1/23. cholesterol embolism in a patient with inflammatory abdominal aortic aneurysm.A 66-year-old man whose renal function had progressively deteriorated had an elevated blood pressure and also was found to have an inflammatory abdominal aortic aneurysm (AAA). Blood examination revealed that he had eosinophilia. livedo reticularis of the toes developed, and a skin biopsy specimen showed embolization of atheromatous plaques in the arterioles of the subcutaneous tissue. Progressive enlargement of inflammatory AAA may have dislodged the atheromatous plaques, resulting in cholesterol embolism.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/23. Late spontaneous extrusion of a texturized silicone gel mammary implant.A case report of late spontaneous extrusion of a 250-cm(3), round, texturized silicone gel mammary implant, 14 months after implantation, is presented. The irregular surface of the implant, the location of the implant pocket, and the absence of the fibrous capsule were responsible for alterations in the skin thickness. In addition, the pressure exerted by the implant against the skin provides for stasis with venous thrombosis at the inferior portion of the breast. The continuous manipulation of the breast over a thin skin with vascular alterations led to the skin perforation with implant extrusion.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/23. glaucoma in episcleritis.Two patients had episcleritis and a secondary open angle glaucoma. Anterior uveitis was absent in three of the four eyes. The low facility of outflow suggests that increased episcleral venous pressure was not the mechanism of the glaucoma. The response of the intraocular pressure and, in one case, the outflow facility to steroid therapy suggests that inflammation of angle structures was the pathogenesis of the raised intraocular pressure.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
4/23. barotrauma secondary to inflammatory maxillary sinus polyp: a case report.Sinus barotrauma, secondary to mucosal disturbances, is a common finding within the aviation community. Multiple etiologies have all led to mucosal inflammation and thickening with potential obstruction of the sinus osteomeatal complex, especially during the barometric changes of flight. Obstruction can, therefore, lead to problems with sinus pressure equilibration with atmospheric pressure, and can lead to barosinusitis. We present a case of a U.S. Air Force Command Pilot with acute left sinus barotrauma during descent while flying a T-37 aircraft, along with a brief review of the pathophysiologic processes involved during barotrauma. An inflammatory polyp within his sinus was identified by plain radiography, confirmed with computed tomography, and subsequently excised. The patient had complete resolution and clearance to fly after an uneventful 4-wk convalescence and altitude chamber flight. This is the first case of sinus barotrauma secondary to an inflammatory maxillary sinus polyp, confirmed by histologic diagnosis, reported in the aeromedical literature.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/23. Continuous milrinone infusion during preoperative anti-inflammatory therapy in inflammatory aortic aneurysm complicating severe congestive heart failure.We report a 48-year-old man with inflammatory aortic aneurysm in the ascending aorta complicating severe heart failure due to massive aortic regurgitation. Continuous intravenous milrinone infusion was highly effective in reducing pulmonary arterial pressure and improving subjective symptoms during preoperative anti-inflammatory corticosteroid therapy over 7 weeks without any adverse effects or tolerance. Bentall's operation with a valved conduit was successfully performed after complete stabilization of inflammatory markers, and then milrinone was tapered off uneventfully. We consider that continuous milrinone infusion may be suitable for patients with surgically correctable inflammatory cardiovascular diseases complicating severe heart failure in whom maintenance of optimal hemodynamics is necessary for several weeks during preoperative anti-inflammatory corticosteroid therapy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/23. A pruritic linear urticarial rash, fever, and systemic inflammatory disease in five adolescents: adult-onset still disease or systemic juvenile idiopathic arthritis sine arthritis?The characteristic rash of systemic juvenile idiopathic arthritis is a transient erythematous eruption associated with a quotidian spiking fever. Usually asymptomatic, it can be pruritic, with dermatographism at sites of scratching or pressure. An illness similar to this entity in adults is designated adult-onset Still disease. The relationship between the pediatric and adult disease is uncertain and differences in case definition have evolved. Specifically, a sustained arthritis for at least 6 weeks is required for a diagnosis of systemic juvenile idiopathic arthritis, whereas transient arthritis and arthralgia are accepted criteria in adult-onset Still disease. We describe five patients less than 16 years of age who presented with an acute illness characterized by fever and a distinctive skin eruption. Intense pruritus and linear erythematous lesions flared with a spiking fever, usually in the late afternoon and evening. Periorbital edema/erythema and nonlinear urticarial lesions were also seen. Two children had splinter hemorrhages of the nail beds and one girl developed a fixed, scaling, pigmented, linear eruption. Severe malaise, myalgia, arthralgia, and leukocytosis were present in every patient. Other systemic manifestations included sore throat, transient arthritis, abdominal pain, lymphadenopathy, hepatomegaly, splenomegaly, hyperferritinemia, and hepatic dysfunction. No patient had a sustained arthritis. The course of the disease was variable. One patient, diagnosed with macrophage activation syndrome, recovered on oral naproxen. Two patients responded to systemic corticosteroid therapy. One girl developed status epilepticus and died from aspiration and asphyxia. A boy with severe hepatitis developed renal failure and thrombotic thrombocytopenic purpura and was treated with plasmapheresis, dialysis, and systemic corticosteroids; he had recurrent episodes of rash and fever into adult life. These children did not fulfill the case definition of systemic juvenile idiopathic arthritis because they lacked a persistent arthritis. adolescent and adult patients with the same clinical and laboratory findings are described under the rubric of adult-onset Still disease. Recognition of the distinctive urticarial skin eruption and spiking fever is important in the diagnosis of a disease with severe morbidity and potentially life-threatening complications.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/23. Paradoxical inflammatory reaction during treatment of cryptococcus neoformans var. gattii meningitis in an hiv-seronegative woman.A human immunodeficiency virus (hiv)-seronegative woman was admitted to the hospital with postpartum onset cryptococcus neoformans var. gattii meningitis and markedly increased intracranial pressure. A poor initial response to antifungal therapy was followed, 2 months after hospital admission, by severe acute meningeal and cerebral inflammation and clearance of yeast cells from cerebrospinal fluid. This first reported case of paradoxical inflammatory reaction to C. neoformans illustrates important aspects of the host-pathogen interaction and highlights possible effects of immunomodulatory therapies.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/23. The pseudopapilledema of neonatal-onset multisystem inflammatory disease.PURPOSE: To report a rare case of neonatal-onset multisystem inflammatory disease with serial photographs to characterize the optic nerve findings. DESIGN: Observational case report. methods: A 6-year-old girl with neonatal-onset multisystem inflammatory disease, who had received systemic corticosteroid therapy for 5 years, had bilateral fibrillar opacities that surrounded the optic disks and extended into the peripapillary nerve fiber layer and vessels. A magnetic resonance imaging examination and lumbar puncture revealed elevated intracranial pressure. RESULTS: The elevated intracranial pressure returned to normal following a corticosteroid taper. optic disk photographs, taken 4 years earlier, were subsequently obtained. The optic disk appearance had remained unchanged over the 4-year period, consistent with a pseudopapilledema. CONCLUSION: The optic disk appearance is not consistent with papilledema from increased intracranial pressure. The optic disk findings, in conjunction with the underlying inflammatory syndrome, suggest an infiltrative etiology for the atypical optic nerve findings in neonatal-onset multisystem inflammatory disease.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
9/23. Latent fatality due to hydatid cyst rupture after a severe cough episode.Hydatid disease is a parasitic disease caused by echinococcus granulosus characterised by cyst formation in various organs. The infestation mostly involves the liver. Hydatid cysts of the liver can rupture either spontaneously or due to trauma. incidence of rupture is about 3-17% of all cases with hydatid disease. Unless treated surgically, rupture can result in death. Here, we present a case of hydatid cyst ruptured after a severe cough episode and disseminated first to the subcapsular area, then to the peritoneal space. Probably due to a decrease in parenchymal pressure in the liver after decompressive effect of rupture, the patient felt an improvement in abdominal pain, refused operation, and left the hospital on his own responsibility. This unfortunate relief resulted in a delay of 55 hours in management. The leakage of liquid materials into peritoneal space resulted in a severe inflammatory reaction and eventually death of the patient. The patient died of a late peritonitis rather than anaphylaxis, which is the most common reason for death in such patients. As a conclusion, physicians should be aware of a temporary relief in abdominal pain after cyst rupture that may cause a delay in management and in turn loss of patient due to peritonitis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/23. Raised intracranial pressure complicating cryptococcal meningitis: immune reconstitution inflammatory syndrome or recurrent cryptococcal disease?We report the case of a patient with advanced hiv disease and cryptococcal meningitis, who after an initially good clinical and mycological response to systemic anti-fungal treatment developed symptomatic raised intracranial pressure 10 days after initiation of highly active anti-retroviral therapy. We describe the subsequent clinical management and the features that suggest that this persistently raised ICP was more likely due to an immune reconstitution syndrome (iris) following HAART rather than relapse of cryptococcal disease or failure of anti-fungal therapy.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
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