary administration of vasodilators. This finding is compatible with a coronary spasm triggered by an adventitial hematoma following stent deployment.- - - - - - - - - - ranking = 1.7142857142857keywords = coronary (Clic here for more details about this article) |
10/83. Autoantibody against prothrombin aberrantly alters the proenzyme to facilitate formation of a complex with its physiological inhibitor antithrombin iii without thrombin conversion.Acquired coagulation factor inhibitors include pathologic immunoglobulins that specifically bind to coagulation factors and either neutralize their procoagulant activity, accelerate their clearance from the circulation, or have proteolytic activity to degrade them into inactive polypeptides. Here, an autoantibody against prothrombin is described in a patient with serious hemorrhagic diatheses. The autoantibody exerts its influence by a previously unknown mechanism in which it inhibits coagulation through aberrant activation of the proenzyme in a catalytic manner. The antibody-bound prothrombin formed a stable stoichiometric complex with antithrombin iii, consisting of intact prothrombin and an antithrombin iii molecule cleaved at the (393)Arg-(394)Ser bond. The antibody dissociated from prothrombin after the complex formation with antithrombin iii. Although the bound antibody elicited protease activity from prothrombin, the complex was not able to convert fibrinogen to fibrin or to activate protein c. Thus, this is the first description of an autoantibody that induces protease-like activity from a human proenzyme, permitting subsequent neutralization by its physiological inhibitor. (Blood. 2001;97:3783-3789)- - - - - - - - - - ranking = 0.0055215323821252keywords = circulation (Clic here for more details about this article) |
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