1/17. Amputations associated with arteriovenous access.This study was performed to investigate the common characteristics of hemodialysis patients who need upper limb amputations. An index case was identified and involved questioning physicians and reviewing hospital and office records. Hemodialysis patients who have diabetes and leg amputations are at high risk for ischemic episodes that may lead to amputation of the arm, distal to the arteriovenous access site.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/17. fecal impaction causing megarectum-producing colorectal catastrophes. A report of two cases.PURPOSE: Massive fecal impaction leading to surgical catastrophes has rarely been reported. We present 2 such patients to remind physicians that neglected accumulation of fecal matter in the rectum may lead to ischemia and perforation of the colon and rectum. methods: Report of 2 patients and a medline search of the literature. RESULTS: In the 1st case massive fecal impaction produced an abdominal compartment syndrome and rectal necrosis. In the 2nd patient fecal impaction resulted in colonic obstruction and ischemia. In both, an operation was life-saving. CONCLUSION: Neglected fecal impaction may lead to a megarectum causing an abdominal compartment syndrome and colorectal obstruction, perforation or necrosis. Measures to prevent fecal impaction are of paramount importance and prompt manual disimpaction before the above complications develop is mandatory. Appropriate operative treatment may be life-saving.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/17. Ischemic colitis during treatment with alosetron.irritable bowel syndrome (IBS) is one of the most common entities observed by both primary care physicians and gastroenterologists. Alosetron is a potent and selective serotonin antagonist that recently became the first food and Drug Administration-approved agent for diarrhea-predominant IBS. However, since approval, significant side effects have been noted with the use of alosetron including severe constipation, fecal impaction, and ischemic colitis. We describe a case of ischemic colitis in a male patient with IBS who was briefly treated with alosetron. Clinical, endoscopic, and pathologic features of the focal colitis strongly suggested ischemia. Symptoms correlated temporally with alosetron use, and symptoms abated with discontinuation of the drug. Endoscopic and pathologic resolution of the colitis were documented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/17. Hypothalamopituitary deficiency and precocious puberty following hyperhydration in diabetic ketoacidosis.We report on a 5-year-old child who survived an intracerebral crisis, following ketoacidosis-revealing diabetes (DKA), with visual impairment due to a vascular occipital lesion. Two and 4 months after the initial episode, a unique hypothalamopituitary disorder consisting in GH, ACTH, TSH deficiencies and central precocious puberty, was detected. Cranial magnetic resonance images showed no visible lesion in the hypothalamopituitary region. The most likely hypothesis is the ischemia of hypothalamopituitary and occipital regions following possible cerebral edema after hyperhydration. She survived with low visual acuteness and received a combined replacement therapy for the neuroendocrinological deficiencies. This case emphasizes that the rehydration at the initial period of DKA is critical, especially when risk factors for cerebral edema are present (young age, marked hyponatremia). The neuroendocrinological consequences of acute cerebral edema are rare, but physicians must be attentive in survivors of these accidents.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/17. Toe-tourniquet syndrome: a diagnostic dilemma!Strangulation of digits, the 'toe-tourniquet' syndrome needs prompt intervention as failure to recognise the condition can lead to ischaemia and loss of the appendage. It is a common condition though relatively under reported. Those who deal with children more frequently are aware of the condition but this is not the case for all medical practitioners and hence the diagnostic dilemma for accidental injury or child abuse arises.We report this case to increase physician awareness of the syndrome, to highlight the importance of early release of the tourniquet and to avoid misinterpretation of the condition as child abuse.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/17. methamphetamine-induced ischemic colitis.A 50-year-old woman with acute onset of right lower quadrant pain and hematochezia proved to have segmental ischemic colitis associated with methamphetamine abuse. The diagnosis was established by colonoscopy with biopsy, and abdominal angiography revealed no thrombosis, vasculitis, or vasospasm. The condition resolved within 10 days. Since methamphetamine abuse is increasing, physicians should be aware of its potential to produce intestinal ischemia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/17. Prediction of the development of sigmoid ischemia on the day of aortic operations. Indirect measurements of intramural pH in the colon.A deviation in an indirect measurement of intramural pH below the limits of normality (6.86) was used as a diagnostic test for sigmoid ischemia in 25 high-risk patients undergoing abdominal aortic operations. The clinical diagnosis of ischemic colitis was made by the attending physicians in only two of the 25, on the day after operation in one and three months after operation in another. In neither was the ischemic colitis considered to have been a causative factor in their subsequent deaths. In contrast, six patients developed pH evidence of ischemia on the day of operation. All six subsequently developed a transient episode of guaiac-positive diarrhea, four developed physical signs consistent with ischemic colitis, and four died. Of 19 who did not develop pH evidence of ischemia, none developed guaiac-positive diarrhea, none developed any signs of ischemic colitis, and none died. Stepwise logistic regression showed the duration of pH evidence of ischemia on the day of operation to be the best predictor for the symptoms and signs of ischemic colitis and for death after operation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/17. Retinal toxicity secondary to intraocular gentamicin injection.The authors present five cases of severe retinal ischemia associated with gentamicin injection. In three of the cases massive doses of gentamicin were erroneously injected into the eye; in two of the cases the authors presume that gentamicin toxicity occurred. The sequence of clinical findings was similar in all five cases. The prominent findings included early superficial and intraretinal hemorrhages, opaque and edematous retina, cotton-wool infarcts, arteriolar narrowing, and venous beading. fluorescein angiography revealed severe retinal vascular nonperfusion. Chronic findings included rubeosis irides, neovascular glaucoma, retinal pigmentary degeneration, and optic atrophy. Of the documented cases of massive intraocular gentamicin injection, two patients had no light perception (NLP) vision and one had bare light perception. Of the two cases of presumed gentamicin toxicity, one had 20/400 vision and one had count fingers vision. Strict precautions are necessary to prevent the catastrophic events resulting from inadvertent gentamicin injection; such precautions should include precise labeling of all injectable solutions on the surgical field, waiting to draw up injectable antibiotics until the time they are needed, and drawing up injectable antibiotics under direct physician observation. All intravitreal injections should be performed slowly, in the anterior vitreous, with the needle bevel up.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/17. paraplegia associated with epidural anesthesia.Spinal anesthesia has lost its popularity among physicians due to rare occurrences of paraplegia that have precipitated lawsuits, with staggering judgments in favor of claimants. Epidural block has now become a popular alternative because some believe it cannot cause paraplegia; however, paraplegia is as prevalent after induction of epidural anesthesia as after spinal anesthesia. arachnoiditis has been incriminated as the causative agent when paraplegia has followed spinal anesthesia. arachnoiditis is also a causative factor when paraplegia follows epidural block. Cord compression and anterior spinal artery syndrome have also been associated with paraplegia after epidural block though they have not been a problem with spinal block.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/17. Management of compartmental syndrome. Diagnostic and surgical considerations.Compartmental syndrome is a condition in which swelling within a closed anatomic space increases the intracompartmental pressure to compromise the circulation and function of tissue within that space. Unless this condition is recognized early and treated by prompt surgical decompression, permanent neuromuscular deficits may result. In those instances in which early clinical evidence of this syndrome is difficult to assess, monitoring of intramuscular pressures may be valuable adjunct in the clinical evaluation of patients at risk for this syndrome. The association of compartmental syndrome with a wide variety of circumstances and the importance of an early diagnosis make it essential that all physicians be familiar with this condition. As physician awareness and recognition of this condition increase, the complications associated with it can be greatly reduced.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
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