1/45. Acute pancreatitis and deep vein thrombosis associated with hellp syndrome.The hellp syndrome (HS) belongs to the list of obstetric complications believed to be associated with coagulation disorders. It was formerly thought that chronic intravascular clotting (DIC) in the placental vessels was the main cause. A hypercoagulable state has been reported in cases of severe HS associated with microvascular abnormalities that may involve cerebral, placental, hepatic and renal vessels. A case of acute pancreatitis and DVT of inferior cava in a pregnant woman, presenting with HS at 29 weeks, who was found to have a R506Q mutation, is reported. Preeclampsia-associated pancreatitis and DVT have rarely been reported. It is hypothesized that APC-R and factor v Leiden mutation may prove to be new and more important markers capable of predicting a more significant maternal morbidity associated with HS. Thrombosis prophylaxis may be considered during pregnancy in order to reduce hazardous multiorgan failure (MOF) in women who are heterozygous for factor v Leiden mutation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/45. Idiopathic enterocolic lymphocytic phlebitis: a rare cause of ischemic colitis.We report on a 74-year-old female patient who was admitted to the hospital because of abdominal pain. She underwent a colonoscopy and a stenosing mass was found in the cecum. Histologic findings in the biopsy specimens were consistent with ischemic colitis. Due to clinical symptoms and the endoscopic and radiologic findings that roused the suspicion that the patient was suffering from a malignant tumor, a right hemicolectomy was performed. histology of the resection specimen disclosed an inflammation of the veins. It was characterized by a predominantly lymphocytic infiltration of the vessels affecting the veins of the colonic wall and the mesentery. Furthermore, secondary thrombosis with focal venous occlusion was observed. The colon showed extensive ischemic colitis with focal transmural coagulation necrosis. The disease was considered to be idiopathic lymphocytic phlebitis, which is a rare disease of unknown origin. Our patient is well and alive after more than 1 year, supporting the notion that the disease shows a benign course after surgery.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
3/45. Microvascular endothelial abnormality in skeletal muscle from a patient with gastric cancer without dermatomyositis.We found a microvascular endothelial abnormality in a biopsy specimen from the gastrocnemius muscle of a patient with gastric cancer, who had severe myalgia and angialgia in the calf region with the symptoms of thrombophlebitis. There were no definite findings of inflammatory myopathy in histochemical and immunohistochemical studies. Electron microscopic examination revealed the accumulation of abnormal mitochondria in the subsarcolemmal area, and a fair number of degenerating capillaries. Immunohistochemical analysis of procoagulant or anticoagulant factors revealed marked reduction of thrombomodulin (TM) expression on small vessels and capillaries. Although a reduction of TM on small vessels has been observed around perifascicular atrophic fibers in patients with dermatomyositis, histochemical findings of the present patient showed no perifascicular atrophy or severely degenerating fibers. These pathological findings in the patient may be related to a malignant neoplasm and may be one of the causes of disseminated intravascular coagulation (DIC), which is the main complication of malignant neoplasms. Further studies are necessary to determine whether the reduction of TM on the small vessels and capillaries in skeletal muscle is a predictor of some severe condition such as DIC or a rare pathological finding in some special condition such as scirrhous carcinoma with thrombophlebitis.- - - - - - - - - - ranking = 1.5keywords = vessel (Clic here for more details about this article) |
4/45. A spinal haematoma occurring in the subarachnoid as well as in the subdural space in a patient treated with anticoagulants.A 75-year-old man on anticoagulant therapy suddenly experienced an excruciating back pain and subsequently developed a paraplegia. At operation a subarachnoid and a subdural haematoma were found, extending between the levels of the vertebrae T3 and L2. This extremely rare combination of haematomas may have been caused either by rupture of a small vessel in the arachnoid membrane or by rupture of the arachnoid membrane itself, secondary to a massive haemorrhage in the subarachnoid space.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/45. Chronic intestinal lymphocytic microphlebitis.The authors report two cases of a peculiar microphlebitis of the intestines, similar to that described by Saraga and Costa quite recently [5]. The patients had undergone hemicolectomy because of evolving ileus caused by cecal polyps or lipohyperplasia, respectively. Pseudomembranous-ulcerative inflammation of the cecum and variously intense lymphocytic infiltrates of numerous small submucosal veins and venules of the intestines were found in both cases. Thrombosis occurred very rarely in the affected vessels, although sometimes it was found in deeper and larger veins. arteries, lymphatics, mesenterial veins and lymph nodes were normal. Parts of the distal ileum and ascending colon displayed the phlebitic changes without mucosal alterations. The authors hypothesize that it was not the abnormal local circulation, but some hitherto not fully clarified immunological disorder that resulted in the disease. In contrast to the claim of Saraga and Costa [5], it is suggested that thrombosis of the small veins does not have a significant role in the development of the lesions, but a complex process that includes the entry of antigens via the altered mucosa followed by an immunogenic inflammatory response of the small veins is responsible for the pathogenesis.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
6/45. Intravascular hematocrit effect in cross-sectional CT imaging.Venous fluid-fluid levels were seen on CT or MR of three patients being evaluated for possible thrombosis. In all three cases, further investigation (by ultrasonography, venography, or surgery) revealed the cause of the fluid-fluid level to be slowly flowing blood without thrombosis. On CT done after intravenous contrast medium administration, the nondependent half of the vessel was denser than the dependent half. In an attempt to confirm this MR and CT picture and, particularly, to explain the dense upper half on CT, we conducted an in vitro study. Our study confirmed that when blood with diatrizoate sodium is not clotted and allowed to settle, a similar fluid-fluid level is observed by CT imaging. Our results indicate that an intravascular fluid-fluid level seen on cross-sectional images represents slowly flowing blood, not thrombosis.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
7/45. Suppurative pylethrombosis: a changing clinical picture.In 2 patients presenting with fever of undeterminated origin, cryptogenic suppurative pylethrombosis caused by bacteroides fragilis was diagnosed. Combined antibiotic and anticoagulant therapy resulted in recanalization of the thrombosed vessels. The role of ultrasonography and computed tomography scan in the diagnosis and follow-up of this rare condition is discussed.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
8/45. Arterial occlusion causing large bowel infarction--a reflection of clotting diathesis in SLE.The patient, a 44-year old woman with systemic lupus erythematosus, (SLE), developed infarction of the bowel and spleen after occlusion of the inferior mesenteric and splenic arteries, necessitating colectomy and splenectomy. She had had previous cerebral thromboses and a lower limb deep vein thrombosis. Histological examination of the involved vessels showed the presence of thrombus only with the total absence of any vasculitis. The patient demonstrated antibodies to phospholipid - the "lupus anticoagulant" (LA) and antibodies to cardiolipin in serum, both strongly associated with thromboses.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
9/45. Heterotopic ossification masquerading as deep venous thrombosis in head-injured adult: complications of anticoagulation.A 26-year-old man manifested clinical signs of a left iliofemoral thrombosis 12 weeks after closed head injury in a motor vehicle accident. The deep vein thrombosis was initially diagnosed by venography and appropriate anticoagulation therapy was instituted. After four days of treatment, there was no significant resolution of signs or symptoms and the circumference of the left thigh had increased with an associated decrease in hemoglobin. A CT scan of the involved thigh revealed hemorrhage and calcification within the quadriceps muscle. In retrospect, it was evident that the hemorrhage and heterotopic ossification had caused compression of the surrounding tissue and vessels thus mimicking a deep vein thrombosis on venography. Clinicians need to be aware of the similarity of the early clinical manifestations of heterotopic ossifications and deep vein thrombosis and the complications which could arise with anticoagulation therapy initiated too early in the course of the disease.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
10/45. Cutaneous manifestations associated with the presence of the lupus anticoagulant. A report of two cases and a review of the literature.Two patients with the lupus anticoagulant exhibited unusual cutaneous manifestations. They both fulfilled four criteria for systemic lupus erythematosus and had experienced deep venous thrombosis. The first patient suffered from a leg ulcer that resembled a pyoderma gangrenosum. The second patient presented erythematous and purplish macules on the fingertips. The histologic studies showed only microthrombosis in the dermal vessels without vasculitis, although such lesions in systemic lupus erythematosus are usually attributed to vasculitis. The association of these cutaneous lesions with lupus anticoagulant has never been reported. It is likely that this association is not fortuitous. After a review of the literature, it seems possible to individualize a new syndrome characterized by the presence of a subgroup of antiphospholipid antibodies. Thrombosis, spontaneous abortions, neurologic manifestations, pulmonary hypertension, positive results of a Coombs' test, and thrombocytopenia can be included in this syndrome, which overlaps with systemic lupus erythematosus. Certain cutaneous symptoms are associated with the presence of lupus anticoagulant or other antiphospholipid antibodies: leg ulcers, distal cutaneous ischemia, widespread cutaneous necrosis, and livedo. They can be considered as the dermatologic manifestations of this syndrome.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
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