1/10. A continuous murmur after surgery for dissecting ascending aortic aneurysm.We report a case of a subcutaneous arteriovenous fistula that developed after aortic surgery. A careful physical examination and the selective use of imaging tests can differentiate this relatively benign complication from the more serious causes of a continuous murmur in this setting.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/10. Aneurysm of the ascending aorta in a neonate.Aneurysms of the thoracic aorta rarely occur in children. We present a female neonate who was referred to our hospital due to a heart murmur associated with cough and fever at 22 days of age. Both the echocardiography and aortography displayed an aneurysm of the ascending aorta at the aortic root. A patent ductus arteriosus (PDA) flow was detected on admission but it was not detectable when she was 3 months old. Neither physical characteristics of Marfan nor turner syndrome were found, but she has had a huge cutaneous hemangioma over the right trunk since birth. The aneurysm did not progress during one year of follow-up. The etiology might be idiopathic or medial agenesis. Surgery will be warranted only if the aneurysm enlarges.- - - - - - - - - - ranking = 0.078380358823096keywords = physical (Clic here for more details about this article) |
3/10. ehlers-danlos syndrome type IV and multiple aortic aneurysms--a case report.Beside atherosclerosis, aortic aneurysms can be part of the clinical spectrum of many systemic diseases, including infectious, inflammatory, genetic and, less often, congenital disorders. A 48-year-old white man presented with multiple large aneurysms of the aorta and its main branches. Medical history was unremarkable except for the presence of a softened abdominal mass since he was 28 years old. On the physical examination, an arterial murmur was heard over the left carotid artery and a palpable mass was noted in the whole right side of the abdomen. No skin or joint abnormalities were noted. aortography, computed tomography, and magnetic resonance angiography showed multiple large aneurysms of the descending thoracic and abdominal aorta. Aneurysms of the innominate, left subclavian, and carotid arteries were also seen. This case resembles those previously reported, in which multiple aortic aneurysms were associated with abnormalities of the type III procollagen gene (COL3A1). Although the classic stigmas of the ehlers-danlos syndrome type IV were lacking, this genetic disease may be the cause of the multiple aneurysms in this patient.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/10. dyspnea lusoria: compression of the pulmonary artery by a Kommerell's diverticulum.We report a rare case of Kommerell's diverticulum presenting as dyspnea on exertion. After careful physical examination, selective imaging tests demonstrated a significant flow abnormality in the left pulmonary artery caused by an aneurysm of the descending aorta in the area of the ligamentum arteriosum.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/10. dissection of aorta: a pediatric case report.We present a 15-year-old boy who developed sudden walking disability and sensory loss. He could not stand up on his feet and had no feeling following a sudden fall while playing basketball. He had been referred to a local hospital with these symptoms. In his physical examination absence of deep tendon reflexes and sensory loss were noted. His arterial blood pressure was 210/160 mmHg. He was transferred to our hospital with these findings and diagnosis of guillain-barre syndrome and hypertensive encephalopathy. There was sudden onset of sensory loss, walking disability and history of trauma. In the following hours hematuria, back pain and lower extremity ischemia developed. We suspected spinal artery injury based on the findings. dissection of descending aorta was established with the help of magnetic resonance imaging of spinal region and contrasted aortography. The patient went to surgery immediately. He was lost on the second day after operation because of malperfusion. We report this case because dissecting aorta is very rare in the pediatric age group. High index of suspicion and early aortography are needed to diagnose aorta dissection.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/10. Abdominal complications after cardiac surgery in cardiopulmonary bypass.Gastrointestinal problems are an infrequent but serious consequence of cardiac surgery that includes cardiopulmonary bypass. Predictors of these complications are not well developed, and the role of fundamental variables remains controversial. Between July 1998 and August 2002, 1,552 patients (1,106 male and 446 female), mean age 56 years, underwent heart surgery with cardiopulmonary bypass. Among those 1,552 patients, 21 (1.35%) had gastrointestinal complications, mainly because of gastrointestinal bleeding due to gastritis and five of them required surgery. We present these five patients, three with intestinal ischemia, two with intestinal bleeding. There Hoffmeister-Finsterer operation, Rydygier resection, hemicolectomy, appendectomy with cecum sewing and sigmoid resection were performed. The mortality in this group was 60% (three of five), and the cause of death was multiorgan insufficiency. Conclusion: Careful monitoring and physical examination of these high-risk patients following cardiac surgery is required for early detection and effective treatment.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/10. Endovascular repair of perirenal and Group IV thoracoabdominal aortic aneurysms: a case study report.BACKGROUND: Endovascular aneurysm repair (EVAR) is an established technique used in infrarenal aneurysms. Fenestrated and branched endografts (FBEGs) are a new option for the treatment of perirenal and Group IV thoracoabdominal aortic aneurysms (TAAAs). With a case study design, the preparation, surgical technique, postoperative nursing care, and medical follow-up involved in Group IV TAAAs treated with an FBEG are discussed. methods: Detailed imaging with state-of-the-art computed tomography scanning is used to create a custom-made endograft in which a combination of fenestrations, scallops, and covered or uncovered stents are used for the visceral arteries. This graft can be introduced in the arterial system through the femoral artery and delivered at the level of the perivisceral abdominal aorta. perioperative nursing care in patients undergoing FBEG draws from protocols of an established EVAR program. With these protocols, preoperative assessment and education are completed to ensure that the patient is both physically and mentally prepared for the surgery. Intraoperatively, the nursing team is instrumental in the functioning of the case: The scrub nurse assists the surgeon while other registered nurses assist with invasive monitoring and emotional support for the conscious patient. Postoperatively, patients are taken directly from the recovery room to a step-down bed where close monitoring occurs. RESULTS: The use of FBEGs to treat Group IV TAAAs reduces the acuity of patient care by avoiding a thoracotomy and major surgical dissection, thus decreasing hospital length of stay. Although long-term follow-up remains limited, durability seems to be promising, and this procedure offers a viable option to high-risk patients. Because EVAR with FBEG is a new procedure in canada, nurses involved with every aspect of care are challenged to maintain high levels of competency by continually educating themselves in this evolving field.- - - - - - - - - - ranking = 0.078380358823096keywords = physical (Clic here for more details about this article) |
8/10. Emergency operation for thoracic aortic aneurysm caused by the ehlers-danlos syndrome.Two patients were treated emergently for impending ruptured thoracic aortic aneurysms caused by type IV ehlers-danlos syndrome. One patient had typical physical evidence of type IV ehlers-danlos syndrome. The other patient had a normal phenotype. Type IV ehlers-danlos syndrome was diagnosed by electrophoresis of the collagen extracted from the skin. The clinician must be aware of the variations in presentation of type IV ehlers-danlos syndrome.- - - - - - - - - - ranking = 0.078380358823096keywords = physical (Clic here for more details about this article) |
9/10. Dacron aorta.During the span of 6 years a 67-year-old woman underwent four consecutive major aortic operations, ultimately replacing her entire thoracoabdominal aorta with the exception of a tiny segment from which the left subclavian artery originated. The relatively uneventful postoperative course with each operation (one emergency and three elective procedures) and her current satisfactory condition at age 73 years have been attributed to her physical and mental fortitude, excellent anesthesia, superb postoperative care, and the chronic nature of her segmental aortic lesions caused by arteriosclerosis.- - - - - - - - - - ranking = 0.078380358823096keywords = physical (Clic here for more details about this article) |
10/10. A ruptured syphilitic descending thoracic aortic aneurysm. The characteristic findings on computed tomography for the etiological diagnosis of aneurysm.We report the case of a 72-year-old man with a ruptured syphilitic descending thoracic aneurysm who underwent an emergency operation and successful graft replacement. Preoperative physical examination showed a pulsative mass on the left back. Preoperative computed tomography showed bone destruction in the TH6 to TH10 thoracic vertebrae and ribs and penetration (or rupture) of the aneurysm into the subcutaneous tissue. During the period of preoperative evaluations, free wall rupture of the aneurysm occurred and emergency operation for graft replacement was performed. The microscopical examination of the aneurysmal wall revealed the syphilitic changes. In literature, the vertebral destruction by atherosclerotic aneurysm is usually located at the TH12 to L3 of vertebral bodies. From the findings of this patient and a study of existing literature, we concluded that the finding of vertebral bone beyond TH12 to L3 region on CT examination of the aneurysm could be a etiological characteristic finding for syphilitic aortic aneurysm.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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