1/450. Recurring myocardial infarction in a 35 year old woman.A 35 year old woman presented with acute myocardial infarction without any of the usual risk factors: she had never smoked; she had normal blood pressure; she did not have diabetes; plasma concentrations of total cholesterol and high and low density lipoprotein cholesterol, fibrinogen, homocysteine, and Lp(a) lipoprotein were normal. She was not taking oral contraceptives or any other medication. coronary angiography showed occlusion of the left anterior descending coronary artery but no evidence of arteriosclerosis. Medical history disclosed a previous leg vein thrombosis with pulmonary embolism. Coagulation analysis revealed protein c deficiency. The recognition of protein c deficiency as a risk factor for myocardial infarction is important as anticoagulation prevents further thrombotic events, whereas inhibitors of platelet aggregation are ineffective.- - - - - - - - - - ranking = 1keywords = occlusion (Clic here for more details about this article) |
2/450. 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 = occlusion (Clic here for more details about this article) |
3/450. The use of the holmium:YAG laser in coronary disease: the utility of a unique lensed fiber catheter.Alternatives to balloon angioplasty, which has a restenosis rate of 25%-68%, are being sought for patients at high risk for restenosis. The mid-infrared holmium laser may have properties more advantageous for coronary angioplasty than the ultraviolet excimer laser. The Coronary HaloCath (Trimedyne, Inc.) has a diverging lens that allows the beam diameter to approximate the catheter tip diameter, increasing the size of the channel that can be created by laser ablation. This unique ability may make it more efficacious in treating arteriosclerotic disease. This device was used to treat: 1) a chronic total occlusion, creating a recanalized diameter larger than the catheter diameter; and 2) an ostial right coronary stenosis, which opened more readily than would have been expected with balloon angioplasty. The Coronary HaloCath may prove useful in difficult-to-treat coronary lesions.- - - - - - - - - - ranking = 1keywords = occlusion (Clic here for more details about this article) |
4/450. Rotablation and stent placement in an unprotected left main coronary ostial stenosis.We report the case of a patient with postinfarction rest angina, high grade ostial left main (LM) stenosis, and right and circumflex coronary occlusion. coronary artery bypass was performed, yet all grafts failed within 2 months of surgery. We elected to proceed with coronary intervention on the ostial LM lesion with intracoronary ultrasound lesion characterization and percutaneous cardiopulmonary bypass support. Rotablation followed by stent deployment achieved a successful angiographic outcome with no associated clinical complications. At 1-year follow-up, the patient remains stable with evidence of mild restenosis. Interventional approaches in unprotected LM coronary stenoses are associated with high procedural risk. Combined atherectomy/ablation with stent placement guided by intracoronary ultrasound may enhance procedural and long-term outcome.- - - - - - - - - - ranking = 1keywords = occlusion (Clic here for more details about this article) |
5/450. Spontaneous reversibility of early reobstruction following percutaneous transluminal angioplasty.Early reocclusion and late restenosis are well-known problems after percutaneous transluminal angioplasty (PTA). We report here on a phenomenon not described so far in two patients with peripheral arterial occlusive disease who had PTA of the common iliac and the superficial femoral artery, respectively. Both had a good hemodynamic and clinical initial result. However, within two days after PTA symptomatic reobstruction occurred documented by noninvasive measurements. Noteworthy, this reobstruction was spontaneously reversible within days. The possible pathomechanism is discussed.- - - - - - - - - - ranking = 1keywords = occlusion (Clic here for more details about this article) |
6/450. Coiling of recurrent and residual cerebral aneurysms after unsuccessful clipping.We treated four patients with 3 recurrent and 1 residual aneurysm after surgical clipping by using Guglielmi detachable coils (GDCs). Three subjects presented after a second subarachnoid hemorrhage (SAH) occurring between 10 and 25 years after the first bleeding. Early postoperative angiography of the fourth patient showed an incompletely clipped aneurysm. In three poor grade patients we observed one good outcome, one fair result and one death due to the sequelae of SAH. One good grade patient remained in excellent condition postoperatively. Three aneurysms were totally occluded and in one a more than 90% occlusion was achieved with GDCs. We consider the treatment with GDC a viable alternative to reoperation in all patients with recurrent or residual aneurysms following failed attempt at surgical obliteration.- - - - - - - - - - ranking = 1keywords = occlusion (Clic here for more details about this article) |
7/450. Temporary arterio-venous shunts to dilate saphenous crossover graft and maintain graft patency.A modification of the Palma operation is described in a 25-year-old man with impaired venous outflow of the right leg. After a phlebitic occlusion of the right superficial femoral and external iliac veins he had been operated on twice for varicose veins. The result of these operations was a serious outflow stasis of the right leg during exercise. A saphenous cross-over graft to the right popliteal vein was constructed. Preoperatively a temporary arterio-venous shunt between the left posterior tibial artery and the great saphenous vein had been made in order to increase the diameter of the saphenous vein. Three months later the dilated saphenous vein was resected at the level of the sapheno-tibial artery shunt and anastomosed to the popliteal vein of the right leg. The cross-over graft occluded several times during this operation. A temporary popliteo-popliteal arterio-venous shunt was established distally to the sapheno-popliteal anastomosis to keep the vein graft patent. This second arterio-venous shunt was resected after three months. Venography one month later showed that the vein graft was patent. The patient's complaints had disappeared one month after the operation and a normalization of his venous outflow was recorded plethysmographically. The graft has remained patent during an observation time of eighteen months.- - - - - - - - - - ranking = 1keywords = occlusion (Clic here for more details about this article) |
8/450. Lupus erythematosus associated with erythema multiforme: does Rowell's syndrome exist?We describe a patient with lupus erythematosus who experienced an unusual erythema multiforme-like eruption suggestive of Rowell's syndrome. We compare our case and 9 other reports of lupus erythematosus associated with erythema multiforme to the 4 cases reported by Rowell. Our findings indicate that Rowell's original criteria are not well preserved. The coexistence of lupus erythematosus with erythema multiforme does not impart any unusual characteristics to either disease, and the immunologic disturbances in such patients are probably coincidental.- - - - - - - - - - ranking = 0.029543491469127keywords = dental (Clic here for more details about this article) |
9/450. Retrograde embolization during saphenous vein graft angioplasty.angioplasty of degenerated saphenous vein grafts is not infrequently complicated by distal embolization of atheromatous debris. We describe an uncommon case in which balloon angioplasty of an old vein graft to a second diagonal branch of the left anterior descending coronary artery was followed by distal embolization. However, the embolization occurred in a retrograde fashion distal to the anastomotic site, resulting in occlusion of the upstream first diagonal branch. The reasons for its occurrence are discussed, together with suggestions for its recognition.- - - - - - - - - - ranking = 1keywords = occlusion (Clic here for more details about this article) |
10/450. A case of central carcinoma of the mandible arising from a recurrent odontogenic keratocyst: delineation of surgical margins and reconstruction with bilateral rectus abdominis myocutaneous free flaps.A case of central carcinoma of the mandible arising from a recurrent odontogenic keratocyst is reported. A 38-year-old man was admitted to the Tokai University Hospital due to postoperative infection of a recurrent odontogenic keratocyst of the left mandible. He had had a cystectomy for an odontogenic keratocyst 4 years ago. The lesion revealed bony destruction of the mandible with worm-eating shaped margins with extension to the facial skin. A biopsy specimen revealed squamous cell carcinoma. The mandible was resected with facial skin and the sublingual space was dissected to preserve the lingual nerve. The oral and the facial resections were reconstructed with a titanium plate and bilateral rectus abdominis myocutaneous free flaps. The plate was removed due to infection around the margins and readjustment of the flaps was conducted 5 months after the surgery. He has not had a local relapse, metastasis, or incisional hernia for 8 months following surgery. Good occlusion has been attained by the residual mandible, and he is able to eat without any problems.- - - - - - - - - - ranking = 1keywords = occlusion (Clic here for more details about this article) |
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