1/82. Renal involvement of thrombotic thrombocytopenic purpura: special reference to the glomeruloid structures.We report the case of a 9-year-old girl with biopsy-proven renal thrombotic microangiopathy in thrombotic thrombocytopenic purpura (TTP), with particular reference to the glomeruloid structures. The renal biopsy sample from this TTP patient revealed platelet thrombus deposition, a glomeruloid structure and aneurysm with relative sparing of the glomeruli. The glomeruloid structure displayed a proliferation of mainly capillary-sized channels lined by factor viii-related, antigen-positive plump endothelial cells embedded in the edematous connective tissue. These glomeruloid vessels communicated with the aneurysmal segment at the end portion of the arteriolar branch. We believe that the glomeruloid structures in TTP represent not merely organization or recanalization of thrombus but rather active angiogenesis through aneurysmal dilation in the arteriolized vessel, probably initiated by platelet agglutination.- - - - - - - - - - ranking = 1keywords = connective (Clic here for more details about this article) |
2/82. Successful resection of ductus arteriosus aneurysm in infancy.We report a case of thrombosed patent ductus arteriosus aneurysm in an infant. The aneurysm was detected accidentally on chest roentgenogram and presented as globular soft tissue density mass in left posterosuperior mediastinum. Resection of the aneurysm was performed without cardiopulmonary bypass. Two years after operation the patient is well and growing normally.- - - - - - - - - - ranking = 0.032153783672912keywords = soft (Clic here for more details about this article) |
3/82. adenocarcinoma of the stomach with tumor-thrombotic microangiopathy in an 11-year-old male patient.The majority of malignancies in childhood are represented by leukemias, lymphomas or other reticuloendothelial neoplasms, tumors of the central nervous system, nephroblastomas and sarcomas. Gastrointestinal tumors represent less than 5% of pediatric neoplasms and carcinomas within this subgroup have been very rarely described, especially those arising in the stomach. In this study, we report a case of an 11-year-old boy with a signet-ring carcinoma of the stomach. The patient initially presented with respiratory symptoms which were caused by massive pulmonary lymphangiosis carcinomatosa and a peculiar microangiopathy, recently addressed as pulmonary tumor thrombotic microangiopathy. To our knowledge, this constellation has not been reported so far.- - - - - - - - - - ranking = 0.52824585832916keywords = neoplasm (Clic here for more details about this article) |
4/82. thrombosis in patients with connective tissue diseases treated with specific cyclooxygenase 2 inhibitors. A report of four cases.Specific inhibitors of cyclooxygenase 2 (COX-2) have been approved for the treatment of osteoarthritis and rheumatoid arthritis. Unlike nonsteroidal anti-inflammatory drugs, specific COX-2 inhibitors do not inhibit platelet activation. However, these agents significantly reduce systemic production of prostacyclin. As a result, theoretical concerns have been raised that specific COX-2 inhibitors could shift the hemostatic balance toward a prothrombotic state. patients with connective tissue diseases (CTD), who may be predisposed to vasculopathy and thrombosis, often have arthritis or pain syndromes requiring treatment with antiinflammatory agents. Herein we describe 4 patients with CTD who developed ischemic complications after receiving celecoxib. All patients had a history of Raynaud's phenomenon, as well as elevated anticardiolipin antibodies, lupus anticoagulant, or a history compatible with antiphospholipid syndrome. It was possible to measure a urinary metabolite of thromboxane a2 in 2 of the patients as an indicator of in vivo platelet activation, and this was markedly elevated in both. In addition, the patients had evidence of ongoing inflammation as indicated by elevated erythrocyte sedimentation rate, hypocomplementemia, and/or elevated levels of anti-dna antibodies. The findings in these 4 patients suggest that COX-2 inhibitor-treated patients with diseases that predispose to thrombosis should be monitored carefully for this complication.- - - - - - - - - - ranking = 5keywords = connective (Clic here for more details about this article) |
5/82. Anaesthetic management of a child with type VIIc ehlers-danlos syndrome.ehlers-danlos syndrome type VIIc is characterized by altered tensile strength of connective tissue. Several severe complications exist but skin fragility is the origin of perioperative morbidity during routine procedures. We describe the difficulties encountered during the anaesthetic management of a child suffering from the disease, and suggest special care advices to avoid any skin injury.- - - - - - - - - - ranking = 1keywords = connective (Clic here for more details about this article) |
6/82. Renal angiomyolipoma extending into the right atrium.Renal angiomyolipomas (AMLs) are benign renal tumors that may possess the features of a malignant neoplasm, such as local and vascular invasion. We describe the diagnosis and management of a rare case of AML associated with tumor thrombus extending into the right atrium.- - - - - - - - - - ranking = 0.26412292916458keywords = neoplasm (Clic here for more details about this article) |
7/82. Thromboendarterectomy of the right common iliac artery in a patient with Marfan's syndrome and restoration with a new technique.Marfan's syndrome is a rare hereditary disease of connective tissue, the surgical interest of which is in its propensity to the development of arterial aneurysms. We describe the case of a 40-year-old male who was admitted to our hospital because of thrombosis of the right common iliac artery and who was treated with a new technique: thromboendarterectomy of the right common iliac artery and covering of the artery with a synthetic graft, in order to avoid the risk of developing an aneurysm of the endarterectomised iliac artery. This is a new technique, here described for the first time in the international literature.- - - - - - - - - - ranking = 1keywords = connective (Clic here for more details about this article) |
8/82. US demonstration of a thrombosed persistent median artery in carpal tunnel syndrome.Median artery of the forearm and wrist is not very frequently observed because it normally involutes before birth. Only a few cases of persistent median artery thrombosis associated with compression of the median nerve in the carpal tunnel have been reported. In these cases symptoms arise suddenly and surgery consists of the excision of the thrombosed arterial branch. In cases of large persistent unthrombosed median artery associated with carpal tunnel syndrome (CTS), excision of the unthrombosed median artery is not indicated because it may sometimes substantially contribute to the circulation of the hand. We report the case of a 39-year-old man with CTS associated with a thrombosis of a persistent median artery detected by high-resolution US and Doppler ultrasound. US can be also useful to exclude other causes of CTS such as tenosynovitis of the flexor tendons, ganglion cyst, musculotendinous variants, and various soft tissue tumors.- - - - - - - - - - ranking = 0.032153783672912keywords = soft (Clic here for more details about this article) |
9/82. Superior mesenteric vein thrombosis presented transient false positivity for lupus anticoagulant under heparin treatment.A 24-year-old Japanese man was admitted because of massive haematemesis and melaena with persistent abdominal pain. Markedly bloody ascites and severely oedematous small intestine were recognized, and angiography then revealed superior mesenteric vein thrombosis. After resection of the necrotic small intestine, continuous intravenous infusion of heparin and urokinase was performed. This patient had no familial or personal history of thrombosis. On the 15th day after operation, an initial search for lupus anticoagulant revealed that the prothrombin time (PT) ratio and dilute activated partial thromboplastin time (aPTT) were positive under heparin treatment, without evidence of rheumatic or connective tissue disease. thrombocytopenia was observed with a nearly normocellular bone marrow. A follow-up examination 1 year later still revealed an increased aPTT. However, all tests for antiphospholipid antibodies had been negative including dilute aPTT for about 2 years since the 15th day after operation. These findings suggest that, in this patient, superior mesenteric vein thrombosis has not been associated with primary antiphospholipid syndrome but is probably idiopathic. Positive tests for lupus anticoagulant in the initial period may be unreliable due to heparin treatment.- - - - - - - - - - ranking = 1keywords = connective (Clic here for more details about this article) |
10/82. Floating ball thrombus in the left atrium with mitral stenosis.We report a case of a floating ball thrombus in the left atrium with mitral stenosis in a 76-year-old woman. The patient had been followed-up at our hospital due to mitral valve stenosis for several years, and was recognized to have atrial fibrillation and a left atrial mural thrombus by echocardiography. She was admitted to our hospital for right cerebral infarction. echocardiography showed a floating ball thrombus in the left atrium. After the treatment of cerebral infarction, she was referred to cardiac surgery, and a semi-urgent operation was performed. Removal of the ball thrombus and mitral valve replacement were performed simultaneously. The thrombus was single, round, soft, relatively smooth surfaced, and about 30 x 30 x 30 mm in diameter. The postoperative course was uneventful. Left atrial ball thrombus appears to be uncommon. This is a rare case, in which it was documented that a pre-existing left atrial mural thrombus was thought to drop off spontaneously, to be a cerebral embolic source, and to develop into a ball thrombus in the left atrium.- - - - - - - - - - ranking = 0.032153783672912keywords = soft (Clic here for more details about this article) |
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