1/237. 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.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/237. thrombosis of mitral valve prosthesis presenting as abdominal pain.A 67-year-old woman presented with abdominal pain, anemia, and leukocytosis. Five years previously, the patient had undergone mitral valve replacement with a St. Jude bileaflet mechanical prosthesis. After her admission, echocardiography confirmed an immobile leaflet of the prosthetic valve. At urgent surgery, thrombosis and pannus, obstructing the disc, were found, and the mechanical valve was replaced with a bioprosthesis. The incidence of mitral valve thrombosis is low, ranging from 0.1% to 5.7% per patient per year. patients who receive inadequate anticoagulation, particularly with valve prostheses in the mitral position, have an increased risk for thrombus or pannus formation. Presentation varies, from symptoms of congestive heart failure or systemic embolization, to fever or no symptoms. New or worsening symptoms in a patient with a prosthetic heart valve should raise concerns about prosthetic dysfunction. Aggressive investigation and, if indicated, urgent or emergency surgery for treatment can be lifesaving.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
3/237. thrombosis of an aortobifemoral bypass graft after total hip arthroplasty.Arterial complications after total hip arthroplasty are relatively rare but potentially limb or life threatening. We report a case of an arterial thrombosis occurring in a patient with an aortobifemoral bypass graft after primary total hip arthroplasty.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
4/237. Intravascular fasciitis of the forearm vein: a case report with immunohistochemical characterization.Intravascular fasciitis is a very unusual variant of nodular fasciitis. A unique case of this lesion occurring in the proximal portion of the superficial vein of the forearm in an otherwise healthy 26-year-old man is reported. The intravascular polypoid lesion grew longitudinally along the vascular lumen, was loosely attached to the intimal layer, and was partly anchored beyond the internal elastic lamina into the medial smooth muscle layer. However, extravascular involvement was absent. The histological features were identical to those observed in ordinary cellular nodular fasciitis. Because of its myofibroblastic phenotype exhibited by highly proliferative spindle cells, certain intimomedial myofibroblasts are thought to be the indigenous source of this unique fibroproliferative lesion. Unless the diagnosis of intravascular fasciitis is considered and appropriate differential markers examined, it may be confused with other intravascular lesions, such as intravascular leiomyoma, intravenous pyogenic granuloma, organized thrombus and, even, fibromuscular dysplasia if it arises in the arteries. A simple excision is considered curable. Even so, two recurrent cases have been documented to date.- - - - - - - - - - ranking = 2keywords = life (Clic here for more details about this article) |
5/237. Thrombotic microangiopathy associated with interferon therapy for patients with chronic myelogenous leukemia: coincidence or true side effect?BACKGROUND: interferon-alpha (rIFN-alpha) is an established therapy for patients with myeloproliferative disorders. Unusual immune-mediated side effects have been associated with rIFN-alpha therapy. The association of rIFN-alpha therapy with hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) has been reported infrequently. methods: Two patients with chronic myelogenous leukemia (CML) treated with rIFN-alpha-based regimens at the University of texas M. D. Anderson Cancer Center developed thrombotic microangiopathy (HUS/TTP). The course of their disease is described. A third patient who developed renal failure while receiving rIFN-alpha therapy and had no other causative factor for his renal failure is also described. RESULTS: The patients were ages 24, 49, and 36 years, and they had received rIFN-alpha therapy for 37, 67, and 92 months, respectively, prior to the development of the disorder. One patient had discontinued rIFN-alpha 1 month before the event because of presumed rIFN-alpha-related cardiomyopathy. Two patients received hydroxyurea and cytarabine as part of their therapy. No patient was receiving any medication known to be associated with HUS/TTP. None had a history of diarrheal illness, but escherichia coli OH157.H7 was grown from the stool of one patient. Two patients responded to plasmapheresis with normalization of counts and other indices, but both developed renal failure and became dependent on dialysis. One patient had evidence of disease progression and died of multiorgan failure. The third patient required dialysis for 18 months but is currently off dialysis; this patient has some residual renal impairment. CONCLUSIONS: Although no definitive association between rIFN-alpha therapy and thrombotic microangiopathies can be concluded from these data, these and other previously reported cases suggest that HUS/TTP is a rare side effect of rIFN-alpha therapy that should be managed in the standard fashion. Hypotheses regarding the mechanism underlying this association are discussed in this article.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
6/237. A rare cause of right atrial mass: thrombus formation and infection complicating a ventriculoatrial shunt for hydrocephalus.BACKGROUND: Thrombus formation around the intracardiac end of the catheter, thromboembolism, and infection are the most important and life-threatening complications of ventriculoatrial shunts. In this article we report a patient with a large right atrial mass that was diagnosed by 2-D echocardiogram and removed via standard median sternotomy and cardiopulmonary bypass. CASE DESCRIPTION: A 63-year-old man who had a right ventriculoatrial shunt was admitted to our department in a septic clinical condition. His hemoglobin was 10.7 grams, white blood cell count was 22,900/mm3, and sedimentation rate was 50 mm/hr. Blood cultures grew coagulase negative staphylococcus. The echocardiogram showed a right atrial mass at the tip of the shunt catheter. The mass had a cystic and "glove-like" appearance and had a pendulous motion in the right atrium. After combined antibiotic therapy for 10 days, symptoms were relieved but echocardiographic findings did not change. A surgical approach was chosen because of the unchanged size of the mass and the risk of pulmonary embolism. First, the distal part of the ventriculoatrial shunt was separated from its pump and a new ventriculoperitoneal shunt was placed. After this, a standard median sternotomy, cardiopulmonary bypass and right atriotomy was performed. The tip of the shunt catheter with the attached pedunculated mass was removed. CONCLUSION: There are few cases of a large right atrial thrombus secondary to a ventriculoatrial shunt in the literature. Because of these serious complications of ventriculoatrial shunting, careful 2-D transthoracic echocardiographic examination should be mandatory for patients with ventriculoatrial shunts.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
7/237. Right heart thrombus: the importance of early intervention.A case report of mobile, right heart thrombus in the accident and emergency (A&E) department is presented. Though frequently associated with major pulmonary embolism, recognition is usually at postmortem examination. Detection of the presence of mobile thrombus in the right heart by early echocardiogram and prompt treatment may be life saving. Surgical or medical treatment options are dependent on local facilities. Early specialist involvement with a contingency plan in A&E departments are advised.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
8/237. Dieulafoy's lesion of the jejunum.Dieulafoy's lesion is a rare vascular anomaly but a potentially life-threatening disease. This lesion can also be found in the small intestine, which can be diagnosed only by angiography. However, the angiography may be normal when the bleeding is inactive. We report a case of jejunal Dieulafoy's lesion with a repeated attack of massive gastrointestinal bleeding with a normal initial angiography. The pathological examination found an unusual picture as a dilated submucosal vessel protruded like a submucosal tumor.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
9/237. Clinical implications of elevated PAI-1 revisited: multiple arterial thrombosis in a patient with essential thrombocythemia and elevated plasminogen activator inhibitor-1 (PAI-1) levels: a case report and review of the literature.Plasminogen activator inhibitor (PAI-1), a member of the serine protein family, is the most active in vivo inhibitor of fibrinolysis induced by plasminogen, tissue plasminogen activator (tPA), and urokinase type plasminogen activator (uPA). While the association between elevated PAI-1 and thrombogenesis has been well studied for several disease processes, including coronary disease, postoperative deep vein thrombosis (DVT), myocardial infarction, malignancy, and diabetes, few studies have concentrated on the correlation between elevated PAI-1 levels and thrombogenesis in patients with myeloproliferative disorders. Essential thrombocythemia (ET), a chronic myeloproliferative disorder, characterized by the overproduction of poorly functioning platelets, is associated with both thrombotic and hemorrhagic life-threatening complications. Although the events resulting in thrombogenesis in such patients may be multifactorial in nature, an association between elevated PAI-1 levels and thrombus formation has been proposed. Herein we present a patient diagnosed with ET complicated by multiple episodes of arterial thrombosis. Elevations in PAI-1 levels were documented repeatedly. The role of elevated PAI-1 when associated with other disease processes is also discussed.- - - - - - - - - - ranking = 3keywords = life (Clic here for more details about this article) |
10/237. Renal involvement of thrombotic thrombocytopenic purpura: special reference to the glomeruloid structures.We report the case of a 9-year-old girl with biopsy-proven renal thrombotic microangiopathy in thrombotic thrombocytopenic purpura (TTP), with particular reference to the glomeruloid structures. The renal biopsy sample from this TTP patient revealed platelet thrombus deposition, a glomeruloid structure and aneurysm with relative sparing of the glomeruli. The glomeruloid structure displayed a proliferation of mainly capillary-sized channels lined by factor viii-related, antigen-positive plump endothelial cells embedded in the edematous connective tissue. These glomeruloid vessels communicated with the aneurysmal segment at the end portion of the arteriolar branch. We believe that the glomeruloid structures in TTP represent not merely organization or recanalization of thrombus but rather active angiogenesis through aneurysmal dilation in the arteriolized vessel, probably initiated by platelet agglutination.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
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