1/54. Massive gastrointestinal hemorrhage in a case of amyloidosis secondary to rheumatoid arthritis.A case of a 60-year-old woman with secondary gastrointestinal amyloidosis to rheumatoid arthritis is reported. biopsy findings in the mucosa of the stomach and lower gastrointestinal tract revealed amyloidosis. Endoscopic examination of the lower gastrointestinal tract revealed multiple nodular elevations. The patient showed massive melena. Emergency angiography was performed and an extravasation was found at branches of the jejunal artery. Embolization was performed and this lead to a good prognosis. patients with massive hemorrhages following gastrointestinal amyloidosis generally have a poorer prognosis. Embolotherapy performed for the present case might represent an effective therapeutic method for gastrointestinal hemorrhage in gastrointestinal amyloidosis.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
2/54. Severe transmyocardial ischemia in a patient with tension pneumothorax.OBJECTIVE: To report tension pneumothorax (TP) as a cause of severe myocardial ischemia. DESIGN: Clinical case report. SETTING: Medical intensive care unit of a university hospital. patients: One patient with severe shock attributable to right TP after unsuccessful percutaneous central venous catheterization. INTERVENTIONS: blood pressure, electrocardiogram (ECG), chest radiograph, and echocardiography during and after shock. MEASUREMENTS AND MAIN RESULTS: On admission the patient was in profound state of shock (heart rate 140 beats/min, blood pressure 65/30 mm Hg). Twelve-lead ECG showed pronounced ST segment elevation in leads II, III, aVF, and V4-V6. Chest radiograph revealed right TP with complete displacement of the mediastinum and the heart to the left side. Immediate right-sided tube thoracostomy resulted in reexpansion of the lung followed by instantaneous hemodynamic and respiratory improvement as well as nearly complete resolution of the ECG changes. Peak value of the creatine phosphokinase was 4140 U/L without significant elevation of the MB isoenzyme at any time. Moreover, the initial hypokinesia of the posterior and lateral left ventricular wall resolved completely, as demonstrated by echocardiography. CONCLUSION: The specific condition of TP may lead to impaired systolic and diastolic coronary artery blood flow affecting ventricular repolarization and T-wave configuration in ECG indicative of transmyocardial ischemia. General symptoms, namely hypotension, tachycardia, and hypoxemia, are likewise typical for cardiogenic shock attributable to myocardial infarction. Yet any therapeutic measure directed toward revascularization, such as thrombolysis or even percutaneous transluminal coronary angioplasty, would have had devastating consequences. Therefore, thorough physical examination of our patient was pivotal in disclosing the true origin of profound shock.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
3/54. Pathologic features of fatal shark attacks.To examine the pattern of injuries in cases of fatal shark attack in South Australian waters, the authors examined the files of their institution for all cases of shark attack in which full autopsies had been performed over the past 25 years, from 1974 to 1998. Of the seven deaths attributed to shark attack during this period, full autopsies were performed in only two cases. In the remaining five cases, bodies either had not been found or were incomplete. Case 1 was a 27-year-old male surfer who had been attacked by a shark. At autopsy, the main areas of injury involved the right thigh, which displayed characteristic teeth marks, extensive soft tissue damage, and incision of the femoral artery. There were also incised wounds of the right wrist. Bony injury was minimal, and no shark teeth were recovered. Case 2 was a 26-year-old male diver who had been attacked by a shark. At autopsy, the main areas of injury involved the left thigh and lower leg, which displayed characteristic teeth marks, extensive soft tissue damage, and incised wounds of the femoral artery and vein. There was also soft tissue trauma to the left wrist, with transection of the radial artery and vein. Bony injury was minimal, and no shark teeth were recovered. In both cases, death resulted from exsanguination following a similar pattern of soft tissue and vascular damage to a leg and arm. This type of injury is in keeping with predator attack from underneath or behind, with the most severe injuries involving one leg. Less severe injuries to the arms may have occurred during the ensuing struggle. Reconstruction of the damaged limb in case 2 by sewing together skin, soft tissue, and muscle bundles not only revealed that no soft tissue was missing but also gave a clearer picture of the pattern of teeth marks, direction of the attack, and species of predator.- - - - - - - - - - ranking = 3keywords = artery (Clic here for more details about this article) |
4/54. A case of central nervous system vasculitis related to an episode of guillain-barre syndrome.The authors report their knowledge about an uncommon case of isolated vasculitis, restricted to the left sylvian artery during an auto-immune guillain-barre syndrome (GBS), sustained by cytomegalovirus (CMV). An acute cardiopulmonary failure requiring a ventilator and vasopressor support manifested, notwithstanding plasma exchanging and immune-modulating therapy. An IgM-enriched formula administration coincided with a rapid amelioration of GBS and vasculitis to a complete recovery the next month after her discharge to a rehabilitation centre.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
5/54. Endovascular therapeutic occlusion following bilateral carotid artery bypass for radiation-induced carotid artery blowout: case report.A patient with breast cancer received radiation therapy to the upper chest wall. Twenty-two years later, she presented with repeated severe bleeding through a left lower neck ulcer. She was taken to surgery for hemostasis, which was not successful because the carotid artery was surgically inaccessible. To manage for explosive carotid blowout, we performed common carotid artery ligation and endovascular coil embolization after contralateral-external-carotid to ipsilateral-common-carotid artery bypass with a polytetrafluoroethylene (PTFE) graft. The patient has experienced no ischemic events or bleeding since this treatment.- - - - - - - - - - ranking = 11keywords = artery (Clic here for more details about this article) |
6/54. Severe hypernatremic dehydration and death in a breast-fed infant.breast milk is acknowledged as the best source of nutrition for neonates. We present the case of a full-term newborn who was fed solely breast milk and developed severe dehydration and hypernatremia. The patient developed cerebral edema, transverse sinus thrombosis, and died. The literature on the uncommon entity of breast-feeding hypernatremia and dehydration is reviewed, and management strategies are presented.- - - - - - - - - - ranking = 0.33240468377574keywords = cerebral (Clic here for more details about this article) |
7/54. Aspirating subdural effusions, so called brain stem shock.A shift of blood into the head during negative pressure aspiration of subdural haematomas in an infant has been demonstrated, and also that aspiration may restart bleeding. An estimate of the elasticity of a 47 cm circumference skull has been obtained. It is suggested that the observed changes in distribution of blood are sufficient to explain the occasional deaths of infants after aspiration of subdural haematomas and that so-called "brain stem shock" need not be invoked.- - - - - - - - - - ranking = 0.052302315325374keywords = brain (Clic here for more details about this article) |
8/54. Unusual petal-like fibromuscular dysplasia as a cause of acute abdomen and circulatory shock.fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory segmental arterial occlusive disorder that involves primarily the renal and carotid arteries, and less often the coronary, iliac, and visceral arteries. We report the case of 78-year-old Japanese woman who presented with acute abdomen complicated by shock. autopsy revealed hemorrhagic necrosis of the small intestine due to severe narrowing of the mesenteric arteries. Histologically, smooth muscles showed in-bundle hyperplasia surrounding the adventitia together with medial and perimedial fibrodysplasia of these arteries, forming the characteristic petal-like appearance of FMD. No occlusive thrombus was observed. Further, another medial fibrodysplasia type of FMD was also seen in the renal and left circumflex coronary arteries. Unusual proliferation of smooth muscles resulted in the petal-like atypical FMD at the superior mesenteric artery.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
9/54. Occlusion of an intraluminal endovascular stent graft after treatment of a ureteral-iliac artery fistula.Ureteral-arterial fistulas are rare causes of intermittent and often massive hematuria. We report the case of a patient presenting with massive hematuria and shock caused by a ureteral-iliac fistula initially treated with a covered endovascular stent graft. Eight months after deployment, the stent occluded, and the patient required a femoral-femoral bypass. This is the first known case of endovascular stent graft occlusion when used for this purpose.- - - - - - - - - - ranking = 4keywords = artery (Clic here for more details about this article) |
10/54. Neonatal brain abscess--potential pitfalls of CT scanning.CASE REPORT. A 6-day-old preterm infant collapsed on the neonatal unit and was found to have enterobacter meningitis. Cranial ultrasounds had been normal in the first few days of life, but an ultrasound on day 9 of life showed a well-defined lesion, which was thought to be an abscess in view of his underlying illness. This finding could not be confirmed on CT scanning, which showed oedematous frontal lobes with a lack of grey-white differentiation. OUTCOME. The correct diagnosis and treatment were delayed until a follow-up CT scan showed more typical features of an abscess 4 days later.- - - - - - - - - - ranking = 0.041841852260299keywords = brain (Clic here for more details about this article) |
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