1/27. pulmonary artery stenosis 5 years after single lung transplantation in primary pulmonary hypertension.This is a case report about a 56-year-old female patient with primary pulmonary hypertension who underwent single, right lung transplantation. Five years postoperatively she developed signs of right heart failure. history and physical examination suggested pulmonary artery stenosis. Diagnosis was confirmed by pulmonary angiography. Percutaneous placement of a balloon expandable stent normalized pulmonary artery pressure.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/27. Insidious symptomatology and misleading physical findings in popliteal artery entrapment syndrome. A case report.A patient presented with an ischemic right forefoot. She suffered rest pain but had relief on walking and on flexing her leg. Popliteal and pedal pulses were palpable. The underlying condition was popliteal artery entrapment. Compression of the popliteal artery occurred with extension of the knee and additional contraction of the gastrocnemius muscles only and was released with flexion. Distal embolizations into all three lower leg arteries had caused acute ischemia. As the emboli had travelled through both tibial vessels very distally pedal pulses were found to be normal. Treatment was operatively by resection of a tiny lateral portion of the medial gastrocnemic tendon which crossed the artery dorsally as the vessel pierced the tendon.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
3/27. popliteal artery entrapment syndrome: diagnosis and management, with report of three cases.popliteal artery entrapment syndrome is an important albeit infrequent cause of serious disability among young adults and athletes with anomalous anatomic relationships between the popliteal artery and surrounding musculotendinous structures. We report our experience with 3 patients, in whom we used duplex ultrasonography, computed tomography, digital subtraction angiography, and conventional arteriography to diagnose popliteal artery entrapment and to grade the severity of dynamic circulatory insufficiency and arterial damage. We used a posterior surgical approach to give the best view of the anatomic structures compressing the popliteal artery. In 2 patients, in whom compression had not yet damaged the arterial wall, operative decompression of the artery by resection of the aberrant muscle was sufficient. In the 3rd patient, operative reconstruction of an occluded segment with autologous vein graft was necessary, in addition to decompression of the vessel and resection of aberrant muscle. The result in each case was complete recovery, with absence of symptoms and with patency verified by Doppler examination. We conclude that clinicians who encounter young patients with progressive lowerlimb arterial insufficiency should be aware of the possibility of popliteal artery entrapment. early diagnosis through a combined approach (careful physical examination and history-taking, duplex ultrasonography, computerized tomography, and angiography) is necessary for exact diagnosis. The treatment of choice is the surgical creation of normal anatomy within the popliteal fossa.- - - - - - - - - - ranking = 10.593021204729keywords = physical examination, physical (Clic here for more details about this article) |
4/27. Serial stent implantation to relieve in-stent stenosis in obstructed total anomalous pulmonary venous return.A nine-year-old girl with complex cyanotic heart disease associated with supracardiac total anomalous venous return and obstruction at the drainage site of the vertical vein into the left innominate vein had stent placement at the age of seven, with immediate increase of oxygen saturation and improvement of physical activity. Significant in-stent stenosis occurred that was successfully treated by concentrical placement of a second stent. This case report demonstrates the transluminal approach to be effective in the treatment of stenoses in congenital heart defects that are not eligible for corrective surgery.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/27. Stenosing tenosynovitis of the pseudosheath of the tendo achilles.This entity consists of a chronic inflammatory process of the peritenon of the tendo Achilles (usually bilateral) at variable points of the tendon itself but usually near the insertion in the Achilles. Its occurrence, not only in runners but in relatively sedentary individuals of both sexes, seems to be the result of microtrauma with insidious onset of local pain in increasing degree with physical activity. Clinically, in the advanced cases, fibrillation, modulation, and "yellowing" of the edematous tendon occur and probably are a precursor to later ruptures. Pathological changes consist of one or more of the following: a myxomatous degeneration of collagenous tissue; fibrosis; round cell inflammatory infiltrate; and proliferation of fibrovascular connective tissue. The use of steroid injections seems to be of no help and probably is contraindicated. Surgery consists of excision of the entire pseudosheath, allowing the tendon to assume a new, nonconstricting alignment. All but one of the nine patients with a follow-up of at least one year went on to clinical, painless recovery, with unrestricted future activity, in just a few months.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/27. Midaortic syndrome associated with fetal alcohol syndrome.Midaortic syndrome (MAS) is an uncommon condition characterized by progressive narrowing of the abdominal aorta and its branches and impressive formation of collateral circulation. It affects children and young adults and presents predominantly as untreatable hypertension. Fetal alcohol syndrome (FAS) refers to a constellation of physical, behavioral, and cognitive abnormalities secondary to alcohol exposure in utero. The authors present an unusual association between a hypoplastic abdominal aorta and fetal alcohol syndrome. The patient discussed in this article presented with severe hypertension that was successfully treated with renal angioplasty.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/27. Pseudomalignant myositis ossificans of the wrist causing compression of the ulnar nerve and artery. A case report.myositis ossificans (MO) is a condition characterised by focal, benign and self-limited idiopathic heterotopic bone formation. It is extremely rare in the hand and wrist and may lead to concomitant nerve compression. Because of the rare incidence of pseudomalignant MO at the wrist and hand, we found it of interest to report a case of this condition localised to the wrist. A 31-year-old female patient presented with swelling and pain of her left wrist. The physical examination findings, magnetic resonance imaging and Tc-99m bone scan suggested acute osteomyelitis or a tumoral condition. Incisional biopsy and pathological examination was done. The microscopic findings confirmed that the lesion was pseudomalignant MO. The lesion was removed totally and decompression of the ulnar nerve and artery was achieved. The patient regained full asymptomatic range of motion of all digits and wrist and the numbness of the fourth and fifth digits had subsided at follow-up five months later.- - - - - - - - - - ranking = 10.593021204729keywords = physical examination, physical (Clic here for more details about this article) |
8/27. pancreatitis-induced extrahepatic portal vein stenosis treated by percutaneous transhepatic stent placement.One month after onset of an acute biliary pancreatitis, a 75-year-old man developed refractory ascites. Duplex ultrasound and CT scan revealed a focal stenosis of the extrahepatic portal vein as confirmed by transhepatic direct portography. In the same session, this stenosis, responsible for symptomatic prehepatic portal hypertension, was successfully dilated and stented and afterwards a residual pressure gradient of 1 mmHg over the stented segment was measured. One week after the stenting procedure the patient was free of ascites and control physical and biochemical examination one year later is completely normal.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/27. Spontaneous remission of persistent severe hematuria in an adolescent with nutcracker syndrome: seven years' observation.A Japanese boy aged 14 years presented with gross hematuria associated with mild proteinuria and was diagnosed as having nutcracker syndrome. magnetic resonance angiography (MRA) revealed significant compression of the left renal vein between the aorta and the superior mesenteric artery with collaterals. A percutaneous renal biopsy on the right kidney revealed no evidence of glomerular or interstitial changes with immune deposition. He was observed closely without any intervention thereafter. Although repeat MRA performed 4 years after our first observation disclosed the development of collateral veins, severe hematuria with an intermittent exacerbation remained unchanged. During the next 2 years, the hematuria completely subsided spontaneously. Although the etiology of spontaneous remission of the disease remains speculative, his good physical development (i.e., approximately 10 cm taller than his height at the onset) may change presumptive hemodynamic factors. These clinical observations suggest that a proportion of pubertal patients with nutcracker syndrome should be treated conservatively for a relatively long time.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/27. Aortic flap valve presenting as neurogenic claudication: a case report.STUDY DESIGN: A case report of a patient who presented with pain in both lower limbs related with walking and standing as a result of an unusual vascular etiology. OBJECTIVES: To describe the pathology and treatment of an unusual case of vascular claudication. SUMMARY OF BACKGROUND DATA: Symptoms of neurogenic claudication may be mimicked by intermittent vascular claudication. Not infrequently, arterial disease coexists with spinal canal stenosis. Determination of correct diagnosis is the prerequisite for effective treatment. methods: The patient was a 64-year-old woman who presented with bilateral buttock pain spreading to the calves. The symptom was related to walking and climbing stairs and relieved by sitting down. MRI of the lumbosacral spine corroborated severe spinal stenosis at L3-L4 and L4-L5. Based on findings on physical examination of the peripheral pulses, an aortogram revealed a flap in the lumen functioning like a valve as the cause of her lower limb ischemic pain. RESULTS: The patient was managed by insertion of a self-expandable metallic stent with complete resolution of her symptoms. CONCLUSIONS: We report a case that was diagnosed as neurogenic claudication on clinical features and MRI evidence. However, subsequent to an aortogram the diagnosis was revised. intermittent claudication is often difficult to distinguish from neurogenic claudication. There are no sensitive discriminators based on history alone. In the presence of poor or absent peripheral pulses, an arteriogram is necessary to ascertain the relative importance of the peripheral arterial circulation.- - - - - - - - - - ranking = 10.593021204729keywords = physical examination, physical (Clic here for more details about this article) |
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