1/34. Remarkable case of early Aspergillus endophthalmitis.BACKGROUND: This case demonstrates the early stage of Aspergillus endophthalmitis and is the second ultrastructural study of endogenous Aspergillus endophthalmitis. It is the first description of phagocytosis of Aspergillus fungi by retinal pigment epithelium (RPE). methods: A case report and detailed light- and electron microscopic findings are presented. RESULTS: Histopathological examination of serial sections of the affected right eye displayed a spread of aspergillus fumigatus fungi along two separate paths: via the retinal and choroidal vessels. The retinal and choroidal lesions were not contiguous. The organisms penetrated blood vessel walls, Bruch's membrane and the internal limiting membrane, but not the RPE layer. A curious accumulation of the Aspergillus fungi was present on the internal aspect of Bruch's membrane, where the RPE acted as a barrier and the subretinal space was not invaded. phagocytosis of fungi by the RPE was observed. No inflammatory cells were present between Bruch's membrane and the RPE. CONCLUSIONS: This report describes a remarkable barrier function, possible local immunosuppression and phagocytosis by the RPE cells in a case of early Aspergillus endophthalmitis.- - - - - - - - - - ranking = 1keywords = blood vessel, vessel (Clic here for more details about this article) |
2/34. Aspergillus osteoarthritis in acute lymphoblastic leukemia.We report an unusual case of arthritis of the right wrist due to aspergillus fumigatus without evidence for a generalized infection, following chemotherapy for acute lymphoblastic leukemia. The diagnosis was made by surgical biopsy. Amphotericin-B (Am-B) was not tolerated by the patient. Liposomal preparations of Am-B penetrate poorly into bone and cartilage. Therefore, oral itraconazole was given; the arthritis improved and chemotherapy was continued without infectious complications. Two weeks after complete hematopoietic recovery, an intracranial hemorrhage from a mycotic aneurysm of a brain vessel occurred, although the patient was still receiving itraconazole. We emphasize the importance of prompt and thorough efforts to identify the causative agent in immunocompromised patients with a joint infection. itraconazole is effective in Aspergillus osteoarthritis but, due to its poor penetration into the brain, the combination with a liposomal formulation of Am-B is recommended.- - - - - - - - - - ranking = 0.077735572365317keywords = vessel (Clic here for more details about this article) |
3/34. Mycotic pseudoaneurysm of the aortic arch: an unusual complication of invasive pulmonary aspergillosis.invasive pulmonary aspergillosis (IPA) is usually a condition of the immunocompromised patients. The organism has a tendency to invade pulmonary blood vessels. Extension of a pulmonary parenchymal lesion to involve the mediastinal great vessels is very rare. This is the first case where the extension of IPA to the aortic arch and the formation of a pseudoaneurysm were demonstrated on serial CT scans.- - - - - - - - - - ranking = 1keywords = blood vessel, vessel (Clic here for more details about this article) |
4/34. Case report. Mycotic arteritis due to aspergillus fumigatus in a diabetic with retrobulbar aspergillosis and mycotic meningitis.A 74-year-old man with diabetes mellitus type II, retinopathy and polyneuropathy suffered from exophthalmus, ptosis and diplopia. magnetic resonance imaging and computer tomography showed a space-occupying process in the right orbital apex. An extranasal ethmoidectomy accompanied by an orbitotomia revealed the presence of septated hyphae. aspergillus fumigatus was grown from the tissue. After surgical removal of the fungal masses, therapy with amphotericin b (1 mg kg(-1) body weight) plus itraconazole (Sempera, 200 mg per day) over 6 weeks was initiated. Five months later the patient's condition deteriorated again, with vomiting, nausea and pain behind the right eye plus increasing exophthalmus. Antifungal therapy was started again with amphotericin b and 5-fluorocytosine. neutropenia did not occur. The patient became somnolent and deteriorated, a meningitis was suggested. Aspergillus antigen (titre 1:2, Pastorex) was detected in liquor. Anti-Aspergillus antibodies were not detectable. Both the right eye and retrobulbar fungal masses were eradicated by means of an exenteratio bulbi et orbitae. However, renal insufficiency and an apallic syndrome developed and the patient died. At autopsy, a mycotic aneurysm of the arteria carotis interna dextra was detected. The mycotic vasculitis of this aneurysm had caused a rupture of the blood vessel followed by a massive subarachnoidal haemorrhage. In addition, severe mycotic sphenoidal sinusitis and aspergillosis of the right orbit were seen, which had led to a bifrontal meningitis.- - - - - - - - - - ranking = 0.92226442763468keywords = blood vessel, vessel (Clic here for more details about this article) |
5/34. Arterial embolization to preoperatively manage pulmonary disease associated with inflammation.Preoperative arterial embolization is used in pulmonary disease to reduce intraoperative blood loss resulting from exposure of extensive adherent pleura due to repeated inflammation. Between January 1996 and February 2001, 5 patients underwent surgery with this procedure. Underlying diseases were 3 cases of aspergilloma and 1 each of chronic expanding hematoma and lung cancer. All embolization was permanent, involving coil insertion. Surgical treatment was successful in all 5 patients without mortality. Such preoperative management proved useful in reducing intraoperative blood loss in hypervascular collateral feeding vessels in the area of resection or decortication.- - - - - - - - - - ranking = 0.077735572365317keywords = vessel (Clic here for more details about this article) |
6/34. Localized deposition of calcium oxalate around a pulmonary aspergillus niger fungus ball.A case of pulmonary aspergillus niger fungus ball is presented. Crystals of calcium oxalate, presumably derived from oxalic acid produced by the fungus, were deposited in tissues around the fungus ball. The crystals were identified by x-ray diffraction analysis. Histochemical technics for the identification of calcium oxalate were applied, and evaluation of those showed Yasue's silver nitrate-rubeanic acid method to be the most satisfactory. More frequently used methods for identifying calcium salts in tissues may give equivocal reactions. oxalic acid may cause localized tissue damage, and if this affects blood vessels severe hemorrhage may follow.- - - - - - - - - - ranking = 0.92226442763468keywords = blood vessel, vessel (Clic here for more details about this article) |
7/34. Laparoscopic retroperitoneal nephrectomy for Aspergillus-infected polycystic kidney.BACKGROUND AND PURPOSE: The management of polycystic kidney disease is mostly restricted to conservative measures. However, nephrectomy may be indicated in particular cases, especially when there are infective complications. To decrease the morbidity of the procedure, the laparoscopic approach has become appealing. We present a laparoscopic retroperitoneal approach to complicated polycystic kidney disease in a high-risk patient. CASERESPORT: We performed right retroperitoneal laparoscopic nephrectomy in a 39-year-old man who had autosomal polycystic kidney disease and had undergone heart transplantation. The immunosuppressed patient presented with severe flank pain, generalized signs of infection, and acute renal insufficiency. With the patient in the right lateral decubitus position, the retroperitoneal space was entered by the open technique, and the posterior pararenal space was developed with finger dissection. Five trocars were used. After the renal vessels had been secured and divided, the cysts were successively punctured, gradually shrinking the operative specimen. The kidney was placed in an Endo-catch and removed after morcellation, with no need to enlarge the 2-cm lumbotomy. The operating time was 80 minutes, and the hospital stay was 4 days. Histologic examination revealed a polycystic kidney with Aspergillus infection. CONCLUSION: The laparoscopic approach is a less-invasive option for removing a polycystic kidney when nephrectomy is indicated. The retroperitoneal route has the advantage of minimizing infection risks because of the absence of peritoneal opening.- - - - - - - - - - ranking = 0.077735572365317keywords = vessel (Clic here for more details about this article) |
8/34. Floating aortic thrombus in systemic aspergillosis and detection by transesophageal echocardiography.After immunosuppressive treatment for a colitis ulcerosa, a 49-yr-old man developed signs of systemic aspergillosis with subsequent septic shock and encephalitis. For recurrent signs of thromboembolism, transesophageal echocardiography was performed and revealed a large floating thrombus of the aortic arch. Despite appropriate antibiotic treatment, the patient died a few days later suffering from adult respiratory distress syndrome. The appearance of aortic thrombi concomitant to systemic fungal infection rarely has been reported. The present case is the first report of in vivo detection of large vessel involvement in systemic aspergillosis by transesophageal echocardiography. In our opinion, transesophageal echocardiography is the method of choice for bedside diagnosis of this rare complication in critically ill patients.- - - - - - - - - - ranking = 0.077735572365317keywords = vessel (Clic here for more details about this article) |
9/34. Case Report. Disseminated aspergillosis complicating pregnancy.We report a case of disseminated aspergillosis in a hitherto healthy 24-year-old woman during her 24th week of pregnancy. Relevant findings at autopsy revealed innumerable septate, dichotomously branched (45 degrees ) hyphae compatible with Aspergillus in lung and liver tissues. Cerebral histology showed cerebral vessels occluded by hyphae causing cerebral infarction. There was no evidence of invasive aspergillosis in the placenta and fetal tissues. Aspergillus sp. was confirmed by amplification of a specific 357-base-pair amplicon from a paraffin block containing lung tissue. This case illustrates a previously uncharacterized spectrum of disseminated aspergillosis, indicating the need for a heightened awareness that Aspergillus species are opportunistic agents for invasive and disseminated infection in pregnancy.- - - - - - - - - - ranking = 0.077735572365317keywords = vessel (Clic here for more details about this article) |
10/34. Pseudoaneurysm of the iliac artery secondary to Aspergillus infection in two recipients of kidney transplants from the same donor.The authors report 2 cases of patients who underwent cadaveric renal transplantation from the same donor in a multiorgan extraction procedure. Both cases showed, during the first 6 months posttransplantation, a worsening in renal graft function and signs of ischemia in the homolateral lower limb. One of the cases was preceded by pain in the sciatic region. In imaging tests, a pseudoaneurysm was detected in the iliac artery in both patients. Grafts had to be removed, and the iliac arteries were ligated with posterior isolation of Aspergillus spp from the arterial vessels but not from the renal tissue. Besides surgery, medical treatment with liposomal amphotericin b was initiated with a different outcome in each patient: patient A died, whereas patient B recovered. The absence of Aspergillus spp infection in liver and heart recipients ruled out a donor-transmitted infection. The graft placements were carried out in different operating rooms, which rules out contamination during the transplantation process. All of this leads us to conclude that the infection must have occurred during the preservation phase of the kidney.- - - - - - - - - - ranking = 0.077735572365317keywords = vessel (Clic here for more details about this article) |
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