1/12. Hughes-Stovin syndrome: a case report and review of the literature.A young man presented with prolonged pyrexia, recurrent optic neuritis, thrombophlebitis and bilateral pulmonary artery aneurysms with thrombus formation. The life-threatening hemoptysis necessitated mechanical ventilatory support and emergency left lower lobectomy. Systemic corticosteroids conferred clinical improvement and reduction of the remaining right pulmonary artery aneurysm. The patient eventually succumbed to sudden massive hemoptysis. This report underscores the unpredictable nature of this syndrome and emphasises the need for aggressive surgical intervention of pulmonary artery aneurysms in Hughes-Stovin syndrome.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/12. Delayed venous occlusion following embolotherapy of vascular malformations in the brain.PURPOSE: To describe the nature and features of delayed venous thrombosis following embolization of arteriovenous fistulae. methods: Retrospective review of the available clinical history, details of embolization procedures, and results of follow-up angiography were carried out on all embolization procedures performed on high-flow vascular malformations of the brain done at our institution since 1987. RESULTS: Four patients were identified who had delayed (greater than 1 week) venous thrombosis/occlusion after embolization of the malformation associated with neurologic complications. Two patients had arteriovenous fistula and two had vein-of-Galen malformations. These patients had no untoward embolization of the venous outlet as a cause of the venous occlusion. CONCLUSIONS: It is postulated that thrombosis in the arteriovenous fistula group was induced by conversion (due to embolization) of a patulous high flow venous outlet into a slow flow system; in the vein-of-Galen group, the occlusion was thought to be due to high-flow venopathy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/12. Supratentorial arachnoidal cyst with intracystic and subdural haematoma.A case of a arachnoidal cyst with intracystic bleeding and subdural haematoma is reported. The association of an arachnoidal cyst in the middle cranial fossa with a subdural haematoma or intracystic bleeding is emphasised. The diagnosis of such lesions, the nature of the pathology and therapy are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/12. Superficial migratory thrombophlebitis and factor xii deficiency.A patient with painful migratory erythematous nodules for 7 years is presented. The nodules, which were localized on the lower and upper extremities, progressed to palpable cords. Multiple venograms showed no evidence of deep vein thrombosis. skin biopsy specimens were diagnostic of superficial thrombophlebitis. There was no evidence of internal malignancy. Extensive evaluation for an underlying hypercoagulable state was remarkable for a factor XII level 17% of normal. The patient was unresponsive to a wide range of treatments. The recalcitrant nature of his disease and lack of deep venous involvement are unique. An underlying hypercoagulable state should be considered when the diagnosis of superficial migratory thrombophlebitis is considered.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/12. Unusual case of central vein thrombosis and sepsis.A patient with Crohn's disease who required placement of a right external jugular vein central catheter for total hyperalimentation is presented. Catheter-induced thrombosis and catheter-associated bacteremia and sepsis subsequently developed. Following the description of the case is a brief discussion of the complications inherent in central line placement, the mechanisms by which thrombosis and sepsis occur, and the measures that can be taken to decrease the incidence of thrombosis and sepsis in central line placement. The management of central venous thrombosis and sepsis is medical and not surgical in nature, and consists of catheter removal, antibiotics, and anticoagulation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/12. Vascular complications as a result of intra-aortic balloon pumping.Intra-aortic balloon conterpulsation (IABP) was used to assist 109 patients with extensive myocardial infarcts, unstable angina, cardiogenic shock, and unstable cardiodynamic states after cardiopulmonary bypass over a six year period. Severe vascular occlusion occurred in three patients (3%) which required an above the knee amputation. Each patient had a long history of smoking. obesity, atherosclerotic disease of the femoral vessels, and extensive coronary artery disease were additional contributing factors. Two of the three patients survived, but both survivors had extensive postoperative myocardial infarctions. A low flow cardiac state and the presence of atherosclerotic changes in the legs must be precipitating factors for the vascular complications. Several possible methods to minimize complications of this nature include 1) angiographic examination of the lower aorta and femoral arteries at the time of cardiac catheterization, 2) frequent monitoring with ultrasound equipment, and 3) use of anticoagulation during and after the period of counterpulsation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/12. Unusual venous thrombosis associated with protein c deficiency.A patient in whom massive puerperal thrombophlebitis developed had protein c deficiency. In patients who initially have thrombosis that is unusual either in its nature or extent, investigation may, as in this case, reveal the presence of a hypercoagulable state.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/12. Inflammatory pseudotumor of the liver.The clinicopathologic features of a rare case of hepatic "inflammatory pseudotumor" are described and compared with those of three similar cases reported in the literature. In all four cases symptoms were systemic. The marked reduction in tumor size and the changing cellular composition, from a predominance of fibroblasts to a predominance of histiocytes, confirmed the reactive nature of the lesion in the present case. The etiology is obscure, and the significance of the associated occlusive phlebitis remains to be determined.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/12. Tampon-related toxic-shock syndrome. Histopathologic and clinical findings in a fatal case.Toxic-shock syndrome (TSS) is consistently associated with penicillin-resistant staphylococcus aureus in the vagina of menstruating women who use tampons. Increasing evidence implicates Staphylococcal toxin(s) in the pathogenesis of the condition, but the nature and biological effects of such toxin(s) are not established. Comprehensive postmortem studies and histopathologic data are few and largely unknown. The autopsy of a 15-year-old girl with this syndrome showed extensive superficial ulcerations and thrombophlebitis of the vagina, with bacteria on the mucosal surface only. Systemic phlebitis and capillaritis, visceral interstitial edema and acute inflammation involving various organs suggest a toxic effect, which is primarily manifested by widespread vascular damage. The histogenesis of the vaginal ulcerations remains unclarified, although they probably contribute to the absorption of toxin(s).- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/12. Thromboembolic disease due to thermolabile conformational changes of antithrombin Rouen-VI (187 Asn-->Asp)A new variant of antithrombin (Rouen-VI, 187 Asn-->Asp) with increased heparin affinity was shown to have normal inhibitory activity which decreased slowly at 4 degrees C and rapidly at 41 degrees C. On electrophoresis the freshly isolated variant had an anodal shift relative to native antithrombin due to the mutation. A further anodal transition occurred after either prolonged storage at 4 degrees C or incubation at 41 degrees C due to the formation of a new inactive uncleaved component with properties characteristic of L-form (latent) antithrombin. At the same time, polymerization also occurred with a predominance of di-, tri-, and tetra-mers. These findings fit with the observed mutation of the conserved asparagine (187) in the F-helix destabilizing the underlying A-sheet of the molecule. Evidence of A-sheet perturbation is provided by the increased rate of peptide insertion into the A-sheet and by the decreased vulnerability of the reactive loop to proteolysis. The spontaneous formation of both L-antithrombin and polymers is consistent with our crystal structure of intact antithrombin where L-form and active antithrombin are linked together as dimers. The nature of this linkage favors a mechanism of polymerization whereby the opening of the A-sheet, to give incorporation of the reactive center loop, is accompanied by the bonding of the loop of one molecule to the C-sheet of the next. The accelerated lability of antithrombin Rouen-VI at 41 versus 37 degrees C provides an explanation for the clinical observation that episodes of thrombosis were preceded by unrelated pyrexias.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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