11/895. Pathologic findings in a steroid-responsive optic nerve infarct in giant-cell arteritis.OBJECTIVE: To investigate the pathophysiologic mechanism of optic nerve infarction in giant-cell arteritis (GCA). BACKGROUND: Previous pathologic reports of optic nerve infarction in GCA involved patients who were blind at the time of death. The optic nerve infarcts were primarily retrolaminar in localization. Simultaneous short ciliary and ophthalmic artery vasculitis was found in all patients. methods: Clinical neurologic and ophthalmologic examination, temporal artery biopsy, and neuroimaging tests were performed in a patient with an anterior ischemic optic neuropathy secondary to GCA. Pathologic examination of the viscera, eye, and brain were performed at autopsy 1 month later. RESULTS: A prelaminar/retrolaminar infarct was found in this patient. Subsiding vasculitis was limited to the short ciliary arteries, sparing the central retinal, pial, and ophthalmic arteries. CONCLUSIONS: The authors believe that the visual improvement observed in this patient was the result of preserved, anterior optic nerve collateral circulation, as well as the neuroprotective and anti-inflammatory effect of the corticosteroids.- - - - - - - - - - ranking = 1keywords = infarction (Clic here for more details about this article) |
12/895. Amelioration of acromegaly after pituitary infarction due to gastrointestinal hemorrhage from gastric ulcer.We report a rare case of acromegaly in which pituitary infarction possibly developed in a GH-producing pituitary adenoma following gastrointestinal bleeding from peptic ulcer. In this case, pituitary infarction resulted in spontaneous remission of acromegaly associated with diabetes mellitus. In addition, detailed histological investigation revealed that clinically silent pituitary apoplexy was mainly an acute ischemic event which occurred recently in a GH-producing adenoma. This event led to massive coagulation necrosis of the tumor and endocrinological improvement.- - - - - - - - - - ranking = 3keywords = infarction (Clic here for more details about this article) |
13/895. Primary antiphospholipid syndrome presented by total infarction of right kidney with nephrotic syndrome.We report the case of a young woman with primary antiphospholipid syndrome (APS), which presented with acute renal failure, hypoproteinemia, hypoalbuminemia and nephrotic proteinuria. Investigations showed total infarction of right kidney by extensive arterial and vein thrombosis and presence of anticardiolipin antibodies IgG isotype (anti-beta2-glycoprotein I-positive). She was submitted to right nefrectomy and initiated anticoagulant therapy. After nefrectomy, the postoperative period was marked by the development of arterial hypertension and persistence of nephrotic syndrome. hypertension was treated with antihypertensive drugs (IECA, beta-blocker and calcium antagonist). As the nephrotic syndrome persisted despite anticoagulant and antihypertensive therapy, the patient was treated with oral corticosteroids. Her renal function improved, hypoproteinemia and hypoalbuminemia corrected to normal values and proteinuria decreased to subnephrotic value. We discuss the unusual presentation of this case of primary antiphospholipid syndrome with total unilateral renal thrombosis and nephrotic syndrome that respond to anticoagulant, antihypertensive and corticosteroid therapy.- - - - - - - - - - ranking = 2.5keywords = infarction (Clic here for more details about this article) |
14/895. Juxtapapillary nerve fiber layer infarction as a complication of coronary artery bypass surgery.BACKGROUND: Recent studies have detailed the prevalence and etiology of ocular complications resulting from coronary artery bypass surgery. Of these, retinal nerve fiber layer infarctions are reported most commonly. The clinical sequelae of nerve infarction may include loss of visual acuity, compromised pupillary function, and visual-field defects (the severity of which may be correlated with the location and extent of the insulted tissue). methods: A patient who had experienced bilateral juxtapapillary nerve fiber layer infarction with subsequent loss of visual acuity and peripheral visual field was followed postoperatively for more than 6 weeks. Immediately before our examination, he underwent quadruple coronary artery bypass graft surgery. RESULTS: From the data collected during initial and follow-up examinations, it was determined that the nerve fiber layer infarction was probably the result of a systemic ischemic event during an otherwise uncomplicated surgery. Such events may include hypovolemic blood loss, systemic hypotension during or following surgery, or a host of complications that would prevent adequate perfusion to capillaries in select regions of the eye. CONCLUSION: The pathology of bilateral juxatapapillary nerve fiber layer infarction as a result of substantial transient systemic ischemia may be explained by examining the microcirculation of this region of the retina. Due to certain anatomic and physiologic characteristics, the capillaries supplying the peripapillary zone are most susceptible to arterial vascular events such as ischemia. It is important to recognize this clinical presentation in order to rule out other possible causes for decreased visual acuity and field defects in the postoperative coronary bypass surgery patient.- - - - - - - - - - ranking = 4.5keywords = infarction (Clic here for more details about this article) |
15/895. Posterior optic nerve infarction after lower lid blepharoplasty.We describe a case of acute and total loss of vision after lower lid blepharoplasty. This major complication followed minor cosmetic surgery. magnetic resonance imaging (MRI) showed posterior segmental infarction of the optic nerve, a finding not previously demonstrated.- - - - - - - - - - ranking = 2.5keywords = infarction (Clic here for more details about this article) |
16/895. Painful swelling of the thigh in a diabetic patient: diabetic muscle infarction.A 44-year-old woman with a 5-year history of poorly controlled Type 1 diabetes mellitus presented with a painful, firm and warm swelling in her right thigh. pain was severe but the patient was not febrile, and had no history of trauma or abnormal exercise. Laboratory tests showed ketoacidosis, major inflammation (erythrocyte sedimentation rate (ESR) = 83 mm/h), normal white blood cell count and normal creatine kinase level. Plain radiographs were normal, and there were no signs of thrombophlebitis at Doppler ultrasound. magnetic resonance imaging (MRI) showed diffuse enlargement and an oedematous pattern of the adductors, vastus medialis, vastus intermedius and sartorius of the right thigh. The patient's symptoms improved dramatically, making biopsy unnecessary, and a diagnosis of diabetic muscular infarction was reached. Idiopathic muscular infarction is a rare and specific complication of diabetes mellitus, typically presenting as a severely painful mass in a lower limb, with high ESR. The diabetes involved is generally poorly controlled longstanding Type 1 diabetes with established microangiopathy. Differential diagnoses include deep vein thrombosis, acute exertional compartment syndrome, muscle rupture, soft tissue abscess, haematoma, sarcoma, inflammatory or calcifying myositis and pyomyositis. In fact, physician awareness should allow early diagnosis on the basis of clinical presentation, routine laboratory tests and MRI, thereby avoiding biopsy and its potential complications as well as unnecessary investigations. rest, symptomatic pain relief and adequate control of diabetes usually ensure progressive total recovery within a few weeks. Recurrences may occur in the same or contralateral limb.- - - - - - - - - - ranking = 3keywords = infarction (Clic here for more details about this article) |
17/895. CT and MRI findings of congestive hepatic infarction caused by tumor thrombus of HCC in the hepatic vein: histopathological correlations.We present a case of diffuse hepatocellular carcinoma of the liver with unusual radiological findings. On both CT and MR imaging, the posterior half of the right hepatic lobe showed a unique attenuation/intensity bordered by a clear margin, as if painted in two tones. It appeared to be analogous to "straight border sign," which is known to reflect hepatic venous stoppage. autopsy revealed congestive hepatic infarction congruous with the area of altered attenuation/intensity caused by tumor thrombus in the corresponding branch of the hepatic vein.- - - - - - - - - - ranking = 2.5keywords = infarction (Clic here for more details about this article) |
18/895. Acute spinal cord infarction: vascular steal in arteriovenous malformation.central nervous system arteriovenous malformations typically present with chronic neurologic impairment. An 8-year-old boy presented with acute spinal cord infarction associated with a spinal arteriovenous malformation. Vascular steal phenomenon suggested by spinal angiography happens to underly the pathogenic mechanism.- - - - - - - - - - ranking = 2.5keywords = infarction (Clic here for more details about this article) |
19/895. Functional, life-threatening disorders and splenectomy following liver transplantation.splenectomy (SPL) in cirrhotic patients undergoing liver transplantation (LTx) may resolve specific problems related to the procedure itself, in case of functional and life-threatening clinical situations often occurring as a result of liver cirrhosis and portal hypertension. METHOD: A single-center experience of ten splenectomies in a series of 180 consecutive adult liver transplant patients over a period of 6 yr is reported. The mean patient age was 46.8 /- 9.5 yr (range 25 57 yr). Indications for SPL were post-operative massive ascitic fluid loss (n = 3), severe thrombocytopenia (n = 3), acute intra-abdominal hemorrhage (n = 2), infarction of the spleen (n = 1), and multiple splenic artery aneurysms (n = 1). RESULTS: Extreme ascites production due to functional graft congestion disappeared post-SPL, with an improvement of the hepatic and renal functions. SPL was also effective in cases of thrombocytopenia persistence post-LTx, leading to an increase in the platelet count after about 1 wk. Bleeding episodes related to left-sided portal hypertension or trauma were also resolved. The rejection rate during hospitalization was 0%, and no other episodes were recorded in the course of the long-term follow-up. However, sepsis with a fatal outcome occurred in 4 patients, i.e. between 2 and 3 wk post-SPL in three cases and 1 yr after the procedure as a result of pneumococcal infection in the last case. Fatal traumatic cranial injury occurred 3 yr post-LTx in another case. Five patients (50%) are still alive and asymptomatic after a median follow-up period of 36 months. CONCLUSION: The lowering of the portal flow appears to resolve unexplained post-operative ascitic fluid loss as a result of functional graft congestion following LTx. However, because of the enhanced risk of SPL-related sepsis, a partial splenic embolization (PSE) or a spleno-renal shunt could be used as an alternative procedure because it allows us to preserve the immunological function of the spleen. SPL is indicated in case of post-transplant bleeding due to left-sided portal hypertension and trauma, spleen infarction, and to enable prevention of hemorrhage in liver transplant patients with multiple splenic artery aneurysms. Severe and persistent thrombocytopenia could be treated with PSE. Because the occurrence of fatal sepsis post-SPL is a major complication in LTx, functional disorders, such as ascites and thrombocytopenia, should be treated with a more conservative approach.- - - - - - - - - - ranking = 1keywords = infarction (Clic here for more details about this article) |
20/895. Bilateral renal infarction secondary to paradoxical embolism.Paradoxical embolism is an uncommon but increasingly reported cause of arterial embolic events. Involvement of the kidney is rarely reported. autopsy studies suggest, however, that embolic renal infarction is underdiagnosed antemortem. We report a case of bilateral, main renal artery occlusion and acute renal failure secondary to paradoxical embolism. Clinical and laboratory data at presentation were not suggestive of renal infarction. Support for the diagnosis of paradoxical embolism, which most commonly occurs across a patent foramen ovale, was made by contrast echocardiography, which provides a sensitive method for detecting right-to-left intracardiac shunts. The often subtle presentation of renal infarction suggests patients with peripheral or central arterial embolic events should be carefully observed for occult renal involvement. Contrast echocardiography should be performed when renal infarction occurs without a clear embolic source to evaluate for paradoxical embolism.- - - - - - - - - - ranking = 4keywords = infarction (Clic here for more details about this article) |
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