1/44. Acute torsion of the renal transplant after combined kidney-pancreas transplant.BACKGROUND: Surgical complications after combined kidney and pancreas transplantation are a major source of morbidity and mortality. Complications related to the pancreas occur with greater frequency as compared to renal complications. The occurrence in our practice of two cases of renal infarction resulting from torsion about the vascular pedicle led to our retrospective review of similar vascular complications after combined kidney and pancreas transplantation. methods: charts were reviewed retrospectively, and two patients were identified who experienced torsion about the vascular pedicle of an intra-abdominally placed renal allograft. RESULTS: Two patients who had received combined intraperitoneal kidney and pancreas transplantation presented at 16 and 11 months after transplant, respectively, with abdominal pain and decreased urine output. One patient had radiological documentation of abnormal rotation before the graft loss; unfortunately, the significance of this finding was missed. diagnosis was made in both patients at laparotomy, where the kidneys were infarcted secondary to torsion of the vascular pedicle. Both patients underwent transplant nephrectomy and subsequently received a successful second cadaveric renal transplant. CONCLUSIONS: The mechanism of this complication is a result of the intra-abdominal placement of the kidney, length of the vascular pedicle, excess ureteral length, and paucity of adhesions secondary to steroid administration. These factors contribute to abnormal mobility of the kidney. Technical modifications such as minimizing excess ureteral length and nephropexy may help to avoid this complication.- - - - - - - - - - ranking = 1keywords = vascular complication (Clic here for more details about this article) |
2/44. Disseminated zygomycosis simulating cerebrovascular disease and pulmonary alveolar haemorrhage in a patient with systemic lupus erythematosus.patients with systemic lupus erythematosus (SLE) may be complicated with serious cerebrovascular accidents and pulmonary alveolar haemorrhage. The authors report an autopsy-proven angioinvasive zygomycosis in a patient with SLE. The clinical features of systemic zygomycosis in this patient masqueraded as SLE-related stroke and pulmonary haemorrhage. The case demonstrates that the simultaneous occurrence of complications that clinically suggest pulmonary haemorrhage and multiple brain infarcts in SLE patients should include the rare disseminated zygomycosis in the differential diagnosis.- - - - - - - - - - ranking = 0.15245814952557keywords = vascular disease (Clic here for more details about this article) |
3/44. Wegener's granulomatosis associated with antiphospholipid syndrome.We report a case of Wegener's granulomatosis (WG) with pulmonary hemorrhage also satisfying the criteria for antiphospholipid antibody syndrome (APS). This association has, to the best of our knowledge, never been described before. Pulmonary hemorrhage may be an early manifestation of several immune and idiopathic disorders such as ANCA-associated vasculitis. Several case-reports of APS patients with capillaritis have been described. A possible explanation is that microvascular thrombosis with subsequent increase in vascular permeability facilitates perivascular IgG and complement deposition leading to development of capillaritis. Whether the vascular disease is secondary to thrombosis or vasculitis or both is important in choosing the proper management strategy. We suggest that anticardiolipin antibodies (aCL) should be detected in ANCA-associated vascularitis because they may contribute to life-threatening events superimposed on vascular damage.- - - - - - - - - - ranking = 0.038114537381393keywords = vascular disease (Clic here for more details about this article) |
4/44. Endovascular interventions on persistent sciatic arteries.PURPOSE: To report our experience with interventional procedures used to treat complete and incomplete persistent sciatic arteries (PSA). case reports: Three female patients with PSAs displayed varying symptoms referable to this rare anatomical variant. In the first woman, a 1-year history of intermittent lower limb ischemia and an acute event prompted angiography, which demonstrated proximal occlusion of 2 crural vessels and a partially thrombosed sciatic artery aneurysm. To prevent further embolism, the aneurysm was excluded with a stent-graft. Endograft patency and aneurysm exclusion have been maintained up to 22 months. In a 41-year-old diabetic with chronic limb ischemia and digital gangrene, a flow-limiting stenosis of the sciatic artery was stented, restoring adequate pedal perfusion. The stent remained patent at the 18-month follow-up. The third patient suffered from a tumor-related pelvic hemorrhage originating from retrograde perfusion through the PSA, which had been ligated during previous surgery. Attempted embolization via a collateral connection between the incomplete PSA and the popliteal artery failed, and the patient died. CONCLUSIONS: Vasculopathies involving the sciatic artery are uncommon but may be amenable to interventional techniques, such as coil embolization and stent implantation. PSA aneurysm exclusion with a stent-graft may represent a new therapeutic alternative to standard surgery that obviates potential sciatic nerve damage, but the durability of the repair remains to be determined.- - - - - - - - - - ranking = 0.022534629135078keywords = diabetic (Clic here for more details about this article) |
5/44. diplopia and involuntary eye closure in spontaneous cerebellar hemorrhage.Spontaneous cerebellar hemorrhage is of difficult clinical diagnosis. The causes can be varied, but the hemorrhage is most often associated with hypertensive cardiovascular disease. The neurological symptomatology is complex and often misleading. The diagnosis is mainly dependent of familiarity of the eye signs seen in this disease. Among these, the spontaneous unilateral eye closure is presented as an additional striking manifestation. The displacement of the brain stem by the hematoma is frequently associated with a seventh nerve palsy on the side of the hemorrhage. The patient in an effort to obviate the diplopia caused by the gaze dissociations and extraocular motor palsies, has only the option to close the eye on the noninvolved side of the face, and thus the eye remaining open is on the side of the cerebellar hematoma. This paper presents reports of two patients with these symptoms.- - - - - - - - - - ranking = 0.038114537381393keywords = vascular disease (Clic here for more details about this article) |
6/44. Unusual occupationally related disorders of the lung: case reports and a literature review.Diseases of the lung are among the work-related conditions most widely recognized among nonspecialists and the lay public. Five pulmonary conditions for which occupational or environmental exposures are not typically emphasized are reviewed here in their clinical-pathologic context. These are diffuse alveolar hemorrhage, lipoid pneumonitis, granulomatous lung disease, pulmonary alveolar proteinosis, and pulmonary vascular disease.- - - - - - - - - - ranking = 0.038114537381393keywords = vascular disease (Clic here for more details about this article) |
7/44. Intra-abdominal hemorrhage caused by segmental arterial mediolysis of the inferior mesenteric artery: report of a case.PURPOSE: This article reports a patient with acute intra-abdominal hemorrhage secondary to a rare vascular disease, segmental arterial mediolysis methods: The patient was a 56-year-old female who presented with severe acute abdominal pain. An abdominal and pelvic computed tomogram demonstrated suggestion of an intra-abdominal hemorrhage. Visceral angiography illustrated aneurysms in the branches of the inferior mesenteric artery. The patient underwent a left hemicolectomy with resection of the diseased artery. RESULTS: The angiographic and histologic findings were consistent with a diagnosis of segmental arterial mediolysis involving only the inferior mesenteric artery. CONCLUSIONS: This is the first known reported case of intra-abdominal hemorrhage related to segmental arterial mediolysis requiring emergent hemicolectomy.- - - - - - - - - - ranking = 0.038114537381393keywords = vascular disease (Clic here for more details about this article) |
8/44. Microangiopathy in ehlers-danlos syndrome type IV.In two patients with ehlers-danlos syndrome type IV, an autosomal dominant disorder characterized by fragility of large vessels, excessive bruising, and deficiency in type III collagen, capillary microscopy was performed at the nailfold. indocyanine green and Na-fluorescein were used as fluorescent tracers. Both patients exhibited microangiopathy of the skin capillaries with microbleedings, presence of microaneurysms and increased transcapillary diffusion. Microvascular involvement appears to be an additional manifestation of the syndrome.- - - - - - - - - - ranking = 0.064180461320124keywords = microangiopathy (Clic here for more details about this article) |
9/44. Buccal fat pad hemorrhage after retrobulbar injection.PURPOSE: To enable ophthalmologists to recognize and manage buccal fat pad hemorrhage occurring after retrobulbar injection. DESIGN: Interventional case report. methods: A 52-year-old woman with proliferative diabetic retinopathy underwent left retrobulbar injection before panretinal photocoagulation (PRP). RESULTS: Immediately after PRP, the patient complained of left cheek swelling. Ocular examination was unremarkable. Computed tomographic imaging studies confirmed the clinical diagnosis of hemorrhage within the buccal fat pad. No hemorrhage was found within the retrobulbar space. The hemorrhage resolved spontaneously without sequelae. CONCLUSION: This case widens the known spectrum of hemorrhagic complications after retrobulbar injection.- - - - - - - - - - ranking = 0.022534629135078keywords = diabetic (Clic here for more details about this article) |
10/44. The ultimate development of mitral valve endocarditis: atrioventricular separation, atrioventricular groove abscess and hemorrhagic pericarditis.A 52-year-old non-insulin-dependent diabetic man presented with cerebral emboli and mitral valve endocarditis with posterior leaflet vegetations and perforation. Surgical intervention demonstrated hemorrhagic pericarditis and an atrioventricular groove abscess. Extensive debridement of the pericardium, valve and abscess cavities, reconstruction of the mitral annulus with a patch of fresh autologous pericardium, and mitral valve replacement with a pericardial bioprosthesis was performed. The chest was left open. Postoperatively, the patient required dialysis and prolonged mechanical ventilation, but recovered well without recurrent endocarditis and was discharged home after 40 days.- - - - - - - - - - ranking = 0.022534629135078keywords = diabetic (Clic here for more details about this article) |
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