1/107. Primary percutaneous transluminal coronary angioplasty performed for acute myocardial infarction in a patient with idiopathic thrombocytopenic purpura.A 72-year-old female with idiopathic thrombocytopenic purpura (ITP) complained of severe chest pain. electrocardiography showed ST-segment depression and negative T wave in I, aVL and V4-6. Following a diagnosis of acute myocardial infarction (AMI), urgent coronary angiography revealed 99% organic stenosis with delayed flow in the proximal segment and 50% in the middle segment of the left anterior descending artery (LAD). Subsequently, percutaneous transluminal coronary angioplasty (PTCA) for the stenosis in the proximal LAD was performed. In the coronary care unit, her blood pressure dropped. Hematomas around the puncture sites were observed and the platelet count was 28,000/mm3. After transfusion, electrocardiography revealed ST-segment elevation in I, aVL and V1-6. Urgent recatheterization disclosed total occlusion in the middle segment of the LAD. Subsequently, PTCA was performed successfully. Then, intravenous immunoglobulin increased the platelet count and the bleeding tendency disappeared. A case of AMI with ITP is rare. The present case suggests that primary PTCA can be a useful therapeutic strategy, but careful attention must be paid to hemostasis and to managing the platelet count.- - - - - - - - - - ranking = 1keywords = pain, chest (Clic here for more details about this article) |
2/107. Hypotensive ischemic optic neuropathy and peritoneal dialysis.PURPOSE: To report anterior ischemic optic neuropathy associated with systemic hypotension in a patient undergoing continuous ambulatory peritoneal dialysis. methods: Case report. A 58-year-old man undergoing continuous ambulatory peritoneal dialysis developed painless blurred vision in both eyes and bilateral optic disk swelling with an altitudinal field defect in the left eye. Twenty-four-hour ambulatory blood pressure monitoring was requested in addition to other routine investigations. RESULTS: Routine blood pressure measurement in the clinic was 130/86 mm Hg, but ambulatory blood pressure monitoring demonstrated pronounced early morning hypotension with individual readings as low as 91/41 mm Hg. CONCLUSIONS: renal dialysis can render patients hypotensive, and this may be associated with anterior ischemic optic neuropathy. The overnight drop in blood pressure may not be appreciated with routine blood pressure measurement. Therefore, 24-hour ambulatory blood pressure monitoring should be considered when investigating patients with suspected anterior ischemic optic neuropathy who are undergoing renal replacement.- - - - - - - - - - ranking = 0.6438750224312keywords = pain (Clic here for more details about this article) |
3/107. Predicting outcome from coma: man-in-the-barrel syndrome as potential pitfall.The glasgow coma scale motor score is often used in predicting outcome after hypoxic-ischemic coma. Judicious care should be exerted when using this variable in predicting outcome in patients with coma following hypotension since borderzone infarction can obscure the clinical picture. We describe a patient who underwent skull base surgery for a schwannoma of the left facial nerve. The operation, which lasted for 10 h, was conducted under controlled hypotension. After the intervention the patient remained comatose with absent arm movements upon painful stimuli. An absent motor score usually carries a poor prognosis. However, magnetic resonance inversion recovery imaging of the brain showed bilateral hyperintense lesions in the arm-hand area indicative of borderzone ischemic damage. The patient received optimal supportive care and after 17 days he regained consciousness with 'man-in-the-barrel syndrome', which also further improved over time.- - - - - - - - - - ranking = 0.6438750224312keywords = pain (Clic here for more details about this article) |
4/107. atrial fibrillation and continuous hypotension induced by sildenafil in an intermittent WPW syndrome patient.A 55-year-old Japanese man was hospitalized for palpitations and severe chest oppression one hour after he ingested about 1500 ml of beer and sildenafil (Viagra) 50 mg. At 43 years of age, he had been diagnosed with intermittent WPW syndrome following a paroxysmal supraventricular tachycardia (PSVT) attack. He took a 1 mg tablet of doxazosin daily for mild hypertension. On admission, his blood pressure was 90/54 mmHg and his heart beat was weak and irregular with a rate of about 220/min. Since atrial fibrillation (Af) was diagnosed on an electrocardiogram (minimum RR interval; 0.22 seconds), direct current shock was performed with 100 joules and 150 joules but conversion to sinus rhythm failed. Sinus rhythm returned spontaneously from Af four hours after taking sildenafil. Since blood pressure was 50/17 mmHg despite the return to sinus rhythm, blood pressure was maintained by dopamine for twelve hours after sinus rhythm returned. The patient underwent catheter ablation for curative therapy and thereafter has not had any further episodes of tachycardia.- - - - - - - - - - ranking = 0.3561249775688keywords = chest (Clic here for more details about this article) |
5/107. Endoleaks following conventional open abdominal aortic aneurysm repair.OBJECTIVE: to describe the complication of <<<<endoleak>>>> following conventional open abdominal aortic aneurysm (AAA) repair. DESIGN: prospective case study. SETTING: two specialist vascular surgical centres. patients AND methods: six patients who had successful conventional open AAA repair. RESULTS: six patients presented with back or abdominal pain or hypotension between one and eighteen months later. An endoleak at the distal anastomosis was noted in five of the cases and one endoleak at the proximal anastomosis. All six cases were successfully repaired; two of these patients required Dacron graft replacement, whilst in four cases only direct resuturing was needed. There was no evidence of infection. CONCLUSIONS: an endoleak is not a phenomenon confined to stent grafts. It should be considered in all patients who present with back or abdominal pain within eighteen months of open AAA repair. The combination of computed tomography (CT) scan and digital subtraction angiography is most useful for preoperative diagnosis.- - - - - - - - - - ranking = 7.6162646861346keywords = abdominal pain, pain (Clic here for more details about this article) |
6/107. Perioperative stroke associated with postoperative epidural analgesia.A patient with an epidural catheter for postoperative analgesia developed a stroke in association with a hypotensive episode resulting from a bolus of local anesthetic. After undergoing resection for femoral chondrosarcoma under epidural anesthesia, the patient received a continuous infusion of epidural morphine for postoperative analgesia. lidocaine 1% (10 mL in divided doses) was administered through the catheter for breakthrough pain. The patient experienced a hypotensive episode and was noted to have a motor and cortical sensory deficit of the left arm and leg 8 hours after the hypotensive episode. Clinical presentation and subsequent workup were consistent with a watershed infarction. The patient recovered full neurologic function before discharge. Postoperative hypotension from epidural analgesia may be associated with stroke; however, a cause-and-effect relationship usually cannot be established with certainty.- - - - - - - - - - ranking = 0.6438750224312keywords = pain (Clic here for more details about this article) |
7/107. hemoperitoneum following rupture of ectopic varix along splenorenal ligament in extrahepatic portal vein obstruction.A 29-year-old man with extrahepatic portal vein obstruction who underwent variceal eradication by sclerotherapy six years ago, was admitted with hypotension and abdominal pain. Abdominal paracentesis yielded frank blood. laparotomy showed bleeding from a large ectopic vessel along the splenorenal ligament. The vessel was ligated and the patient recovered.- - - - - - - - - - ranking = 3.8081323430673keywords = abdominal pain, pain (Clic here for more details about this article) |
8/107. Anterior mediastinal tumour identified by intraoperative transesophageal echocardiography.PURPOSE: To report a child with anterior mediastinal tumour misdiagnosed as pericardial effusion who had been sent to the operating theatre for drainage. After induction of general anesthesia she developed cardio-respiratory collapse. The diagnosis was made with the aid of transesophageal echocardiography (TEE). CLINICAL FEATURES: A 14-yr-old girl suffered from cough and intermittent fever for one month before admission. Four days before admission, she became orthopneic and was admitted to the intensive care unit. Precordial echocardiography showed an anterior and posterior echolucent space between the pericardium and epicardium that was thought to be a pericardial effusion. She was sent to the operating room for emergency drainage. After induction of general anesthesia, breath sounds were not heard on the left side of the chest. The patient developed increasing hypoxemia and hypotension despite cardiocentesis. A TEE determined that an anterior mediastinal mass was the cause of her hypoxemia and hypotension. The tumour was debulked and the patient made an uneventful postoperative recovery. CONCLUSION: In this case, the correct diagnosis of an anterior mediastinal mass was made with TEE. The place of TEE may be indicated in patients with unexplained hypoxemia and hypotension.- - - - - - - - - - ranking = 0.3561249775688keywords = chest (Clic here for more details about this article) |
9/107. Use of the intra-aortic balloon pump to stop gastrointestinal bleeding.Temporary aortic occlusion can be lifesaving in selected conditions. We describe the unorthodox use of an intra-aortic balloon pump without counterpulsation to achieve temporary vascular control in a patient with shock caused by rapid upper gastrointestinal bleeding. The technique of aortic balloon occlusion has been reported in several clinical circumstances, primarily trauma. However, its use to increase blood pressure and gain time for resuscitation before laparotomy for catastrophic gastrointestinal bleeding has not previously been described.- - - - - - - - - - ranking = 0.03004187829285keywords = upper (Clic here for more details about this article) |
10/107. Acute hypotension and bradycardia by medulla oblongata compression in spinal surgery.A 71-year-old man was admitted to the hospital with subarachnoid hemorrhage caused by a cervical dural arteriovenous shunt. During surgery, the patient developed acute hypotension and bradycardia, probably caused by surgical compression of the medulla oblongata. During posterior fossa and upper cervical surgery, monitoring cardiovascular, respiratory, and evoked potential parameters is advocated. In the current case, only cardiovascular monitoring detected alteration of brain stem function. Anesthesiologists should be aware that surgical manipulation of the dorsal medulla might cause hemodynamic changes and expose patients to danger. Through close cardiovascular monitoring we can rapidly detect changes in vital signs, which allows prompt intervention to prevent irreversible neurologic deficits and potentially catastrophic patient outcome.- - - - - - - - - - ranking = 0.03004187829285keywords = upper (Clic here for more details about this article) |
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