11/42. heparin-induced thrombocytopaenia complicated by bilateral adrenal haemorrhage.Acute adrenal insufficiency due to bilateral adrenal haemorrhage is an important clinical diagnosis and its association with heparin-induced thrombocytopaenia is infrequent. We report on a patient in whom life threatening acute adrenal insufficiency occurred consequent to such an association. The clinical manifestations simulated septic shock, highlighting the need to consider specifically acute adrenal insufficiency in such settings, and institute therapy promptly prior to obtaining results of confirmatory tests.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
12/42. Bleeding to the adrenal gland as a terminal manifestation of acute leukaemia.The authors refer about an unusual localization of haemorrhage to the adrenal glands, observed in two patients with acute leukaemia similar to the picture of Waterhouse-Friderichsen's syndrome. This complication causing serious and dramatic effects should be taken into differential diagnostic consideration. literature data and own results are given in order to review the general characteristics of bleeding in acute leukaemia.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
13/42. Case report: unusual appearance of a giant adrenal pseudocyst.Adrenal pseudocysts are uncommon lesions which usually present with abdominal discomfort and swelling due to their large size. The computed tomographic appearances typically demonstrate a smooth thin-walled low attenuation mass with peripheral curvilinear calcification. This case demonstrates the unusual appearances of a pseudocyst with multiple central punctate calcifications as a result of repeated haemorrhage. The radiological appearance of this complex mass mimicked an hydatid cyst. The increase in size of the pseudocyst is demonstrated over a 4 year period.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
14/42. Septicaemia and adrenal haemorrhage in congenital asplenia.Five patients developed overwhelming infection as a result of congenital asplenia, which was previously unsuspected in all cases. Each illness followed a fulminant course resulting in death within 24 hours. They illustrate the respective roles of haemophilus influenzae infection (n = 4) and adrenal haemorrhage (n = 4) in this condition. We suggest a management protocol for screening infants with abnormalities of the atria or viscera with splenic ultrasound and examination of a blood film for Howell-Jolly bodies. vaccination and prophylactic antibiotics should be considered for those at risk. Vigorous use of parenteral antibiotics and steroids in suspected infection is recommended.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
15/42. adrenoleukodystrophy. Preliminary report of a connatal case. light- and electron microscopical, immunohistochemical and biochemical findings.This is the first description of a connatal case of adrenoleukodystrophy. The clinical picture consisted of severe psychomotor retardation, convulsions and hypsarrhythmia, but no obvious signs of adrenal insufficiency. Pathologically, the adrenals were small. The entire cortex was largely replaced by large round cells. Ultrastructurally, some cells in the adrenal cortex contained inclusions with electron-lucent clefts surrounded by a membrane. The anterior pituitary lobe could be demonstrated to have produced ACTH. The central nervous system showed extensive zones of demyelination in the brainstem, the cerebellum and the right-sided capsula interna. In the demyelinated areas there was sudanophilic breakdown and an intense gliosis. Ongoing demyelination could also be demonstrated by the chemical analysis. In the gray matter there waere micropolygyria of the insular cortex and swollen nerve cells in the nucleus arcuatus. Ultrastructure revealed the type of inclusions in the microglia of the same type as in the adrenals, and a different type of inclusions in unidentifiable cells, possibly neurons. These latter inclusions consisted of loosely stacked lamellar material. The findings are interpreted as further evidence of storage taking place in this disease.- - - - - - - - - - ranking = 4.9702503120601E-7keywords = brain (Clic here for more details about this article) |
16/42. Hypercalcaemia in acute adrenal insufficiency. A case report.A woman aged 62 developed a septic shock and pulmonary embolism after skin grafting for extensive burns. She was put on anticoagulants. A second shock led to renal insufficiency. Hypercalcaemia developed. A CT scan of the upper abdomen disclosed enlarged adrenal glands. An acute adrenal haemorrhage was suspected. The levels of cortisol were low in the plasma and urine and did not respond to ACTH stimulation. cortisone replacement therapy improved the condition of the patient and normalized plasma calcium levels. The mechanisms of hypercalcaemia in acute adrenal insufficiency are discussed. Multiple factors have been proposed: haemoconcentration, an increased affinity of plasma proteins for calcium, an increase in the filtrable calcium complexes, and an enhanced calcium mobilization of skeletal origin.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
17/42. Multifocal vacuolar leucoencephalopathy: a distinct hiv-associated lesion of the brain.A 20-year-old male AIDS patient developed rapidly progressive dementia for more than 3 months prior to death. autopsy showed, in addition to adrenal cytomegalovirus (CMV) infection and focal cerebral necrosis due to toxoplasmosis, multifocal subcortical white matter lesions of the brain which were strikingly similar to the histopathology of vacuolar myelopathy in AIDS. These distinct lesions contained macrophages which were rarely multinucleated and expressed hiv antigens by immunocytochemistry. The distribution of lesions mimics extrapontine myelinolysis and progressive multifocal leucoencephalopathy (PML); PML was excluded by the absence of papovaviruses by immunocytochemistry and by in situ dna hybridization. Tissue damage in multifocal vacuolar leucoencephalopathy is different from hitherto characterized hiv-specific neuropathology such as hiv encephalitis and hiv leucoencephalopathy, and should be included in the list of conditions with damage of the brain white matter in AIDS.- - - - - - - - - - ranking = 2.7728863974277E-5keywords = cerebral, brain (Clic here for more details about this article) |
18/42. Multimodality evoked potentials in patients and carriers with adrenoleukodystrophy and adrenomyeloneuropathy.A combination of brain-stem auditory evoked potentials (BAEPs), short latency somatosensory evoked potentials (SEPs) and pattern reversal visual evoked potentials (VEPs), were studied in two patients with adrenoleukodystrophy (ALD) and one patient with adrenomyeloneuropathy (AMN), as well as in one female carrier of each of the respective diseases. Abnormalities in at least 1 of the 3 evoked potentials were found in every case, including the carriers of ALD and AMN. The two most common findings were prolongation of the I-V interval of the BAEP and the N13-N20 interval of the SEP. These abnormalities were recorded either alone or in combination in all 5 cases. This finding suggests delayed conduction time in the central sensory pathways in both diseases, probably due to demyelination. The remarkable result, which distinguished AMN from ALD, even in their respective carriers, was delay of the N9 latency of the SEP, indicating slowing in conduction velocity of the peripheral nerve. Multimodality evoked potentials are useful not only in raising the detection rate for abnormal findings, but also in providing additional information about the functional state of separate afferent pathways. It is also of value in detecting and differentiating the carriers of ALD and AMN.- - - - - - - - - - ranking = 4.9702503120601E-7keywords = brain (Clic here for more details about this article) |
19/42. diagnosis and management of neonatal adrenal haemorrhage.Three patients with neonatal adrenal haemorrhage (NAH), presenting with various signs and symptoms, are reported. The role of ultrasonography in diagnosis and management of this entity is emphasized. Conservative management is advocated, once the diagnosis is confirmed. Surgery is indicated only for cases of uncontrollable haemorrhage.- - - - - - - - - - ranking = 1.2keywords = haemorrhage (Clic here for more details about this article) |
20/42. Ongoing role of pulmonary embolectomy.pulmonary embolism remains a frequent and often fatal disorder. For the majority of patients, anticoagulation with heparin followed by warfarin represents the primary mode of treatment. thrombolytic therapy is recommended for the patient with massive pulmonary embolism that has produced hypotension. embolectomy is reserved for the patient with post embolic systemic hypotension who has an absolute contraindication to thrombolysis or who deteriorates despite thrombolytic therapy. Following successful embolectomy the surgeon must treat the complications of the surgery and prevent recurrence. Complications include cerebral infarction, pulmonary infarction and endobronchial hemorrhage, right ventricular failure, local or systemic bleeding and venous stasis. A case of successful pulmonary embolectomy with a complicated postoperative course is presented and the pathophysiology and treatment of the complications are discussed.- - - - - - - - - - ranking = 2.4746713787041E-5keywords = cerebral (Clic here for more details about this article) |
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