1/26. Anaerobic septicaemia by fusobacterium necrophorum: Lemierre's syndrome.Lemierre's syndrome is characterized by acute pharyngotonsillitis with secondary thrombophlebitis of the internal jugular vein which is complicated by multiple metastatic foci of infections. This syndrome is caused by fusobacterium necrophorum in healthy young persons and is extremely rare in occurrence. A pre-school child with Lemierre's syndrome is reported. The diagnostic and therapeutic aspects are emphasized in order to sensitize physicians to this uncommon condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/26. Spontaneous rupture of the iliac vein.Two unusual cases of iliac vein spontaneous rupture into the retroperitoneum are presented together with 18 cases reported by the literature. In one patient of ours, entrapment of clots in an IVC filter and proximal iliac vein involvement into the scar tissue surrounding the left limb of an aortoiliac bifurcation graft might have caused flow disturbances and subsequent predisposition to rupture of the thrombosed external iliac vein. Inflammatory parietal changes, including infiltration of macrophages, T and B lymphocytes producing elastin degradation by means of cytokines, may have led ultimately to vein disruption. Despite clinical features and CT scan findings, the physician's awareness of this disease remains the most important factor for the early treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/26. Perioperative medical management of antiphospholipid syndrome: hospital for special surgery experience, review of literature, and recommendations.patients with antiphospholipid syndrome (APS), who are predisposed to vascular thrombotic events, are at additional risk for thrombosis when they undergo surgery. Serious perioperative complications (recurrent thrombosis, catastrophic exacerbation, or bleeding) occur despite prophylaxis. We describe our perioperative experience with APS patients who underwent a variety of surgeries, review the literature, and discuss strategies that may guide other physicians in their perioperative evaluation and management of patients with APS. Recommendations: perioperative strategies should be clearly identified before surgical procedure; pharmacological and physical antithrombosis interventions vigorously employed; periods without anticoagulation kept to a minimum; and any deviation from a normal course should be considered a potential disease related event.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/26. Resection of an icteric type hepatoma with tumor thrombi filling the right posterior bile duct.A 67-year-old male with jaundice was found to have hepatocellular carcinoma in the right hepatic lobe and tumor thrombi in the common hepatic duct. physicians initially considered the tumor unresectable, and treated the patient with transcatheter arterial infusion chemotherapy and biliary endoprosthesis. The patient developed a liver abscess after the second transcatheter arterial infusion, and the physicians consulted our department for another form of therapy. Percutaneous transhepatic biliary drainage was performed to relieve revived obstructive jaundice. cholangiography revealed tumor thrombi extending through the right posterior segmental bile duct into the common hepatic duct. Most biliary branches of the caudate lobe joined with the left lateral posterior segmental branch. Arterial and portal venous branches of the caudate lobe were not involved. Right hepatic lobectomy and extrahepatic bile duct resection were performed 1 year after initial diagnosis. On histologic examination, the epithelium of the right posterior segmental bile duct, which was filled with the tumor thrombi, was not detected. The patient is alive without recurrence 24 months after surgery. Careful investigation of biliary branches of the caudate lobe on cholangiography is essential to determine the necessity of caudate lobectomy in patients with hepatocellular carcinoma and tumor thrombi filling the right posterior segmental bile duct.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/26. myocardial infarction resulting from nonatherosclerotic coronary artery diseases.myocardial infarction (MI) infrequently results from nonatherosclerotic coronary diseases such as coronary embolism, spasm, dissection, and arteritis. If these disorders are not considered in the differential diagnosis of MI, specific beneficial therapies would be overlooked. Because physicians see large number of patients with MI during their career, the likelihood that they will encounter patients with MI resulting from nonatherosclerotic diseases is high. Two cases are presented to highlight different etiologies and treatment approaches of nonatherosclerotic MI.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/26. Inferior vena cava thrombosis: an unusual complication of a large simple non-parasitic liver cyst requiring an integrated approach.Most of the simple hepatic cysts are asymptomatic and have a benign course. However, some exceptional life-threatening complications may occur. We herein report the successful management of a case who suffered from a cystic compression of the inferior vena cava complicated by thrombosis of the inferior vena cava itself. To our knowledge this is the first report of such a complication and diagnostic and therapeutic aspects are discussed. This case is paradigmatic of the possible complexity of the diagnosis and treatment of cystic lesions of the liver and should induce physicians to consider a therapeutic approach if a clear tendency to enlarge can be recognized.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/26. Complications associated with intermittent pneumatic compression.The intermittent pneumatic compression device (IPCD) is prophylaxis for prevention of deep-venous thrombosis (DVT). This pneumatic leg sleeve has been used extensively in high-risk surgical patients, without complication. We describe two cases, one with peroneal neuropathy and the other with compartment syndrome, associated with IPCD use during surgery. Case 1 involves a patient with pancreatic cancer and weight loss who developed bilateral peroneal nerve palsies during surgery. Case 2 involves a patient with bladder cancer who developed lower leg compartment syndrome during prolonged surgery in the lithotomy position. These cases are unusual for several reasons. First, patients wearing IPCDs during surgery are at increased risk of neurovascular compression. Second, significant weight loss may predispose the peroneal nerve to injury from intermittent compression garments. Third, patients undergoing surgery in the lithotomy position are at risk of compartment syndrome. Therefore, physicians may wish to use another method of DVT prophylaxis in surgical patients with cancer or significant weight loss, or those who are undergoing procedures in the lithotomy position.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/26. In utero losartan withdrawal and subsequent development of fetal inferior vena cava thrombosis.BACKGROUND: Angiotensin receptor blockers are antihypertensive medications prescribed by a wide variety of physicians, especially for patients with coexistent diabetes mellitus. Angiotensin receptor blockers, as well as angiotensin-converting enzyme inhibitors, are contraindicated in pregnancy. CASE: We describe the reversal of losartan-induced oligohydramnios at 27 weeks of gestation with subsequent development of fetal thrombosis and possible mechanism of action for this extremely rare in utero complication. CONCLUSION: This theory may help explain the fetal stillbirths in women taking this class of medications during the second and third trimester of pregnancy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/26. Systemic embolization following thrombolytic therapy for acute myocardial infarction.We describe a patient with acute inferior myocardial infarction who developed a "saddle" aortic embolus during streptokinase infusion. Three months previously, this patient had sustained an anterior infarction, and an apical aneurysm was found. This patient's embolus had most probably originated from a left ventricular mural thrombus that had been dislodged by streptokinase. As fibrinolytic treatment is gaining wide acceptance, physicians should be aware of this rare, but possible, complication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/26. Postanginal sepsis. A pain in the neck.The primary care physician must be on the alert when a patient presents with a sore throat, signs of sepsis, and a rapidly deteriorating condition. Recognition of this distinct clinical presentation should lead to the diagnosis of postanginal sepsis. Once this diagnosis is suspected, therapy with an antibiotic that provides coverage against streptococci and anaerobes should be initiated promptly, and a drainable focus of infection should be excluded.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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