1/19. renal artery embolism: therapy with intra-arterial streptokinase infusion.Two patients with acute renal artery embolism were reported. One patient had a history of rheumatic valvular heart disease and the other patient had hereditary cardiomyopathy. Both patients had atrial fibrillation on physical examination. Both patients presented with acute back pain and one patient had hematuria. The final diagnosis of acute renal artery embolism was made after one to three days of hospitalization and renal angiography was finally done documenting complete occlusion of the main branch of the renal artery on one side. Intra-arterial streptokinase infusion 5,000 unit per hour was given to both patients using an arterial pump for 17 hours to 30 hours with complete recanalization of the intrarenal branches and complete recovery of signs and symptoms of renal artery embolism although the renal scan still showed diminished renal function.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/19. 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 = 0.59340419722738keywords = physical (Clic here for more details about this article) |
3/19. A patient with diabetes mellitus and severe arterial embolism.An 89-year-old man with diabetes mellitus was admitted to the hospital because of a low-grade fever and a disturbance in consciousness. He had been diagnosed as having diabetes mellitus at the age of 22 years and had been taking oral hypoglycemic drugs for 16 years at least. A few days before admission, a loss of appetite was noticed by his family; he developed a stupor on the day of admission. On physical examination, his lower extremities were pale and his skin temperature was low. Laboratory tests showed an increase in his white blood cell count and his blood culture was positive for staphylococcus aureus. An MRI showed that the abdominal aorta was totally occluded beneath the renal arteries, and no significant collateral circulation was observed. He was given antibiotics and anticoagulants, but his general condition continued to worsen. Laboratory tests showed renal failure and liver dysfunction, indicating multi-organ failure. On the 24th day of admission, he died of respiratory and heart failure. An autopsy showed the aorta to be totally occluded beneath the renal arteries by an embolism; atherosclerotic changes were rather mild. Acute plaque change on the surface of the aorta may have induced the sudden development of emboli in the aorta.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/19. Isotope angiograpy for detection of embolic arterial occlusion.radionuclide angiography is a safe, noninvasive, easily performed and rapidly executed technique which will accurately demonstrate the presence of an acute occlusion of the arterial tree of the lower extremities. The diagnosis of embolic or thrombotic occlusion of the arterial circulation of the lower extremity in the critically ill patient often is not clear. Visualization of the arterial tree prior to any operation is advantageous, but these patients are invariably in such poor general physical condition that one wound prefer not to submit them to the invasive and time-consuming procedure of conventional contrast arteriography. radionuclide angiography was performed in three patients who had an equivocal diagnosis of acute occlusion of the femoral artery. Acute occlusion was correctly diagnosed by this technique in all three patients.- - - - - - - - - - ranking = 0.14835104930685keywords = physical (Clic here for more details about this article) |
5/19. Aortic saddle embolus presenting with transient lower extremity paresthesia.We report the case of a 58-year-old woman who developed acute onset of bilateral lower-extremity numbness and difficulty ambulating at home. On presentation to the emergency department, however, the patient's symptoms essentially had resolved. An aortic saddle embolus was suspected based on the patient's cardiac history and the absence of distal pulses in the lower extremities. This case illustrates that even with vague or resolving complaints, a high index of suspicion should be maintained for the diagnosis of aortic saddle embolus based on the patient's medical history and on physical examination.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/19. mitral valve endocarditis: an uncommon cause of myocardial infarction.A 39 year old woman presented with acute anterior myocardial infarction. At coronary angiography the distal left anterior descending coronary artery (LAD)was occluded despite otherwise normal coronary arteries. The LAD was successfully recanalized using PTCA. Subsequently, a transesophageal echocardiogram revealed vegetations and a significant incompetence of the mitral valve.blood cultures identified out enterococcus faecalis. Despite intra-venous antibiotic treatment guided by sensitivity testing, the patient ultimately required elective mitral valve replacement. During a prior outpatient diagnostic work-up of fever/malaise, the diagnosis of infective endocarditis was not made.This case conveys two main messages: 1) because the history and physical sings of bacterial endocarditis can be subtle or non-specific, the first step to diagnose infective endocarditis is to include it in the differential diagnosis. 2) percutaneous coronary intervention is an effective treatment of septic embolic occlusion of a major coronary artery.- - - - - - - - - - ranking = 0.14835104930685keywords = physical (Clic here for more details about this article) |
7/19. Septic emboli from a radial artery catheter with local manifestations of subacute bacterial endocarditis.Septic emboli, giving rise to physical signs similar to those of subacute bacterial endocarditis, are extremely rare complications of radial artery catheterization. A case is reported with splinter hemorrhages and Janeway lesions, resulting from an infected radial artery catheter. Five other cases with these signs are collected from among 21 patients with localized septic complications described in the literature. The duration of radial artery catheterization was 4 days or longer in all cases, and staphylococcus aureus was the offending agent in all. We conclude that arterial lines should be removed as early as possible, and in any case they should be pulled out at the earliest sign of a local complication. In the presence of signs of local infection, antistaphylococcal treatment should be given until results of cultures are available.- - - - - - - - - - ranking = 0.14835104930685keywords = physical (Clic here for more details about this article) |
8/19. Massive systemic silicone embolism: a case report and review of literature.Subcutaneous injections of inert or quasi-inert plastic material designed to smooth out wrinkled skin or to create a more esthetically sought appearance have become very popular with the American public in general, and, in particular, with certain groups highly focused on their physical image. The case of the injection procedure has attracted into the field of plastic medicine a substantial number of illegal, incompetent, and unscrupulous operators. Their ignorance of involved medical risks and procedures not uncommonly results in severe complications, disfigurement, and death of patients. We report the typical pathological and chemical findings of a systemic fatal silicone embolism in a 53-year-old heterosexual woman following illegal chronic injections of silicone in her hips and buttocks. The injected subcutaneous silicone apparently migrated rapidly from the interstitial subcutaneous tissue into the general blood stream resulting in a fatal systemic silicone embolism. An analysis of the presented case in conjunction with a review of the pertinent medical literature, including a recent article, revealed a marked similarity in the clinicopathologic findings between silicone embolism and fat embolism.- - - - - - - - - - ranking = 0.14835104930685keywords = physical (Clic here for more details about this article) |
9/19. Bilateral brachial artery emboli presenting as aortic dissection.Loss of peripheral pulses in a patient with chest pain suggests the diagnosis of aortic dissection. An 80-year-old woman presented with an episode of chest pain and acute bilateral loss of upper extremity pulses that was initially treated as aortic dissection. Findings of physical examination and echocardiography were consistent with mitral stenosis. Angiography revealed bilateral brachial artery emboli, which were treated by embolectomy. To our knowledge, this case represents the first report of simultaneous brachial artery emboli in association with mitral stenosis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/19. echocardiography in planned interruption of the inferior vena cava.Interruption of the inferior vena cava by the transvenous placement of a filter or umbrella effectively prevents pulmonary embolism by acting primarily as a physical barrier to emboli. Such a device will be effective only if the site of thrombosis is distal to the planned placement site. We have presented two cases in which a preoperative echocardiogram revealed a right atrial embolus, thereby mandating either embolectomy, fibrinolytic therapy, or continued anticoagulation in addition to the filter placement. These cases suggest that an echocardiogram should be included in the evaluation preceding interruption of the inferior vena cava.- - - - - - - - - - ranking = 0.14835104930685keywords = physical (Clic here for more details about this article) |
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