1/101. Mixed germ cell tumor presenting as intratumoral hemorrhage: report of a case originated from the pineal region.A 17-year-old male patient was brought to our clinic because of sudden onset of headache, vomiting, followed by transient loss of consciousness during a strenuous exercise. Neurologic examinations revealed that the patient had severe sensorimotor and brain stem dysfunction. Examinations of cranial CT and MR imaging showed a huge heterogeneously enhanced tumor originated from the pineal region with tumoral hemorrhage. The tumor markers were found to be high in AFP but not the beta-HCG and CEA. A clinical diagnosis highly suggestive of germ cell tumor was made. Prior to the planned emergency radiation therapy, he received an external ventricular drainage (EVD) and open biopsy of the tumor. Due to a postoperative complication of cerebellar hemorrhage observed 8 hours later, another maneuver was therefore required to extirpate the pineal tumor and cerebellar hematoma. The histological diagnosis proved to be a mixed germ cell tumor with tumoral hemorrhage. Spontaneous intratumoral hemorrhage in germ cell tumor of the pineal region is rare, probably due to compromised venous circulation within the tumor. The bleeding propensity, which may contribute to the formation of cerebellar hematoma, warrants a special attention when a biopsy procedure is to be performed.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
2/101. radiation-related arterial disease.Arterial occlusive disease has been recognized in association with radiation arteriopathy and, rarely, with spontaneous arterial disruption. This association results from the greater role of radiation therapy in the current management of malignant diseases coupled with longer patient survival and the lengthy latency period between radiation and clinical manifestations of radiation arteriopathy. Experience with six patients having radiation-associated arterial disease was retrospectively reviewed. There were four men and two women, with a mean age of 51 years (range, 36-74). arteries exposed to radiation include two carotids, three subclavians, one coronary, and one femoral. The time from radiation therapy until clinical arterial disease was a mean of 14.3 years (range, 4-30). Operative repairs with polytetrafluoroethylene and saphenous vein bypass grafts were performed in four patients, stent placement in one patient, and one patient had spontaneous carotid disruption that ultimately was treated with ligation. In conclusion, elective bypass can be performed safely and successfully for arterial occlusive disease in a previously irradiated artery. In contrast, life-threatening arterial disruption secondary to radiation arteriopathy usually requires concomitant exposure to a source of bacterial contamination, and ligation may be the best choice to prevent recurrent hemorrhage.- - - - - - - - - - ranking = 2.263969205903keywords = coronary (Clic here for more details about this article) |
3/101. Catastrophic outcomes of noncardiac surgery soon after coronary stenting.OBJECTIVES: To assess the clinical course of patients who have undergone coronary stent placement less than six weeks before noncardiac surgery. BACKGROUND: Surgical and percutaneous transluminal coronary angioplasty revascularization performed before high-risk noncardiac surgery is expected to reduce perioperative cardiac morbidity and mortality. Perioperative and postoperative complications in patients who have undergone coronary stenting before a noncardiac surgery have not been studied. methods: Forty patients who underwent coronary stent placement less than six weeks before noncardiac surgery requiring a general anesthesia were included in the study (1-39 days, average: 13 days). The records were screened for the occurrence of adverse clinical events, including myocardial infarction, stent thrombosis, peri- and postoperative bleeding and death. RESULTS: In 40 consecutive patients meeting the study criteria, there were seven myocardial infarctions (MIs), 11 major bleeding episodes and eight deaths. All deaths and MIs, as well as 8/11 bleeding episodes, occurred in patients subjected to surgery fewer than 14 days from stenting. Four patients expired after undergoing surgery one day after stenting. Based on electrocardiogram, enzymatic and angiographic evidence, stent thrombosis accounted for most of the fatal events. The time between stenting and surgery appeared to be the main determinant of outcome. CONCLUSIONS: Postponing elective noncardiac surgery for two to four weeks after coronary stenting should permit completion of the mandatory antiplatelet regimen, thereby reducing the risk of stent thrombosis and bleeding complications.- - - - - - - - - - ranking = 20.375722853127keywords = coronary (Clic here for more details about this article) |
4/101. Cerebellar hemorrhage after coil embolization for a ruptured vertebral dissecting aneurysm.BACKGROUND: We present a case of ruptured vertebral dissecting aneurysm that exhibited cerebellar hemorrhage after successful embolization of the vertebral artery including the dissected site. CASE PRESENTATION: A 59-year-old man suffered a sudden onset of severe occipital headache when he looked up. Computed tomography demonstrated subarachnoid hemorrhage. angiography revealed a right vertebral dissecting aneurysm distal to the posterior inferior cerebellar artery. Endovascular embolization of the aneurysm was performed with preservation of the posterior inferior cerebellar artery. The next day, the patient suffered a cerebellar hemorrhage in the vermis. The intracranial pressure was controlled by external ventricular drainage. The patient was discharged with mild cerebellar ataxia and bilateral abducens nerve palsy. CONCLUSION: In a case of vertebral dissecting aneurysm distal to the posterior inferior cerebellar artery, blood circulation in the vertebral arterial system may change after embolization of the aneurysm. In our case, the preserved posterior inferior cerebellar artery might have been hemodynamically stressed postoperatively, resulting in cerebellar hemorrhage. Therefore, strict control of blood pressure is essential in the acute stage after occlusion of the aneurysm.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
5/101. Sudden cardiac death from thrombotic thrombocytopenic purpura.Clinical thrombotic thrombocytopenic purpura (TTP) is characterized by a pentad of microangiopathic hemolytic anemia, thrombocytopenia, neurological symptoms, renal involvement, and fever. A case of TTP in which early symptoms and signs were suggestive of ischemic heart disease, renal failure, and severe thrombocytopenia developed to a rapid outcome of death. The postmortem examination revealed coronary artery microthrombi, typical of TTP. The clinical presentation of this TTP was atypical: severe thrombocytopenia, striking renal and CNS symptoms were present, but fever and anemia were not present. Thrombotic thrombocytopenic purpura is an uncommon condition that carries a high fatality rate if untreated. awareness of this syndrome and its high risk of sudden death underlines the importance of rapid diagnosis and treatment.- - - - - - - - - - ranking = 2.263969205903keywords = coronary (Clic here for more details about this article) |
6/101. Sudden bilateral deafness from hyperleukocytosis in chronic myeloid leukemia.Sudden-onset bilateral deafness as a clinical manifestation of hyperleukocytosis in chronic myeloid leukemia (CML) is a rare occurrence. We found only 27 clinical descriptions in 16 published papers. In this work, the authors present a review on deafness in CML and describe a new case with prominent hyperleukocytosis, where the neurological findings suggest slowing of the circulation through small blood vessels in the brainstem as the cause of deafness. The evolution was good after treatment. To our knowledge, this is the second case documented with electrical auditory brainstem-evoked potentials and the first with magnetic resonance imaging.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
7/101. mixed connective tissue disease with multiple organ damage: successful treatment with plasmapheresis.A 24-year-old-woman with mixed connective tissue disease (MCTD) developed multiple organ failure, disseminated intravascular coagulation (DIC), metabolic acidosis, and respiratory and renal failure resulting from visceral vasospasm, so-called visceral Raynaud's phenomenon. After plasmapheresis, the condition of multiple organ failure was markedly improved. The successful treatment with plasmapheresis was dependent upon the removal of immune complexes in serum and improvement of visceral circulation. Thus plasma exchange is recommended as a possible a treatment for multiple organ damage in MCTD.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
8/101. Inhaled nitric oxide for pulmonary hemorrhage due to acute pulmonary vein trauma.A 57-year-old man with a history of prosthetic aortic valve and supracoronary ascending aortic replacement presented with a 9.8 cm Sinuses of Valsalvae aneurysm ruptured into the left upper pulmonary vein leading to massive pulmonary hemorrhage due to acute rupture of small pulmonary veins. Prosthetic graft replacement of the aneurysm and reconstruction of the atrial roof and left upper pulmonary vein was performed. Inhaled nitric oxide reversed treatment-refractory hypoxemia following massive small pulmonary vein trauma.- - - - - - - - - - ranking = 2.263969205903keywords = coronary (Clic here for more details about this article) |
9/101. Clinical application of procedural platelet monitoring during percutaneous coronary intervention among patients at increased bleeding risk.The goal of platelet function testing in the catheterization laboratory is to provide information about the platelet contributions to the risk of thrombotic or hemorrhagic events and optimization of anti-platelet therapy for percutaneous interventions. We present several illustrative cases in which platelet monitoring with the Rapid Platelet Function Assay (RPFA, Accumetrics) was used to guide dosing of a glycoprotein (GP) IIb/IIIa inhibitor for coronary and peripheral intervention among patients at increased bleeding risk.- - - - - - - - - - ranking = 11.319846029515keywords = coronary (Clic here for more details about this article) |
10/101. Emergent operation for percutaneous coronary rupture after abciximab administration.A 72-year-old woman had rupture of a coronary artery during angioplasty in the setting of abciximab therapy. Prolonged reinflation of the balloon failed to produce closure of the perforated site. Emergency coronary ligation and bypass after abciximab administration was associated with excessive postoperative bleeding.- - - - - - - - - - ranking = 13.583815235418keywords = coronary (Clic here for more details about this article) |
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