1/10. Surgical treatment of internal carotid artery anterior wall aneurysm with extravasation during angiography--case report.A 54-year-old female presented subarachnoid hemorrhage from an aneurysm arising from the anterior (dorsal) wall of the internal carotid artery (ICA). During four-vessel angiography, an extravasated saccular pooling of contrast medium emerged in the suprasellar area unrelated to any arterial branch. The saccular pooling was visualized in the arterial phase and cleared in the venophase during every contrast medium injection. We suspected that the extravasated pooling was surrounded by hard clot but communicated with the artery. Direct surgery was performed but major premature bleeding occurred during the microsurgical procedure. After temporary clipping, an opening of the anterior (dorsal) wall of the ICA was found without apparent aneurysm wall. The vessel wall was sutured with nylon thread. The total occlusion time of the ICA was about 50 minutes. Follow-up angiography demonstrated good patency of the ICA. About 2 years after the operation, the patient was able to walk with a stick and to communicate freely through speech, although left hemiparesis and left homonymous hemianopsia persisted. The outcome suggests our treatment strategy was not optimal, but suture of the ICA wall is one of the therapeutic choices when premature rupture occurs in the operation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/10. Multiple bullae and paresis after drug-induced coma.Two cases of bullous skin lesions and paresis following coma due to the ingestion of many antipsychotic drugs were reported. Histological examination showed an intra-epidermal blister in case 1 and degeneration of sweat glands in both cases. An immunofluorescence study showed massive deposits of IgM and C3 in the dermal vessels. As similar deposits of immunoglobulin and complement were not observed in patients with ordinary lesions such as decubitus, a different mechanism in the formation of the bullous skin lesion other than pressure is suggested.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
3/10. Factors affecting the response to plasma therapy in thrombotic thrombocytopenic purpura.Factors affecting the response to plasma therapy (plasma exchange and plasma infusion) were studied in four cases of thrombotic thrombocytopenic purpura (TTP) treated in our hospital. Plasma therapy led to recovery from advanced TTP, but three of the patients exhibited chronic relapse. The longer the period from onset, the more marked was the progression of TTP, from the first stage (thrombocytopenia alone) to the second stage in which thrombocytopenia was accompanied by microangiopathic hemolytic anemia (MHA), and the third stage in which neurological abnormalities appeared. Platelet thrombi, which are thought to be the primary pathogenetic feature, probably enlarge leading to stenosis of the vessels during the progression of TTP. Although the severity of TTP in the early stages could be judged from two markers, LDH and the platelet count, it was impossible to determine the severity of advanced TTP by these two markers. However, the severity of advanced TTP could be judged by including the grade and period of neurological abnormalities. The dose of plasma needed to induce recovery was small in the early stage, but as the period from onset lengthened, the dose had to be increased. Though the early platelet thrombi might be easily eliminated by plasma infusion, larger and well-established platelet thrombi might not be lysed even by massive doses of plasma.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/10. Carotid arteriospasm.Arteriospasm can result from manipulation or fresh blood around an artery. This myogenic reflex can spread to obliterate collateral flow and can last from minutes to days. Ischemic strokes from carotid spasm ensue neurosurgical procedures, endarterectomies, and even chiropractic manipulation. The diagnosis and prevention of arteriospasm are presented, and a patient who has carotid arteriospasm following excision of a branchial cleft cyst is detailed. If the vessel constriction is noted at surgery, topical application of a local anesthetic is effective. Transfusion, hydration, oxygenation, and maintenance of blood pressure are the cornerstones of nonoperative therapy.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/10. serum levels of adhesion molecules and thrombomodulin as indicators of vascular injury in severe plasmodium falciparum malaria.Severe plasmodium falciparum malaria is characterized by multiple organ involvement due to sequestration of infected erythrocytes in small vessels. Endothelial cell adhesion molecules play an important role in this interaction. During the course of a severe cerebral P. falciparum malaria infection we found very markedly elevated levels of the soluble adhesion molecules intercellular adhesion molecule-1, e-selectin, and vascular cell adhesion molecule-1, with a maximum increase of nine, seven, and eight times, respectively. These very high levels of soluble adhesion molecules point to an endothelial cell injury as an additional cause to physiological release or shedding due to receptor interactions. Soluble thrombomodulin (sTM) levels showed an extremely marked elevation up to 332 ng/ml (up to 13 times the normal value) as well. malaria patients without severe organ involvement/cerebral manifestation showed only a mild elevation of sTM levels. TM is a parameter independent of the immunological system. It is regarded as a marker of vasculitis and endothelial cell destruction. Therefore, markedly elevated sTM levels document a substantial endothelial cell injury in severe malarial infection and may be of diagnostic and prognostic importance.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
6/10. Brainstem lesion with coma for five years following manipulation of the cervical spine.A woman, aged 38, lost consciousness immediately after manipulation of the cervical spine and remained in coma for nearly 5 years in a combined decorticate and decerebrate state. cerebral angiography revealed impaired circulation in the vertebrobasilar system. The EEG initially showed generalized cerebral dysrhythmia but tended, over the years, to become more normal with desynchronized fast activity of low voltage. Neuropathological examination postmortem revealed a large cystic lesion in the pressure equalization area of the carotid and basilar circulation in the upper pons, mesencephalon, posterior hypothalamus and basal thalamus. No definite stenosis or occlusion was seen in the cerebral vessels on angiography or at the postmortem examination. The mechanism of the lesion is considered to have been temporary interference with the blood flow in the vertebrobasilar system during manipulation of the cervical spine sufficient to cause ischemia and subsequent infarction of the brainstem. The pathogenesis of vascular lesions of the brain stem following manipulation of the cervical spine is discussed briefly.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
7/10. Nail bleeding associated with neurological diseases: all that uncommon? Report of 3 cases.We report 3 patients, without bleeding disorders, presenting with onychomadesis and focal haemorrhages at multiple proximal nail folds or in the nail tissue. In one of our patients it was possible to check the appearance of a drop of blood on each side, beneath the proximal nail fold when he pressed the pulp of the fingers of his previously fractured forearm on a hard surface. All patients had major peripheral or major peripheral and central neurological deficits, prior to the nail bleeding. Peripheral vascular dilatation produced by paralysis of the vasoconstrictors in the nail area slows the venous return in the dilated vessels, mainly in the proximal nail fold.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
8/10. Myocardial damage and rhabdomyolysis associated with prolonged hypoxic coma following opiate overdose.CASE REPORT: We report a case of biopsy proven myocardial damage after opiate-induced rhabdomyolysis. Myocardial biopsy showed focal lesions formed by small mononuclear inflammatory cells with a few neutrophils, associated with degenerated and necrotic myocardial fibers, interstitial edema and congestion of intrinsic blood vessels. These findings were similar to those seen with other drug overdoses if combined with strenuous muscular effort or hypoxic coma. We hypothesize that myocardial damage is a consequence of intracapillary myohypoxia associated with prolonged hypoxic coma following opiate overdose.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
9/10. Intestinal infarction in systemic lupus erythematosus--report of a case with an unusual obliterative vascular lesion.Intestinal infarction is a rare complication of systemic lupus erythematosus (SLE). A 26-year-old Papua New Guinean female who developed such a complication and underwent emergency laparotomy is described. The pathological changes in the mesenteric vessels and possible pathogenetic mechanisms are discussed. The relevant literature is briefly reviewed.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
10/10. Evaluation of acute mental status change in the nonhead injured trauma patient.Acute mental status change in the first 24 hours after trauma is uncommon in nonhead injured patients who initially present with a normal sensorium. Although arterial hypoxemia is the classic etiology for such a mental status change, three less common etiologies should always be considered: cerebral fat embolism, blunt carotid artery injury, and vertebrobasilar artery thrombosis. Prompt diagnosis and appropriate treatment can significantly improve patient morbidity and mortality. Three nonhead injured trauma patients are described illustrating cerebral fat embolism, blunt carotid artery injury, and vertebrobasilar artery thrombosis as causes of acute mental status change. Each patient initially presented with a clear sensorium, but subsequently developed neurological deficits within 24 hours after admission. All had a normal admission CT scan of the head. MRI or conventional arteriography was diagnostic in each case. Any patient who is initially lucid and subsequently develops a neurological deficit, or a patient whose neurological status does not correlate with brain CT findings should undergo immediate evaluation for possible cerebral fat embolism or cervical vessel injury. An algorithm for management of nonhead injured trauma patients with acute mental status deterioration is presented.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
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