1/27. naloxone infusion and drainage of cerebrospinal fluid as adjuncts to postoperative care after repair of thoracoabdominal aneurysms.The mechanisms that produce paraplegia in patients after TAA repair are complex and involve alterations in regional blood flow to the spinal cord, CSF dynamics, and reperfusion. Although neither the minimal level of blood flow nor the maximal spinal cord pressure that can be tolerated by the spinal cord is known, adjuncts such as CSF drainage and naloxone infusions may allow longer durations of aortic cross-clamping before irreversible ischemia occurs. Because paraplegia is multifactorial and none of the recommended adjuncts alone provides complete protection of the spinal cord, a combination of treatments may be necessary to reduce the prevalence of neurological complications after thoracoabdominal aortic reconstruction. critical care nurses thus must be acquainted with the advanced monitoring techniques and the pathophysiology behind these new treatment modalities. Advanced assessment skills are also essential to recognize the potential neurological complications that may occur in these patients. Care of patients with TAA is a challenge. critical care nurses must use multidimensional skills in the areas of hemodynamic monitoring, physical assessment, and psychological counseling to effectively manage postoperative care of these patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/27. Transesophageal echocardiography detection of an esophageal sarcoma mimicking aortic dissection.This report shows that transesophageal echocardiography can detect thoracic pathology, in this case esophageal sarcoma, as well as cardiac and aortic abnormalities. Transesophageal echocardiography can help differentiate cardiac from aortic or other intrathoracic pathology when the patient's history and physical examination do not provide enough information.- - - - - - - - - - ranking = 10.597141233794keywords = physical examination, physical (Clic here for more details about this article) |
3/27. Clinical considerations in the chiropractic management of the patient with marfan syndrome.OBJECTIVE: To describe the chiropractic management of a patient with whiplash-associated disorder and a covert, concomitant dissecting aneurysm of the thoracic aorta caused by marfan syndrome or a related variant. CLINICAL FEATURES: A 25-year-old man was referred by his family physician for chiropractic assessment and treatment of neck injuries received in a motor vehicle accident. After history, physical examination, and plain film radiographic investigation, a diagnosis of whiplash-associated disorder grade I was generated. INTERVENTION AND OUTCOME: The whiplash-associated disorder grade I was treated conservatively. Therapeutic management involved soft-tissue therapy to the suspensory and paraspinal musculature of the upper back and neck. Rotary, manual-style manipulative therapy of the cervical and compressive manipulative therapy of the thoracic spinal column were implemented to maintain range of motion and decrease pain. The patient achieved full recovery within a 3-week treatment period and was discharged from care. One week after discharge, he underwent a routine evaluation by his family physician, where an aortic murmur was identified. Diagnostic ultrasound revealed a dissecting aneurysm measuring 78 mm at the aortic root. Immediate surgical correction was initiated with a polyethylene terephthalate fiber graft. The pathologic report indicated that aortic features were consistent with an old (healed) aortic dissection. There was no evidence of acute dissection. Six month follow-up revealed that surgical repair was successful in arresting further aortic dissection. CONCLUSION: The patient had an old aortic dissection that pre-dated the chiropractic treatment (which included manipulative therapy) for the whiplash-associated disorder. Manipulative therapy, long considered an absolute contraindication for abdominal and aortic aneurysms, did not provoke the progression of the aortic dissection or other negative sequelae. The cause, histology, clinical features, and management considerations in the treatment of this patient's condition(s) are discussed.- - - - - - - - - - ranking = 10.597141233794keywords = physical examination, physical (Clic here for more details about this article) |
4/27. Aortic subannular left ventricular aneurysm in a patient of Asian ancestry.An asymptomatic 50-year-old Japanese man was diagnosed with an aortic subannular left ventricular aneurysm during a routine physical checkup. Operative findings showed the subaortic aneurysm had developed beneath the noncoronary cusp of the aortic valve and expanded into the epicardium between the aortic root and left atrium. The operation involved patch closure of the orifice of the annular subaortic aneurysm, aortic valvuloplasty, and plication of the dilated ascending aorta.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/27. Unruptured sinus of valsalva aneurysm in an asymptomatic patient.A 75-year-old asymptomatic male patient was referred for transesophageal echocardiography after detection of a diastolic murmur on routine physical examination and widened mediastinum on a chest radiograph. Transesophageal echocardiography revealed a large, unruptured sinus of valsalva aneurysm, filled with a thrombus and spontaneous echocontrast and protruding into the right atrium. Unruptured sinus of valsalva aneurysms are rare, frequently asymptomatic, and not associated with any physical findings. The diagnosis was made by transesophageal echocardiography and was confirmed by angiography and at surgery. The need for corrective surgery of asymptomatic, incidentally diagnosed sinus of Valsalva aneurysm is not well defined in the absence of precise knowledge of its natural history. We provide a description of the natural history and rationale for early corrective surgery of sinus of valsalva aneurysms in asymptomatic patients.- - - - - - - - - - ranking = 11.597141233794keywords = physical examination, physical (Clic here for more details about this article) |
6/27. Report of a child with aortic aneurysm, orofacial clefting, hemangioma, upper sternal defect, and marfanoid features: possible PHACE syndrome.We report a female patient who had a scalp hemangioma, a cleft uvula, an upper sternal defect, pectus excavatum, arachnodactyly, pes planus, and joint hypermobility. She had rupture of an aortic aneurysm after minor trauma at 11 years of age. At 17 years of age, elective repair of a dilated, ectatic aorta was complicated by cerebral ischemia. Other vascular abnormalities in the proband included an aneurysm of the left subclavian artery, atresia of the right carotid artery, and calcified cerebral aneurysms. We believe that the proband's physical anomalies are best described by the PHACE (posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities) phenotypic spectrum. This spectrum of physical anomalies also includes sternal clefting and hemagiomas as part of the sternal malformation/vascular dysplasia (SM/VD) association, as found in our patient, and the acronym PHACES has also been used. We consider that the PHACE phenotypic spectrum is likely to be broader than previously recognized and includes orofacial clefting and aortic dilatation and rupture. Our patient also had skeletal anomalies that lead to consideration of marfan syndrome as a diagnosis. It should be recognized that there is clinical overlap between PHACE syndrome and marfan syndrome when aortic dilatation is present. We would also like to emphasize the minor nature of the cutaneous findings in our patient despite her severe vascular complications. This is in contrast to previous reports of large or multiple hemangiomas in PHACE syndrome.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
7/27. Congenital aneurysm of the sinus of valsalva protruding into the left ventricle. review of diagnosis and treatment of the unruptured aneurysm.During a routine physical examination, a 34-year-old man, in apparent good health, had an electrocardiogram which revealed left axis deviation. Cardiac evaluation disclosed mild aortic regurgitation and left anterior fascicular block. Nine months later, the patient was admitted to the critical care unit after he had experienced cardiac arrest while jogging. Angiograms demonstrated a large unruptured aneurysm in the right coronary sinus of valsalva protuding into the left ventricle. Echocardiographic manifestations also suggested also suggested a sinus of valsalva aneurysm. The defect was repaired through an aortic approach. The aneurysmal sac was emptied and the neck sutured securely. Twenty-two months postoperatively, the patient continues to be asymptomatic. We anticipate that this will decrease the threat of recurrent arrhythmias..- - - - - - - - - - ranking = 10.597141233794keywords = physical examination, physical (Clic here for more details about this article) |
8/27. Ruptured aneurysm of the sinus of valsalva into the right atrium. An uncommon congenital heart defect.rupture of an aneurysm of the sinus of valsalva is an uncommon heart defect. A continuous murmur may be the first clinical sign of this rupture. Additional imaging techniques, and in the first place echocardiography, can be used to confirm the diagnosis. We present a case where, at the age 53 years, the diagnosis was made of a ruptured sinus of valsalva into the right atrium, with a typical windsock image on echocardiogram. Although several cases of a ruptured sinus of valsalva are reported in the literature, it is still an underdiagnosed condition because it is frequently missed during physical examination.- - - - - - - - - - ranking = 10.597141233794keywords = physical examination, physical (Clic here for more details about this article) |
9/27. ectopia lentis and aortic root dilatation in congenital contractural arachnodactyly.Congenital contractural arachnodactyly (CCA) was described by Beals and Hecht as an autosomal dominant disorder distinct from marfan syndrome and comprising joint contractures, arachnodactyly, scoliosis, and a distinct "crumpled ear" deformity. While the disorder is similar to marfan syndrome, it was split from it due to the distinct physical appearance of the patients and, more importantly, the lack of heart and eye findings. Since the original report, several CCA patients have been found to have mitral valve prolapse, structural cardiac anomalies, and occasionally aortic root dilatations similar to those seen in marfan syndrome. We report on a patient with CCA with bilateral ectopia lentis and aortic root dilatation. Our review of the literature of CCA showed that serial echocardiography and careful eye examinations have not become a standard of medical practice in this condition. Partly this may be due to a lack of documented cases of CCA having severe ectopia lentis and cardiac complications. This patient underscores the need for periodic eye and echocardiographic evaluations of all CCA patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/27. Large ascending aortic aneurysm and severe aortic regurgitation in a 7-year-old child with marfan syndrome and a review of the literature. marfan syndrome in childhood.A 7-year-old girl was admitted because of dyspnea on exertion and palpitations. Her symptoms had gradually worsened for the last 6 months. She had physical features of the marfan syndrome. Transthoracic echocardiography showed an ascending aortic aneurysm, severe aortic regurgitation, and mildly dilated left ventricle. Because of marked aortic aneurysm and severe aortic regurgitation, the patient was treated with a beta-blocker and an angiotensin converting enzyme inhibitor. Surgery was refused by her parents. We describe here a child with marfan syndrome in whom significant dilatation of the ascending aorta and severe aortic regurgitation is encountered and major cardiovascular complications of marfan syndrome were reviewed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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