Partial Resolution Of Symptoms Research Articles

Index of Suspicion

Index of Suspicion

C1 esterase inhibitor deficiency, airway compromise, and anesthesia.

C1 esterase inhibitor deficiency, airway compromise, and anesthesia.

Pathogenesis and management of upper-extremity ischemia following angioaccess surgery.

Thirty-four patients with end-stage renal disease requiring hemodialysis developed over the course of 7 years (1987-1994) severe ischemia in the extremity carrying the angioaccess secondary to arterial 'steal'. Seven of these patients were treated with access ligation, 4 with banding reducing the flow through the access, and 23 with ligation of the artery distal to the inflow of the arteriovenous fistula and establishing of an arterial bypass from a point 5 cm proximal to the fistula to the distal artery. Of the 7 patients who underwent ligation, 5 had complete resolution of symptoms, 1 had persistent pain, and 1 patient had residual ischemic neuropathy. Of the 4 patients who underwent banding, 3 lost their access due to thrombosis shortly after the banding procedure, and in 1 patient partial resolution of symptoms was achieved. Of the 23 patients who underwent arterial ligation-bypass procedure, all showed immediate signs of improvement. One patient who presented with advanced gangrene eventually required amputation, and 3 patients had some residual symptoms. The cumulative patency of the access with this procedure was 73% at 1 year and 45.5% at 2 years. The patency for the bypass was 95.6% at 1 and 2 years. The arterial ligation-bypass procedure is currently the treatment of choice for patients developing severe ischemia secondary to 'steal' following construction of an arteriovenous fistula for dialysis.

Coxiella (Q fever)‐associated myelopathy

We describe six men with a slowly progressive myelopathy characterized by asymmetric, incomplete spinal cord syndrome manifested with a thoracic sensory level, mild spastic paraparesis, and urinary incontinence. The spinal cord lesions were evident by MRI in four of them. Coxiella burnetii infection was confirmed in the blood of all patients by immunofluorescence microscopic assay (IFA) and transmission electron microscopy (TEM). In two patients, we detected C burnetii by TEM and IFA using CSF from the patients inoculated onto fresh peripheral blood lymphocyte. Four patients, treated with appropriate antibiotics, responded either with partial resolution of symptoms or arrest of further neurologic progression. In three, the MRI lesions decreased in size.

Innominate artery compression of the trachea

The standard treatment of innominate artery compression of the trachea has been innominate artery suspension, but the syndrome can recur when this technique is used. From October 1985 until March 1991, 29 infants and children were treated for this syndrome by innominate artery reimplantation. In all patients severe anterior vascular compression of the trachea was demonstrated preoperatively by bronchoscopy and in 17 the diagnosis was confirmed by magnetic resonance imaging scanning. Indications for operation included apneic episodes in 17 (58.6%), severe stridor in seven (24.1%), recurrent bronchopulmonary infections in four (13.8%), and exercise-induced stridor in one (3.4%). Through a median sternotomy, the innominate artery was reimplanted more proximally on the ascending aorta and to the right of the trachea. In this new position, the innominate artery no longer crosses the trachea anteriorly, and the anatomic cause of tracheal obstruction is completely eliminated. There were no early or late deaths, and 27 of the 29 patients (93%) had complete resolution of symptoms. Partial resolution of symptoms was seen in two patients (7%). Reimplantation of the innominate artery offers a unique method by which the anatomic cause of tracheal compression is eliminated. It is a safe and effective means of treating symptomatic compression of the trachea by the innominate artery.

Conventional versus thrombolytic therapy in spontaneous (effort) axillary-subclavian vein thrombosis

Effort axillary-subclavian vein thrombosis in young patients has produced long-term disability because of the failure of the thrombosed vein to recanalize. Ten consecutive patients treated in our institution were analyzed. All patients were diagnosed by venography. Four patients received thrombolytic therapy. Three of these had complete resolution and one had partial resolution of the symptoms and thrombus, that was confirmed by venography and duplex imaging. The remaining six patients were treated with conventional anticoagulant therapy. Three of these patients had no resolution, one had complete resolution of both symptoms and thrombus, and two had only partial resolution of symptoms but no resolution of thrombus. Thrombolytic therapy appears to be superior to anticoagulation in the dissolution of symptoms in effort vein thrombosis and should be considered in its management if the diagnosis is made early.

Pharmacotherapy of Allergic Disease

In 1987 the clinician has available to him a wide range of pharmacologic agents with which to treat allergic disease. These drugs used alone or in combination may eliminate or significantly modify allergic symptoms in any organ system. The appropriate use of several drugs in combination can alleviate the need to accept partial resolution of symptoms. However, due to the complexity of some of these agents and the possibility of drug interactions and associated side effects a thorough understanding of their use and pharmacology is needed.

Cryptococcal peritonitis complicating a ventriculoperitoneal shunt in unsuspected cryptococcal meningitis

A 34 year old male was hospitalized because of the probability of a posterior fossa lesion that had increased intracranial pressure. A ventriculoperitoneal shunt was implanted, resulting in partial resolution of symptoms. Subsequently Cryptococcus neoformans was cultured from the cerebrospinal fluid and a diagnosis of cryptococcal meningitis was made. Despite amphotericin B therapy, the patient continued to deteriorate and died on the eighty-fifth day of hospitalization. Autopsy demonstrated cryptococcal meningitis and cerebral edema. An unexpected finding was cryptococcal peritonitis, which was not associated with disseminated disease. This case is unique because cryptococcal peritonitis is rare, and the spread of the organism occurred through a ventriculoperitoneal shunt.