1/1020. Systemic infection with Alaria americana (trematoda). Alaria americana is a trematode, the adult of which is found in mammalian carnivores. The first case of disseminated human infection by the mesocercarial stage of this worm occurred in a 24-year-old man. The infection possibly was acquired by the eating of inadequately cooked frogs, which are intermediate hosts of the worm. The diagnosis was made during life by lung biopsy and confirmed at autopsy. The mesocercariae were present in the stomach wall, lymph nodes, liver, myocardium, pancreas and surrounding adipose tissue, spleen, kidney, lungs, brain and spinal cord. There was no host reaction to the parasites. Granulomas were present in the stomach wall, lymph nodes and liver, but the worms were not identified in them. hypersensitivity vasculitis and a bleeding diathesis due to disseminated intravascular coagulation and a circulating anticoagulant caused his death 8 days after the onset of his illness. ( info) |
2/1020. Alternative imaging techniques in vascular surgery. Progress in vascular surgery has led to the need for more sophisticated methods of imaging the vascular system. Although conventional contrast angiography is still the primary method of visualizing the vascular system, it has problems and limitations that occasionally render it unsafe or inadequate. When conventional angiography cannot provide the needed information, 3 newer imaging methods--3-dimensional (3-D) spiral computed tomographic scanning, computed tomographic angiography, and magnetic resonance angiography--are being used more widely to supplement or replace contrast angiography. The advantages, disadvantages, and clinical application of each method will be described. These methods have fundamentally changed the practice of vascular surgery and a thorough knowledge of them is essential. ( info) |
3/1020. Arterial imaging. angioscopy, magnetic resonance angiography, computed tomography, and nuclear medicine are assuming an increasingly important role in arterial imaging. This review discusses recent advances in these modalities. angioscopy has proven valuable in monitoring intraoperative surgical procedures as well as percutaneous interventions. Carotid artery magnetic resonance angiography is gaining increasing acceptance in clinical practice. magnetic resonance angiography of the peripheral arteries is limited by spatial resolution and signal loss distal to the stenosis. The role of computed tomography in limiting the number of aortograms performed in evaluating aortic laceration remains controversial; however, several recent papers indicate its usefulness in evaluating clinically stable patients with abnormal chest radiographs. Computed tomography of abdominal aortic aneurysms may obviate the need for preoperative aortography in the majority of cases. Nuclear imaging for deep venous thrombosis using 111In-labeled antifibrin monoclonal antibodies was shown highly sensitive in its initial report. ( info) |
4/1020. Unilateral iliac vein occlusion, caused by bladder enlargement, simulating deep venous thrombosis. A variety of conditions cause unilateral leg swelling and thus mimic deep venous thrombosis (DVT). A heretofore-underappreciated condition that may lead to unilateral iliac vein compression, simulating DVT, is massive enlargement of the bladder caused by urinary retention. A case that demonstrates this condition is described. Although this disorder has been reported only three times before, its occurrence should be recognized by clinicians in light of the overall aging of our society. In addition, this case highlights the need for careful and thorough evaluation of patients who have unilateral lower-extremity edema. ( info) |
| A case of intermittent claudication in a middle-aged lifelong non-smoker caused by cystic adventitial disease is reported. Etiology, clinical and angiographic findings, modes of operative treatment, and other possible causes of calf claudication in young non-smokers are briefly discussed. ( info) |
6/1020. Sudden hearing loss in a patient hepatitis c virus (HCV) positive on therapy with alpha-interferon: a possible autoimmune-microvascular pathogenesis. Alpha interferon (alpha-IFN) is used for the treatment of various systemic disorders. Side-effects of alpha-IFN therapy can involve numerous organ systems, but sudden hearing loss has only once been recorded. We report a case of sudden hearing loss occurring in a patient with chronic hepatitis c treated with alpha-IFN and recovered five days after the discontinuation of this agent. This is the first record of anti-endothelial cell antibodies detection in a patient with sudden hearing loss. The finding of anti-endothelial cell antibodies suggests an association between sudden hearing loss and microvascular damage during interferon therapy. ( info) |
7/1020. Systemic lupus erythematosus-associated catastrophic antiphospholipid syndrome occurring after typhoid fever: a possible role of Salmonella lipopolysaccharide in the occurrence of diffuse vasculopathy-coagulopathy. We report a case of well-documented typhoid fever in a 30-year-old woman with inactive systemic lupus erythematosus with asymptomatic lupus anticoagulant and high-titer anticardiolipin antibody (aCL). Despite prompt eradication of the salmonella typhi obtained with appropriate antibiotic therapy, multiple organ system dysfunction occurred. The central nervous system was involved, with ischemic infarcts in the occipital lobes. High-dose corticosteroid therapy failed to improve the neurologic manifestations, which responded to repeated plasmapheresis. A sharp fall in aCL and anti-beta2-glycoprotein I antibody titers was recorded before the start of plasmapheresis. At the same time, IgM and IgG antibodies to Salmonella group O:9 lipopolysaccharide became detectable; the IgM antibodies disappeared within 4 months, whereas the IgG antibodies remained detectable during the next 13 months. Despite treatment with high-dose corticosteroids and cyclophosphamide, rapidly progressive glomerulonephritis developed, leading to chronic renal failure. There is convincing evidence of a link between the S. typhi infection and the ensuing catastrophic syndrome in this patient, probably precipitated by bacterial antigens. ( info) |
8/1020. Disseminated intravascular meconium in a newborn with meconium peritonitis. A 3-day-old premature infant with meconium peritonitis, periventricular leukomalacia, and pulmonary hypertension died with respiratory insufficiency. An autopsy disclosed intravascular squamous cells in the lungs, brain, liver, pancreas, and kidneys. Numerous pulmonary capillaries and arterioles were occluded by squamous cells, accounting for pulmonary hypertension. brain parenchyma surrounding occluded cerebral vessels showed infarct and gliosis. A mediastinal lymph node filled with squamous cells alluded to the mechanism by which these cells from the peritoneal cavity likely entered the bloodstream--namely, via diaphragmatic pores connecting with lymphatics. Thus, disseminated intravascular meconium rarely may complicate meconium peritonitis and have devastating consequences. ( info) |
| In a 32-year-old woman and a 40-year-old man with cutaneous vasculitis, etiological allergic responses to foods and airborne allergens were found. During provocation tests, observations were made on blood levels of fibrinopeptide a(FPA) and coagulation factors, fibrinogen degradation products (FDP) and serum complement components. skin biopsies were taken for microscopic and immunofluorescence analysis. In case 1, anaphylactoid allergy to milk and reaginic and anaphylactoid hypersensitivity to grass pollens were found. Dermal provocations with grass pollens gave arthralgia, hematomas, serum C3 fluctuation, factor vii reduction and fibrinolysis. During peroral milk challenge, transient increases in FPA and FDP levels were observed before symptoms appeared. In case 2, anaphylactoid hypersensitivity responses to bacteria, animal danders, foods and pollens were found. Two inhalations with sheep-wool extract resulted in a typical skin eruption. The first also gave an early reduction of C3 and then FPA liberation. Nasal birch-pollen test gave an increase of FPA in the latent period and then typical nodules. At least no low molecular weight FDP were detected during provocations. In patients with vasculitis reactions to exogenous allergens, FPA and FDP estimations after provocations may discriminate harmful from innocuous allergens and reveal individual response patterns in coagulation and fibrinolysis systems. ( info) |
10/1020. insulin and type 2 diabetes. Last resort or rational management? BACKGROUND: Recent evidence indicates that lower glucose levels in people with type 2 diabetes result in fewer complications. People with diabetes generally have sub-optimal glycaemic control. The natural progression of diabetes is characterised by increasing glucose levels requiring increasing therapy. OBJECTIVE: This article explores the possible role of therapeutic insulin in the management of type 2 diabetes. Arguments for earlier use of insulin, illustrative cases and common dilemmas faced when introducing insulin are examined. DISCUSSION: Findings from the United Kingdom Prospective Diabetes Study (UKPDS) are reviewed. It suggests that active and aggressive management of type 2 diabetes in general practice can have a role to play in reducing complications from diabetes. It now appears that insulin has a role earlier in the management of type 2 diabetes. ( info) |