1/5. Transradial approach to coil embolization of an intracranial aneurysm.PURPOSE: To report the use of a transradial approach to coil embolization of an intracranial aneurysm in a morbidly obese patient. TECHNICAL NOTE: When the transfemoral approach was inaccessible in a morbidly obese patient with a ruptured intracranial aneurysm, coil embolization was performed via a 6-F sheath placed in the radial artery. Multiple platinum coils were delivered to exclude the 14-mm basilar tip aneurysm. Because heparin was not reversed, the sheath was left in the artery for 24 hours then removed. The radial artery was pulsatile, and blood supply to the hand was good. CONCLUSIONS: The radial artery appears to be a suitable route for access to the intracranial vessels when the femoral artery is not available.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/5. Dysphagia lusoria: a complication following gastric bypass surgery?A 23-year-old Caucasian female presented with progressive dysphagia beginning 5 months following laparoscopic gastric bypass for morbid obesity. She was diagnosed with an aberrant right subclavian artery and underwent a combined right supraclavicular approach and left thoracotomy for resection, with reimplantation of the vessel to the ipsilateral carotid artery. The patient had complete resolution of symptoms.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/5. Chronic obesity lymphoedematous mucinosis: three cases of pretibial mucinosis in obese patients with pitting oedema.Pretibial mucin deposition on the shins is known as pretibial myxoedema. We report three patients with pretibial mucinosis without thyroid disease. The patients were characterized clinically by morbid obesity and bilateral lower extremity pitting oedema with gradual and painless onset, and that did not involve the feet and ankles. Vesicles, semitranslucent papules or a woody plaque were found on the shins. Histologically, patients showed characteristic features of epidermal atrophy with effacement of the rete ridge pattern, separation of collagen bundles associated with oedema with stellate to linear fibroblasts, upward-running increased capillary and small vessels with haemosiderin deposition, and mucin deposition at the superficial papillary dermis and around the vessels. We propose that the present cases of 'chronic obesity lymphoedematous mucinosis' belong to the clinical entity of pretibial mucinosis.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
4/5. Massive localized lymphedema in the morbidly obese: a histologically distinct reactive lesion simulating liposarcoma.We report 14 cases of a soft tissue lesion in the limbs of morbidly obese adults that presents as a large mass and histologically simulates well-differentiated liposarcoma (WDL). Based on its distinctive clinical setting and morphologic identity to diffuse lymphedema we have termed this process massive localized lymphedema (MLL). All cases occurred in morbidly obese adults (mean weight 372 lbs; mean age 47 years). women predominated (9 women; 5 men). The lesions affected the proximal medial aspect of the extremities (12 thigh; 2 arm) and were unilateral in all but two patients. Etiologically significant antecedent events include ipsilateral axillary lymphadenectomy in both patients with arm lesions, chronic lymphedema resulting from vein-stripping 10 years prior in one patient. inguinal lymphadenectomy for anal carcinoma in another patient, and significant blunt trauma to the inner thigh during a motor vehicle accident in a third patient. The tumors were long standing ( I-IO years) and extremely large (mean size 33.4 cm, 7408 g). Clinically, they were diffuse, ill-defined masses that histologically consisted of lobules of mature fat interrupted by expanded connective tissue septa. The constituents of the septa were fine, fibrillary collagen, edema fluid, and uniformly distributed fibroblasts. Clusters of capillaries were frequently found at the interface between fat and connective tissue. The widened septa simulated the fibrous bands of sclerosing WDL, but MLL lacks the degree of nuclear atypia seen in the former. The consistent clustering of reactive vessels at the interface between the fat and fibrous tissue also contrasted with WDL. Six patients experienced persistent or recurrent lesions within 10 months to 10 years. No aggressive growth or histologic progression was observed during this time, however. awareness of the features of MLL is important to avoid misclassification of this reactive lesion with WDL.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/5. Excessive oral amphetamine use as a possible cause of renal and splanchnic arterial aneurysms: a report of two cases.INTRODUCTION: Multiple visceral aneurysms are uncommon and usually result from connective tissue diseases, systemic arteritis, or mycotic lesions. An association between multiple visceral aneurysms and excessive oral amphetamine use has not been reported. methods: The clinical features of 2 patients at the University of michigan Medical Center for treatment of multiple visceral aneurysms and amphetamine use were reviewed. RESULTS: The patients had histories of excessive oral amphetamine use that ranged from 50 mg daily for 22 years to 200 mg daily for 2 years. No evidence was seen of systemic arteritis, connective tissue disorder, or an infectious process that may have caused the aneurysms. The arteriograms documented multiple splanchnic and renal artery aneurysms that involved both the large and the small arteries. The aneurysms of 1 patient were managed conservatively, and the patient has not had any clinical sequelae of the aneurysms during 14 years of follow-up. The second patient had hematobilia from a ruptured hepatic artery aneurysm that was treated with transcatheter embolic occlusion of the bleeding vessel. The patient had no recurrent gastrointestinal problems and continued to use amphetamines until his death from a cerebrovascular accident 6 years later. CONCLUSION: A possible association between excessive oral amphetamine use and multiple visceral aneurysms is reported for 2 patients in whom other risk factors were absent. The potential for chronic oral amphetamine use to cause multiple visceral aneurysms is an ill-defined but not unexpected complication of this substance that is known to contribute to arterial hypertension and to produce a form of necrotizing arteritis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |