1/7. Spontaneous rupture of the iliac vein.Two unusual cases of iliac vein spontaneous rupture into the retroperitoneum are presented together with 18 cases reported by the literature. In one patient of ours, entrapment of clots in an IVC filter and proximal iliac vein involvement into the scar tissue surrounding the left limb of an aortoiliac bifurcation graft might have caused flow disturbances and subsequent predisposition to rupture of the thrombosed external iliac vein. Inflammatory parietal changes, including infiltration of macrophages, T and B lymphocytes producing elastin degradation by means of cytokines, may have led ultimately to vein disruption. Despite clinical features and CT scan findings, the physician's awareness of this disease remains the most important factor for the early treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Massive hemoperitoneum due to rupture of a retroperitoneal varix.Intra-abdominal hemorrhage from ruptured varices is an unusual, life-threatening complication of portal hypertension. We present the case of a 58-year-old man with alcoholic cirrhosis who presented with increasing abdominal girth, hypovolemic shock, and profound anemia due to rupture of a retroperitoneal varix into the peritoneal cavity. The clinical presentation of this rare problem is remarkably consistent among published reports. Early recognition may help the treating physician reduce the likelihood of a catastrophic outcome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Recurrent haemoperitoneum in a mild von Willebrand's disease combined with a storage pool deficit.Haemoperitoneum secondary to haemorrhagic corpus luteum has been described in severe bleeding disorders such as afibrinogenaemia, type 3 von Willebrand's disease and patients under oral anticoagulation. We have studied one patient who presented three episodes of severe bleeding at ovulation, requiring surgery twice, with the diagnosis of mild von Willebrand's disease and mild storage pool deficiency. Mild von Willebrand's disease (associated with other thrombopathies or coagulopathies) should be considered in this pathology, although physicians would prefer to find a severe haemorrhagic disorder as the underlying condition in these cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Nonoperative management of spontaneous splenic rupture in infectious mononucleosis: the role for emerging diagnostic and treatment modalities.infectious mononucleosis (IM) is a self-limiting lymphoproliferative disorder affecting teenagers and young adults. splenomegaly is a common manifestation of IM and results in a compromised organ that may rarely rupture spontaneously, with significant morbidity and mortality. The IM spleen should be protected from even minor trauma. Although traditional management of spontaneous splenic rupture in IM has been splenectomy, the role of nonoperative management is evolving. The advent of endovascular interventional modalities has augmented the physician's armamentarium in managing these patients nonoperatively. We report a case of spontaneous splenic rupture in a patient with IM managed conservatively with the aid of splenic angiography. The option of arteriography, with or without embolization, should be considered in the management of all patients with spontaneous splenic rupture in the setting of IM.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Unrecognized pregnancy in the overdosed or poisoned patient.A 22-year-old woman was found in bed unresponsive and hypotensive after an apparent overdose. Subsequent workup in the emergency department identified a ruptured ectopic pregnancy and extensive hemoperitoneum. A significant delay occurred when emergency physicians excluded the possibility of pregnancy because of the patient's normal menstrual history. A qualitative serum or urine pregnancy test is recommended in all women of child-bearing age who present with poisoning or drug overdose.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Fatal staphylococcus aureus infective endocarditis: the dental implications.Infective endocarditis remains an important and life-threatening infection despite improvements in diagnosis and management. There is currently a greater role for nosocomial acquisition of organisms and immunosuppression in the pathogenesis of this disease and emergence of a broader spectrum of infective organisms including those not commonly isolated from the mouth such as staphylococci. We report a case of infective endocarditis caused by staphylococcus aureus in which the patient developed disseminated intravascular coagulation and multiple septic infarcts resulting in a frontal lobe brain abscess. Multiple dental extractions were complicated by delayed postextraction hemorrhage and the immediate cause of death was abdominal hemorrhage. The dental management in infective endocarditis should be planned in consultation with the attending physician, and should take into account both the causative organism and the presence of complications. When the oral cavity cannot be proven as the bacterial source for infective endocarditis, the immediate dental management should be directed toward improving the patient's oral hygiene and providing pain relief. Definitive long-term treatment, including any extractions, is ideally delayed until the patient has fully recovered from the infective endocarditis and its attendant complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. hemoperitoneum in a postmenopausal woman.As the number of postmenopausal women increases, physicians will have more opportunities to treat elderly women with gynecological complications. This case report describes a 76-year-old, obese, multiparous woman, known to have gallstones who presented with acute abdomen complaints and was admitted for observation. Treatment was delayed until significant blood loss was recognized. At laparotomy, a ruptured ovarian granulosa cell tumor was found.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |