1/65. Lessons from an unusual case: malignancy associated hypercalcemia, pancreatitis and respiratory failure due to ARDS.A 37-year old woman, presenting with severe hypercalcaemia-associated pancreatitis with pseudocyst formation, was admitted to intensive care because she developed ARDS with respiratory failure. Skeletal metastasis from non-small cell bronchial carcinoma were subsequently diagnosed. After she developed arterial occlusion in the lower limb, supportive treatment was withdrawn. Severe pancreatitis is an exceedingly unusual presentation of non-small cell bronchial carcinoma. Concepts of diagnostic and therapeutic strategies in the context of suspected unusual pathology, and the concept of futility are briefly discussed.- - - - - - - - - - ranking = 1keywords = stasis (Clic here for more details about this article) |
2/65. Traumatic inferior vena caval obstruction.A 57-year-old male sustained an injury to the supradiaphragmatic portion of the inferior vena cava, which presented as progressive lower extremity thrombophlebitis culminating in thrombosis of his inferior vena cava. The indications for operative intervention centered around impaired renal, hepatic, and intestinal circulation. extracorporeal circulation permitted extraction of the clot and repair of the injury.- - - - - - - - - - ranking = 0.64238352840416keywords = obstruction (Clic here for more details about this article) |
3/65. budd-chiari syndrome due to obstruction of the inferior vena cava. A report of two cases.Two cases of budd-chiari syndrome caused by membranous occlusion of the proximal portion of the inferior vena cava are presented. Both were treated surgically, using the modified technique of Kimura in one case, and a resection with direct vision and extracorporeal circulation in the other. Both patients progressed well. We discuss the etiology and pathogenesis of the syndrome, the diagnostic means that can be used, and the importance of early treatment.- - - - - - - - - - ranking = 0.64238352840416keywords = obstruction (Clic here for more details about this article) |
4/65. Cavographic study of an early stage of obstruction of the hepatic portion of the inferior vena cava.BACKGROUND: liver disease caused by a chronic lesion of the hepatic portion of the inferior vena cava (IVC) is clinically characterized by dilated superficial veins in the body trunk with cephalad flow, hepatomegaly and splenomegaly. Cavography shows stenosis or complete obstruction near the cava-atrial junction. methods: Early (acute and subacute) forms of the disease were recognized. The early stage of the disease manifested as jaundice, hepatomegaly or ascites and fever. patients with acute and subacute onset of the illness with no past history of liver disease were studied with inferior vena cavography. Some of the patients had repeat cavography at 6 months and at 1 year after the initial investigations. RESULTS: Three types of cavographic lesions were observed in the early stages of the disease: type 1, linear lucent area in the IVC close to cava-atrial junction; type 2, a smooth or irregular narrowing of almost the whole segment of the hepatic portion of the IVC; and type 3, a constriction or narrowing of a segment of the IVC near the cava-atrial junction. The first two types were associated with the acute stage of the disease and type 3 with the subacute stage. Type 2 and 3 lesions were associated with post-stenotic dilatation (PSD) close to the atrium. Lucent areas resulting from thrombosis are common in PSD. The acute and subacute hepatic IVC diseases in nepal are commonly associated with bacterial infection. CONCLUSIONS: It is postulated that the early cavographic lesions are consistent with thrombosis and thrombophlebitis of the hepatic portion of the IVC, and that resolution of the lesions leads to the development of stenosis and to complete obstruction.- - - - - - - - - - ranking = 0.96357529260624keywords = obstruction (Clic here for more details about this article) |
5/65. The clinical significance of biphasic venous emptying curves from the lower limb in venous occlusion plethysmography.The utilization of venous occlusion plethysmography in the routine diagnosis of acute venous thrombosis in the leg has disclosed a previously unreported type of biphasic venous emptying curve that has proved to be of special diagnostic significance. The examinations were undertaken with a Dohn plethysmograph for segmental application of the calf. The emptying curves in question had an initial phase at the ordinary rapid rate, changing distinctly within 1.5 sec into a definitely slower phase of venous emptying. Biphasic emptying curves were found to be characteristic of patients with isolated, high venous obstruction, mostly acute thromboses, but more or less intact veins in peripheral parts of the leg. The same type of pathological emptying curves could be provoked by external compression of the femoral vein or Valsalva's manoeuvre, providing experimental evidence of the underlying mechanism. The venous emptying course might be similarly influenced also by varicose veins, pregnancy, and right heart failure. The diagnostic experience of biphasic emptying curves in clinical practice indicates, that this particular way of interpreting venous occlusion plethysmography is a valuable complement to phlebography in the detection of proximal venous obstructions in the lower limb, whether due to iliac thrombosis or elusive intrapelvic tumours.- - - - - - - - - - ranking = 0.32119176420208keywords = obstruction (Clic here for more details about this article) |
6/65. Venacavography, corticosteroids and surgery in the management of idiopathic retroperitoneal fibrosis.Four patients with idiopathic retroperitoneal fibrosis were found to have characteristic obstruction and anterior displacement of the lumbar vena cava. Varying degrees of venous collateral circulation were present, depending on the degree of vena caval compression. All 4 patients underwent ureterolysis to relieve the hydronephrosis and to confirm diagnosis by biopsy. Two patients were treated with corticosteroids postoperatively. Followup venacavography demonstrated improved filling and decrease in the collateral circulation in these 2 patients. Of the remaining 2 untreated patients 1 was lost to followup and the other revealed no change. diagnosis of idiopathic retroperitoneal fibrosis can be made if characteristic changes are present on inferior venacavography and may provide an objective measure for following the basic disease process during medical treatment.- - - - - - - - - - ranking = 0.16059588210104keywords = obstruction (Clic here for more details about this article) |
7/65. Noninvasive prevention of thrombosis of deep veins of the thigh using intermittent pneumatic compression.Intermitten venous compression promotes cyclic emptying and refilling of the veins and sinuses of the legs. It prevents stasis and formation of thrombi while the patient is on the operating table and during recovery. Once the patient is ambulatory, the system is discontinued. While the system is in use, thromboelastography, venous impedance plethysmography and venography, when indicated, are used to monitor the system. The intermittent pneumatic compression system is safe, simple and practical to use for almost all patients. There was no evidence of deep vein thrombosis or pulmonary embolism in 123 patients, as determined by an absence of clinical signs, a negative impedance plethysmogram and a negative venogram.- - - - - - - - - - ranking = 1keywords = stasis (Clic here for more details about this article) |
8/65. Superior vena cava obstruction bypass - an alternative technique using bovine pericardial conduit: a case report.An alternative technique of superior vena cava obstruction bypass using bovine pericardial conduit is described. The patient in this case had recurrent bilateral thrombophlebitis and thrombosed saphenous veins. Most of the surgical techniques reported in the literature so far have described the use of polyethylene terephthalate (Dacron) graft, polytetrafluoroethylene graft, autologous pericardial patch, and spiral vein graft. The use of synthetic grafts has been plagued with high rates of thrombosis. The pathology, clinical presentation, surgical technique, and outcome are discussed.- - - - - - - - - - ranking = 0.8029794105052keywords = obstruction (Clic here for more details about this article) |
9/65. Fatal abdominal thorotrast granuloma.We report a case of fatal abdominal thorotrast granuloma seen in a 65-year-old man who had undergone a femoral angiography of thorotrast with some accidental extravasation 49 years previously. As the thorotrast granuloma gradually increased in size, it caused ureteral obstruction, venous thrombosis, and perforation of the urinary bladder and rectum. Symptomatic abdominal thorotrast granuloma is quite rare and this is the first reported case of the granuloma associated with perforation through the urinary bladder and rectum.- - - - - - - - - - ranking = 0.16059588210104keywords = obstruction (Clic here for more details about this article) |
10/65. Enhanced anticoagulant effect of coumarin derivatives induced by doxycycline coadministration.OBJECTIVE: To report two cases of enhanced oral anticoagulant effect induced by doxycycline coadministration. DESIGN: Case report. SETTING: University teaching hospital. patients: Two patients on chronic oral anticoagulation therapy who presented with severe bleeding and marked impairment in blood coagulation tests shortly after the initiation of doxycycline therapy. DISCUSSION: The literature concerning the possible effects of tetracyclines on hemostasis with or without antecedent anticoagulation therapy is reviewed and the speculated mechanisms for such an interaction are discussed. CONCLUSIONS: The administration of tetracyclines such as doxycycline to patients on chronic oral anticoagulation therapy may be associated with a marked enhancement in anticoagulant effect. In such patients the prothrombin ratio should be closely monitored and the anticoagulant dosage adjusted accordingly.- - - - - - - - - - ranking = 1keywords = stasis (Clic here for more details about this article) |
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