1/11. Esophageal erosion as a possible bacterial entry site in an acute lymphoblastic leukemia patient with sepsis.A 69-year-old man with relapsed acute lymphoid leukemia was treated with adriamycin, vincristine, and prednisolone. During this chemotherapy, the patient developed sepsis and meningitis. Although many kinds of antimicrobial drugs, including imipenem, meropenem, amphotericin-B, and gamma-globulin were administered, the patient died of respiratory failure. A positive result for enterococcus faecalis was obtained in both blood and cerebrospinal fluid culture. autopsy revealed multiple small erosions in the lower esophagus. Histopathological examination showed multiple nuclear inclusion bodies of herpes simplex virus in the squamous epithelial cells at the edge of the erosions. Moreover, proliferation of micrococci was observed at the base of the erosions and in the lumina of the submucosal small vessels. These findings suggested that E faecalis entered the blood circulation from this lesion. In many patients with febrile neutropenia, the pathogenesis of infection remains unclear. Our case seems significant for clarifying the focus and pathogenesis of febrile neutropenia.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/11. histiocytic sarcoma with fatal duodenal ulcers.histiocytic sarcoma is an uncommon neoplasm of mature histiocytes with very poor outcome. We report an autopsy case of a true histiocytic sarcoma with characteristic symptoms of so-called "malignant histiocytosis of the intestine". The liver and spleen were enlarged, with remarkable tumor cell infiltration in the hepatic sinusoids and splenic sinuses. Tumor cells aggregated to form sporadic nodular lesions in the liver, which often showed coagulative necrosis. Infarcted lesions also occurred at the splenic subcapsular area. In addition, tumor cell infiltration was noted in the sinuses of bone marrow and lymph node. Tumor cells often demonstrated moderate pleomorphism with multinucleated giant cells. They were positive for CD68 and negative for T- and B-cell lineage markers, megakaryocytic markers, and CD30. Various examinations were done to rule out infection-associated hemophagocytic syndrome, and the absence of infectious diseases was revealed. Thus, the diagnosis of histiocytic sarcoma was made. Apart from these lesions, multiple ulcerations, some with fatal perforation, were found in the esophagus and duodenum. They showed only non-specific inflammatory changes without tumor cell involvement. The ulcers probably derived from ischemic condition through an embolic process caused by tumor cell infiltration elsewhere in the blood vessels at the periphery of the ulcers.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/11. Aberrant right subclavian artery: varied presentations and management options.Although an aberrant right subclavian artery arising from the proximal portion of the descending thoracic aorta is the most common aortic arch anomaly, few patients have clinical symptoms directly attributable to it. When symptoms do occur they are usually causally related to aneurysmal or occlusive sequelae of atherosclerotic disease of the anomalous vessel. More unusual manifestations peculiar to the anomalous artery include aneurysmal degeneration of the origin of the vessel from the aortic arch, with its inherent risk of rupture, or symptoms of compression of the trachea or more commonly the esophagus by the anomalous vessel as it traverses the superior mediastinum. In patients with symptoms a variety of operative approaches and management strategies have been used. Our recent experience with treatment of two patients with clinical symptoms caused by an aberrant right subclavian artery illustrate the varied surgical options and prompted a review of the surgical management of this unusual anomaly.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
4/11. Giant esophageal ulcer healed with steroid therapy in an AIDS patient.AIDS patients have been seen with a variety of ulcerating esophageal lesions, which may be refractory to both diagnostic approaches and empiric medical intervention. There are reports of these ulcers eroding vessels and severely limiting oral nutrition. After the report of success with prednisone therapy for oral and hypopharyngeal ulcers in AIDS patients, we attempted similar treatment of an AIDS patient with a refractory giant esophageal ulcer. The patient responded promptly to this therapy. To our knowledge this is the first report of successful prednisone therapy for giant esophageal ulcer in an AIDS patient.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/11. Sudden death from perforation of a benign oesophageal ulcer into a major blood vessel.Two cases of sudden death due to perforation of a benign oesophageal ulcer into a major blood vessel are reported. In one man, anaemia and aspiration pneumonitis dominated the clinical picture. He had an oesophageal stricture and a chronic peptic ulcer associated with an incarcerated hiatus hernia. Death was due to haemorrhage caused by perforation of the ulcer into the thoracic aorta. The second patient presented with confusion and falls, backache and indigestion. She had a hiatus hernia and a large benign chronic oesophageal ulcer. Death was due to perforation of the ulcer into the left pulmonary vein. The cases are presented for their rarity, to illustrate the complex and late presentation of problems in geriatric medicine, and as a reminder that reflux oesophagitis can be dangerous.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
6/11. Value and limitations of calcium channel blockade in the treatment of pulmonary hypertension associated with CREST--case reports.Reversible vasospasm has been hypothesized to underlie the development of pulmonary hypertension in patients with CREST. Drugs that prevent arterial spasm have been used to treat pulmonary hypertension with variable results. The disparate pulmonary hemodynamic responses to calcium channel blockade reported herein suggest that CREST patients with mild pulmonary hypertension may have a component of reversible vasospasm responsive to vasodilator therapy, whereas patients with moderate to severe pulmonary hypertension may have fixed vessel lesions precluding a satisfactory response to calcium channel blockade.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/11. Significant hemorrhage as a complication of hydraulic suction biopsy of the esophagus.An histological diagnosis of gastroesophageal reflux disease is more accurately made with biopsies obtained by the hydraulic suction method than by endoscopic biopsy forceps. We report significant hemorrhage as a complication of biopsying the esophagus by hydraulic suction. This bleed was explained by an aberrantly large vessel in the lamina propria of an otherwise histologically normal esophagus. This risk of hemorrhage in our extensive experience is less than 0.1%, and hydraulic suction biopsy can be regarded as a safe technique and the optimal method of obtaining histological information in the esophagus.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/11. Ultrasonic blood flow assessment in colon esophageal bypass procedures.Colonic serosal and mesenteric blood flows were assessed by use of the Doppler ultrasound device during three colon bypass procedures for obstructing esophageal carcinoma. The technique allowed confirmation of pulsatile blood flow in large and small vessels after mobilization of the colon and following completion of critical anastomoses. We recommend use of this technique to eliminate serious compromise of colonic blood flow in colon bypass procedures.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/11. Percutaneous stenting for symptomatic stenosis of aberrant right subclavian artery.Aberrant origin of the right subclavian artery is the most common abnormality of the aortic arch vessels and occurs in approximately 0.5% to 1% of the population. Symptoms can result from compression of the esophagus by the aberrant vessel, aneurysm formation, or atherosclerotic occlusion. Occlusive symptoms are typically relieved by surgical revascularization (i.e., transposition or carotid-subclavian bypass) through a cervical approach. An alternative approach to the management of stenosis of normal subclavian arteries is percutaneous angioplasty and stenting, an approach not previously used for occlusive disease of an aberrant right subclavian artery. We describe a case of focal stenosis of an aberrant right subclavian artery causing dizziness and arm claudication in a patient who underwent successful percutaneous angioplasty and stenting.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
10/11. Fatal upper esophageal hemorrhage caused by a previously ingested chicken bone: case report.Perforation of the upper esophageal wall by ingested bones can cause sudden death and death under suspicious circumstances. Perforation usually takes place at sites of physiologic and pathologic strictures. Temporary bleeding from the respiratory and digestive tracts is an important signal and may be crucial in the diagnosis of esophageal perforation and small vessel injury by ingested bone. Polymorphism and long symptomatology can cause diagnostic and therapeutic failure, thus presenting a special medicolegal problem. We present a case report of unknown cause of death and death under suspicious circumstances resulting from ingested bone perforation of upper esophagus. A chicken bone had been swallowed about 6 months before death caused by hemorrhage from a decubitus in the cervical esophagus. The patient underwent urgent surgery because of suspected bleeding of a ventricular ulcer.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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