1/8. Aorto caval fistula--the "bursting heart syndrome".Aorto caval fistula is one of the less well recognised complications of abdominal aortic aneurysm seen in accident and emergency departments. It presents in a number of different ways the commonest of which is high output congestive cardiac failure with warm peripheries. Initial diagnosis is based on the index of suspicion of the clinician. However, early diagnosis by the emergency physician and early surgery can markedly improve the patients prognosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Postlaminectomy arteriovenous fistula: the Brazilian experience.arteriovenous fistula is an infrequent complication of lumbar disc surgery. It is often not suspected, and the symptoms are diagnosed as deep venous thrombosis or heart failure. As a result of our review of the Brazilian literature and a survey of 3,500 Brazilian physicians, 5 cases of post-laminectomy arteriovenous fistula are added to the literature. A review of these cases shows that: (1) the right common iliac artery was injured in most cases, (2) the vena cava was frequently injured, and (3) direct repair was possible when the vena cava and the aorta were injured. A vascular prosthesis was necessary when the iliac arteries were damaged. The correct diagnosis is usually made by detection of an abdominal bruit in a patient with a history of lumbar disc surgery and is confirmed by arteriogram. Surgical treatment, either by suture or bypass, is the treatment of choice and results in cure.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Spontaneous common iliac arteriovenous fistula manifested by acute renal failure: a case report.Arteriovenous fistulas between the common iliac vessels resulting from spontaneous rupture of aneurysms are rare, with only 31 cases having been reported since 1971. Clinical diagnosis is possible when a unique set of findings is present, namely high-output cardiac failure, a pulsatile abdominal mass associated with a bruit or thrill, and unilateral arterial insufficiency or venous engorgement. Recently, with advancements in diagnostic techniques, the number of cases in which an arteriovenous fistula is found between the common iliac vessels has increased. Diagnosis can be difficult, however, as in the case of one of our patients in whom the predominant sign was acute renal failure. Other reports of renal failure or impairment in the presence of a common iliac fistula have also appeared. awareness of this phenomenon can help the physician to establish the diagnosis when one or more of the classic signs are absent. Prompt diagnosis and surgical management have contributed to the high incidence of survival in patients with arteriovenous fistulas between the common iliac vessels.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Aortocaval fistulae: an occasional cause of congestive cardiac failure.Two atypical patients with spontaneous aortocaval fistulae with a successful outcome, are presented. Lack of physician awareness is considered an important contributor to diagnostic delay. A finding at cardiac catheterization is described. review of the English literature shows that satisfactory results in the management of this condition can now be expected.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Percutaneous interventional catheter therapy for lesions of the chest and lungs.Percutaneous, nonsurgical interventions using angiographic catheter techniques and radiologic guidance were used in the management of seven cases of various lesions of the chest and lungs. Successful catheter therapy included the embolization of a large, acquired, postinflammatory vascular malformation causing massive hemoptysis and a cavernous hemangioma of the chest wall. Sixteen pulmonary arteriovenous fistulas (one patient), an iatrogenic internal mammary artery-to-innominate vein fistula, and a persistent, postbiopsy bronchopleural fistula were successfully closed. Percutaneous drainage of a pyogenic lung abscess and the nonoperative retrieval of an intravascular foreign body that had embolized to the left pulmonary artery were also successfully achieved. Performed under local anesthesia with minimal morbidity, stress, and risk, interventional catheter therapy is remarkably cost-effective. Primary chest physicians are encouraged to consider this mode of therapy whenever applicable.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Postlaminectomy arteriovenous fistula.Forty-nine cases of postlaminectomy arteriovenous fistula have been reported. Perforation of the anterior spinal ligament by the pituitary rongeur during discectomy with resultant simultaneous damage to artery and vein is causative. Whether aorta, cava, and/or iliac vessels are involved depends upon the level of laminectomy, the angle of the instrument, and anatomic variations in aortocaval bifurcation. Nine patients presented early after operation and were diagnosed promptly. The 40 patients who presented from months to years following laminectomy to physicians unfamiliar with this entity often had a distressing delay in diagnosis. High output congestive heart failure, particularly in a young person, and the characteristic abdominal and back bruit, should arouse suspicion. Arteriography confirms the diagnosis and allows planning for the operative repair. Though potentially disastrous, the operative correction of a major arteriovenous fistula may be done safely if standard principles of vascular surgery are followed. When combined with technical hints regarding clamp placement, transvascular repair, balloon catheter use, vein preservation, and the multiple inventive uses of the Dacron vascular prosthesis, a successful outcome should be expected.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Ureteroarterial fistula: case report and review of the literature.Ureteroarterial fistulae are rare. We report 2 cases of this clinical problem. Ureteroarterial fistulae can occur in association with prolonged ureteral stenting, radiation therapy, vascular pathology, and prior pelvic or vascular surgery. Identification of a fistula is often difficult and requires the physician to be highly alert and vigilant. Diagnostic and therapeutic options for a ureteroarterial fistula are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. The ophthalmology of intracranial vascular abnormalities.PURPOSE: To provide a practical review of the ophthalmologic manifestations of intracranial vascular abnormalities. methods: We reviewed ocular manifestations of the most common intracranial vascular abnormalities: intracranial aneurysms, carotid-cavernous fistulas, arteriovenous malformations, and cavernous malformations. RESULTS: Unruptured aneurysms can compress the third cranial nerve and the anterior visual pathways. Ruptured aneurysms and subarachnoid hemorrhage can result in Terson syndrome and papilledema. Direct and indirect carotid-cavernous fistulas most commonly cause the classic triad of proptosis, conjunctival chemosis, and cranial bruit but can masquerade as chronic conjunctivitis. arteriovenous malformations, with or without hemorrhage, may compress portions of the retrochiasmal pathways, causing visual field loss. Cavernous malformations, when in the brainstem, commonly cause abnormalities of supranuclear, nuclear, and fascicular ocular motility. CONCLUSIONS: The ophthalmologist may be the first physician to encounter clinical manifestations of intracranial vascular abnormalities that may herald devastating neurologic complications. Prompt diagnosis facilitates appropriate management and therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |