1/2166. Transplant kidney protection during aortic aneurysm surgery. PURPOSE: Renal allografts are sensitive to ischemic insult. During aortic cross clamping prevention of ischemic damage to a kidney below an aneurysm is vital. Many maneuvers have been reported. We describe a simple technique of protecting the transplant kidney from ischemic damage during aortic surgery. MATERIALS AND methods: During vascular cross clamping a sterile ice slush was placed around the kidney for surface cooling, obviating the need for some of the complicated procedures previously reported. RESULTS: After removal of the ice slush and clamps, urine production resumed and creatinine levels remained unchanged. CONCLUSIONS: External cooling with ice slush provides adequate renal protection during aortic cross clamping and requires no special expertise or equipment. ( info) |
2/2166. Post-traumatic thrombosis of a segmental branch of the inferior mesenteric vein. We report the case of man with post-traumatic thrombosis in a segmental branch of the inferior mesenteric vein with secondary venous congestion and ischemia of the sigmoid colon. We discuss the current imaging modalities for diagnosing venous thrombosis and their relative significance. ( info) |
| Vascular graft infection due to aspergillus is a rare event. Only 11 previous case reports have been documented. All of these infections were in the aortic position, and infrainguinal arterial prosthetic graft involvement has been uncommon. The usual clinical presentation was back pain. fever and systemic complaints were usually present. An unusual case that began with bilateral groin pain is reported and a review of the clinical presentation and the management of the other cases described in the literature is presented. ( info) |
4/2166. Delayed presentation of traumatic arterial vasospasm. Traumatic arterial vasospasm with no surrounding anatomic damage is a rare finding. Delayed presentation of arterial vasospasm several days from the inciting event is also rare. However, when the diagnosis of arterial vasospasm is considered, evaluation and treatment must be initiated promptly to avoid prolonged ischemia to the extremity. We present an 11-year-old female who presented with a delayed presentation of arterial vasospasm, and also review the literature. ( info) |
5/2166. Atrial tamponade causing acute ischemic hepatic injury after cardiac surgery. A patient developed late cardiac tamponade after aortic valve replacement and coronary artery bypass grafting. nausea and dramatic elevations of serum aminotransferases were the initial clinical manifestations of cardiac tamponade. Severe acute ischemic hepatic injury secondary to isolated compression of both atrial cavities by two loculated thrombi was diagnosed. ( info) |
6/2166. Limb-threatening lower extremity ischemia successfully treated with intra-arterial infusion--case reports. The authors present two patients with acute arterial vasospasm of the lower extremities causing marked ischemia. One patient had a history of Raynaud's disease, the second had been taking Cafergot for migraine headaches. Both patients's were given a test dose of intra-arterial tolazoline (50 mg). The patient with Raynaud's disease demonstrated marked improvement diffusely and was successfully treated with overnight infusion of papaverine. The second patient, taking Cafergot, demonstrated no angiographic response to tolazoline. It was speculated that the arteries of this patient were thrombosed. The patient was successfully treated with urokinase and remained free of pain at the 15-month follow-up. ( info) |
| giant cell arteritis most often affects the superficial temporal artery. Arterial territories such as the facial, carotid, myometrial and upper and lower limb arteries may be affected. In this paper we describe the case of a 52-year-old patient with upper and lower limb ischaemia who presented with grade III ischaemia in the left lower limb. giant cell arteritis was diagnosed as responsible for the symptoms. After treatment with corticoids, an angiographic improvement was evidence after 2-year period. The low number of reported cases, the diverse symptoms and varied course make diagnosis of GCA difficult. Therefore, GCA must be taken into consideration in the ischaemia of inferior and superior limbs whether isolated or simultaneous. ( info) |
8/2166. Subacute ischaemic proctitis: a rare condition requiring extensive rectal surgery. Subacute ischaemic proctitis is a rare condition. We describe the case of a 60-year-old male patient who developed, after aortic aneurysm repair, a transient ischaemic colitis that totally healed without sequelae. He eventually developed symptoms of severe proctitis. Investigations identified a stenosis of the mid rectum, while the upper rectum was inflammatory. On angiogram, there was a poor blood flow through the Riolan's arcade and a stenosis of the proximal aorto-graft anastomosis. diagnosis of subacute ischaemic proctitis due to poor blood supply through the internal iliac arteries was made. Anti-inflammatory drugs and dilations were inefficient. A subtotal proctectomy with low colorectal anastomosis was required. On pathological specimen, the lesions were strongly suggestive of an ischaemic process. The patient had an excellent recovery and was asymptomatic 8 months after the operation. ( info) |
9/2166. Atypical decubital fibroplasia associated with bizarre parosteal osteochondromatous proliferation (Nora's reaction). We describe recurring bizarre parosteal osteochondromatous proliferation (Nora's reaction) associated with atypical decubital fibroplasia in the region of the greater trochanter of the femur in a 52-year-old man. We hypothesize that these two recently introduced entities may represent two forms of tissue response to injury (ischemia) inducing proliferative reaction of bone and cartilage in the vicinity of periosteum, and necroses with hyperplastic granulation tissue and myxoid stroma in the subcutaneous tissues. ( info) |
| The target article discusses various aspects of the relationship between the sympathetic system and pain. To this end, the patients under study are divided into three groups. In the first group, called "reflex sympathetic dystrophy" (RSD), the syndrome can be characterized by a triad of autonomic, motor, and sensory symptoms, which occur in a distally generalized distribution. The pain is typically felt deeply and diffusely, has an orthostatic component, and is suppressed by the ischemia test. Under those circumstances, the pain is likely to respond to sympatholytic interventions. In a second group, called "sympathetically maintained pain" (SMP) syndrome, the principal symptoms are spontaneous pain, which is felt superficially and has no orthostatic component, and allodynia. These symptoms, typically confined to the zone of a lesioned nerve, may also be relieved by sympathetic blocks. Since the characteristics of the pain differ between RSD and SMP, the underlying kind of sympathetic-sensory coupling may also vary between these cases. A very small third group of patients exhibits symptoms of both RSD and SMP. The dependence or independence of pain on sympathetic function reported in most published studies seems to be questionable because the degree of technical success of the block remains uncertain. Therefore, pain should not be reported as sympathetic function independent until the criteria for a complete sympathetic block have been established and satisfied. ( info) |