1/4. Asymptomatic coronary artery disease in a pregnant patient. A case report and review of literature.BACKGROUND: Acute myocardial infarction during pregnancy has been reported and has been shown to be associated with poor maternal and fetal outcomes. However, the vast majority of these patients do not have previously recognized ischemic heart disease. pregnancy and delivery pose significant cardiac stress and risk to the mother and fetus. However, it is unknown how available therapies can be utilized in the pregnant patient with identified ischemic heart disease to minimize these risks. CASE REPORT: We present a 39-year-old asymptomatic diabetic female with a positive stress echocardiogram at 16 weeks of pregnancy who remained asymptomatic throughout pregnancy with medical management and went on to have a normal vaginal delivery in the process suffering a small non-ST elevation myocardial infarction with pulmonary edema following delivery due to volume overload. She ultimately underwent cardiac catheterization and successful four-vessel CABG 1 months after her delivery. CONCLUSION: We present this patient to suggest a successful strategy of managing a patient with non-revascularized asymptomatic coronary artery disease during pregnancy. In addition to reviewing the appropriate medical therapy during pregnancy, we discuss the data on revascularization procedures as well as recommendations for delivery and stress testing for such patients.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
2/4. Ischaemic necrosis of the glans penis: a complication of urethral catheterization in a diabetic man.Ischaemic necrosis of the glans penis is rare. Diabetic patients commonly have small vessel disease which may affect the penis. We report the case of a man with extensive diabetic vascular disease, in whom partial penectomy was necessary for ischaemia of the glans penis, following urethral catheterization. The decision to use a urethral catheter in diabetics, particularly those with evidence of vascular disease, must be made with the knowledge that internal compression caused by the catheter may cause irreversible ischaemic changes. In such patients, a suprapubic catheter should be considered as an alternative.- - - - - - - - - - ranking = 5keywords = catheterization (Clic here for more details about this article) |
3/4. Musculoelastosis: a change of small pulmonary arteries found in a case with atrial septal defect and pulmonary hypertension.Interesting findings were obtained in the lung biopsy of a 46 year old female patient with secundum atrial septal defect and pulmonary hypertension. In the intima of small pulmonary arteries, there were a marked increase in elastic fibers and marked proliferation of longitudinal smooth muscle cells. The vascular lumen was markedly stenotic, but reconstruction of small pulmonary arteries indicated that all vascular lumina were patent. The case was accordingly diagnosed as operable and closure of atrial septal defect was undertaken. Three years postoperatively, the patient is well with much improved condition and lowered pulmonary arterial pressure was demonstrated by cardiac catheterization. This case had apparently serious vascular lesions due to severe intimal thickening which we labeled "musculoelastosis", but it was found that such thickening alone did not cause peripheral pulmonary arterial occlusion. It is therefore thought to be a benign pulmonary vascular condition.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
4/4. Penile necrosis in a diabetic with renal disease and clean intermittent catheterization for recurrent urethral stricture. Case report.In a patient with diabetic microangiopathy and renal disease, penile necrosis occurred in connection with clean intermittent catheterization. Microangiopathy of the urethral and penile arteries presumably lowered the local defences, so that the catheterization initiated penile necrotic changes by introducing bacteria and traumatizing the poorly vascularized urethral epithelium.- - - - - - - - - - ranking = 6keywords = catheterization (Clic here for more details about this article) |