21/895. Surgical repair of type B aortic dissection complicated by early postoperative lung vein and artery thrombosis.A 24-year old man with marfan syndrome previously operated for abdominal aortic aneurysm and type A dissection sustained a type B dissection. He underwent graft replacement of the descending and upper abdominal aorta, complicated by infarction of the left upper lobe and lobectomy was carried out. The postoperative course was uneventful. The mechanism for this rare complication is discussed.- - - - - - - - - - ranking = 1keywords = infarction (Clic here for more details about this article) |
22/895. Hepatic infarction in preeclampsia as part of the hellp syndrome: CT appearance.We describe the computed tomographic (CT) findings of hepatic infarctions in two preeclamptic pregnant women. These infarcts were part of the hellp syndrome (hemolysis, elevated liver function tests, and low platelets count). In both cases, CT disclosed features characteristic of multiple nonenhancing, low-attenuation, peripheral lesions with vessels coursing through and a mottled appearance. The recognition of such CT findings in liver disease associated with preeclampsia can establish the correct diagnosis.- - - - - - - - - - ranking = 5keywords = infarction (Clic here for more details about this article) |
23/895. Mesenteric infarction due to combined protein c deficiency and prothrombin 20210 defects.The prothrombin gene mutation, 20210A, a guanine to adenine substitution at nucleotide position 20210, has recently been described as an additional risk factor for venous thromboembolic disease. We describe the case of a patient with combined heterozygous prothrombin 20210A mutation and type 1 protein c deficiency who presented with massive mesenteric venous infarction of his small bowel and survived following the use of protein C concentrate and extensive small bowel resection.- - - - - - - - - - ranking = 5keywords = infarction (Clic here for more details about this article) |
24/895. Acute renal infarction. Clinical characteristics of 17 patients.We analyzed the medical records of patients with an established diagnosis of acute renal infarction to identify predictive parameters of this rare disease. Seventeen patients (8 male) who were admitted to our emergency department between May 1994 and January 1998 were diagnosed by contrast-enhanced computed tomography (CT) as having acute renal infarction (0.007% of all patients). We screened the records of the 17 patients for a history with increased risk for thromboembolism, clinical symptoms, and urine and blood laboratory results known to be associated with acute renal infarction. A history with increased risk for thromboembolism with 1 or more risk factors was found in 14 of 17 patients (82%); risk factors were atrial fibrillation (n = 11), previous embolism (n = 6), mitral stenosis (n = 6), hypertension (n = 9), and ischemic cardiac disease (n = 7). All patients reported persisting pain predominantly from the flank (n = 11), abdomen (n = 4), and lower back (n = 2). On admission, elevated serum lactate dehydrogenase was found in 16 (94%) patients, and hematuria was found in 12 (71%) of 17 patients. After 24 hours all patients showed an elevated serum lactate dehydrogenase, and 14 (82%) had a positive test for hematuria. Our findings suggest that in all patients presenting with the triad--high risk of a thromboembolic event, persisting flank/abdominal/lower back pain, elevated serum levels of lactate dehydrogenase and/or hematuria within 24 hours after pain onset--contrast-enhanced CT should be performed as soon as possible to rule out or to prove acute renal infarction.- - - - - - - - - - ranking = 8keywords = infarction (Clic here for more details about this article) |
25/895. Orbital infarction and melting in a patient with systemic lupus erythematosus.OBJECTIVE: To present a patient with systemic lupus erythematosus who developed infarction and melting of the orbit secondary to her systemic disease. DESIGN: A case report. PARTICIPANT: A 61-year-old white woman with a 5-year history of systemic lupus erythematosus. methods: The patient presented with left orbital pain, limitation of extraocular movements, and a fistula from the ethmoid sinus to the upper eyelid. A detailed examination with computerized tomography, ultrasound, and a comprehensive medical evaluation with laboratory testing was performed. Histopathologic analysis with special stains of the orbital tissues was also performed. RESULTS: Histopathologic examination of the biopsy specimens revealed the features of an inflammatory process involving the orbit, similar to a panniculitis. These include a lymphocytic reaction with a predominance of plasma cells, vasculitis with occlusion, and thickening of the vessel walls, necrosis, and hyalinization of fat. CONCLUSION: This is a unique case in which infarction and melting of the entire orbital structures occurred in the presence of systemic lupus erythematosus. The underlying disease process is a lupus-related panniculitis. The authors stress that this is a very rare entity and that other diseases should be ruled out before entertaining this diagnosis.- - - - - - - - - - ranking = 6keywords = infarction (Clic here for more details about this article) |
26/895. Precise localization of dysfunctional areas in vertebro-basilar infarction by FDG- and O-15-H2O-PET using standardized image analysis and image registration to 3-D MR.The advantages of standardized multimodal image analysis are demonstrated in a case of symptomatic tremor after basilar thrombosis. Functionally and structurally lesioned areas were mapped in Talairach space using 3-D MRI, cerebral FDG-PET and O-15-H2O-PET. Structural lesions were found in the left midbrain, thalamus, putamen and cerebellar areas. Voxel-based statistics in comparison to a normal data base revealed hypometabolism in the left thalamus, left red nucleus, left cerebellar hemisphere including dentate nucleus and in the left inferior olivary nucleus. The O-15-H2O-PET investigation revealed metabolic uncoupling along the rubroolivocerebellar loop. Given the delicate anatomy of the structures involved, image registration and standardized image analysis techniques are essential for a synoptic multimodality analysis of morphological and functional pathology and should generally be used for cerebral PET investigations.- - - - - - - - - - ranking = 4keywords = infarction (Clic here for more details about this article) |
27/895. A case of carcinoid.A patient is described with a malignant carcinoid tumour of the ileum with nodal secondaries causing mesenteric vessel occlusion and ileal infarction.- - - - - - - - - - ranking = 1keywords = infarction (Clic here for more details about this article) |
28/895. Recurrent optic nerve head infarctions associated with combined factor v Leiden- and factor II:G20210A-mutation.PURPOSE: To demonstrate the association of bilateral recurrent optic nerve head infarctions with thrombophilia due to combined factor v:R506Q- and factor II:G20210A-mutation. methods: Case report. We examined a 55-year-old man with a two-year history of three segmental optic nerve head infarctions. visual acuity was 20/80 on the left and 20/25 on the right eye. RESULTS: Ophthalmologic, cardiologic, radiologic, neurologic and hematologic-immunologic examinations were unremarkable except for increased APC-resistance (APC ratio: 1.4; normal value >2) due to heterozygous factor v:R506Q-mutation and high factor II-levels due to factor II:G20210A-mutation. Therapy with coumarin was instituted at INR 2.0-3.0 and no relapse has occurred over the past 1-year period. CONCLUSION: Combined occurrence of thrombogenic factor II:G20210A-mutation and factor v:R506Q-mutation may be causally linked to recurrent optic nerve head infarctions.- - - - - - - - - - ranking = 7keywords = infarction (Clic here for more details about this article) |
29/895. uterine perforation resulting in bowel infarction: sharp traumatic bowel and mesenteric injury at the time of pregnancy termination.BACKGROUND: By law, elective terminations of pregnancy are not performed in U.S. military institutions. However, in the civilian sector, more than a million abortions are performed each year, some of which are on military beneficiaries. Although complications are relatively rare, patients not uncommonly present for follow-up care to their military installation. We report the case of a patient who presented after a second-trimester elective abortion and was found to have suffered uterine perforation with mesenteric and bowel injury that required bowel resection. CASE: An 18-year-old gravida 1 para 0 female presented from an outlying facility 1 week after elective termination at 18 weeks of gestation with complaints of severe abdominal pain, nausea, and vomiting. Exploratory laparotomy for presumed bowel obstruction revealed uterine perforation and bowel devitalization and necrosis, which required small bowel resection. Fetal bones were discovered within the surgical specimen. CONCLUSION: Morbid, even potentially fatal, complications can occur as a result of pregnancy termination. With second-trimester procedures, perforation can result in injury to abdominal viscera from the perforating instruments or even from sharp fetal bony structures. Military gynecologic surgeons, who are not in abortion practice, must nevertheless be cognizant of the potential for perforation leading to serious visceral injury.- - - - - - - - - - ranking = 4keywords = infarction (Clic here for more details about this article) |
30/895. Enhanced platelet aggregation, high homocysteine level, and microvascular disease in diabetic muscle infarctions: implications for therapy.Muscle infarction is a rare complication in patients with diabetes mellitus, probably because of the rich vascular supply of this tissue. We describe a patient with type 1 diabetes who had infarction of the muscles in her right thigh. We report, for the first time, that the patient, in addition to an advanced microvascular disease in the muscle, had increased plasma total homocysteine levels and increased platelet aggregation. These pathologies might have a synergistic effect on the development of this rare complication and should be treated aggressively to prevent further episodes.- - - - - - - - - - ranking = 6keywords = infarction (Clic here for more details about this article) |
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