1/63. Demonstration of reactivity to airborne and food allergens in cutaneous vasculitis by variations in fibrinopeptide a and other blood coagulation, fibrinolysis and complement parameters.In a 32-year-old woman and a 40-year-old man with cutaneous vasculitis, etiological allergic responses to foods and airborne allergens were found. During provocation tests, observations were made on blood levels of fibrinopeptide a(FPA) and coagulation factors, fibrinogen degradation products (FDP) and serum complement components. skin biopsies were taken for microscopic and immunofluorescence analysis. In case 1, anaphylactoid allergy to milk and reaginic and anaphylactoid hypersensitivity to grass pollens were found. Dermal provocations with grass pollens gave arthralgia, hematomas, serum C3 fluctuation, factor vii reduction and fibrinolysis. During peroral milk challenge, transient increases in FPA and FDP levels were observed before symptoms appeared. In case 2, anaphylactoid hypersensitivity responses to bacteria, animal danders, foods and pollens were found. Two inhalations with sheep-wool extract resulted in a typical skin eruption. The first also gave an early reduction of C3 and then FPA liberation. Nasal birch-pollen test gave an increase of FPA in the latent period and then typical nodules. At least no low molecular weight FDP were detected during provocations. In patients with vasculitis reactions to exogenous allergens, FPA and FDP estimations after provocations may discriminate harmful from innocuous allergens and reveal individual response patterns in coagulation and fibrinolysis systems.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
2/63. Pacing lead adhesions after long-term ventricular pacing via the coronary sinus.Left ventricular pacing via the coronary sinus is being increasingly used. There is little data to guide possible lead extractions that might be required in the future. Significant adhesions to the coronary veins were found 12 years after placing a pacing lead in the posterolateral coronary vein in a man with double inlet left ventricle and severe subpulmonary stenosis who had undergone a Fontan operation. The appearances suggest that percutaneous extraction from the proximal coronary sinus may be feasible but that difficulty may be encountered if the lead tip is placed into the distal coronary veins.- - - - - - - - - - ranking = 2keywords = tract (Clic here for more details about this article) |
3/63. Cervical myelopathy due to compression by bilateral vertebral arteries--case report.A 69-year-old man presented with progressive cervical myelopathy due to vascular compression of the upper cervical spinal cord. Vertebral angiography and magnetic resonance imaging revealed that the elongated bilateral vertebral arteries (VAs) had compressed the spinal cord at the C-2 level. The spinal cord was surgically decompressed laterally by retracting the VAs with Gore-Tex tape and anchoring them to the dura. The patient's symptoms improved postoperatively. decompression and anchoring of the causative vessels is recommended due to the large size of the VAs.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
4/63. Laparoscopic solution of a vascular complication occurring during an open procedure in a child.Usually the word conversion implies conversion from a laparoscopic procedure to an open procedure to solve complications occurring during laparoscopy. In this article we report a conversion from an open procedure to a laparoscopic one, to treat a vascular complication that occurred during an orchiectomy performed in open surgery. A 2-year-old boy came to our center for a right orchiectomy. The clinical history of this baby showed the presence of a right atrophic testis positioned in the medial part of the inguinal canal, a finding also confirmed by ultrasonography. One of our residents performed a right orchiectomy via an open inguinal procedure. After removing the testis, and before ligating the inner spermatic vessels at the level of the internal inguinal ring, the forceps that held the vessels was inadvertently opened, causing a contraction of the spermatic vessels. Since we were unable to identify the vessels and achieve hemostasis via the inguinal opening, a conversion to laparoscopic surgery was decided. A 10-mm 0 degrees optics was introduced through an umbilical trocar and revealed a large retroperitoneal hematoma along both the inner spermatic vessels and the deferential vessels, for about 3-4 cm from the internal inguinal ring. Two 5-mm trocars were positioned in triangulation and hemostasis was achieved by positioning clips on the vessels at the level of internal inguinal ring and proximally to the hematoma. Surgery lasted 1 hour; the laparoscopic procedure, 25 minutes. The baby was discharged 2 days after surgery. At a 9-month follow-up the clinical and ultrasonographical evaluation was normal. This case clearly shows the usefulness of laparoscopy in pediatric surgery, as well as to solve complications due to open surgery. We think that nowadays the use of laparoscopy should be considered indispensable by every pediatric surgical team.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
5/63. Appearance of rectal varices in extrahepatic portal obstruction after treatment for esophago-gastric varices: a case report.We report a case of rectal varices that developed after endoscopic injection sclerotherapy (EIS) and Hassab's operation for esophageal varices with extrahepatic portal obstruction. A 54-year-old woman was admitted to our hospital in September 1997 for treatment of hematochezia. Emergent colonoscopy revealed tortuous rectal varices with a white plug. angiography revealed that rectal varices were provided with backward blood flow by the inferior mesenteric vein due to extrahepatic portal obstruction. In this case, previous treatment, EIS and Hassab's operation, for esophago-gastric varices might have inhibited the development of collaterals apart from surface of gastrointestinal tract, such as para-esophageal collateral veins or spleno-renal shunt. Since the thrombus in the extrahepatic portal vein causes strong pressure on inferior mesenteric vein which is connected to the inferior vena cava via the inferior rectal vein, rectal varices might be developed. In this case, it was considered that rectal varices were not treated enough by endoscopic therapy because of regurgitant hyper blood flow against portal venous pressure. Therefore, rectal transection was performed. After the treatment, the patient suffered no further episodes of bleeding from rectal varices.- - - - - - - - - - ranking = 12.657938716358keywords = gastrointestinal tract, tract (Clic here for more details about this article) |
6/63. An alternative bent-knee prosthesis.Prosthetic fitting in patients with below-knee amputations and concurrent knee flexion contractures poses inherent difficulties to the prosthetic rehabilitation team. The standard bent-knee prosthesis is bulky and awkward. It treats the patient functionally as a knee disarticulation and yields no potential for improving the patient's degree of contracture. This paper describes a case report with an alternative to the bent-knee prosthesis that not only offered improved function relative to the standard bent-knee prosthesis, but also acted therapeutically by reducing the patient's knee-flexion contracture.- - - - - - - - - - ranking = 3keywords = tract (Clic here for more details about this article) |
7/63. Multiple subcutaneous leiomyosarcomas in an adolescent with AIDS.The case of 17-year-old boy with thalassemia major who contracted the human immunodeficiency virus (hiv) through multiple transfusions is described. Eight years after the onset of generalized lymphadenopathy, and 5 years after the documentation of hiv infection on serologic grounds, he developed the first of multiple, painful, subcutaneous nodules, which proved to be leiomyosarcomas of vascular origin. The histopathology and possible pathogenesis of these unusual tumors are discussed.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
8/63. Cavernous transformation of the portal vein associated to multiorgan developmental abnormalities.Initial diagnosis of cavernous transformation of the portal vein (portal cavernoma) is rarely made in adults. Its main clinical manifestation is upper gastrointestinal hemorrhage due to variceal bleeding. More rarely, diagnosis is made from obstructive jaundice. In children, this condition is frequently associated to prehepatic portal hypertension and congenital anomalies, the most frequent of which are atrial septal defects or malformations of the biliary tract or of the inferior vena cava. We describe here a case of a 23-year-old female presenting with massive hematemesis due to the presence of esophageal and small intestinal varices. She had a cavernous transformation of the portal vein with prehepatic portal hypertension associated with heretofore unreported malformations such as right pulmonary hypoplasia, cardiac dextroposition, and right renal ectopia. A unifying hypothesis (e.g. an intrauterine vascular insult) to explain the pathogenesis of these defects seems unlikely. Appropriate tests failed to identify specific functional abnormalities in these organs. Although she bled more than once, the combination of sclerotherapy and beta-blockers has been, thus far, able to control the major clinical consequences of this disease.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
9/63. Pulmonary vascular lesions in the adult respiratory distress syndrome caused by inhalation of zinc chloride smoke: a morphometric study.Two soldiers were fatally injured by accidental inhalation of zinc chloride (ZnCl2) from a smoke bomb. Although exposed to a relatively short but high smoke concentration, acute injury was minor and for 10 days the patients were clinically satisfactory. Unexpectedly, both then rapidly developed features typical of severe adult respiratory distress syndrome with pulmonary hypertension. intubation and mechanical ventilation were instigated on day 15 (patient no. 1) and day 12 (patient no. 2) after the inhalation, but death followed at days 25 and 32, respectively. lung vascular injury was assessed by angiography and morphometric techniques. The lungs showed extensive interstitial and intra-alveolar space fibrosis. Vessels showed a significant lumen reduction by contracture (that is, reduction in vessel external diameter) affecting preacinar and intraacinar arterial and venous segments, the extent of injury suggesting that hexite causes more severe venous injury than seen in other types of adult respiratory distress syndrome. In microvessels there was obliteration and widespread occlusion by endothelial cell proliferation and clot. No evidence of infection was identified during life or at autopsy. It is unclear whether the long lag time was due to the fact that the infection was not a complicating event or because steroids, administered prophylactically, had sufficed to delay, but not to prevent, the amplification of injury that seems responsible for the adult respiratory distress syndrome.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
10/63. aluminum foil treatment combined with basic fibroblast growth factor (bFGF) for gangrene of the fingertip caused by collagen disease.Although basic fibroblast growth factor (bFGF) is used for the treatment of various intractable ulcers, there have been no reports of using it for gangrene of the fingertips caused by collagen diseases. We successfully treated gangrene as a result of malignant rheumatoid arthritis with aluminum foil combined with bFGF.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
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