1/22. Staphylococcal coronary arteritis as a complication of septicemia.We describe a case of staphylococcal coronary arteritis in the setting of sepsis due to arteriovenous fistula and dialysis catheter infection. The left circumflex coronary artery was the only vessel involved. The patient was a 77-year-old, insulin-dependent diabetic man with chronic renal failure. The immunosuppressed state in diabetes with subsequent septicemia may have facilitated a large number of bacteria to lodge in the atheromatous plaque of the coronary artery. We briefly review previously reported cases and suggest that bacterial arteritis may be an underrecognized cause of acute coronary occlusion.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/22. calciphylaxis associated with cholangiocarcinoma treated with low-molecular-weight heparin and vitamin K.calciphylaxis is a rare disorder of small-vessel calcification and cutaneous infarction associated with chronic renal failure. Rare cases of calciphylaxis not associated with chronic renal failure have been reported with breast cancer, hyperparathyroidism, and alcoholic cirrhosis. To our knowledge, we report the first case of calciphylaxis without chronic renal failure associated with cholangiocarcinoma and the first attempt to treat calciphylaxis with vitamin K. A 56-year-old woman presented with necrotic leg ulceration. She was treated initially with low-molecular-weight heparin, with no effect. A coagulation work-up showed vitamin k deficiency. During vitamin K therapy, the patient had fulminant progression of the calciphylaxis. She died, and an autopsy showed metastatic cholangiocarcinoma. thrombosis and protein c deficiency have been implicated in the pathophysiology of calciphylaxis. Functional protein c deficiency may be one of several factors contributing to the development of calciphylaxis. Vitamin K therapy was ineffective in our patient and may have been detrimental.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/22. Fatal bowel infarction and sepsis: an unusual complication of systemic strongyloidiasis.A 58 year old Chinese male, one week after arriving in canada from hong kong, presented with acute abdominal pain and diarrhoea which was rapidly followed by escherichia coli infection causing septicaemia and meningitis. His past history revealed bronchial asthma for 15 years treated with steroids. At laparotomy, 7 days after the onset of symptoms, he was found to have extensive haemorrhagic infarction of the small bowel and right colon. Examination of the fibrosed mesenteric vessels revealed numerous filariform larvae of strongyloides stercoralis, within the walls, and in all layers of bowel wall. The role of the parasite in the production of obliterative arteritis in this fatal case of haemorrhagic enteropathy is discussed. Clinical strongyloidiasis, in uncomplicated cases, varies from mild to severe with gastroenteritis, nausea, colicky abdominal pain, electrolyte imbalance and symptoms of malabsorption syndrome (MARCIAL-ROJAS, 1971). In malnourished individuals and patients with debilitating infections, either newly acquired or asymptomatic latent infection with S. stercoralis can assume severe dimensions (BROWN and perna, 1958; HUGHTON and HORN, 1959). Similarly, in patients on steroid (CRUZ et al., 1966; WILLIS and MWOKOLO, 1966; NEEFE et al., 1973) and immunosuppressive therapy for lymphomatous diseases or deficient in immune response (ROGERS and NELSON, 1966; RIVERA et al., 1970), systemic strongyloidiasis is often fatal. The increased frequency of auto-infection in such patients with a breached immune barrier is, however, unclear. Further complications of this infection due to severe enterocolitis result in sepsis, bacteraemia and meningitis (BROWN and perna, 1958; HUGHTON and HORN, 1959). This paper presents a fatal case of S. stercoralis infection which illustrates an uncommon if not unique, mechanism in its production of haemorrhagic enteropathy leading to sepsis and death.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/22. Fatal malignant hyperthermia--delayed onset and atypical course.A case of malignant hyperthermia (mh) in a 27-year-old man is described. In a first anaesthesia using isoflurane and succinylcholine, the end-tidal CO(2) rose from 39 to 49 mmHg 2.75 h post-intubation and the body temperature rose to 39.8 degrees C 14 h post-intubation but was normal again the next day. In a second anaesthesia using the same medication, the maximal end-tidal CO(2) was 44 mmHg and the body temperature rose to 39 degrees C after 9 h. After 4 days, the fever rose to 40 degrees C, and to 42 degrees C when death occurred 10 days after the second anaesthesia. Masseter spasms or muscle rigidity were never present. According to the death certificate, death was due to multi-organ failure from sepsis. At autopsy, the skeletal muscles were pale and oedematous. histology demonstrated focal necroses in the skeletal muscles, shock kidneys with myoglobin excretion and myoglobin clots in small blood vessels of the lungs. Hence, the postmortem diagnosis "malignant hyperthermia" was established but accusations of medical maltreatment were rejected because of the atypical and protracted clinical course and because uncharacteristic signs of malignant hyperthermia were attributable to the clinically suspected sepsis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/22. adult purpura fulminans associated with staphylococcal infection and administration of colony-stimulating factors.purpura fulminans (PF) is a rare syndrome of progressive haemorragic necrosis due to disseminated intravascular coagulation (DIC) and dermal vascular thrombosis leading to purpura and tissue necrosis. PF is more often associated with either a benign infection or a severe sepsis. Rarely, it has been related to drug intake. We report the case of a 24-year-old female patient who suffered from staphylococcal sepsis and pancytopenia, for which she was treated with antibiotics, granulocyte-colony stimulating factor (G-CSF) and granulocyte/macrophage CSF (GM-CSF). Two days after the last GM-CSF dose, she developed widespread necrotic plaques with erythematous borders and purpura in the breast, arms and legs. Coagulation tests indicated DIC and a skin biopsy showed fibrin thrombi in the superficial dermal vessels. The patient totally recovered after removal of the necrotic tissues and application of skin autografts. Although staphylococcal infection was most probably involved in the development of PF, a role of CSF cannot be excluded in this case.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/22. 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) |
7/22. Fatal sepsis following peripheral intravenous cannula embolus.This is a case report of multiple septic complications of a peripheral intravenous cannula as a direct result of proximal embolization of a fragment of the cannula to the heart and major vessels.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/22. Effect of methylene blue on middle cerebral artery flow velocity in a patient with severe sepsis following clipping of a cerebral aneurysm.INTRODUCTION: The use of methylene blue, an inhibitor of guanylate cyclase, has been described in patients with septic shock who are unresponsive to inotropic agents. However, the effects of methylene blue on the human cerebral circulation are not known. methods AND RESULTS: This article presents a case report of a 58-year old-female with a clinical presentation compatible with severe sepsis and increasing inotropic requirements following clipping of a cerebral aneurysm. Administration of methylene blue (2 milligrams/kilograms) intravenously was undertaken with monitoring of mean arterial pressure and middle cerebral artery flow velocity (FVm). The effect of methylene blue on mean arterial pressure occurred quite rapidly after initiation of the infusion, allowing downward titration of norepinephrine. Initially, FVm increased in association with an increase in mean arterial pressure, reaching its highest value halfway through the infusion. Subsequently, FVm decreased to baseline by the end of the monitoring period. The rise in mean arterial pressure and increase in FVm were accompanied by a reductionin cerebral vascular resistance assuming intracranial pressure, and the diameter of the insonated vessel was unchanged during and immediately after infusion of methylene blue. CONCLUSION: methylene blue did not appear to have a major untoward effect on cerebrovascular resistance in this patient. The limited characterization of cerebrovascular effects provided by this article mandates the need for careful monitoring of cerebrovascular behavior and adequacy during use of methylene blue.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/22. Bronchial revascularization in double-lung transplantation: a series of 8 patients. Bordeaux Lung and heart-Lung Transplant Group.Donor airway ischemia is the main cause for defective tracheal or bronchial healing after double-lung transplantation. Anatomical studies and bronchial arteriograms have shown that the right intercostal bronchial artery is constant (95% of instances) and provides an important blood supply to the distal trachea, the carina, and the right bronchial tree as well as to the left side through a subcarinal and periadventitial anastomostic network. To maintain this important bilateral bronchial circulation, it is of capital importance not to mobilize the arteries individually and to avoid large dissections around the carina. Both bronchi can thus be revascularized by indirect aortic reimplantation using a bypass graft to a single aortic patch that includes the origin of the right intercostal bronchial artery. Furthermore, the origin of other vessels (a common trunk and left arteries) can be found within a short distance of the right intercostal bronchial artery and possibly be contained within the same aortic patch. From a series of 56 lung transplantations, 8 patients underwent restoration of the bronchial vascularization using a recipient saphenous vein graft between the donor bronchial arteries and the anterior aspect of the recipient's ascending aorta. A lower tracheal anastomosis was performed. Bronchial arterial blood supply was evaluated both by endoscopy and by arteriography at about the 15th postoperative day. The bronchial circulation was visualized at this time in five of seven arteriographies, and this was associated with excellent tracheal healing in all 8 patients.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/22. Superior vena caval thrombosis detected by transesophageal echocardiography.Three patients with clinical suspicion of bacterial endocarditis, induced by either pacemaker or indwelling catheter, underwent transesophageal echocardiography. High short-axis cuts through the great vessels, however, revealed the presence of superior vena caval thrombus in all three patients. Transesophageal echocardiography is more sensitive in establishing the diagnosis of superior vena caval thrombus than surface echocardiography. Comparison of transesophageal echocardiography with other diagnostic modalities is needed in assessing its overall sensitivity and specificity.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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