1/21. Pancreatic adenocarcinoma presenting as sinistral portal hypertension: an unusual presentation of pancreatic cancer.A rare syndrome, sinistral (left-sided) portal hypertension resulting from splenic vein thrombosis secondary to pancreatic adenocarcinoma of the tail is presented here. Pancreatic cancer is notorious for presenting with vague and nonspecific symptoms, including but not exclusively weight loss, abdominal pain, and anorexia with or without jaundice. However, physicians should be aware that in the presence of splenic vein thrombosis, this finding alone puts pancreatic cancer high on the differential diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/21. Deep cerebral venous thrombosis: an illustrative case with reversible diencephalic dysfunction.BACKGROUND: Isolated thrombosis of the deep cerebral veins is rare and its diagnosis can be difficult. mortality is often high and little is known about the long-term prognosis. CASE REPORT: We report a 24-year-old woman with akinetic mutism and extensive bilateral thalamic lesions. CT and MRI allowed early diagnosis by demonstrating thrombosis within the internal cerebral veins, without the need for angiography. heparin treatment was used safely despite the presence of thalamic and intraventricular hemorrhage. After five weeks, the patient recovered rapidly and remains well at 18 months. Serial MRI showed dramatic resolution of the imaging abnormalities. CONCLUSIONS: The clinical features and characteristic neuroimaging appearance of deep cerebral venous thrombosis should be recognized by physicians caring for stroke patients. Deep cerebral venous thrombosis can produce extensive venous congestion and vasogenic edema without early infarction. Excellent clinical recovery is possible even after severe and prolonged neurological deficits.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/21. Clinical evaluation of thallium-201 single photon emission computed tomography in equivocal neuroradiological supratentorial lesions.BACKGROUND: We performed cerebral 201Tl SPECT study on 38 presurgical patients with equivocal neuroradiological supratentorial lesions to detect differences in 201Tl uptake index between tumor/non-tumor and high-grade/low-grade samples. methods: Authors identified 38 cases with presurgical equivocal neuroradiological supratentorial mass lesions. All cases were submitted to histological confirmation of the lesion by biopsy, sub-total or gross-total removal of the tumor. Between 23 patients suffering from gliomas, 13 were histologically classified as being of low-grade malignant tumors and 10 were classified as being of high-grade malignancy. Fifteen non-tumor histopathological specimens were also detected. The 201Tl index was defined as the ratio of average counts per pixel in the lesion to these in the opposite region. analysis of variance (ANOVA) and unpaired Student's OtO-test statistical methods were applied. Actuarial survival time from the date of diagnosis was calculated using the Kaplan-Meier method. Follow-up evaluation and survival time were obtained through referring physicians. Cerebral CT or MR images were obtained every three months after discharged, or more often if indicated. RESULTS: Results showed that the 201Tl uptake index ranged from 1.10 to 3.00 in the tumors lesions (mean /-SD: 1.68 /-0.51) and from 0.80 to 1.40 in the non-tumors lesions (mean /-SD: 1.07 /-0.17), (alpha < 0.0006 percent;). The 201Tl uptake index ranged from 1.10 to 2.30 in 13 patients with low-grade tumors (mean /-SD: 1.45 /-0.34) and from 1.30 to 3.00 in 10 patients with high-grade tumors (mean /-SD: 1.98 /-0.55), (alpha < 0.5 percent;). CONCLUSIONS: Our results demonstrate the clinical utility of 201Tl brain SPECT to differentiate equivocal neuroradiological supratentorial lesions and to correlate relationship between preoperative diagnosis, histological tumor grade and prognosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/21. Protected iliofemoral venous thrombectomy in a pregnant woman with pulmonary embolism and ischemic venous thrombosis.Although thromboembolism is uncommon during pregnancy and the postpartum period, physicians should be alert to the possibility because the complications, such as pulmonary embolism, are often life threatening. pregnant women who present with thromboembolic occlusion are particularly difficult to treat because thrombolysis is hazardous to the fetus and surgical intervention by any of several approaches is controversial. A 22-year-old woman, in her 11th week of gestation, experienced an episode of pulmonary embolism and severe ischemic venous thrombosis of the left lower extremity The cause was determined to be a severe protein s deficiency in combination with compression of the left iliac vein by the enlarged uterus. The patient underwent emergency insertion of a retrievable vena cava filter and surgical iliofemoral venous thrombectomy with concomitant creation of a temporary femoral arteriovenous fistula. The inferior vena cava filter was inserted before the venous thrombectomy to prevent pulmonary embolism from clots dislodged during thrombectomy When the filter was removed, medium-sized clots were found trapped in its coils, indicating the effectiveness of this approach. The operation resolved the severe ischemic venous thrombosis of the left leg, and the patency of the iliac vein was maintained throughout the pregnancy without embolic recurrence. At full term, the woman spontaneously delivered an 8-lb, 6-oz, healthy male infant.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/21. The use of low-molecular-weight heparins in outpatient oral surgery for patients receiving anticoagulation therapy.BACKGROUND: When planning oral surgery, dentists occasionally will have patients who first need to have their anticoagulation regimen altered. To minimize the side effects and not adversely affect the patient's health, therapeutic anticoagulation should be interrupted for as short a time as possible. Low-molecular-weight heparins, or LMWHs, recently have emerged as an alternative in the management of patients whose anticoagulant status should not be modified for lengthy periods. CASE DESCRIPTION: A 72-year-old man, who had a history of deep venous thrombosis, needed to have 19 teeth extracted and an alveoloplasty performed. An LMWH was substituted for warfarin a few days before surgery, and it was withheld from the patient for only a few hours the day of the surgery. CLINICAL IMPLICATIONS: LMWHs are administered on an outpatient basis and do not require hospitalization, as does unfractionated heparin. As a result, they are more cost-effective and offer greater convenience than heparin therapy. Depending on the procedure and the degree to which patients are medically compromised, dentists may not feel comfortable treating patients who continuously receive anticoagulation therapy. As a result, patients' physicians may prescribe LMWH injections to be administered by patients, family members or caregivers to more safely manage the patients' care during oral surgery. As part of the health care team, dentists must be familiar with LMWH and its use to help guide patients safely through treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/21. Unusual presentation of factor xiii deficiency.factor xiii deficiency is a rare inherited bleeding disorder that is often difficult to diagnose. The standard screening tests are normal in these patients and their bleeding phenotype may be variable. We report the case of a 3-year-old girl who presented with an intracranial haemorrhage. Several confounding factors, such as the suspicion of an arteriovenous malformation and the development of a deep venous thrombosis, led to a delay in the diagnosis of factor xiii deficiency. Subsequently, her brother was also found to have severe factor xiii deficiency. This case highlights the importance of a detailed history and of screening families in which index cases have been identified. It should also remind physicians that bleeding disorders may have unusual presentations and should be sought when investigating unexplained bleeding.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/21. Renal vein and inferior vena cava thrombosis associated with acute pancreatitis.Renal vein thrombosis (RVT) is a well-recognized complication of the nephrotic syndrome, but it is extremely rare in patients with acute pancreatitis. Vascular thrombosis complicating pancreatitis is thought to be due to release of proteolytic enzymes from the pancreas and direct vasculitis. Peripancreatic vessels are most commonly involved in the complications associated with pancreatitis. Renal vein and inferior vena cava (IVC) thrombosis, however, is an exceptionally rare complication of pancreatitis. awareness of this complication will help physicians in its early diagnosis and management. We report a case of renal vein and IVC thrombosis in a patient with acute pancreatitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/21. Treatment of upper limb deep vein thrombosis with low molecular weight heparin.Upper limb deep vein thrombosis has been an under-recognized disease; however, physicians' awareness of it as a cause of arm pain and edema is increasing. Previously thought of as benign, upper limb deep vein thrombosis has been shown in recent studies to pose a significant risk for pulmonary embolus and death. The need for treatment is now recognized; however, effective treatments for upper limb deep vein thrombosis have not been fully defined. Anticoagulation with oral agents is known to be successful in preventing complications and recurrence. This report presents the first case of upper limb deep vein thrombosis successfully treated with only low molecular weight heparin.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/21. protein s deficiency presenting as deep vein thrombosis--a case report.A rare case of spontaneous bilateral internal jugular vein (IJV) thrombosis is presented in absence of oral infection, malignancy, or intervention. Swelling of face, neck, and both upper limbs developed in a 30-year-old man 1 month before admission and after 4 weeks of use of nonpadded crutches. Computed tomography of the neck showed thrombus occluding both internal jugular veins extending to the opening of the superior vena cava. Protein S activity was found to be 30.3%, less than half of the lower limit of normal. fibrinogen was 450 mg%, higher than normal. protein c and antithrombin iii were normal. The patient was treated conservatively, and discharged on aspirin 150 mg/day. Follow-up after 3 months showed no complications. It was concluded that the outcome in IJV thrombosis, caused by protein s deficiency, is usually good. The advantage of being aware of diagnosis is that physician can be more vigilant for potential complications and treat them earlier.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/21. Mesenteric vein thrombosis associated with intravaginal contraceptives: a case report and review of the literature.Mesenteric vein thrombosis (MVT) is a distinct clinical cause of intestinal ischemia representing 5-15% of all ischemic events. MVT has acute, subacute, and chronic presentations and an underlying cause can be found in nearly 75% of cases. Exogenous hormones are used worldwide by millions of women for contraception and postmenopausal replacement therapy. Current preparations include oral, transdermal, and intravaginal delivery systems. The risk of venous and arterial thrombosis with oral preparations is well established, however the risk with parenteral preparations has not been fully established. The mechanisms underlying these increased risks have not been fully elucidated.We report a case of mesenteric vein thrombosis associated with intravaginal hormonal contraception. A review of the current literature reveals no prior reports of this complication of intravaginal or transdermal hormonal therapy. When taking a medical history, it is imperative for physicians to be aware of all medications, including those not taken orally.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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