11/986. Delayed onset keratectasia following laser in situ keratomileusis. We present a case of unilateral iatrogenic keratectasia developing 10 months after bilateral laser in situ keratomileusis (LASIK) involving enhancement surgery using a broad-beam excimer laser (Summit Apex) to treat 6.6 diopters (D) of myopia. The ectasia progressed rapidly over the subsequent 12 months. The surgeon did not measure preoperative pachymetry, but preoperative topography and corneal measurements did not reveal underlying keratoconus or forme fruste keratoconus. corneal transplantation was required for final visual rehabilitation. light microscopy of the button revealed no underlying inflammation, which suggests biomechanical corneal weakening as the cause of the ectasia. Scanning electron microscopy showed the dramatic thinning seen clinically. latrogenic keratectasia appears to be a possible complication of LASIK. ( info) |
12/986. Iatrogenic breaks in Buuch's membrane in choroidal melanoma. Three patients with choroidal melanoma have been observed to develop subretinal hemorrhages associated with their ocular examinations. One hemorrhage appears to have been caused by transillumination, while two others have occurred during radioactive phosphorus testing. Histopathology confirms defects in Bruch's membrane through which blood or tumor cells have entered the subretinal space. ( info) |
13/986. The risk of paraplegia through medical treatment. In the Orthopedic University Hospital of Heidelberg (section orthopedics II, treatment and rehabilitation of paraplegics), 21 patients with iatrogenic paraplegia were treated between 1968 and 1991. paraplegia occurred in nine cases after procedures close to the spinal cord. In 12 cases paraplegia complicated medical treatment. Procedures close to the spinal cord, such as laminectomy, vertebrotomy, spondylodesis, and peridural anaesthesia, involve the risk of mechanical damage to the spinal cord, the level of paraplegia depends on the area of treatment. Any previous damage to the spinal cord increases the risk of paraplegic complications. The main risks in procedures distant from the spinal cord, such as vascular surgery, angiography, radiotherapy, bronchial artery embolisation, and umbilical artery injection, are disturbances of the blood supply or toxic mechanisms. The ischaemic genesis of spinal cord damage is obvious in the case of vessel ligatures or cross-clamping of the aorta with resulting hypotonic discirculation. In radiomyelopathy as well, the damage to the spinal vessels outweighs the direct neuronal damage. Corresponding to the vascular cause, lesions are more likely to occur at the level of borderlines of blood supply in the middle thoracic cord or in the area of a non-anastomosed great radicular artery in the lumbar spinal cord. knowledge of the consequences and side effects of medical treatment is imperative. Knowing about the risk of a paraplegic lesion, we need a strict indication for diagnostic and therapeutic interventions. Due to progress in science some of the reasons of iatrogenic paraplegia have become manageable. Especially in radiotherapy, vascular surgery and angiography the risk of neurological complications has been lowered. ( info) |
14/986. Therapeutic embolization for unusual latrogenic complications related to coronary revascularization. Percutaneous therapeutic embolization may be an effective strategy to manage distal coronary perforations or inadvertent iatrogenic coronary arteriovenous fistula complicating revascularization procedures. We present two cases in which embolization techniques were used to manage these patients and avoid the need for surgical intervention. ( info) |
15/986. hypertensive encephalopathy as a complication of hyperdynamic therapy for vasospasm: report of two cases. OBJECTIVE AND IMPORTANCE: After developing subarachnoid hemorrhage, patients may deteriorate from a variety of well-known causes, including rebleeding, hydrocephalus, and vasospasm. Many patients now undergo empirical hyperdynamic vasospasm therapy with hypervolemia, induced hypertension, and nimodipine. CLINICAL PRESENTATION: We report two cases of iatrogenic hypertensive encephalopathy occurring during hyperdynamic therapy for cerebral vasospasm after subarachnoid hemorrhage. hypertensive encephalopathy is a syndrome of rapidly evolving generalized or focal cerebral symptoms occurring in the setting of severe hypertension, which is reversible with antihypertensive therapy. INTERVENTION: The syndrome can be diagnosed in the appropriate clinical setting with computed tomographic or magnetic resonance imaging that demonstrates characteristic findings. In both cases, decreasing the blood pressure resulted in neurological improvement. CONCLUSION: In the setting of induced hypertensive/hypervolemic therapy for vasospasm, hypertensive encephalopathy should be considered as a potentially reversible cause of delayed neurological decline. ( info) |
| Stasis dermatitis is a cutaneous finding associated with chronic venous failure resulting in venous stasis. arteriovenous fistula in the hand may cause a chronic venous stasis. We report a case of stasis dermatitis of the hand associated with an iatrogenic arteriovenous fistula. Stasis dermatitis should be considered as a potential complication of iatrogenic arteriovenous fistula. ( info) |
17/986. Subcutaneous, orbital, and mediastinal emphysema secondary to the use of an air-abrasive device. subcutaneous emphysema can occur whenever compressed air is employed intraorally. A case is presented of subcutaneous, orbital, and mediastinal emphysema subsequent to the use of an air-abrasive device. The case is believed to be the first reported case of an air-abrasive-related emphysema and is presented as a cautionary report. ( info) |
18/986. Orthodontic-prosthetic treatment to replace maxillary incisors exfoliated because of improper use of orthodontic elastics: a case report. This article describes the iatrogenic exfoliation of maxillary central incisors following the improper use of orthodontic elastic bands. The unsecured rubber band had migrated apically and caused an almost "bloodless extraction" of both maxillary central incisors. A combined orthodontic-prosthetic solution was used to replace the lost incisors. ( info) |
19/986. An unusual complication of an ankle arthroscopy and its management. This report describes a case of a routine ankle arthroscopy which went awfully wrong. In trying to excise a loose body the surgeon had excised the distal fibula. A reasonable solution to the problem now facing the patient would have been an ankle fusion. The authors, however, performed an osteoarticular fibular grafting. At 34 months, this has been a success so far clinically and radiologically. Both the complication and its treatment have not been described before. ( info) |
20/986. Iatrogenic Mycobacterium infection after an epidural injection. STUDY DESIGN: Case report. OBJECTIVES: Successful excision of the mass and identification of the causative agent by histologic and microbiologic studies. SUMMARY OF BACKGROUND DATA: Spinal pain, caused by an infective mass, developed in a 39-year-old man 3 months after an epidural injection for low back pain. methods: Exploratory surgery was performed to remove the mass, and histologic and microbiologic studies were conducted. RESULTS: The inflammatory mass was excised successfully, and several specimens were examined for bacteriologic presence. Histologic examination of the excised specimen showed chronic granulomatous inflammation, and subsequent microbiologic studies cultured an acid- and alcohol-fast bacillus that was later identified as mycobacterium fortuitum. CONCLUSION: A review of the literature shows that this is a particularly uncommon micro-organism. ( info) |