1/22. hemoperitoneum following rupture of ectopic varix along splenorenal ligament in extrahepatic portal vein obstruction.A 29-year-old man with extrahepatic portal vein obstruction who underwent variceal eradication by sclerotherapy six years ago, was admitted with hypotension and abdominal pain. Abdominal paracentesis yielded frank blood. laparotomy showed bleeding from a large ectopic vessel along the splenorenal ligament. The vessel was ligated and the patient recovered.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/22. Hypotensive hemorrhagic necrosis in basal ganglia and brainstem.Hypotensive hemorrhagic necrosis of the basal ganglia and brainstem has only occasionally been described. Three such cases are reported. Cardiac arrest had occurred in all cases, and it took at least 1 hour to restore adequate circulation. The patients remained comatose for 2 days to 2 weeks until death. Persistent hypotension causing ischemia in the distribution of deep perforating arteries is considered to have been the key underlying mechanism. hemorrhage is thought to have been caused by extravasation of red blood cells through damaged blood vessels.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
3/22. Persistent hypotension and intestinal infarction in a patient with primary amyloidosis.A patient with primary amyloidosis and the nephrotic syndrome had diarrhea and gastrointestinal bleeding probably due to intestinal ischemia. He died with extensive intestinal infarction. The infarction was most likely caused by decreased splanchnic perfusion secondary to the chronic hypotension of the nephrotic syndrome and to amyloid deposition within the walls of the small blood vessels supplying the gut. Although amyloidosis was suspected prior to death, a fixation artifact probably prevented the correct antemortem biopsy diagnosis.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/22. Two men with toxic shock syndrome presenting with targetoid and spotty skin rashes.Two previously healthy men who presented with hypotension, constitutional symptoms, and targetoid and discrete spotty erythematous plaques were diagnosed with toxic shock syndrome based on histopathological findings. Specifically, their biopsies revealed necrotic keratinocytes, neutrophils in the epidermis, and neutrophils surrounding dilated superficial vessels. In one case, the diagnosis of toxic shock syndrome was confirmed with rising titers to toxic shock syndrome toxin-1. Both patients recovered with supportive care and clindamycin administration. We suggest that patients with fever, hypotension, constitutional symptoms and rash should be started on clindamycin and have a skin biopsy as part of their initial evaluation. An understanding that toxic shock syndrome can strike anyone has manifold dermatological manifestations and defined histopathological findings is important for its early diagnosis and effective treatment.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/22. A case of vasovagal syncope with convulsions--the effects of midodrine hydrochloride.A 42-year-old female had suffered from repeated syncope. She had vasovagal syncope with convulsions from vasodilatation and cardiac standstill which lasted for 9.8 sec. The 60 degrees head-up tilt test, nitroglycerin injection and isoproterenol infusion provoked vasovagal reaction. Although a beta blocker was not effective in preventing tilt-induced hypotension and bradycardia, midodrine hydrochloride (alpha-1 stimulant) or atropine prevented it. In this patient, insufficient constriction of capacitance vessels might have played an important role in activation of an inhibitory reflex from cardiopulmonary mechanoreceptors which caused hypotension and bradycardia.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
6/22. Severe hypotension in the prone position in a child with neurofibromatosis, scoliosis and pectus excavatum presenting for posterior spinal fusion.A 34-mo-old boy with neurofibromatosis, scoliosis, and pectus excavatum developed severe hypotension when positioned prone. A magnetic resonance image study revealed neurofibromas encircling the great vessels. During the next anesthetic the patient was placed in the prone position on transverse bolsters and hypotension ensued again. A transesophageal echocardiogram (TEE) revealed compression of the right ventricle by the sternum. When the child was turned supine, the blood pressure returned to baseline. The patient was returned to the prone position, this time with bolsters placed longitudinally, without problem. This case supports a cardiac evaluation, possible intraoperative TEE, and avoidance of sternal pressure in patients with chest wall deformities requiring prone positioning. IMPLICATIONS: A child with neurofibromatosis, scoliosis, and a chest wall deformity presenting for spinal fusion developed severe hypotension while prone. This was due to compression of the heart by the sternum, not compression of the great vessels by neurofibromas. Sternal pressure in prone patients with chest wall deformities should be avoided. Unique management included the use of transesophageal echocardiography to determine the cause of the hypotension.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/22. Late bleeding from right internal mammary artery after HeartMate left ventricular assist device implantation.Postoperative bleeding is one of the major complications after implantation of left ventricular assist devices. We experienced 5 unusual cases, which had bleeding from the right internal mammary artery between 5 and 69 days after implantation of a HeartMate (Thoratec Corporation, Pleasanton, CA) device. It was evident that the outflow graft had eroded through the vessel. Sudden decreases in device flow, hypotension, bleeding from the driveline or chest tube sites, and a drop in hematocrit were the initial manifestations. Chest roentgenogram and transthoracic echocardiography were effective in identifying hemothorax and cardiac tamponade. Four out of 5 patients survived to heart transplantation and were discharged from the hospital. When identified and treated appropriately, this complication does not impair patient outcome.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
8/22. Beraprost sodium-induced hypotension in two patients after cardiac surgery.Two episodes of hypotension caused by oral beraprost sodium administration following cardiac surgery are described. The first case was a 67-year-old female who underwent concomitant surgery for mitral valve replacement, tricuspid annuloplasty, and a radiofrequency maze procedure for atrial fibrillation. The second case was a 45-year-old female who underwent 4-vessel coronary artery bypass grafting associated with endarterectomy in the right coronary artery. Beraprost sodium was administered for the treatment of residual pulmonary hypertension in the first case, and was initiated as an antiplatelet agent following coronary endarterectomy in the second case. hypotension occurred at approximately one hour after beraprost sodium administration in both cases. Careful observation to prevent this adverse effect is critical after the administration of beraprost sodium, especially in patients who have undergone cardiac surgery.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
9/22. Man-in-the-barrel syndrome in a noncomatose patient: a case report.A 62-year-old man developed man-in-the-barrel syndrome (MIBS) after emergency four-vessel coronary artery bypass surgery. MIBS refers to the clinical syndrome of bilateral upper extremity paresis with intact motor functioning of the lower extremities, giving the appearance of being confined within a barrel. The pathogenesis of MIBS is believed to be cerebral hypoperfusion leading to border zone infarctions between the territories of the anterior and middle cerebral arteries. physical examination revealed bibrachial paresis, decreased upper extremity tone, mild left central VII palsy, flat affect, mild cognitive deficits, and poor balance while ambulating. An EMG showing poor motor unit recruitment and slow-firing motor units, and abnormal SSEPs indicated an upper motor neuron lesion. There was good progress in physical and occupational therapy, and good return of upper extremity function in four months. Only 11 cases of MIBS have been reported, all of whom were comatose; ten died. Our patient was never comatose and had good functional recovery.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
10/22. pulmonary embolism presenting as exercise-induced hypotension.A 68-year-old man with remote history of previous myocardial infarction presented with a four-week history of intermittent dyspnea. After developing hypotension during an exercise tolerance test, he underwent cardiac catheterization, revealing significant pulmonary hypertension and two-vessel coronary artery disease. Pulmonary angiography confirmed the presence of pulmonary emboli which partially resolved after thrombolytic therapy. Subsequent treadmill testing confirmed the absence of exercise-induced hypotension two months following treatment. This case underscores the importance of considering pulmonary embolism as a potential cause of exercise-induced hypotension, since it can be successfully treated with thrombolytic agents weeks after the initial onset of symptoms.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
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