1/3. Cerebral embolization presenting as delayed, severe obtundation in the postanesthesia care unit after total hip arthroplasty.Catastrophic neurologic events occur rarely postoperatively and must be diagnosed quickly. A 63-year-old woman who had undergone uneventful total hip arthroplasty experienced obtundation after admission to the postanesthesia care unit. Cranial magnetic resonance imaging revealed multiple lesions consistent with ischemia or infarction, and fat cerebral embolism was diagnosed. We describe the numerous complications that may occur in patients in the postanesthesia care unit and review the differential diagnosis of altered mental status in such patients. Paradoxical cerebral fat embolization must be considered in the differential diagnosis of altered mental status after pelvic or long bone fracture or lower extremity major joint replacement, and this condition may occur despite normal pulmonary function and no patent foramen ovale or right-to-left intracardiac shunt. magnetic resonance imaging with T2-weighted sequences is the cranial imaging study of choice for early evaluation of patients with sudden multifocal neurologic deficits and suspected fat embolism syndrome.- - - - - - - - - - ranking = 1keywords = lower extremity, extremity (Clic here for more details about this article) |
2/3. Severe fracture complications in myelodysplasia.Prevention of fractures in the patient with myelodysplasia is aided by minimizing disuse osteoporosis by continuing weight-bearing whenever possible. The presentation and treatment of lower extremity fractures in the postoperative myelodysplasic patient have been reviewed. After these fractures severe systemic dysfunction can occur. A clinical situation involving hypovolemia and suggestive of fat embolism has responded well to immobilization in the posterior half of the spica cast and to fluid replacement.- - - - - - - - - - ranking = 1keywords = lower extremity, extremity (Clic here for more details about this article) |
3/3. The clinical spectrum of renal cholesterol embolization.Renal cholesterol embolization can occur spontaneously or as a complication of aortic surgery or major vessel angiography in patients with diffuse atherosclerosis. The demonstration of characteristic cholesterol crystals in tissue biopsy specimens is a pathognomonic finding. However, renal cholesterol embolism may be clinically diagnosed when renal failure develops after known inciting factors or together with systemic manifestations of atheromatous embolization such as lower extremity livedo reticularis, focal digital ischemia or retinal embolism. Previous investigators have emphasized the progressive nature of renal insufficiency due to cholesterol embolism, its poor prognostic significance and almost uniformly fatal outcome. In this report, we describe five additional patients with renal cholesterol embolization. In three of them only moderate renal insufficiency developed, and kidney function subsequently improved in all. In two patients the condition progressed to end-stage renal disease; one died with chronic renal failure whereas the other patient required four months of hemodialysis before kidney function eventually improved. Thus, cholesterol embolization may produce a spectrum of renal functional impairment. In some patients there is only a moderate loss of renal function with subsequent improvement; in others renal failure ensues. In this latter group, eventual return of kidney function can occur even after a prolonged period of renal insufficiency.- - - - - - - - - - ranking = 1keywords = lower extremity, extremity (Clic here for more details about this article) |