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Eur Radiol. 2002 Jun;12(6):1401-4. Epub 2001 Nov 16.
Lumbar artery pseudoaneurysm and arteriovenous fistula as a complication of laparoscopic splenectomy: treatment by transcatheter embolization.
Maleux G, Vermylen J, Wilms G.
Department of Radiology, University Hospitals, Herestraat 49, 3000 Leuven, Belgium. geert.maleuz.kuleuven.ac.be
Iatrogenic injury of a lumbar artery is very rare and mostly causes retroperitoneal hemorrhage. We report a case of a lumbar artery pseudoaneurysm and a concomitant arteriovenous fistula complicating laparoscopic splenectomy and provoking renal colic-like flank pain due to mass effect on the left ureter. Definitive treatment of both vascular lesions was obtained after percutaneous transcatheter embolization of several lumbar arteries. Control computed tomography scan 3 months after embolization showed almost complete resorption of the retroperitoneal hematoma.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12042945&dopt=Abstract hemorrhage
J Ayub Med Coll Abbottabad. 2002 Jan-Mar;14(1):2-5.
Clinical versus C.T. scan diagnosis in stroke--a comparative study of 50 cases.
Shams-ur-Rehman, Khan MA.
Department of Medicine, PGMI, Lady Reading Hospital, Peshawar, Pakistan.
BACKGROUND: Cerebrovascular disease is one of the three leading causes of death in the world along with cancer and heart disease. Differentiation between cerebral infarction and intracerebral haemorrhage is important because now a days proper management of the acute stroke syndrome is based on the correct diagnosis of the pathological type. This study compared clinical and C.T. scan diagnosis of stroke and determined the reliability of the clinical diagnosis in cases of stroke. METHODS: This study was conducted on 50 patients of stroke at Postgraduate Medical Institution, Lady Reading Hospital, Peshawar from Jan 1995 to May 1996. Clinical diagnoses were made in conformity with criteria for clinical diagnosis of intracranial haemorrhage, cerebral infarction due to embolism or thrombosis. The clinical diagnosis was then compared with the CT diagnosis. RESULTS: We found that from careful history and clinical examination differentiation could be made between cerebral infarction and haemorrhage. In our study at Government Lady Reading Hospital, cerebral hemorrhage accounted for 42% of cases of stroke and cerebral infarction in 58%. CONCLUSIONS: In order to make a clinical diagnosis of stroke, a detailed history and thorough clinical examination is mandatory. As far as treatment planning is concerned clinical diagnosis of stroke is not safe enough as a guide for anticoagulant or thrombolytic therapy. In order to confirm the aetiological diagnosis of stroke one must rely on C.T. scan examination.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12043326&dopt=Abstract hemorrhage
Ugeskr Laeger. 2002 May 13;164(20):2617-23.
[Fever and skin hemorrhages in children--is it meningococcal disease?]
[Article in Danish]
Nielsen HE, Andersen EA, Andersen J, Bottiger B, Christiansen KM, Daugbjerg PS, Larsen SO, Lind I, Nir M, Olofsson K.
Amtssygehuset i Gentofte, DK-2900 Hellerup.
INTRODUCTION: Our main aims were to establish criteria for early distinction between meningococcal disease and other conditions with similar clinical features, and to identify other causes of haemorrhagic rashes accompanied by fever. MATERIALS AND METHODS: This prospective study comprised 264 infants and children hospitalised with fever and skin haemorrhages. RESULTS: We identified an aetiological agent in 28%: 15% had meningococcal disease, 2% another invasive bacterial infection, 7% enterovirus infection, and 4% adenovirus infection. Five clinical variables discriminated meningococcal disease from other conditions on admission: skin haemorrhages of (1) characteristic appearance; (2) universal distribution and (3) a maximum diameter of > 2 mm; (4) poor general condition; and (5) nuchal rigidity. DISCUSSION: If any two or more of these clinical variables were present, the probability of identifying a patient with meningococcal disease was 97% and the false-positive rate was only 12%. This diagnostic algorithm did not identify children in whom septicaemia was caused by other bacterial species.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12043405&dopt=Abstract hemorrhage
Int J Infect Dis. 2002 Mar;6(1):52-9.
Prognostic factors of death in leptospirosis: a prospective cohort study in Khon Kaen, Thailand.
Panaphut T, Domrongkitchaiporn S, Thinkamrop B.
Khon Kaen Hospital, Khon Kaen, Thailand.
OBJECTIVES: To determine the prognostic factors of death in leptospirosis. METHODS: A prospective cohort study was conducted. One hundred and twenty one patients with clinically compatible leptospirosis, serologically confirmed, were recruited in this study. Clinical presentations and biochemical parameters on admission were selected as input variables for survival analysis. Multivariable Cox regression model was used to identify the prognostic factors of death. RESULTS: Most patients were male (94.2%), with the mean +/-SD age of 38+/-13.4 years; 77.4% of them were farmers. Among the 121 patients, 1206 patient-days were observed. Seventeen patients died. Overall mortality rate was 1.4 per 100 patient-days (95% confidence interval [CI]: 0.9-2.3). The causes of death included: a) pulmonary hemorrhage in eight (47.1%) patients; b) complicated acute renal failure in three (17.6%) patients; c) multiple organ failure in three (17.6%) patients; d) acute respiratory distress syndrome in two (11.8%) patients, and e) irreversible shock in one (5.9%) patient. Four independent risk factors associated with the mortality were identified, including hypotension (relative risk [RR], 10.3; 95% CI, 1.3-83.2; P<0.05); oliguria (RR, 8.8; 95% CI, 2.4-31.8; P<0.01); hyperkalemia (RR, 5.9; 95% CI, 1.7-21; P<0.01), and presence of pulmonary rales (RR, 5.2; 95% CI, 1.4-19.9; P<0.05). CONCLUSION: The presence of oliguria, hyperkalemia, pulmonary rales, or hypotension on admission in patients with leptospirosis indicated high risk of death. Intensive care and early intervention should be provided for patients who present with these risk factors.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12044303&dopt=Abstract hemorrhage
Cardiovasc Surg. 2002 Jun;10(3):287-90.
Triple valve replacement in a patient with severe carcinoid heart disease.
Wilhelmi M, Fritz MK, Fischer S, Haverich A, Harringer W.
Division of Thoracic and Cardiovascular Surgery, Hanover Medical School, Carl Neuberg Strasse 1, 30623, Hanover, Germany. wilhelmhg.mh-hannover.de
We report on the case of a 34-year-old male patient suffering from end-stage carcinoid heart disease with severe tricuspid, pulmonary and mitral valve regurgitation. In addition, a persisting foramen ovale was present. The primary carcinoid tumor was never discovered. However, urine 5-hydroxy-indole-acetic-acid (5-HIAA) were consistently elevated after the first diagnosis of carcinoid disease and after eight years of medication with Octreotide and Interferon alpha-2b our patient developed significant cardiac insufficiency mainly due to severe valvular dysfunction. Ultimately, mechanical tricuspid, mitral and pulmonary valve replacement was performed. Twelve hours following the operation the patient had to be returned to the operating room for persisting intrathoracic hemorrhage. He recovered uneventfully and was discharged from hospital on day 37. Twelve months following triple valve replacement the cardiac status recovered from preoperative NYHA-IV to NYHA-I.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12044440&dopt=Abstract hemorrhage
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