Cases reported "Thrombosis"

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1/126. lemierre syndrome and acute mastoiditis.

    lemierre syndrome seldom follows an episode of pharyngotonsillitis. Characteristically, it is comprised of septic thrombosis of the internal jugular vein and bacteremia, leading to lung emboli and metastatic abscess formation. We describe lemierre syndrome that complicates an acute mastoiditis, with considerations regarding its pathogenesis and management. Despite its sporadic occurrence, awareness of lemierre syndrome is important, since early recognition reduces both the morbidity and mortality associated with it.
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2/126. Thrombolytic treatment of type A right atrial thrombi: description of three cases and review of the literature.

    Type-A right atrial thrombosis is characterized by echocardiographic detection of mobile worm-shaped thromboemboli in the right atrium, with a high propensity to embolic dislocation into the pulmonary circulation. This type of thrombus is associated with a very high mortality rate that exceeds 60% in untreated patients. Surgical embolectomy has been proposed as the treatment of choice, but the availability of an experienced surgical staff and the patients' eligibility for surgical treatment cannot be taken for granted. Efficacy of systemic thrombolysis for treatment of type-A right atrial thrombosis has repeatedly been reported during the past few years, with early mortality rates comparable to those of surgical approach. The major advantages of thrombolysis would be ease of administration and independence of patient's hemodynamic status. Our experience confirms these impressions and argues in favor of the routine use of systemic thrombolysis in the presence of a type-A right atrial thrombus, while reserving surgical embolectomy for patients with formal contraindications to thrombolysis.
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3/126. Rheolytic thrombectomy: a new treatment for stent thrombosis.

    Coronary stent thrombosis, a rare complication after stent deployment, carries major morbidity and mortality. Traditional treatments for stent thrombosis include local or systemic delivery of thrombolytic agents and balloon angioplasty, both with far from optimum results. We report on two cases of coronary stent thrombosis successfully treated with rheolytic thrombectomy as an adjunct to balloon angioplasty.
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4/126. Idiopathic mesenteric thrombosis following caesarean section.

    Mesenteric venous thrombosis, "the great mimicker", is a very rare disorder in pregnancy and the puerperium, particularly when not associated with any pre-existing thrombophilia or autoimmune states. We describe a patient requiring a resection of 150 cm of gangrenous small bowel after uncomplicated elective Caesarean section. The only risk factor for thrombosis was recovery from an elective Caesarean section, a condition classified by the Royal College of Obstetricians and Gynaecologists as "low risk". death from thromboembolism is the leading cause of maternal mortality and should always be considered with unusual post partum symptoms. early diagnosis of mesenteric vascular occlusion is difficult and recent evidence suggests that elevated GST isoenzyme may be helpful. In all cases of MVT anti-coagulation is the basis of treatment. patients who are not anti-coagulated after surgery have a recurrence rate of 25 per cent compared with 13 per cent of heparinised post-operative patients. As no other pre-existing cause for MVT was found, management was with warfarin for 6 months, the oral contraceptive pill was contraindicated and heparin prophylaxis was recommended for future pregnancies.
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5/126. Traumatic basilar artery dissection in a child: need for anticoagulation?

    dissection of a cerebral blood vessel is a rare complication of acute neurotrauma with a high incidence of morbidity and mortality. We report on a case of a pediatric patient with severe neurological symptoms in whom angiography showed evidence of a basilar artery dissection. The patient was heparinized and recovered uneventfully.
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6/126. Catastrophic outcomes of noncardiac surgery soon after coronary stenting.

    OBJECTIVES: To assess the clinical course of patients who have undergone coronary stent placement less than six weeks before noncardiac surgery. BACKGROUND: Surgical and percutaneous transluminal coronary angioplasty revascularization performed before high-risk noncardiac surgery is expected to reduce perioperative cardiac morbidity and mortality. Perioperative and postoperative complications in patients who have undergone coronary stenting before a noncardiac surgery have not been studied. methods: Forty patients who underwent coronary stent placement less than six weeks before noncardiac surgery requiring a general anesthesia were included in the study (1-39 days, average: 13 days). The records were screened for the occurrence of adverse clinical events, including myocardial infarction, stent thrombosis, peri- and postoperative bleeding and death. RESULTS: In 40 consecutive patients meeting the study criteria, there were seven myocardial infarctions (MIs), 11 major bleeding episodes and eight deaths. All deaths and MIs, as well as 8/11 bleeding episodes, occurred in patients subjected to surgery fewer than 14 days from stenting. Four patients expired after undergoing surgery one day after stenting. Based on electrocardiogram, enzymatic and angiographic evidence, stent thrombosis accounted for most of the fatal events. The time between stenting and surgery appeared to be the main determinant of outcome. CONCLUSIONS: Postponing elective noncardiac surgery for two to four weeks after coronary stenting should permit completion of the mandatory antiplatelet regimen, thereby reducing the risk of stent thrombosis and bleeding complications.
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7/126. Acardiac twinning where the pump twin dies in utero due to thrombosis in the umbilical arteries.

    A case of acardiac twinning where the pump twin dies in utero due to massive thrombotic occlusion of umbilical arteries at a site of umbilical cord stricture of the intact twin. In acardiac twinning the morbidity and mortality of the pump twin can be reduced by some invasive or medical approaches. The authors believe that in this interesting case the death of the pump twin could not be prevented by antenatal treatment.
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8/126. Acute occlusion of an abdominal aortic aneurysm--case report and review of the literature.

    Acute thrombosis of an abdominal aortic aneurysm (AAA) is a surgical emergency. Only 44 cases have been reported in the literature. The mechanism of the thrombosis has not been delineated. The proposed etiologies include propagation of thrombus from distal artery occlusion, cardiac thromboembolism, and dislodgment of a mural thrombus. patients often present bilateral lower extremity ischemia, mimicking a saddle embolism. Systemic heparinization immediately after diagnosis and prompt surgical revascularization can reduce the mortality rate. The authors present a patient with sudden thrombosis of an AAA who was successfully treated with an axillobifemoral bypass graft. All published cases of thrombosed AAAs are analyzed.
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9/126. Thrombosis of mechanical valve prosthesis: thrombolysis vs surgical treatment. Report of two cases, personal experience and review of the literature.

    We report the cases of two patients, previously operated for mitral mechanical valve replacement who developed thrombosis of the prosthesis. The two patients were successfully treated with pharmacological thrombolysis with no recurrence. One patient developed late peripheral embolization most probably due to late mobilisation of a thrombotic fragment. Our experience with surgical management is reported (39 mitral and 5 aortic prosthetic thrombosis from 1982 to 1999 among 89 patients with prosthetic malfunction). Average time interval between surgery and thrombus formation is 26 months (max 204, min 1 month). Rate of mitral thrombosis is 3.9% and aortic 0.25%. Clinical presentation spreads from almost asymptomatic patients to critically ill patients with pulmonary oedema or frank cardiogenic shock. Temporary suspension of anticoagulant therapy (83% in our study group) to rule out minor surgery, appears to be the most frequent cause of thrombosis. Transthoracic or better transoesophageal echo-cardiography and Doppler are by far the most accurate diagnostic tools that can entirely replace angiographic assessment. Operative mortality was 64% in the prosthetic mitral thrombosis and 20% in the aortic one. Thrombolytic treatment may be affected by minor to relevant complications such as peripheral or central embolization but in our experience and according to the literature it seems much less hazardous than re-do surgery. Thrombolytic treatment is advocated for critical patients unless emergency institution of cardio pulmonary bypass is required and/or indicated. Re-do surgery remains indicated for all other cases of prosthetic malfunction.
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10/126. Acute thrombosis of an aortic aneurysm.

    The natural history of abdominal aortic aneurysms is to enlarge gradually. Associated complications are rupture, peripheral embolization and infection.1-5 Complete occlusion of an abdominal aortic aneurysm by thrombus is extremely rare and constitutes a surgical emergency, with an estimated mortality of 50%.1-5 We report a case of a patient with this very uncommon complication of abdominal aortic aneurysm and review the literature discussing its optimal identification and management.
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