Patient In Addition Research Articles

Burned out Takayasu aortitis with superimposed atherosclerosis and left subostructive coronary ostium in young woman

Takayasu disease or arteritis (TA) is a chronic, idiopathic, inflammatory disease that that principally affects the aorta and its primary branches. The pathological changes depend on stage of the disease. The late “burned out” stage is marked by fibrous scarring, leading to intimal and advantitial thickening, which may contain dystrophic calcification. Similar histopathological findings are also seen in many other causes of aortitis. We here in report chronic “burned out” TA in 28-year-old woman with superimposed atherosclerosis and left sub obstructive coronary ostium. This patient in addition had Aortic stenosis and calcification of ascending aorta.

Complex aortic disease: Changes in perception, evaluation and management

Complex aortic disease continues to have a high mortality and morbidity despite advances in medical and surgical treatment. Repair of thoracoabdominal aneurysms, treatment of patients with connective tissue disorders, and the approach to dissections of the ascending and descending aorta have evolved over time; however, the results of intervention in all but highly specialized centers remain poor. As vascular surgeons, our role must extend beyond that of the pure technician; we have been vested with the life-long care of these patients and, therefore, have a responsibility to the patient in addition the scientific community and society at large to create a strategy for management that serves all three interests justly. We will outline some of the changes in the conceptual approach that we consider important to the treatment of complex aortic disease.

Plasma cell tumors with calcified amyloid mimicking chondrosarcoma

We report a case of amyloidoma of iliac bone, mimicking chondrosarcoma radiologically, associated with multiple myeloma in a 52-year-old man. This patient in addition had myeloma deposit in the nasal cavity.

Introduction: Culture and Psychiatry

Introduction: Culture and Psychiatry

Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane.

Refractory status epilepticus (RSE) is defined as continued seizures after 2 or 3 antiepileptic drugs have failed. Several intravenous agents have been used for RSE; however, problems occur with their toxicity and/or effectiveness. To report our experience with inhalational anesthesia (IA) in patients who were refractory to other antiepileptic drugs. Retrospective review during a 4-year period of patients with RSE treated with isoflurane and/or desflurane. Efficacy of IA on therapy in terminating RSE. Seven patients (4 male) aged 17 to 71 years received 7 to 15 (mean, 10) antiepileptic drugs in addition to IAs. The IAs were initiated after 1 to 103 (mean, 19) days of RSE and were used for a mean +/- SD 11 +/- 8.9 days. All patients received isoflurane, and 1 patient in addition received desflurane anesthesia 21 days after the onset of RSE for a total of 19 days. Regardless of seizure type, isoflurane and desflurane consistently stopped epileptic discharges with adequate, sustained electroencephalographic burst suppression within minutes of initiating IA therapy. Four patients had good outcomes, 3 died (1 of acute hemorrhagic leukoencephalitis, 1 of bowel infarction, and 1 of toxic encephalopathy, who remained in a persistent vegetative state until death 5.5 months after the onset of seizures). Complications during IA therapy included hypotension (7/7), atelectasis (7/7), infections (5/7), paralytic ileus (3/7), and deep venous thrombosis (2/7). No patient developed renal or hepatic dysfunction. Isoflurane and desflurane adequately suppressed RSE in all cases. Complications were common, but mortality and long-term morbidity were related to the underlying disease and duration of RSE. Prolonged use of isoflurane and desflurane is well tolerated.

Infarto cerebral silente en pacientes con anemia falciforme

Ictus is a complication in patients with Sickle Cell Anemia (SCA), in these is of importance the precocious diagnosis of Silent Cerebral Infarcts (SCI).To determine the incidence of ICS in patients with SCA without neurological symptoms but with images in Cerebral Magnetic Resonance (RMC).A total of 18 patients (13 males, 5 females) with ages between 5 and 24 years (11.5 4,9), without history of neurological alterations, taken care at the Instituto Hematol gico de Occidente Banco de Sangre, Estado Zulia Venezuela. Methods. A clinical history was made to each patient in addition to detailed physical and neurological examinations that included the state of mind, conscience, language, sensitivity, cranial pairs, muscular force, reflexes, cerebella tests, neck and march. Later, RMC studies were carried out.It was found that 2/18 (11,1%) patients without neurological manifestations showed alterations in the RMC and they were diagnosed as ICS. The findings by images showed asymmetry of lateral ventricles and one of them showed gliosis as well.11,1% of the all the studied cases (2/18) showed SCI, for what is suggested to carry out neurological evaluation and images, once a year, and to offer opportune therapies, for their impact in the function neurocognitive

Sebaceous Adenomas, Squamous Cell Carcinoma and Skin Infections in a Patient with Carcinoma of the Colon, Rectum and Bladder

Sebaceous adenomas and squamous cell carcinoma developed in a male patient in addition to viral, mycotic and bacterial infections, several years after the removal of three malignant tumors from his lower gastrointestinal and urinary tract. Skin tests with trichophytin, candidin, and mixed bacteria were negative. Various aspects regarding cutaneous changes associated with colorectal and bladder carcinomas are discussed.

Reinfusion of postoperative wound drainage in total joint arthroplasty: Red blood cell survival and coagulopathy risk

Fifty patients with total joint arthroplasties (28 total hip arthroplasties, 11 total knee arthroplasties, and 11 bilateral total knee arthroplasties) received autotransfusions from their postoperative wound drainage. The blood was collected in a closed sterile drainage system without any additional anticoagulant. Pre- and postoperative measurements were made of the patient's hemoglobin, platelets, fibrinogen, haptoglobin, fibrin degradation products, and D-dimer (a specific type of fibrin degradation product). Red blood cell survival was assessed in 16 of the patients by labeling the shed blood with 51Cr sodium chromate prior to reinfusion. To control for fluid shifts, continued bleeding, and dilution effects of further transfusions in the immediate post-operative period, 10 patients also had their native blood labeled with 111In oxime. In this study, the mean estimated blood loss was 1,062 mL (±1,247) with a mean wound drainage of 836 mL (±338). Of this, a mean of 450 mL (±261) of blood was was given back to the patient in addition to routine, preoperative autologous donated blood. Six (12%) patients experienced transient fevers at the time of retransfusion. Detailed hematologic studies were performed on the shed blood in 19 patients. The collected blood was completely defibrinated, but did contain fibrin degradation products, as indicated by the D-dimer level, and hemolyzed blood as the haptoglobin was reduced. Even though the blood containing the above breakdown products was reinfused to the patients, there were no clinical manifestations of disseminated intravascular coagulation. Both the hemolyzed and defibrinated products were subsequently cleared by the body. After correcting for fluid and volume changes in the first 3 days, 66% (SEM, 5.3%) of the labeled red blood cell activity remained and was used to determine a mean red blood cell survival half-life of 40.6 days (SEM, 4.2). There was no significant change in the 111In: 51Cr: ratio in the first 24 hours, indicating that the initial drop in activity equally affected both the native red blood cell population and the labeled shed blood. There were no adverse clinical effects resulting from a transient coagulopathy. Autotransfusion of postoperative shed red blood cells is a safe method with reinfused cells that have a normal or increased lifespan.

Successful Therapy for Trilateral Retinoblastoma

Trilateral retinoblastoma, the intracranial malignancy associated with bilateral retinoblastoma, is an uncommon and clinically aggressive malignancy with a uniformly fatal outcome. Three children with newly diagnosed trilateral retinoblastoma were treated with systemic (cyclophosphamide and vincristine) and intrathecal (methotrexate, hydrocortisone, and cytarabine) chemotherapy, as well as craniospinal irradiation (one patient) in addition to therapy of the eye lesions. All three patients have had partial or complete response of the pineal tumors to chemotherapy, with no active disease eight or more years, 33 or more months, and 12 or more months, respectively, after diagnosis of the lesions.

Cyclosporin-associated akinetic mutism and extrapyramidal syndrome after liver transplantation.

Three patients developed akinetic mutism on the third day after the introduction of intravenous cyclosporin A, given for immunosuppression after liver transplantation. One patient in addition developed a florid orofacial dyskinesia, which resolved completely, as did the akinetic mutism, after withdrawal of cyclosporin. In these patients the time course of the akinetic mutism and extrapyramidal syndrome, which developed in the absence of any other identifiable cause, suggests cyclosporin A was the precipitating factor. Subsequently, two of the patients showed signs of pseudobulbar palsy with abnormalities in the pons on MRI scanning, suggesting central pontine myelinolysis (CPM). None of the patients had experienced significant fluctuations in serum sodium or other risk factors for central pontine myelinolysis and the exact relationship to the earlier cyclosporin related mutism was not clear.

Familial poly-endocrinopathy.

ABSTRACT Two family histories are presented. In the first (family W.) two siblings, aged 12 and 16, had idiopathic Addison's disease. The younger patient also had a goitre, possibly representing Hashimoto's thyroiditis. In the second family Graves' disease was present in three generations in direct succession. The oldest patient in addition had Addison's disease, diabetes mellitus and total alopecia. Organ-specific antibodies were looked for quite extensively in the serum of the patients and their relatives, with several positive findings, but without a consistent pattern. A review is given of the literature on familial poly-endocrinopathies and the probable auto-immune character of these dieases. The present cases constitute strong evidence for a genetic transmission of these diseases, and for a common basic aetiology. If this common basis is an auto-immuno aberration, it seems most reasonable, in view of the polyglandular involvement, to assume that the immune-system proper is at fault, rather than a defect in the individual organs.

Complete heart block in patients with peroneal muscular atrophy.

Summary Two patients with peroneal muscular atrophy who also had complete heart block are reported. The pathogenesis of heart block in one of these patients was investigated by left ventricular volume analysis which showed a normal ejection fraction, indicating intact left ventricular function. This patient in addition had a normal coronary arteriogram. These findings suggest that heart block in patients with peroneal muscular atrophy may be due to primary conduction tissue disease rather than cardiomyopathy.

Method for reconstruction of the orbital floor and anterior wall of the maxillary sinus

Summary A new method is described for reconstruction of the orbital floor and anterior wall of the maxilla. A plastic plate is prepared beforehand, and is anchored to the adjacent bony structures with a wire suture. Because of the communication with the external environment, free skin grafting is performed to substitute for the mucosa of the sinus. The operation controls the position of the eye, normal opening and closing of the mouth and feeding of the patient in addition.

Method for reconstruction of the orbital floor and anterior wall of the maxillary sinus

Summary A new method is described for reconstruction of the orbital floor and anterior wall of the maxilla. A plastic plate is prepared beforehand, and is anchored to the adjacent bony structures with a wire suture. Because of the communication with the external environment, free skin grafting is performed to substitute for the mucosa of the sinus. The operation controls the position of the eye, normal opening and closing of the mouth and feeding of the patient in addition.

Chronic pulmonary insufficiency secondary to Silo-filler's disease

A case of severe chronic pulmonary insufficiency is presented which we believe was caused by exposure to silage gas. This patient in addition had a respiratory infection which precipitated acute respiratory distress. Pulmonary function studies revealed a diffuse bronchiolar obstructive process, which improved somewhat with symptomatic therapy but was largely irreversible.