1/13. Pseudoaneurysm of the left ventricle progressing from a subepicardial aneurysm.A 56-year-old man presented with an inferior myocardial infarction and a huge pseudoaneurysm below the inferior surface of the left ventricle, which had progressed from a small subepicardial aneurysm over a 6-month period. Transthoracic echocardiography, doppler color flow images, radionuclide angiocardiography, magnetic resonance imaging and contrast ventriculography all revealed an abrupt disruption of the myocardium at the neck of the pseudoaneurysm, where the diameter of the orifice was smaller than the aneurysm itself, and abnormal blood flows from the left ventricle to the cavity through the orifice with an expansion of the cavity in systole and from the cavity to the left ventricle with the deflation of the cavity in diastole. coronary angiography revealed 99% stenosis at the atrioventricular nodal branch of the right coronary artery. At surgery the pericardium was adherent to the aneurysmal wall and a 1.5-cm orifice between the aneurysm and the left ventricle was seen. Pathological examination revealed no myocardial elements in the aneurysmal wall. The orifice was closed and the postoperative course was uneventful. Over-intense physical activity as a construction worker was considered to be the cause of the large pseudoaneurysm developing from the subepicardial aneurysm. These findings indicate that a subepicardial aneurysm may progress to a larger pseudoaneurysm, which has a propensity to rupture, however, it can be surgically repaired.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/13. Ruptured dissecting aneurysm in bilateral iliac arteries caused by Ehlers-Danlos syndrome type IV: report of a case.ehlers-danlos syndrome (EDS) is an inherited disorder of connective tissue characterized by hyperextensible skin, hypermobile joints, and abnormalities of the cardiovascular system. Ten types and several subtypes of EDS have so far been recognized based on genetic, clinical, and biochemical characteristics. The spectrum of the disorder varies from mild to life-threatening vascular complications. EDS type IV is a particularly dangerous form with a lethal spontaneous rupture of the major arteries and aneurysmal formation. We present herein a case of a ruptured dissecting aneurysm in the bilateral iliac arteries caused by EDS type IV. A previously healthy 33-year-old man without any physical features of this connective tissue disorder experienced a metachronous vascular rupture two times. Successful synthetic bypass grafting was performed with great difficulty. The diagnosis of EDS type IV was made afterwards based on an electrophoresis analysis of a skin biopsy specimen which revealed a lack of type III collagen. Surgical intervention in cases of arterial complications in EDS type IV patients have been reported to be both difficult and frequently unsuccessful. The early clinical recognition of this syndrome is therefore of great importance due to the hazards of such surgical therapies.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/13. Spontaneous false aneurysm of left internal mammary artery.A 15-year-old female patient presented with a history of a mass just medial to the left breast and fever. Her physical examination revealed upper extremity hypertension, delayed and diminished pulsations in the femoral arteries and a midsystolic murmur over the back. On catheterization of the aorta a 45 mmHg systolic pressure gradient was obtained across the coarctation segment. The selective left internal mammary artery angiography showed the relationship of distal portion with false aneurysm. A magnetic resonance scan showed a left parasternal mass extending anteriorly.- - - - - - - - - - ranking = 6.8482225748859keywords = physical examination, physical (Clic here for more details about this article) |
4/13. Presentation, diagnosis, and management of arterial mycotic pseudoaneurysms in injection drug users.Injection drug users frequently present with abscess, cellulitis, and endocarditis. The development of arterial mycotic pseudoaneurysm (AMP) as a sequela of injection drug use, however, is much less frequently reported. We undertook a study to determine the prevalence and presenting clinical characteristics of AMP, utilizing a retrospective review of all emergency department cases seen at one city public hospital for the 5-year period 1994-1999. Initial evaluation included physical examination, CT scan, ultrasound, and/or angiography. There were 7,795 patient visits for complications of injection drug use; 11 patients had AMP (0.14%). AMP involved the brachial (n = 5), subclavian (n = 2), radial (n = 2), femoral (n = 1) and popliteal arteries (n = 1). fever was absent in the majority of patients (7/11). Either pulsatility or a mass was noted in three cases, and both were seen in 6/11 (54%). AMP was not initially suspected in three cases, which were treated as abscesses and surgically incised, resulting in arterial rupture. The annual prevalence of AMP in the presenting population was estimated to be 0.03%. However, a high index of suspicion for AMP should be maintained with injection drug users presenting with a mass or pulsatility over an artery, as there is risk of rupture, rapid exsanguination, and distal embolization.- - - - - - - - - - ranking = 6.8482225748859keywords = physical examination, physical (Clic here for more details about this article) |
5/13. Subarachnoid haemorrhage: a clinical overview.Subarachnoid haemorrhage affects up to 9,000 people a year in the UK (Lindsay and Bone 1997) and is a devastating condition. Although many patients make a good physical recovery, some are left with cognitive and perceptual deficits. Early rehabilitation and support is essential, and caring for these patients and their families is a major challenge for nurses.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/13. Ruptured renal artery aneurysm: an uncommon cause of acute abdominal pain.Previously thought to be extremely rare, renal artery aneurysms are now being found more commonly as incidental findings during the evaluation of refractory hypertension. Symptoms related to the aneurysm are uncommon and rupture occurs infrequently, but with devastating consequences. Factors predisposing to rupture include pregnancy, polyarteritis nodosa, and lack of aneurysmal calcification. Angiography is the study of choice for diagnosing the presence of visceral aneurysm and rupture. We report a case of ruptured renal artery aneurysm that presented with sudden onset of abdominal pain but no significant findings on physical examination. The patient's size precluded the detection of a pulsatile abdominal mass or the ability to obtain an abdominal angiogram. Computed tomography scan with contrast revealed the correct diagnosis, and successful treatment was initiated.- - - - - - - - - - ranking = 6.8482225748859keywords = physical examination, physical (Clic here for more details about this article) |
7/13. Homicidal cerebral artery aneurysm rupture.When a normally natural mechanism of death is induced by physical injury or intense emotional stress, it is appropriate to rule the manner of death as something other than natural. When the case-specific circumstances are such that the death occurs as a result of the criminal activity of another person, it is acceptable to rule such deaths as homicides. Presented herein is a case of homicidal cerebral artery aneurysm rupture occuring in an intoxicated, 46-year-old man who was punched in the face by another individual. The details of the case are presented, followed by a discussion of the controversies that exist when dealing with such cases. Guidelines for investigating similar deaths are presented, with emphasis on the timing of the trauma in relation to onset of symptoms due to aneurysm rupture.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/13. Behavioural training during acute brain trauma rehabilitation: an empirical case study.Operant conditioning-based behavioural interventions are commonly used for the behavioural problems of individuals with mental retardation. There is also growing evidence of the benefits of these interventions for treating some of the behavioural problems of individuals with acquired cognitive deficits resulting from brain trauma. However, the effects of behavioural interventions on behavioural problems occurring during acute neurorehabilitation, when orientation and memory are most impaired, have not been studied. In this empirical case study, operant conditioning-based procedures were applied with an 8-year-old girl recovering from brain trauma and related neurosurgery. Screaming, non-compliance and aggression, which were disrupting rehabilitation therapies and follow-up neuroimaging, were treated using differential positive reinforcement techniques. Beneficial behavioural intervention effects were demonstrated using single-subject experimental methods. Aberrant behaviour during physical and occupational therapies was reduced, and cooperation with a computerized tomography (CT) scan without sedation was accomplished using operant behavioural intervention. Results support the use of operant interventions early in recovery from brain trauma, and highlight the importance of interdisciplinary collaboration for the implementation and further study of early behavioural interventions.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/13. rupture of dissecting aneurysm in a china Airlines co-pilot.A 46-year-old male co-pilot of china Airlines developed shortness of breath during landing on a flight from tokyo to Taipei on May 17, 1994. He was found dead shortly after landing. He was well and had passed his semi-annual health examination with no history of cardiovascular disease or hereditary disease. A dissecting aneurysm of DeBakey type I and cardiac tamponade with 200 ml blood inside the pericardial cavity during autopsy was noted. The right and left coronary arteries showed atherosclerotic changes with the lumen narrowing down to 30% in the anterior descending branch. Focal myocardial infarction with a healing scar, atheroma and arteriosclerosis of the small arteries including the kidney were observed. Nonspecific changes of the chest X-Ray and EKG with hyperlipoproteinemia suggests that a more advanced technique is required to carefully examine the heart condition during regular physical checkups to prevent sudden illness that might contribute to mass disaster.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/13. Aneurysmal subarachnoid hemorrhage associated with weight training: three case reports.Weight training is a popular component of physical fitness in north america. This form of training remains relatively safe with few cases of life-threatening injuries. However, a series of studies have demonstrated that repetitive upper- and lower extremity weight training incorporating a valsalva maneuver can increase arterial pressure to values as high as 480/350 mm Hg. This marked increase in arterial pressure is transmitted to the cerebral vasculature and increases cerebral arterial transmural pressure and may have the potential to initiate the rupture of a previously innocuous intracranial aneurysm. We report three cases of subarachnoid hemorrhage (SAH) associated with arm (bicep) curls and leg press weight training and discuss the possible link between this form of exercise and aneurysmal SAH.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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