1/20. Massive gastrointestinal hemorrhage after transoesophageal echocardiography probe insertion.PURPOSE: To describe a case of a massive gastric bleeding following emergency coronary artery bypass surgery associated with transoesophageal echocardiographic (TEE) examination. CLINICAL FEATURES: A 50-yr-old man was referred for an acute myocardial infarction and pulmonary edema (Killip class 3). Twelve hours after his myocardial infarction, he was still having chest pain despite an i.v. heparin infusion. coronary angiography revealed severe three-vessel disease with multifocal stenosis of the left anterior descending, circumflex and total occlusion of the right coronary artery. The patient was transferred to the operating room for emergency coronary artery bypass graft surgery. After total systemic heparinization (3 mg.kg-1) was obtained for cardiopulmonary bypass, a multiplane TEE probe was inserted without difficulty to monitor myocardial contractility during weaning from CPB. During sternal closure, the TEE probe was removed and an orogastric tube was inserted with immediate drainage of 1,200 ml red blood. Endoscopic examination demonstrated a mucosal tear near the gastro-oesophageal junction and multiple erosions were seen in the oesophagus. These lesions were successfully treated with submucosal epinephrine injections and the patient was discharged from the hospital eight days after surgery. CONCLUSION: This is a report of severe gastrointestinal hemorrhage following TEE examination in a fully heparinized patient. This incident suggest that, if the use of TEE is expected, the probe should preferably be inserted before the administration of heparin and the beginning of CPB.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/20. Pulmonary hemorrhage in association with negative pressure edema in an intubated patient.Negative pressure pulmonary edema due to upper airway obstruction following extubation is a well-recognized problem. However, frank pulmonary hemorrhage as a manifestation of upper airway obstruction is uncommon. We report a case of significant pulmonary hemorrhage and negative pressure pulmonary edema in an intubated patient. bronchoscopy showed a collection of blood in the right lower lobe of the lungs, suggesting a localized source of bleeding. There have been two previously reported cases of pulmonary hemorrhage after upper airway obstruction. One suggested that the bleeding was due to damage to the pulmonary capillaries, the other that it was due to disruption of the bronchial vessels. We feel that in our case there was some indication that the pulmonary bleeding was a result of bronchial vessel damage. A number of factors might have been involved in its development, including negative pulmonary pressure, recent respiratory tract infection, and positive airways pressure (due to coughing).- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/20. reperfusion pulmonary edema after pulmonary endarterectomy.pulmonary artery thromboendarterectomy is a potentially curative procedure in chronic, major vessel thromboembolic pulmonary hypertension. However, persistent pulmonary hypertension and unrelenting reperfusion edema have serious complications, often requiring prolonged mechanical ventilation. A 50-year-old man who was diagnosed with a thromboembolism in both pulmonary arteries underwent a bilateral pulmonary endarterectomy. He received O2-isoflurane-fentanyl anesthesia. When the lungs were reperfused with CPB weaning, massive hemorrhage occurred in the left lung. After the operation, the patient was taken to the intensive care unit. Mechanical ventilation was performed immediately and then both inhaled NO and i.v. furosemide therapies were administered. The patient was discharged from ICU 15 days postoperation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/20. Pathological features of the lung in fatal high altitude pulmonary edema occurring at moderate altitude in japan.In order to characterize the pathological features of high altitude pulmonary edema (HAPE) occurring at moderate altitude in japan, we performed routine hematoxylin and eosin (HE) staining in lung materials from HAPE autopsied cases. We also undertook advanced immunohistochemical staining for observation of type II pneumocytes, pulmonary surfactant (PS), and mast cells in the lung of HAPE cases to examine the biological changes within the lung parenchyma. The pathological findings of HAPE were characterized by alveolar edema, congestion of pulmonary vessels, alveolar hyaline membranes, alveolar hemorrhage, and multithrombi and fibrin clots, but maintained alveolar structure. The immunostaining results showed that the type II pneumocytes were cellular fusion, deformity, and exfoliation from the walls of alveoli; the PS not only lined the alveolar surface, but was also patchily distributed within alveoli; and the number of mast cells were increased (9.0 /- 0.9 cells/mm(2)) compared to that in controls (1.1 /- 0.4 cells/mm(2)) (p < 0.01). We conclude that the pathological features of HAPE at moderate altitude in japan are similar to others reported worldwide, and that the type II pneumocytes, PS, and mast cells may contribute to some extent to pathophysiological parts in the development and progression of HAPE.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/20. A case of renal artery brachytherapy for in-stent restenosis: four-year follow-up.renal artery stent implantation is associated with high rates of restenosis, particularly in vessels less than 4.5 mm in diameter. We describe 4-year follow-up results in the first patient to receive renal artery brachytherapy for this indication. A 68-year-old man who presented with flash pulmonary edema, hypertension and renal impairment was found to have severe bilateral renal artery stenosis and was treated with bilateral stent implantation. Following clinical deterioration due to severe in-stent restenosis, he underwent repeat angioplasty followed by intra-stent brachytherapy. To our knowledge, this is the first use of such therapy and hence the 4-year follow-up demonstrating excellent bilateral patency is the longest to date.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/20. zygomycosis involving lungs, heart and brain, superimposed on pulmonary edema.zygomycosis is an uncommon but frequently fatal infection and occurs mostly in immunosuppressed hosts, whereas approximately 50% of zygomycosis occurs in diabetic patients. The current patient initially presented with persistent pulmonary edema secondary to renal failure. This was the last of four admissions within 1 year for this 68-year-old woman, for whom the chief complaints were shortness of breath and chest pain. Her past medical history included insulin-requiring type 2 diabetes and hypertension for 10 years, and chronic heart and renal failure. She was previously admitted to the hospital for what appeared to be pulmonary edema secondary to renal failure. In the last admission the patient developed pulmonary hemorrhage and metabolic acidosis. Transbronchial biopsy was performed, showing irregular fungal hyphae in the blood vessels, morphologically consistent with zygomycosis. central nervous system computed tomography also revealed a large infarct in the cerebral hemisphere. The patient died on the seventh hospital day. At autopsy three organs were extensively involved by zygomycosis: (i) lungs were diffusely hemorrhagic with acute infarcts; (ii) pericardium had fibrotic inflammation; and (iii) the left cerebral hemisphere, cerebellum and pons had large hemorrhagic infarct by zygomycosis infection. Corticosteroid medication and hemodialysis triggered increasing hyperglycemia, metabolic acidosis and iron overload, which contributed to zygomycosis infection that subsequently spread to the heart and brain as a rare consequence.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/20. Mycotic aneurysms and death in a hemodialysis patient.A patient with newly diagnosed end-stage renal disease (ESRD) received a femoral catheter for hemodialysis (HD). Shortly thereafter he developed fever, and blood cultures grew methicillin-resistant staphylococcus aureus. The catheter was removed and the patient was treated with both vancomycin and rifampin; however, blood culture positivity persisted. The cerebrospinal fluid showed sterile meningitis. Subsequent imaging studies demonstrated aortic valve endocarditis and multiple mycotic aneurysms that appeared to include the intra- and extracranial vessels. The patient eventually died from sepsis. This case illustrates the aggressive and invasive nature of systemic infection with S. aureus and underscores the high morbidity and mortality associated with infections related to HD catheters.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/20. Unilateral pulmonary edema due to pulmonary venous obstruction from fibrosing mediastinitis.An unusual case of fibrosing mediastinitis with obstruction of the inferior and superior left pulmonary veins and severe narrowing of the right pulmonary artery, disclosed after unilateral pulmonary edema, is described. The 18-year-old male patient had a long history of cough, progressive dyspnea and recurrent hemoptysis and the possible diagnosis of "interstitial fibrosis" from a previous lung biopsy. The diagnosis and the pulmonary vessels involvement were suspected after right heart catheterization combined with transesophageal echocardiography and confirmed during urgent thoracotomy and at postmortem examination.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/20. Pulmonary vein edema in a patient undergoing coronary artery bypass graft surgery and concomitant radiofrequency ablation for chronic atrial fibrillation.The syndrome of pulmonary vein stenosis characterized by pulmonary hypertension, dyspnea on exertion, and right heart failure, is a well-described complication of percutaneous ablation approaches, but has not been described with surgical approaches. We describe the case of a patient who developed localized edema at the pulmonary vein-left atrial junction after undergoing intraoperative radiofrequency ablation for chronic atrial fibrillation as part of CABG for severe triple vessel disease. The pulmonary vein edema resolved within 10 months suggesting that it may be a clinically silent and self-resolving phenomenon.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/20. Three-vessel coronary artery disease complicated with congestive heart failure in a highly aged patient with tetralogy of fallot having undergone palliative surgeries.An increasing number of patients with tetralogy of fallot (TOF) are reaching older age. We encountered a 75-year-old woman with uncorrected TOF and concomitant severe coronary artery disease (CAD) with congestive heart failure. Her CAD risk factor was hyperlipidemia, which had been untreated. Successful percutaneous coronary interventions have improved her clinical condition and provided long-term survival. Although CAD is considered to be a rare complication in adults with TOF, both strict modification of CAD risk factors and early detection of CAD would be also required in this population, given the residual TOF lesions relating to acute exacerbation of clinical presentation.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
| | Next -> |