1/57. diagnosis of ruptured sinus of valsalva aneurysms: potential value of transesophageal echocardiography.Two patient cases are reported in which an aneurysm of the right coronary sinus of valsalva ruptured into the right ventricular outflow tract, near the crux of the heart. Transthoracic two-dimensional echocardiography and transesophageal echocardiography using Doppler color flow mapping allowed accurate preoperative assessment of the left-to-right shunt, which was subsequently confirmed by contrast aortography and surgery.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/57. Pathologic-spontaneous-rupture of the spleen as a presenting sign of splenic T-cell lymphoma--case report with review.A 39 year-old man presented for surgery with epigastric pain, tachycardia, hypotension and a progressive decrease of hemoglobin due to blood loss. Immediate abdominal ultrasonography followed by prompt paracentesis revealed massive intraperitoneal hemorrhage. During emergency laparotomy, a linear, actively bleeding rupture of an enlarged spleen was found and splenectomy was performed. The patient survived and the post-operative course was uneventful. Histopathology of the spleen as well as bone marrow biopsy confirmed the diagnosis of T-Cell lymphoma. Chemotherapy was initiated 3 weeks after surgery. To the best of our knowledge, this is the first reported case of previously undiagnosed T-Cell lymphoma presenting as pathologic rupture of the spleen.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/57. Linear IgA disease.PURPOSE: A case of linear IgA disease is reported to alert ophthalmologists and physicians to this unusual cause of chronic cicatrizing conjunctivitis. methods: Clinical records of a patient suffering from linear IgA disease were reviewed. RESULTS: A 65-year-old woman with a complicated medical history experienced rapidly progressive chronic cicatrizing conjunctivitis leading to corneal perforation. Undiagnosed gingivitis and palatal ulceration had been present for 5 years prior to the onset of ocular symptoms and vitamin C deficiency had followed the consequent dietary restrictions. A diagnosis of linear IgA disease was made on conjunctival biopsy, which demonstrated linear deposits of IgA along the epithelial basement membrane. The perforation was managed successfully with a conjunctival pediculate flap. Control of the inflammation was achieved with systemic prednisolone and cyclophosphamide but at the expense of serious systemic side-effects. CONCLUSIONS: Linear IgA disease causes progressive conjunctival cicatrization in many affected individuals.Although dapsone generally controls the inflammation, heavier systemic immunosuppression was required in this case. Involvement of skin or other mucosal surfaces may become symptomatic before the conjunctivitis, and physicians must be educated to refer patients for ophthalmological review on diagnosis. Conversely, ophthalmologists encountering ocular linear IgA disease should be aware of the possibility of other mucosal involvement requiring physician intervention.- - - - - - - - - - ranking = 10keywords = near (Clic here for more details about this article) |
4/57. Primary peritoneal pregnancy: a case report.A 22-year-old primipara using intrauterine contraceptive device was diagnosed to be in haemorrhagic shock due to acute ruptured ectopic pregnancy. At laparotomy, both tubes and ovaries were normal and products of conception were found to be implanted on the posterior surface of uterus near the attachment of right uterosacral ligament producing a haemoperitoneum of more than 2 l. This is the fourth case report of primary abdominal pregnancy associated with intrauterine contraceptive device (IUCD).- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/57. Boerhaave syndrome.Boerhaave syndrome is a serious and rapidly fatal spontaneous esophageal rupture that mimics myocardial infarction or upper gastrointestinal conditions. Initially misdiagnosed about 50% of the time, Boerhaave syndrome has a mortality rate of more than 90% without prompt diagnosis and treatment. This article presents a case of nearly fatal Boerhaave syndrome in an otherwise healthy young adult and discusses the historical, statistical, pathophysiological, diagnostic and therapeutic aspects of the disease.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/57. Unexpected birth trauma with near fatal consequences.Rupturing of the liver due to delivery is an uncommon but severe birth trauma. Although described in the preterm neonate with very low birthweight or after complicated delivery, we present a case of capsular liver haemorrhage in a term newborn with normal birthweight after a seemingly uncomplicated delivery. The infant presented with severe shock and petechiae as first symptoms and initial therapy was based on the hypothesis of sepsis. Clinical suspicion of liver haemorrhage a few hours later was confirmed with abdominal ultrasound. Since shock was not amenable to fluid replacement therapy, the haemorrhage had to be managed surgically. Even without evidence of birth trauma, intra-abdominal bleeding must always be suspected in a newborn with suddenly prevailing shock and unexpected anaemia.- - - - - - - - - - ranking = 4keywords = near (Clic here for more details about this article) |
7/57. Case report: outer sheath rupture may precede complete chordal rupture in fibrotic mitral valve disease.rupture mechanics of mitral valve chordae have been difficult to elucidate because most surgical repairs and pathological examinations are performed after the rupture. In an excised anterior leaflet from a fibrotic mitral valve, chordae were observed in an initial phase of rupture. Microscopic sections showed that thinned, nearly ruptured chordal segments were actually chordal cores, containing highly aligned collagen fibers. The outer sheath of elastic fibers, disorganized circumferentially oriented collagen fibers, and endothelial cells that normally surrounds the collagen core apparently had retracted to the extreme ends of the thinned segment, resulting in a bulbous shape, as noted in the chordal rupture literature. In conclusion, these new observations lead us to propose that the rupture of mitral valve chordae is not spontaneous, but may occur over time. The failure of the outer sheath may represent the first phase in a slow, two-part process leading to eventual chordal rupture.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/57. Spontaneous gastric perforation in premature twins.Two pairs of identical and non-identical premature neonates proceeding from twin pregnancies were operated on for spontaneous gastric perforation. The newborns in our case, one girl and one boy two different pregnancies were delivered by emergency cesarean section. Their gestational ages were 30 and 32 weeks, and their birth weight 1400 and 2100 g, respectively. Both of the neonates were being treated in the Neonatal intensive care Unit when the perforations were diagnosed. They presented clinically abrupt symptoms of abdominal distension and pneumoperitoneum. The sites of the ruptures were located at the anterior gastric wall near the gastroesophageal junction. The sibling twins were consequently also observed very carefully and fortunately they did not develop any similar clinical symptoms. All four twins were finally discharged from the hospital in good condition.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/57. Ultrasound diagnosis of interstitial pregnancy: findings and pitfalls.The diagnosis of an unruptured interstitial gestation can be made by means of ultrasound examination. The most specific finding is an incomplete myometrial mantle around the sac. An eccentrically placed sac and failure to demonstrate the sac within the uterine cavity, i.e., near the internal os on the longitudinal scans, may be helpful ancillary findings. The differential diagnosis must take into consideration a pregnancy within one horn of a bicornuate uterus and a pregnancy within a myomatous uterus. Although this is a rare condition, it carries significant mortality if it ruptures. diagnosis prior to rupture will reduce mortality and offer the possibility of preserving reproductive capabilities.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
10/57. Successful laparoscopic treatment of a ruptured primary ovarian pregnancy.A 26-year-old woman had classic symptoms of primary ovarian pregnancy. Ultrasound examination disclosed a cystic mass surrounded by a complex mass that was compatible with hematoma in the pouch of Douglas, as well as an intrauterine device (IUD) displaced near the isthmic portion of the uterine cavity. laparoscopy revealed a ruptured gestational sac in the cul-de-sac that was encapsulated by a hematoma originating from the right ovary. All deep-seated products of conception were excised from the ovary, and the IUD was removed. Treatment was successful and avoided more invasive intervention.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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