1/25. Extensive haemorrhagic-bullous skin manifestation of systemic AA-amyloidosis associated with IgGlambda-myeloma.In an 86-year-old woman with a multiple myeloma of the IgG lambda subtype a coinciding systemic amyloidosis manifested as a macroglossia, diffuse alopecia and generalized cutaneous involvement. The skin was affected by milium-like papules, petechial haemorrhages and an increased tissue fragility with subsequent blister formation. The typical histology and immunohistology pattern revealed large intradermal amyloid masses, reacting positively with anti-amyloid A antibodies, which surrounded cuff-like dilatated blood capillaries. The abundance of these amyloid deposits led to significant deflexibilization and fragility of the capillaries and the dermal matrix eventually resulting in the haemorrhagic-bullous eruptions. The peculiar feature of the present case is the intensity of bullous-haemorrhagic skin damage due to amyloid A deposition without any detection of cutaneous IgGl as the myeloma-derived paraprotein assumed to be causative for the development of systemic AA amyloidosis.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/25. Traumatic asphyxia complicated by unwitnessed cardiac arrest.We report a case of traumatic asphyxia complicated by unwitnessed cardiac arrest in which the patient has made a good, functional recovery. Traumatic asphyxia is an uncommon clinical syndrome usually occurring after chest compression. Associated physical findings include subconjunctival hemorrhage and purple-blue neck and face discoloration. These facial changes can mimic those seen with massive closed head injury; however, cerebral injury after traumatic asphyxia usually occurs due to cerebral hypoxia. When such features are observed, the diagnosis of traumatic asphyxia should be considered. Prompt treatment with attention to the reestablishment of oxygenation and perfusion may result in good outcomes.- - - - - - - - - - ranking = 0.065403197070341keywords = cerebral (Clic here for more details about this article) |
3/25. Recurrent splinter haemorrhages weeks after a tick bite.A 52-year-old man developed fever, headache, tinnitus, and painful joints. He reported a tick bite contracted during a summer holiday in the netherlands, followed by erythema on his left arm three weeks earlier. Initial treatment with doxycycline had failed and he had now developed signs of meningoencephalitis. Laboratory tests showed an increased white cell count (16.1 x 10(9)/1), and elevated ESR (51/1h).- - - - - - - - - - ranking = 4keywords = haemorrhage (Clic here for more details about this article) |
4/25. Unusual manifestations of pneumococcal infection in human immunodeficiency virus-infected individuals: the past revisited.Although AIDS was largely recognized and defined because of the increased presence of diseases that reflect deficiencies in cell-mediated immunity, susceptibility to common extracellular bacterial pathogens has also been shown to be increased. To our knowledge, adults with concurrent infection due to human immunodeficiency virus (hiv) and streptococcus pneumoniae whose cases have been described to date have all had pneumococcal pneumonia and/or bacteremia. We describe five cases of hiv-infected patients who had unusual manifestations of pneumococcal infection, which include recurrent exudative pleural effusion, pyopneumothorax, purpura fulminans, mediastinitis with chest wall abscess, and multiple brain abscesses. Such complications of pneumococcal infection occurred more or less commonly in the preantibiotic era, but on the basis of our experience and an exhaustive literature search, these complications have been exceedingly rare in the past few decades. In four of our five patients, the unusual, complicated pneumococcal disease preceded and prompted a search for hiv infection. Because concurrent hiv infection increases the susceptibility to pneumococcal disease, other such cases are likely to be seen.- - - - - - - - - - ranking = 0.001337819894624keywords = brain (Clic here for more details about this article) |
5/25. Death due to positional asphyxia under severe alcoholisation: pathophysiologic and forensic considerations.In contrary to "physical restraint", describing a fixed body position due to external devices, "positional restraint" is defined as an abnormal body position, resulting from accidental fixation under unfortunate circumstances. We report on a remarkable case of positional asphyxia of an alcoholised young man after a fall down a staircase. On external examination, the body showed petechiae of the conjunctivae and oral mucosa, abrasions on the left zygomatic region and scratch marks, respectively. Neither broken fingernails, etc. nor signs of external violence against the neck were found. autopsy revealed haemorrhages in the praevertebral cervical musculature and Simon's sign. Haemorrhagic pulmonary edema and cerebral edema were observed; blood alcohol concentration: 2.60 g/l, urine alcohol concentration: 3.26 g/l. As cause of death, positional asphyxia after blunt head trauma has to be considered as well as lethal ethanol intoxication. To us, alcoholisation attributed to the fall and together with unconsciousness following blunt head trauma circumvented self-rescue efforts, and therefore, aggravated the potentially lethal impact of positional restraint.- - - - - - - - - - ranking = 1.0327015985352keywords = haemorrhage, cerebral (Clic here for more details about this article) |
6/25. Epstein syndrome: oral lesions in a patient with nephropathy, deafness and thrombocytopenia.Epstein syndrome is a rare dominantly inherited disorder in which the main features are nephritis, deafness and macrothrombocytopathic thrombocytopenia. A case with oral haemorrhage and purpuric lesions is reported. This appears to be the first report of this syndrome in the dental literature.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
7/25. protein c and protein s levels in two patients with acquired purpura fulminans.purpura fulminans (PF) is a cutaneous manifestation of a dramatic and deadly syndrome of systemic disseminated intravascular coagulation (DIC). It is characterized by microvascular thrombosis in the dermis followed by perivascular haemorrhage. Since two other related syndromes involve the protein c (PC) system, we undertook a serial study to investigate the levels of PC and protein s (PS) in two patients with acquired PF. Laboratory findings were consistent with DIC, and both patients were treated with blood replacement and heparin therapy. The levels of PC activity were very low during the initial 24-36 h after onset and gradually increased until returning to normal levels. The total and 'free' PS were also abnormal during the initial onset of PF. The total and free PS increased to normal after 4-6 d. Although the pathogenesis is not fully understood, the infection and sepsis appears to consume PC and PS selectively during the PF and DIC phase. Acquired PF appears to selectively involve the PC system in a similar fashion to two other syndromes of PF-like lesions.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
8/25. Salmonella meningitis complicated with subdural empyema, brain abscess and purpura fulminans: report of one case.There exists high incidence of bacteremia, sepsis and meningitis in young infants with Salmonella infection. However, focal intracranial abscesses due to salmonella infections are rare. We reported a 2-month-old male baby presenting salmonella infection with brain abscess and purpura fulminans. The patient's clinical course was fulminant. He was admitted due to fever, irritability, anemia and leukopenia. He developed cardiac arrest, shock and skin diathesis on his second hospitalization day. After resuscitation he became comatous and showed acrocyanosis and gangrenous skin over the hands, feet and left ear lobe. Both blood and cerebrospinal fluid cultures were Salmonella Group B. The patient got worse rapidly in spite of vigorous treatment. Subdural empyema, ventriculitis and later brain abscess were detected by serial brain sonograms. He died of central nervous system failure, gastrointestinal bleeding and renal failure on the eighteenth hospitalization day.- - - - - - - - - - ranking = 0.0093647392623677keywords = brain (Clic here for more details about this article) |
9/25. Disseminated strongyloidiasis presenting as purpura.We report a patient with disseminated strongyloidiasis who was being treated with steroids for cerebral edema caused by brain metastases from urinary bladder carcinoma. He had extensive purpura involving the abdomen, arms, and thighs. A skin biopsy specimen showed numerous larvae of strongyloides stercoralis. Subsequently, rhabdoid larvae of S. stercoralis were isolated in the stool and the sputum. The patient died 2 days later despite thiabendazole therapy.- - - - - - - - - - ranking = 0.034039418429794keywords = cerebral, brain (Clic here for more details about this article) |
10/25. Purpura cerebri in gram-negative septicaemia. A histological and immunohistochemical study.Two cases with brain purpura following Gram-negative septicaemia were examined morphologically and immunohistochemically. The brain lesions, including ball and ring haemorrhages, a few days old, with some microglial cells accumulated around the older foci, were restricted to the white matter. Immunohistochemically, scanty deposits of IgG, IgA and IgM mainly in the macrophages in brain, kidneys and lungs were found, whereas staining with antibodies directed against IgE and complement (C3, C4) remained negative. In the brain, immunoglobulin deposits were located mainly in the macrophages, furthermore, in and around the walls of a few intact (non-haemorrhagic) vessels; within the perivascular haemorrhagic foci no deposits could be demonstrated. The relevance of these observations to the pathogenesis of brain purpura is discussed.- - - - - - - - - - ranking = 1.0066890994731keywords = haemorrhage, brain (Clic here for more details about this article) |
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