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Sample records for case delayed hemorrhage

  1. Delayed hemorrhage from hepatic artery after ultrasound-guided percutaneous liver biopsy: A case report

    Institute of Scientific and Technical Information of China (English)

    Fen-Yu Ren; Xi-Xu Piao; Ailian Jin

    2006-01-01

    Percutaneous liver biopsy is considered one of the most important diagnostic tools to evaluate diffuse liver diseases. Pseudoaneurysm of hepatic artery is an unusual complication after ultrasound-guided percutaneous liver biopsy. Delayed hemorrhage occurs much less frequently. We report a case of pseudoaneurysm of the hepatic artery of a 46-year-old man who was admitted for abdominal pain after 4 d of liver biopsy. The bleeding was controlled initially by angiographic embolization.However, recurrent bleeding could not be controlled by repeat angiography, and the patient died 4 d after admission from multiorgan failure. The admittedly rare possibility of delayed hemorrhage should be considered whenever a liver biopsy is performed.

  2. Delayed Intracerebral Hemorrhage Secondary to Ventriculoperitoneal Shunt: A Case Report and Literature Review.

    Science.gov (United States)

    Ma, Li; Chen, Yi-Li; Yang, Shu-Xu; Wang, Yi-Rong

    2015-11-01

    The ventriculoperitoneal (VP) shunt is a routine procedure for cerebrospinal fluid (CSF) diversion, and is associated with many complications. A delayed hemorrhage after the VP shunt surgery, however, is quite rare. In this study, we report a case involving late-onset hemorrhage. The 67-year-old male patient with a history of head trauma and brain surgery underwent a VP shunt placement for hydrocephalus. The surgery course was uneventful and no bleeding was revealed in the first computed tomographic (CT) scan after the procedure. However, a massive intraparenchymal and intraventricular hemorrhage occurred 8 h following adjustment of the valve system on the 8th day after surgery.Erosion of the vasculature by catheter cannulation and a sudden reduction of CSF pressure after downregulation of the valve could be one of the possible causes of the intracerebral hemorrhage (ICH).

  3. Management of Delayed Arterial Hemorrhage After Pancreato-Duodenectomy. A Case Report Study

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    Konstantinos Alexiou

    2015-07-01

    Full Text Available Context Delayed arterial hemorrhage after pancreatoduodenectomy is defined as bleeding 5 or more days postoperatively. Objective We present the management of delayed hemorrhage after PD, due to gastro-duodenal arterial stump aneurysm. Case report A sixty-nineyear- old man suffering from pancreatic head carcinoma underwent pancreatoduodenectomy. On the 12th postoperative day he developed melena. Endoscopic evaluation revealed occult bleeding coming from the afferent limb of the gastro-jejunal anastomosis. The patient was treated conservatively. On the 15th postoperative day the patient presented a new episode of melena and hematemesis. Upper abdominal series control by computer tomography, selective angiography of the celiac trunk and superior mesenteric artery set the diagnosis of a pseudoaneurysm of the gastro-duodenal arterial stump. The patient was managed by trans-catheter arterial embolization and complete hemostasis was achieved. Conclusion Delayed intraluminal hemorrhage after pancreatoduodenectomy may be caused after pseudoaneurysm due to some visceral arterial stem erosion. Initial management, both diagnostic and therapeutic, should be the angiographic control and trans-catheter embolization of the bleeding vessel. In case of hemodynamic instability or when angiographic embolism is unsuccessful reoperation is the proper treatment.

  4. An Unusual Complication of Hypertensive HemorrhageDelayed Oculomotor Palsy: Case Report and Literature Review

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    C. Dardis

    2011-09-01

    Full Text Available We present a case of oculomotor palsy due to hypertensive hemorrhage in the caudate nucleus, with intraventricular extension. To our knowledge, this is the only instance of this complication occurring due to hypertensive hemorrhage. Our patient initially developed headache at the time of her hemorrhage; 8 days later, she developed complete third nerve palsy, which showed improvement at follow-up 4 months later. This was due to tracking of blood into the perimesencephalic cistern. The presence of hemorrhage in the basal cisterns was not visible on the initial CT scans and highlights the role of MRI in evaluating the brainstem for the presence of blood products.

  5. Delayed cerebral ischemia associated with reversible cerebral vasoconstriction in a patient with Moyamoya disease with intraventricular hemorrhage: Case report.

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    Matsuoka, Go; Kubota, Yuichi; Okada, Yoshikazu

    2015-06-01

    We describe a case of cerebral infarctions caused by transient vasoconstrictions in the posterior circulation 2 weeks after intraventricular hemorrhage without subarachnoid hemorrhage in a 35-year-old patient with Moyamoya disease. To our knowledge, this is the first case report where diffuse segmental vasoconstrictions of the basilar and posterior cerebral arteries were recognized after intraventricular hemorrhage in Moyamoya disease. The patient complained of severe and acute-onset headache 14 days after the intraventricular hemorrhage, which had a different character and severity from the one she complained of at the onset of intraventricular hemorrhage. Finally, headache disappeared within 1 month and vasoconstriction resolved in 2 months. Reversible cerebral vasoconstriction syndrome was under consideration for the etiology of her condition because of the "thunderclap" characteristics of the headache and the delayed timing of occurrence of the vasoconstriction. This case report informs and alerts neurologists, neurosurgeons and neuroradiologists who observe and treat patients with Moyamoya disease that vasoconstriction in the posterior circulation may occur after intraventricular hemorrhage in these patients.

  6. Delayed Intracerebral Hemorrhage Secondary to Ventriculoperitoneal Shunt

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    Ma, Li; Chen, Yi-Li; Yang, Shu-Xu; Wang, Yi-Rong

    2015-01-01

    Abstract The ventriculoperitoneal (VP) shunt is a routine procedure for cerebrospinal fluid (CSF) diversion, and is associated with many complications. A delayed hemorrhage after the VP shunt surgery, however, is quite rare. In this study, we report a case involving late-onset hemorrhage. The 67-year-old male patient with a history of head trauma and brain surgery underwent a VP shunt placement for hydrocephalus. The surgery course was uneventful and no bleeding was revealed in the first computed tomographic (CT) scan after the procedure. However, a massive intraparenchymal and intraventricular hemorrhage occurred 8 h following adjustment of the valve system on the 8th day after surgery. Erosion of the vasculature by catheter cannulation and a sudden reduction of CSF pressure after downregulation of the valve could be one of the possible causes of the intracerebral hemorrhage (ICH). PMID:26632700

  7. 外伤迟发性颅内出血死亡案例研究%A Case Study on Delayed Traumatic Intracranial Hemorrhage Death

    Institute of Scientific and Technical Information of China (English)

    张海宁

    2013-01-01

    通过对一例外伤迟发性颅内出血死亡案例分析,探讨了外伤迟发性颅内出血的临床表现、诊断依据、病理组织学特点及相关法医检验的应对要素。研究发现,外伤性迟发性颅内出血是外伤后早期未发生出血、经数日或数周突发出血,引发伤者出现颅内压升高症状及体征,经CT复查而发现的一种延迟性出血。其成因为外伤时外力作用致脑实质多发小软化灶,持续地损伤脑内血管,因诱因导致血压的突然升高或附近组织急剧变化的抵抗而发生出血。所以,对于外伤性迟发性颅内出血,需结合调查,全面分析其伤后医疗病历、CT检查回报以及尸检病理组织学所见等,综合判断。以避免引起伤者、致伤者、医院甚至办案单位等多方纠纷。%Through a case analysis of delayed traumatic intracranial hemorrhage death, this article discusses the clinical manifestations, diagnosis bases, histopathological features of intracranial hemorrhage and key factors of dealing with relevant forensic examinations. Studies show that delayed traumatic intracranial hemorrhage is a type of delayed intracranial bleeding that suddenly occurs in several days or weeks after the initial trauma. It can result in the signs and symptoms of increased intracranial pressure, which is often diagnosed by CT reexamination. Its attributing reason is that exogenic action makes brain parenchyma produce multiple small softened lesions, which continuously damage brain vessels, and ultimately lead to bleeding upon a surge in blood pressure or rapid changes of nearby tissue. Therefore, the delayed traumatic intracranial hemorrhage should be judged by investigations, comprehensive analyses of their post-injury medical records, results of CT examination and pathological histology of corps so as to avoid multi-party disputes among the injured, the people causing injury, hospitals and even the law-enforcement agencies

  8. Delayed rebleeding of a spontaneously thrombosed aneurysm after subarachnoid hemorrhage

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    Muhammad Omar Chohan

    2014-01-01

    Full Text Available Background: This report provides a rare documentation of spontaneous thrombosis of a ruptured aneurysm followed by delayed recanalization and subsequent rerupture. Case Description: A 47-year-old female presented with spontaneous subarachnoid hemorrhage (SAH. Four aneurysms were identified on CT angiogram including a basilar apex aneurysm, considered source of bleeding. Cerebral angiogram on postbleed day (PBD #1 showed spontaneous thrombosis of basilar apex aneurysm. The patient was discharged to a nursing home on PBD #18 after two subsequent studies showed no recanalization of the basilar aneurysm. The patient returned on PBD #26 with a second episode of spontaneous SAH. The previously thrombosed basilar aneurysm had recanalized and reruptured, which was now treated with coil embolization. Conclusion: We are not aware of a previous report of saccular cerebral aneurysm documenting spontaneous thrombosis after SAH and recanalization with second hemorrhage. This occurrence presents a dilemma regarding the timing and frequency of subsequent cerebrovascular imaging and treatment.

  9. Delayed intracerebellar hemorrhage secondary to lumboperitoneal shunt insertion

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    Er, Uygur; Akyol, Çetin; Bavbek, Murad

    2016-01-01

    Aim of this paper is to present and discuss a case of a delayed cerebellar parenchymal hemorrhage developing after L/P shunt placement with a NPH patient. A hypertensive patient admitted to our clinic with a diagnosis of NPH. The patient was placed a pressure adjustable L/P shunt without any surgical complication. He was discharged with an uneventful period. The patient was admitted to the emergency clinic of our hospital with a 1.5 × 1.5 cm diameter hematoma at the left cerebellar hemisphere on 2 days after his discharge. CSF drainage by an L/P shunt can generate intracerebellar hemorrhages especially in hypertensive patients. PMID:27695558

  10. Cerebral computed tomographic angiography scan delay in subarachnoid hemorrhage

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    Lukosevicius Saulius

    2005-01-01

    Full Text Available CONTEXT: Computed tomographic angiography (CTA is widely applied in the evaluation of cerebral vessels. Contrast enhancement in cerebral CTA without care or test bolus is not always sufficient for high-quality images. AIMS: Evaluation of the possibilities of calculation of scan delay for cerebral CTA in case of subarachnoid hemorrhage (SAH, based on clinical data of a patient and to find out prognostic error of the model. SETTINGS AND DESIGN: Prospective study in Neurosurgery and Radiology departments. MATERIALS AND METHODS: Scan delay in 53 patients suffering an acute SAH was measured employing test bolus technique. Cerebral CTA was performed afterwards. STATISTICAL ANALYSIS USED: SPSS for Windows v.10.1 software package was applied for dispersion analysis, including one-sample Kolmogorov-Smirnov′s test and Levene′s Test of Equality of Error Variances. RESULTS: A statistical model for the prediction of scan delay in SAH was developed. Cerebral CTA scan delay was dependent upon age, neurological status and impact of the latter factors together (P<0.05. The determined mean square error of prognosis of scan delay of the developed model equals 3.3 sec. CONCLUSION: Using our proposed model it is possible to estimate an optimal delay time for CTA in most patients with SAH with a determined error.

  11. Report of a Pediatric Case of Hemorrhagic Stroke

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    N Tabkhi

    2009-01-01

    Full Text Available Stroke, though rare in children is among the top 10 causes of death in childhood. Incidence of ischemic and hemorrhagic stroke is the same in children .We report a case of hemorrhagic stroke in a two year old girl who presented with a limp, inability to stand on the left leg and left hemiparesia. Her complaint began 10 days ago after a bout of left clonic seizure. She had been admitted to the hospital for a week due to delayed hemorrhage of the umbilical stump at the age of 18 days. Brain CT scan showed a round, hyper dense area with mass effect in the right supraparietal region. Craniotomy revealed a hemorrhage and report of pathology was hematoma. Considering the delayed umbilical cord bleeding and normality of usual tests for hemostasis and partial deficiency of factor XIII in both parents, the problem was diagnosed as homozygote severe deficiency of factor XIII.

  12. Role of interventional endovascular therapy for delayed hemorrhage after pancreaticoduodenectomy

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    WANG Zhi-jun; WANG Mao-qiang; LIU Feng-yong; DUAN Feng; SONG Peng; FAN Qing-sheng

    2010-01-01

    Background Delayed massive hemorrhage (DMH) after pancreaticoduodenectomy (PD) is a sedous complication and one of the most common causes of mortality after PD. Its ideal management remains unclear. This paper is to present our experience in the endovascular treatment of patients with DMH after PD using different techniques and materials.Methods During a seven years period, 19 patients (fifteen men, four women) with DMH arter PD were treated with endovascular procedures, including transcatheter arterial embolization (TAE) with coils embolization in eight cases, with coils plus N-butyl-2-cyanoacrylate (NBCA)-Lipiodol mixture in six cases, and stent-graft placement in five cases. The mean age of the patients was 58.2 years. Follow-up, including clinical condition, liver function tests, and Doppler ultrasound examinations, was documented.Results The immediate technical success rate was 84.2% (16/19). There were no significant procedure-related complications. Hemostasis was not achieved with interventional procedures in three patients: one died of uncontrolled bleeding four days after the second TAE, and two patients required emergency laparotomy without re-angiography because of worsening clinical status. Among the 16 patients with successfully stopped bleeding who became hemodynamically stable after the procedure without evidence of further bleeding, two patients died during the peri-interventional procedure period because of multiple organ failure, and fourteen patients survived to hospital discharge. The mean length of follow-up was 14.6 months. Recurrent bleeding after discharge did not occur in any of these cases. Clinical and laboratory follow-up findings were unremarkable. Doppler ultrasound examinatation verified patency of the hepatic artery in the four patients with stent-graft placement during the follow-up period (5 months-29 months; mean, 15.3 months).Conclusions Interventional endovascular procedure is a safe and technically feasible solution to control

  13. Cataleptic postures in thalamic hemorrhage: case report

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    Saposnik Gustavo

    2001-01-01

    Full Text Available We report a case of catalepsy associated with thalamic hemorrhage. A 72 year-old hypertensive woman had acute onset of right-sided weakness and speech disturbances. She was on anticoagulants because of aortic valve replacement. When postures were imposed, the patient maintained the left upper limb raised for several minutes, even in uncomfortable or bizarre positions. A CT scan of the head revealed a left thalamic hemorrhage. Cataleptic postures have been reported in few cases with acute stroke.

  14. Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage : the role of coagulation and fibrinolysis

    NARCIS (Netherlands)

    M.D.I. Vergouwen

    2009-01-01

    Patients with aneurysmal subarachnoid hemorrhage (SAH) are at risk to develop complications, especially within the first two weeks after the hemorrhage. Delayed cerebral ischemia (DCI) is a complication which occurs in about 30% of SAH patients, leading to symptoms such as aphasia, hemiparesis, or i

  15. Hemostasis and fibrinolysis in delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage : a systematic review

    NARCIS (Netherlands)

    Boluijt, Jacoline; Meijers, Joost C. M.; Rinkel, Gabriel J. E.; Vergouwen, Mervyn D. I.

    2015-01-01

    Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) has been associated with microthrombosis, which can result from activated hemostasis, inhibited fibrinolysis, or both. We systematically searched the PUBMED and EMBASE databases to identify hemostatic or fibrinolytic par

  16. Two cases of asymptomatic massive fetomaternal hemorrhage.

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    Peedin, Alexis R; Mazepa, Marshall A; Park, Yara A; Weimer, Eric T; Schmitz, John L; Raval, Jay S

    2015-04-01

    Evaluation of fetomaternal hemorrhage (FMH) in the immediate postpartum period is critical for the timely administration of Rh immunoglobulin (RhIG) prophylaxis to minimize the risk of alloimmunization in D-negative mothers of D-positive newborns. We report a series of two clinically-unsuspected cases of massive FMHs identified at our university medical center. Retrospective records of two cases of massive FMH were investigated using the electronic medical record. After positive fetal bleed screens, flow cytometric analysis for hemoglobin F was performed to quantify the volume of the hemorrhages in both cases. Flow cytometric enumeration with anti-D was also performed in one case. The two patients had 209.5 and 75 mL of fetal blood in circulation, resulting in 8 and 4 doses of RhIG administered, respectively. For the former patient, flow cytometric analysis with anti-D ruled out hereditary persistence of fetal hemoglobin and supported the fetal origin of the red cells. Due to the clinically-silent nature of both hemorrhages, further evaluation of the newborns' blood was not performed. These cases highlight the importance of rapidly obtaining accurate measurements of fetal blood loss via flow cytometric analysis in cases of FMH, particularly in clinically-unsuspected cases, to ensure timely administration of adequate immunoprophylaxis to D-negative mothers.

  17. Primary Congenital Glaucoma with Delayed Suprachoroidal Hemorrhage following Combined Trabeculotomy Trabeculectomy and 5-Fluorouracil

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    Roseline Duke

    2015-01-01

    Full Text Available Background. Delayed postoperative suprachoroidal hemorrhage (DSCH may occur following intraocular surgery for the treatment of glaucoma. It is considered to be a rare and debilitating event if not managed appropriately. Reported herewith is a case of Primary Congenital Glaucoma followed by DSCH with successful immediate surgical intervention and visual restoration. Patient and Method. An 8-month-old male child had bilateral Primary Congenital Glaucoma (PCG. Combined Trabeculotomy Trabeculectomy with 5-Fluorouracil (5FU was performed. He developed delayed suprachoroidal hemorrhage (DSCH within 24 hours after intraocular surgery which was drained. In addition, he developed exposure keratopathy and left amblyopia. Outcome. Resolution of the DSCH was seen with surgical drainage in addition to treatments for exposure keratopathy and amblyopia. These resulted in reduced intraocular pressure and improved visual acuities. Conclusion. There appears to be a difference in the overall management of PCG and DSCH between adults and children. A high index of suspicion as well as emergency surgical treatment for DSCH and associated conditions should be performed on pediatric patients that present with these challenges.

  18. CT examination, clinical situation and experimental characteristics of infants with intracranial hemorrhage induced by delayed vitamin K deficiency

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    Zhiqing Lin; Feng Fang; Min Chen; Guoxiang Cai

    2006-01-01

    BACKGROUND: Delayed vitamin K deficiency is characterized by acute onset, severe illness and high fatality rate. 33%-50% survivors accompany with other various nervous system sequelas. Therefore, diagnosis and treatment of intracranial hemorrhage in time become a key factor for improving healing rate and reducing fatality rate and incidence of sequela.OBJECTTVE: To investigate the clinical situation, experimental characteristics, CT examination and terminative characteristics of infants with intracranial hemorrhage induced by delayed vitamin K deficiency.DESIGN: Case analysis.SETTING: Department of Pediatrics, Zhongshan Hospital Affiliated to Xiamen University.PARTICIPANTS: A total of 17 infants with intracranial hemorrhage induced by delayed vitamin K deficiency aged 1-3 months including 11 boys and 6 girls were selected from Department of Pediatrics, Zhongshan Hospital Affiliated to Xiamen University from January 1994 to December 2005. All infants had drowsiness,rejective milk, spiting milk, gaze of both eyes, tic, coma, full anterior fontanelle, high muscular tension and cerebral hernia, etc. Experimental examination demonstrated that infants had anemia at various degrees;prothrombin time and partial thromboplastin time were prolonged; platelet count was normal. CT examination indicated that screenages of subarachnoid hemorrhage, subdural hematoma, cerebral parenchyma hemorrhage and intraventricular hemorrage were changed. Hemorrhage was stopped by the application of vitamin K. All patients provided informed consent.METHODS: ① Clinical situation and physical sign of infants were observed after hospitalization and scanned with rapid spiral CT scanning system. The thickness and average space of layers were 8-10 mm and the scanning time was 5 s with window width of 30-80 Hu and window position of 28-35 Hu. ② After hospitalization, four items of blood coagulation was measured with Futura meter and biochemical indexes of blood, such as serum calcium, serum

  19. A Case of Sudden Deafness with Intralabyrinthine Hemorrhage Intralabyrinthine Hemorrhage and Sudden Deafness.

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    Park, Jeong Jin; Jeong, Se Won; Lee, Jae Wook; Han, Su-Jin

    2015-12-01

    Sudden hearing deterioration may occur in our population, but it is difficult to explain the exact pathophysiology and the cause. Magnetic resonance imaging (MRI) in sudden sensorineural hearing loss (SSNHL) is usually useful to evaluate neural lesions such as acoustic schwannoma and hemorrhage in labyrinth. Recently some cases of SSNHL caused by intralabyrintine hemorrhage were reported by the advance of MRI. In the case of intralabyrintine hemorrhage, MRI showed a hyperintense signal in the labyrinth on the pre-contrast and contrast enhanced T1-weighted image and relatively weak intensity on T2-weighted image. The prognosis SSNHL by intralabyrintine hemorrhage is generally known to be poor. We report a case of sudden deafness with intralabyrintine hemorrhage who has a history of anticoagulant administration, with a review of literature.

  20. [Intra-cranial hemorrhage in infants due to vitamin K deficiency - report of 2 cases

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    Grillo, E; Silva, R J; Filho, J H

    2000-01-01

    OBJECTIVE: Drive attention to the late form of the hemorrhagic disease of the newborn, secondary to vitamin K deficiency, as a cause of intracranial hemorrhage in young infants.METHODS: The authors describe and analyze two cases of late hemorrhagic disease of the newborn, secondary to vitamin K deficiency, producing intracranially hemorrhage during the second month of age. The most important publications on this subject are reviewed.RESULTS: Both infants had not received prophylaxis with vitamin K at birth. They were both being fed exclusively on breast milk. They developed intracranial hemorrhage, and the clotting defect was rapidly corrected with intramuscular vitamin K. At 3 and 4 years of age, one of them has showed normal psychomotor development, and the other has showed moderate developmental delay with microcephaly.CONCLUSION: Late hemorrhagic disease of the newborn must be considered in young infants, between 2 and 12 weeks of age, with intracranial hemorrhage, especially those fed exclusively on breast milk who did not receive vitamin K at birth. It may produce neurodevelopmental delay. The clotting defect is rapidly corrected with intramuscular vitamin K. This condition is preventable. The prophylaxis is recommended with 1 mg of intramuscular vitamin K to all newborns, at birth, even without risk factors.

  1. Fetal-Maternal Hemorrhage: A Case and Literature Review

    OpenAIRE

    2012-01-01

    Nearly all pregnancies include an insignificant hemorrhage of fetal blood into the maternal circulation. In some cases, the hemorrhage is large enough to compromise the fetus, resulting in fetal demise, stillbirth, or delivery of a severely anemic infant. Unfortunately, the symptoms of a significant fetal-maternal hemorrhage can be subtle, nonspecific, and difficult to identify at the time of the event. We present the case of a severely anemic newborn who was delivered in our facility with an...

  2. Changes in Cerebral Perfusion around the Time of Delayed Cerebral Ischemia in Subarachnoid Hemorrhage Patients

    NARCIS (Netherlands)

    Dankbaar, J. W.; de Rooij, N. K.; Smit, E. J.; Velthuis, B. K.; Frijns, C. J. M.; Rinkel, G. J. E.; van der Schaaf, I. C.

    2011-01-01

    Background: Because the pathogenesis of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is unclear, we studied cerebral perfusion at different time points around the occurrence of DCI. Methods: We prospectively enrolled 53 patients admitted to the University Medical Center Utrech

  3. Relationship between vasospasm, cerebral perfusion, and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

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    Dankbaar, Jan W.; Rijsdijk, Mienke; van der Schaaf, Irene C.; Velthuis, Birgitta K.; Wermer, Marieke J. H.; Rinkel, Gabriel J. E.

    2009-01-01

    Vasospasm after aneurysmal subarachnoid hemorrhage (SAH) is thought to cause ischemia. To evaluate the contribution of vasospasm to delayed cerebral ischemia (DCI), we investigated the effect of vasospasm on cerebral perfusion and the relationship of vasospasm with DCI. We studied 37 consecutive SAH

  4. Epidemiological and clinical characteristics of 266 cases of intracerebral hemorrhage in Hangzhou, China

    Institute of Scientific and Technical Information of China (English)

    Yun-zhen HU; Jian-wen WANG; Ben-yan LUO

    2013-01-01

    Ethnicity and socioeconomic factors can influence disease susceptibility,clinical presentation,and outcome.We investigated the clinical characteristics (age,sex,seasonal variation,lesion site,symptoms,complications,prognosis,and sequelae) and risk factors for intracerebral hemorrhage (ICH) in 266 cases treated at our hospital in Hangzhou City,China,from January 2011 to December 2011.Risk of ICH increased dramatically with age; only 4.3%of cases were <30 years old,while 44.4% were >60 years of age.Men outnumbered women by 2:1 (67.3% vs.32.7%).Single hemorrhage was most often located in the cerebral lobes (37.2% of cases),basal ganglia (34.2%),thalamus (8.3%),cerebellum (6.8%),ventricle (1.5%),and brainstem (1.1%),while 10.9% of cases exhibited hemorrhages at multiple sites.Hypertension was also a major risk factor for ICH,as 47% of all patients were hypertensive and the percentage increased with age.In hypertensive patients,the most common hemorrhage site was the basal ganglia and ICH was often associated with thrombopenia.In patients with leukemia (all forms),most hemorrhages were lobar.Warfarin-and encephalic operation-associated ICHs were all lobar.Headache was the major symptom of occipital,temporal,and frontal lobe hemorrhage.Dizziness,nausea,and vomiting were the major symptoms of cerebellum hemorrhage.Limb dysfunction was the major symptom of thalamic and basal ganglia hemorrhage.Disturbed level of consciousness was the major symptom in multisite,ventricular,parietal lobe,and brainstem hemorrhage.Hyperspasmia occurred most often in lobar hemorrhage and blurred vision in occipital lobe hemorrhage.Hospital mortality was 24.4% (n=65) with a mean delay from presentation to death of (10.5±18.5) d.The majority of fatalities were cerebral hernia cases (58.5%) and these patients also had the shortest time to death [(2.9±3.5) d].Mortality was 100%in brainstem ICH and hemorrhagic conversion of cerebral infarct

  5. Fetal-Maternal Hemorrhage: A Case and Literature Review

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    Nino Solomonia

    2012-11-01

    Full Text Available Nearly all pregnancies include an insignificant hemorrhage of fetal blood into the maternal circulation. In some cases, the hemorrhage is large enough to compromise the fetus, resulting in fetal demise, stillbirth, or delivery of a severely anemic infant. Unfortunately, the symptoms of a significant fetal-maternal hemorrhage can be subtle, nonspecific, and difficult to identify at the time of the event. We present the case of a severely anemic newborn who was delivered in our facility with an extensive literature review.

  6. Delayed Traumatic Subarachnoid Hemorrhage in a Polytraumatized Patient with Disseminated Intravascular Coagulation

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    Jiwoong Oh

    2015-11-01

    Full Text Available The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH remains unclear in multipletrauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and antithrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.

  7. Different CT perfusion algorithms in the detection of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

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    Cremers, Charlotte H.P. [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Room G03.232, Brain Center Rudolf Magnus Department of Neurology and Neurosurgery, PO Box 85500, Utrecht (Netherlands); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Dankbaar, Jan Willem; Bennink, Edwin; Velthuis, Birgitta K.; Schaaf, Irene C. van der [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Vergouwen, Mervyn D.I.; Rinkel, Gabriel J.E. [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Room G03.232, Brain Center Rudolf Magnus Department of Neurology and Neurosurgery, PO Box 85500, Utrecht (Netherlands); Vos, Pieter C. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands)

    2015-05-01

    Tracer delay-sensitive perfusion algorithms in CT perfusion (CTP) result in an overestimation of the extent of ischemia in thromboembolic stroke. In diagnosing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH), delayed arrival of contrast due to vasospasm may also overestimate the extent of ischemia. We investigated the diagnostic accuracy of tracer delay-sensitive and tracer delay-insensitive algorithms for detecting DCI. From a prospectively collected series of aSAH patients admitted between 2007-2011, we included patients with any clinical deterioration other than rebleeding within 21 days after SAH who underwent NCCT/CTP/CTA imaging. Causes of clinical deterioration were categorized into DCI and no DCI. CTP maps were calculated with tracer delay-sensitive and tracer delay-insensitive algorithms and were visually assessed for the presence of perfusion deficits by two independent observers with different levels of experience. The diagnostic value of both algorithms was calculated for both observers. Seventy-one patients were included. For the experienced observer, the positive predictive values (PPVs) were 0.67 for the delay-sensitive and 0.66 for the delay-insensitive algorithm, and the negative predictive values (NPVs) were 0.73 and 0.74. For the less experienced observer, PPVs were 0.60 for both algorithms, and NPVs were 0.66 for the delay-sensitive and 0.63 for the delay-insensitive algorithm. Test characteristics are comparable for tracer delay-sensitive and tracer delay-insensitive algorithms for the visual assessment of CTP in diagnosing DCI. This indicates that both algorithms can be used for this purpose. (orig.)

  8. Electroencephalographic Response to Sodium Nitrite May Predict Delayed Cerebral Ischemia After Severe Subarachnoid Hemorrhage

    Science.gov (United States)

    Rowland, Matthew J.; Ezra, Martyn; Herigstad, Mari; Hayen, Anja; Sleigh, Jamie W.; Westbrook, Jon; Warnaby, Catherine E.; Pattinson, Kyle T. S.

    2016-01-01

    Objectives: Aneurysmal subarachnoid hemorrhage often leads to death and poor clinical outcome. Injury occurring during the first 72 hours is termed “early brain injury,” with disruption of the nitric oxide pathway playing an important pathophysiologic role in its development. Quantitative electroencephalographic variables, such as α/δ frequency ratio, are surrogate markers of cerebral ischemia. This study assessed the quantitative electroencephalographic response to a cerebral nitric oxide donor (intravenous sodium nitrite) to explore whether this correlates with the eventual development of delayed cerebral ischemia. Design: Unblinded pilot study testing response to drug intervention. Setting: Neuroscience ICU, John Radcliffe Hospital, Oxford, United Kingdom. Patients: Fourteen World Federation of Neurosurgeons grades 3, 4, and 5 patients (mean age, 52.8 yr [range, 41–69 yr]; 11 women). Interventions: IV sodium nitrite (10 μg/kg/min) for 1 hour. Measurements and Main Results: Continuous electroencephalographic recording for 2 hours. The alpha/delta frequency ratio was measured before and during IV sodium nitrite infusion. Seven of 14 patients developed delayed cerebral ischemia. There was a +30% to +118% (range) increase in the alpha/delta frequency ratio in patients who did not develop delayed cerebral ischemia (p < 0.0001) but an overall decrease in the alpha/delta frequency ratio in those patients who did develop delayed cerebral ischemia (range, +11% to –31%) (p = 0.006, multivariate analysis accounting for major confounds). Conclusions: Administration of sodium nitrite after severe subarachnoid hemorrhage differentially influences quantitative electroencephalographic variables depending on the patient’s susceptibility to development of delayed cerebral ischemia. With further validation in a larger sample size, this response may be developed as a tool for risk stratification after aneurysmal subarachnoid hemorrhage. PMID:27441898

  9. Protective effects of batimastat against hemorrhagic injuries in delayed jellyfish envenomation syndrome models.

    Science.gov (United States)

    Wang, Beilei; Liu, Dan; Liu, Guoyan; Zhang, Xin; Wang, Qianqian; Zheng, Jiemin; Zhou, Yonghong; He, Qian; Zhang, Liming

    2015-12-15

    Previously, we established delayed jellyfish envenomation syndrome (DJES) models and proposed that the hemorrhagic toxins in jellyfish tentacle extracts (TE) play a significant role in the liver and kidney injuries of the experimental model. Further, we also demonstrated that metalloproteinases are the central toxic components of the jellyfish Cyanea capillata (C. capillata), which may be responsible for the hemorrhagic effects. Thus, metalloproteinase inhibitors appear to be a promising therapeutic alternative for the treatment of hemorrhagic injuries in DJES. In this study, we examined the metalloproteinase activity of TE from the jellyfish C. capillata using zymography analyses. Our results confirmed that TE possessed a metalloproteinase activity, which was also sensitive to heat. Then, we tested the effect of metalloproteinase inhibitor batimastat (BB-94) on TE-induced hemorrhagic injuries in DJES models. Firstly, using SR-based X-ray microangiography, we found that BB-94 significantly improved TE-induced hepatic and renal microvasculature alterations in DJES mouse model. Secondly, under synchrotron radiation micro-computed tomography (SR-μCT), we also confirmed that BB-94 reduced TE-induced hepatic and renal microvasculature changes in DJES rat model. In addition, being consistent with the imaging results, histopathological and terminal deoxynucleotidyl transferase-mediated UTP end labeling (TUNEL)-like staining observations also clearly corroborated this hypothesis, as BB-94 was highly effective in neutralizing TE-induced extensive hemorrhage and necrosis in DJES rat model. Although it may require further clinical studies in the near future, the current study opens up the possibilities for the use of the metalloproteinase inhibitor, BB-94, in the treatment of multiple organ hemorrhagic injuries in DJES.

  10. Two cases of arachnoid cyst complicated by spontaneous intracystic hemorrhage

    Directory of Open Access Journals (Sweden)

    Gunduz Burak

    2010-01-01

    Full Text Available Arachnoid cysts are developmental anomalies which are usually asymptomatic. Intracystic hemorrhage after trauma is a well known complication; however, spontaneous intracystic hemorrhage is rare. This report presents two rare cases of arachnoid cyst complicated by spontaneous intracystic hemorrhage. The first patient was admitted following transient loss of consciousness and speech disturbance, and a subacute subdural hematoma at the left temporal region was diagnosed. The second patient presented with severe headache of four days duration and a subdural hematoma at the left temporoparietal region was diagnosed. In both the patients, both on radiological examination and during surgical intervention, hematomas were found to be intracystic.

  11. Early events triggering delayed vasoconstrictor receptor upregulation and cerebral ischemia after subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Povlsen, Gro Klitgaard; Johansson, Sara Ellinor; Larsen, Carl Christian

    2013-01-01

    that the drop in cerebral blood flow (CBF) and wall tension experienced by cerebral arteries in acute SAH is a key triggering event. We here investigate the importance of the duration of this acute CBF drop in a rat SAH model in which a fixed amount of blood is injected into the prechiasmatic cistern either......Upregulation of vasoconstrictor receptors in cerebral arteries, including endothelin B (ETB) and 5-hydroxytryptamine 1B (5-HT(1B)) receptors, has been suggested to contribute to delayed cerebral ischemia, a feared complication after subarachnoid hemorrhage (SAH). This receptor upregulation has been...

  12. A case of repeated intracerebral hemorrhages secondary to ventriculoperitoneal shunt

    Directory of Open Access Journals (Sweden)

    Jinbing Zhao

    2015-03-01

    Full Text Available Ventriculoperitoneal shunt is a routinely performed treatment in neurosurgical department. Intracerebral hemorrhage, as a complication after shunt catheterization, is really rare but with high mortality. In this study, we reported a case of a 74-year-old man who suffered from repeated intracerebral hemorrhage after ventriculoperitoneal shunt. The first hemorrhage happened 63 h after the 1st surgery, and most hematomas were located in the ipsilateral occipital lobe and intraventricles, along the ventricular catheter. Fresh blood clot casts blocked the external ventricular draining catheter, which was inserted into the right front horn during the 3rd surgery, indicating new intraventricular bleeding happened. A large hematoma in ipsilateral frontal lobe was detected on the 3rd day after the removal of external ventricular draining catheter. Different hemorrhagic locations and time points were encountered on the same case. We discussed the possible causes of repeated hemorrhage for this case, and the pre-operative preparation including risk evaluation in future clinical work.

  13. Dengue hemorrhagic fever and acute hepatitis: a case report

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    Maria Paula Gomes Mourão

    2004-12-01

    Full Text Available Dengue fever is the world's most important viral hemorrhagic fever disease, the most geographically wide-spread of the arthropod-born viruses, and it causes a wide clinical spectrum of disease. We report a case of dengue hemorrhagic fever complicated by acute hepatitis. The initial picture of classical dengue fever was followed by painful liver enlargement, vomiting, hematemesis, epistaxis and diarrhea. Severe liver injury was detected by laboratory investigation, according to a syndromic surveillance protocol, expressed in a self-limiting pattern and the patient had a complete recovery. The serological tests for hepatitis and yellow fever viruses were negative. MAC-ELISA for dengue was positive.

  14. Presentation of moyamoya disease with occipital hemorrhage: a case report

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    Serkan Demir

    2012-12-01

    Full Text Available Moyamoya disease is a cerebrovascular disease which is characterized with stenosis and occlusions at the distal part of internal carotid artery and at the proximal part of anterior and middle cerebral arteries. It rarely causes temporary or recurrent hemiparesis due to intracranial hemorrhage while symptoms like headache, convulsion, nystagmus, aphasia and ataxia may also occur. In this paper, we present a case of Moyamoya disease which was diagnosed with a 23 year old female patient who was admitted to our emergency department with headache, nausea and vomiting complaints and whose radiological findings showed occipital lobe hemorrhage.

  15. Key concepts in the management of difficult hemorrhagic cases.

    Science.gov (United States)

    MacLaren, Robert

    2007-09-01

    Goals of hemorrhage management involve promoting coagulation and reducing fibrinolysis to enhance clot formation and stability, and minimizing hemorrhagic expansion to reduce the likelihood of adverse outcomes. The optimal hemostatic regimen to obtain these goals will differ according to the clinical scenario. Two hypothetical cases of patients with hemorrhage are presented that are typical of those encountered by clinical pharmacists who practice in centers that treat trauma or surgical patients or patients in need of emergency or critical care because of serious bleeding. To maximize therapy, the clinician must be aware of how best to clinically apply hemostatic agents, their comparative benefits and disadvantages, and the optimal methods for monitoring their effectiveness and toxicities.

  16. Hemorrhagic Bronchopneumonia in Adults with Chickenpox. A Case Report

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    Miguel Ángel Serra Valdés

    2012-11-01

    Full Text Available Chickenpox is an acute viral infectious disease that is highly contagious and very common in children. When it occurs in adults, age increases severity, with complications that can lead to death in a short period of time. Among the most lethal complications we can find pneumonia and bronchopneumonia, injuries overinfection caused by streptococci and staphylococci with severe sepsis, diverse bleeding, encephalitis, shock, hemorrhagic nephritis with renal failure and necrotizing fasciitis, among others. The case of an 83 years old male patient, with a history of chronic obstructive pulmonary disease and ischemic cerebrovascular atherosclerotic disease that contracted chickenpox and whose evolution was very rapid, with acute respiratory failure and bronchopneumonia massive hemorrhagic shock, to the point of death, is presented. Given the increased incidence of chickenpox, according to reports of the Pedro Kouri Institute of Tropical Medicine, we decided to have this case published.

  17. Cllnical analysis on 80 cases with hypertensive cerebral hemorrhage compllcating upper digestive tract hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Yang Y1chao; Wang Jian; Ye Bin; Li Honghong

    2000-01-01

    Objective: To irrvestigate the treatment and prognosis of the hypertensive cerebral hemorrhage (HCH)With upper dgest tract hemorrhage (UDDIH). Scence:I a surey of 760 cases randomely with HCH in nerve department betweem Jaruarry 1995 and October 1999, including 80 cases wuth UDTH (9.5%). Of the 80 cases 55 were males and25 were fenales, mean age of 60.2 years andrange of 45 to 80 years. Methods:To analyze the clinical materials of 80 cases with HCH complicating UDTH and HCH without UDTH for the same time. Results: Of the 80 cases 52 were cled during the treatment, death rate was 65%, but the death rate of cases without UDTH was 30.2% at the sane time. The death rate of HCH complicating UDTH was significantly ligher than that without UDTH Discussion The nosogeny of HCH complicating UDTH was more likely related to thalanic and brain-stem Lew is thought that thalemric and brain-stem were stimulated to secret CRF and made pituitany gland release ACTH, futhet secret advencortirn These factors gave rise to UDTH by incriesed to secretion of gastic acid Therefore, original ciseases wre Primarily be predcted and treated Patients with intracranial lypenrtension should be inmediately treated by using manniol or glyceric co, and antiacid, anticholinergic drugs. If all kinds of methods shouldn′t control UDTH, thrombin and noradrenaline bitarlrate with cold Natrii Chlori de would be giwn by nostril There have bettertherapeutic efficiency. Conclusion: HCH with UDTH belongs to severe cases, death rates are higher, original diseases and complication should be actively treated

  18. Hemorrhagic shock and encephalopathy syndrome: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Sook Ja; Choi, Yun Sun; Shin, Chung Ho; Cho, Sung Bum; Cho, Jae Min; Kim, Hyun Sook; Han, Tae Il; Yoon, Yong Kyu [Eulji Univ. School of Medicine, Seoul (Korea, Republic of)

    2001-03-01

    Hemorrhagic shock and encephalopathy syndrome (HSES) is a sudden-onset symptom complex that involves multisystem failure and includes encephalopathy, shock, coma, convulsions, prerenal azotemia, hepatic dysfunction, and bleeding coagulopathy and progressive thrombocytopenia in previously healthy infants and children. Its radiologic findings have rarely been reported, and it has not been described in Korea. We present a case of clinically diagnosed HSES, and include the CT and MRI findings.

  19. Placenta previa percreta left in situ - management by delayed hysterectomy: a case report

    Directory of Open Access Journals (Sweden)

    Stefanovic Vedran

    2011-08-01

    Full Text Available Abstract Introduction Placenta percreta is an obstetric emergency often associated with massive hemorrhage and emergency hysterectomy. Case presentation We present the case of a 30-year-old African woman, gravida 7, para 5, with placenta percreta managed by an alternative approach: the placenta was left in situ, methotrexate was administered, and a delayed hysterectomy was successfully performed. Conclusions Further studies are needed to develop the most appropriate management option for the most severe cases of abnormal placentation. Delayed hysterectomy may be a reasonable strategy in the most severe cases.

  20. MR imaging findings of retinal hemorrhage in a case of nonaccidental trauma

    Energy Technology Data Exchange (ETDEWEB)

    Altinok, Deniz; Saleem, Sheena; Smith, Wilbur [Children' s Hospital of Michigan, Department of Pediatric Imaging, Detroit, MI (United States); Zhang, Zaixiang [Wayne State University School of Medicine, Department of Radiology, Detroit, MI (United States); Markman, Lisa [Children' s Hospital of Michigan, Child Protection Team, Detroit, MI (United States)

    2009-03-15

    Retinal hemorrhage is a well-recognized manifestation of child abuse found in many babies with shaken baby syndrome. The presence of retinal hemorrhage is generally associated with more severe neurological damage and a worse clinical outcome. MR imaging findings of retinal hemorrhages are not well described in the pediatric literature. We present a 6-month-old boy with new-onset seizures, subdural hemorrhage and bilateral retinal hemorrhages that were detected by MRI and confirmed by indirect ophthalmoscopy. This case demonstrates the MR imaging findings of retinal hemorrhages and the importance of radiologists being able to recognize these specific imaging features. (orig.)

  1. Intracranial chordoma presenting as acute hemorrhage in a child: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Kenneth A Moore

    2015-01-01

    Conclusion: There are few previous reports of petroclival chordomas causing acute intracranial hemorrhage. To the authors′ knowledge, this is the first case of a petroclival chordoma presenting as acute intracranial hemorrhage in a pediatric patient. Although uncommon, it is important to consider chordoma when evaluating a patient of any age presenting with a hemorrhagic lesion of the clivus.

  2. [Adrenal hemorrhage in a newborn with factor V Leiden--a clinical case].

    Science.gov (United States)

    Vulkova, A; Kovacheva, K; ionov, M; Rosmanova, R; Atanasova, V; Slavkova, N; Ivanov, P

    2009-01-01

    Neonatal adrenal hemorrhage is frequently associated with birth trauma, perinatal asphyxia, septicemia, coagulation defects and thromboembolism. We report a case of bilateral adrenal hemorrhage in newborn baby with perinatal asphyxia. Ultrasound findings of subacute adrenal hemorrhage draw attention to its presumable antenatal genesis. DNA analysis for thrombophilic mutations identifies factor V Leiden.

  3. Hemorrhagic cystitis with massive bleeding from nontyphoidal Salmonella infection: A case report.

    Science.gov (United States)

    Na, Sun-Kyung; Jung, Hye-Kyung; Kim, Young Shin; Yun, Hye-Won; Chung, Jung-Wha; Jung, Ka-Young; Shim, Ki-Nam; Jung, Sung-Ae

    2013-06-01

    Hemorrhagic cystitis is defined by lower urinary tract symptoms that include dysuria, hematuria, and hemorrhage and is caused by viral or bacterial infection or chemotherapeutic agents. Reports of hemorrhagic cystitis caused by non-typhoidal salmonella (NTS) are extremely rare. We report a case of a 41-year-old man with hemorrhagic cystitis from NTS that caused massive bleeding and shock. The patient was hospitalized for uncontrolled diabetes and obstructive uropathy related to severe cystitis. A urine culture was positive for group D NTS. This case demonstrated that hemorrhagic cystitis in a patient with a risk factor such as diabetes can be a manifestation of local extra-intestinal NTS infection.

  4. [Two Cases of Ruptured Cerebral Aneurysm Complicated with Delayed Coil Protrusion after Coil Embolization].

    Science.gov (United States)

    Furukawa, Takashi; Ogata, Atsushi; Ebashi, Ryo; Takase, Yukinori; Masuoka, Jun; Kawashima, Masatou; Abe, Tatsuya

    2016-07-01

    We report two cases of delayed coil protrusion after coil embolization for ruptured cerebral aneurysms. Case 1:An 82-year-old woman with a subarachnoid hemorrhage due to a ruptured small anterior communicating artery aneurysm underwent successful coil embolization. Eighteen days after the procedure, coil protrusion from the aneurysm into the right anterior cerebral artery was observed without any symptoms. Further coil protrusion did not develop after 28 days. Case 2:A 78-year-old woman with a subarachnoid hemorrhage due to a ruptured small left middle cerebral artery aneurysm underwent successful coil embolization. Twenty days after the procedure, coil protrusion from the aneurysm into the left middle cerebral artery was observed, with a transient ischemic attack. Further coil protrusion did not develop. Both patients recovered with antithrombotic treatment. Even though delayed coil protrusion after coil embolization is rare, it should be recognized as a long-term complication of coil embolization for cerebral aneurysms.

  5. Acute Hemorrhagic Edema of Infancy: A Case Report Case Report¬

    Directory of Open Access Journals (Sweden)

    Hakan Turan

    2011-04-01

    Full Text Available Introduction: Acute hemorrhagic edema of infancy is a rare subtype of leukocytoclastic vasculitis. It is characterized by target-like hemorrhagic plaques with edema. Lesions are localized to face and distal extremities. It usually heals spontaneously without any sequelae.Case Report: Herein, an 8-month-old girl infant with acute hemorrhagic edema of infancy was presented. Conclusion: Both dermatologists and pediatricians must be familiar with this rare type of leukocytoclastic vasculitis. We believe that this familiarity will eliminate unnecessary treatment and anxiety about the disease (Journal of Current Pediatrics 2011; 9: 50-2

  6. 婴儿晚发性维生素K缺乏并颅内出血的CT诊断(附23例分析)%Clinical CT analysis of 23 infants with delayed vitamin K deficiency and intracranial hemorrhage

    Institute of Scientific and Technical Information of China (English)

    林新杰; 董学萍; 任玉琴; 纪丽莉

    2001-01-01

    目的:探讨晚发性维生素K(Vit k)缺乏症并颅内出血的发病机制及CT表现,提高CT检查对本病价值的认识。方法:分析了23例临床资料完整,确诊晚发性Vit K缺乏症并颅内出血的临床CT表现。结果:蛛网膜下腔出血16例,硬膜下出血14例,脑内出血11例,脑室内出血4例。结论:CT是Vit K缺乏症并颅内出血的首选检查方法,对临床制定综合治疗计划,估计预后提供可靠依据。%Objecbive:To study the mechanism and CT features of delayed vitamin K deficiency with intracranial hemorrhage,to show the diagnostic value of CT scan to the disease. Methods:Analyzing the clinical CT features of 23 infants with delayed vitamin K deficiency and intracranial hemorrhage. Results: 16 cases with subarachnoid hemorrhage, 14 with subdural hemorrhage,11 with intracerebral hemorrhage, 4 with ventricular hemorrhage. Conclusion:CT scan should be the first reliable choice of accessory examinations for making general plan of treatment to the disease.

  7. Intraventricular Hemorrhage in the Newborn. A Case Report

    Directory of Open Access Journals (Sweden)

    Bárbara Aleida García Hernández

    2016-02-01

    Full Text Available Intraventricular hemorrhage is a serious disease that usually occurs in the first hours or days of life, especially in premature infants weighing less than 1500 g. We present the case of full-term newborn with normal birth weight who was non-institutionally delivered. At 17 days old, he was referred to the Paquito González Cueto Hospital because of fever and seizures. Subsequently, he was admitted to the Pediatric Intensive Care Unit. Increased head circumference, tense anterior fontanelle and global hypertonia were found. A transfontanelle ultrasound revealed a subependymal/intraventricular hemorrhage. Computed tomography and magnetic resonance imaging were used to confirm the diagnosis. Symptoms and echoencephalographic results improved as occurs in 65% of cases. We decided to present this case since the condition developed in a full-term newborn with normal weight, which is unusual, and the fact that he was born outside a hospital. Although the relationship between this fact and the disease could not be established, it helps general practitioners to develop the ability to consider such serious diseases in cases that do not necessarily meet what is classically described.

  8. A Case of Crimean-Congo Hemorrhagic Fever in Oman

    Directory of Open Access Journals (Sweden)

    Matllooba Al-Zadjali

    2013-05-01

    Full Text Available In the summer of June 2011, the first case of Crimean-Congo hemorrhagic fever (CCHF was observed in Oman since the last fifteen years. The first blood sample using reverse transcriptase polymerase chain reaction (PCR test were sent looking for CCHF, tick-borne encephalitis, dengue, Japanese encephalitis, Chikungunya and West Nile. All resulted as negative. The repeated serology for CCHF came strongly positive after five days from the initial negative test, and accordingly patient started on ribavirin and he responded to it. His condition improved dramatically.

  9. Early whole-brain CT perfusion for detection of patients at risk for delayed cerebral ischemia after subarachnoid hemorrhage.

    Science.gov (United States)

    Malinova, Vesna; Dolatowski, Karoline; Schramm, Peter; Moerer, Onnen; Rohde, Veit; Mielke, Dorothee

    2016-07-01

    OBJECT This prospective study investigated the role of whole-brain CT perfusion (CTP) studies in the identification of patients at risk for delayed ischemic neurological deficits (DIND) and of tissue at risk for delayed cerebral infarction (DCI). METHODS Forty-three patients with aneurysmal subarachnoid hemorrhage (aSAH) were included in this study. A CTP study was routinely performed in the early phase (Day 3). The CTP study was repeated in cases of transcranial Doppler sonography (TCD)-measured blood flow velocity (BFV) increase of > 50 cm/sec within 24 hours and/or on Day 7 in patients who were intubated/sedated. RESULTS Early CTP studies revealed perfusion deficits in 14 patients, of whom 10 patients (72%) developed DIND, and 6 of these 10 patients (60%) had DCI. Three of the 14 patients (21%) with early perfusion deficits developed DCI without having had DIND, and the remaining patient (7%) had neither DIND nor DCI. There was a statistically significant correlation between early perfusion deficits and occurrence of DIND and DCI (p 50 cm/sec within 24 hours, revealing a perfusion deficit in 3 of them (38%). Two of the 3 patients (67%) developed DCI without preceding DIND and 1 patient (33%) had DIND without DCI. In 4 of the 7 patients (57%) who were sedated and/or comatose, additional CTP studies on Day 7 showed perfusion deficits. All 4 patients developed DCI. CONCLUSIONS Whole-brain CTP on Day 3 after aSAH allows early and reliable identification of patients at risk for DIND and tissue at risk for DCI. Additional CTP investigations, guided by TCD-measured BFV increase or persisting coma, do not contribute to information gain.

  10. Hemorrhagic fever with renal syndrome during pregnancy: Case report

    Directory of Open Access Journals (Sweden)

    Todorović Zoran

    2010-01-01

    Full Text Available Introduction Hemorrhagic fever with renal syndrome (HFWRS is an acute infectious disease with abrupt onset, high fever, renal failure and frequent hemorrhages. HFWRS during the pregnancy has relatively low occurrence, with only few described cases mostly in the region of the former Soviet Union. Although, according to the data from the literature, the disease is less severe during the pregnancy, the eclampsy, stillbirth and fetal infection were also described. Material and methods During the summer period, June-September 2002 in the area of nort-heast Montenegro, and mainly among people whose job was connected with rural areas, the HFRS was observed more frequently. In that area during the stated period , 12 patients underwent treatment whose disease was confirmed by the I I F method at the Torlak Institute of Virology in Belgrade. Among the patients there were two pregnant women aged 23 and 29 (both in their second pregnancies, in the 23rd and 26th gestational week, respectively. The aim of this study is to present 2 case studies and to show the disease impact on fetal development. Results The patients aged 23 and 29 yrs, were previously healthy women in their second pregnancies (23rd and 26th gestational week, respectively. The disease had typical beginning. The predictions made according to the laboratory abnormalities and the level of oliguria were that the disease would have a less severe course. Hemorrhagic syndrome was less prominent, and the laboratory analyses were normalized after 15 to 18 days. The monitoring of pregnancy during the disease period and after recovering showed no fetal suffering. The patients had PV delivery, in 39-th an 40-th, respectively. The newborns blood testing on Hantan viruses was done by ELISA method in Torlak Institute, Belgrade. Only the IgG antibodies (1/ 512, were detected, the IgM antibodies were not found. Two years later the tests were repeated, and showed negative results.

  11. Delayed extradural hematoma : a case report.

    Directory of Open Access Journals (Sweden)

    Alappat J

    2002-07-01

    Full Text Available Three patients of delayed extradural hematoma (EDH were seen in the last one year among forty eight consecutively treated cases of EDH. All the three hematomas were evacuated. Awareness of this entity and a high degree of vigilance are strongly recommended to detect such cases. Repeat CT should always be done, especially after decompression by either surgical or medical means, recovery from shock or whenever there is evidence of even minimal bleeding under a skull fracture on initial CT scan.

  12. Cerebral hemorrhage without manifest motor paralysis. Reports of 5 cases

    Energy Technology Data Exchange (ETDEWEB)

    Taketani, T.; Dohi, I.; Miyazaki, T.; Handa, A. (Central Hospital of JNR, Tokyo (Japan))

    1982-01-01

    Before the introduction of computerized tomography (CT) there were some cases of intracerebral bleeding who were wrongly diagnosed as hypertensive encephalopathy or senile psychosis. We here report 5 cases who did not show any sign of motor paralysis. The clinical aspects of these cases were nausea and vomiting with dizziness (case 1), nausea and vomiting with slight headache (case 2), agnosia of left side with several kinds of disorientation (case 3), nausea and vomiting (case 4), and visual disturbance of right, lower quadrant (case 5). All of these cases showed no motor paralysis or abnormal reflex activities. By examination with CT each of them exhibited a high density area in the subcortical area of the right parietal lobe, the subcortical area of the right occipital lobe, the right temporal and parietal lobe, rather small portion of the left putamen and external capsule, and the subcortical area of left occipital lobe, respectively. Patients of cerebral hemorrhage without motor or sensory disturbances might often be taken for some psychic abnormality. We here have emphasized the importance of CT in such a group of patients. But for this technique, most of them would not be given adequate treatment and might be exposed to lifethreatening situations.

  13. Ileal Lymphangioma Presenting with Gastrointestinal Hemorrhage: A Case Report

    Institute of Scientific and Technical Information of China (English)

    Hong-qun ZHENG; Ming LIU; Bei-qiu HAN; Qi-fan ZHANG

    2010-01-01

    @@ Introduction Lymphangioma is a rare benign tumor of lymphatic vessel origin.The tumor often appears in the head and neck region at a young age and can occasionally be found in the abdomen of adults with protean degrees of symptoms depending on the tumor size and location. How-ever, lymphangioma of the small intestine is extremely rare with only a few cases reported in the literature. As the tumor is not well-recog-nized, many patients with small intestine lymphangioma have been given an incorrect preoperative diagnosis. The ideal treatment for the disease is surgical excision, and the prognosis is comparatively good.In this paper, we report a rare case of ileal lymphangioma with gas-trointestinal hemorrhage preoperatively diagnosed using enteroscopy and treated with surgery.

  14. Acute Hemorrhagic Leukoencephalitis in Children: A Case Report

    Science.gov (United States)

    Khademi, Gholam Reza; Aelami, Mohammad Hasan

    2016-01-01

    Acute hemorrhagic leukoencephalitis (AHLE) is a rare demyelinating disease characterized by an acute rapidly progressive fulminant inflammation of the white matter. In this case report, we introduce a case of AHLE in children with an interesting and lengthy process and successful treatment. A previously healthy 13-year-old girl was admitted to the hospital because of fever and loss of consciousness. After 4 days, she was referred to our pediatric intensive care unit in Mashhad, Iran. On admission, she had right-sided parotiditis. With a diagnosis of AHLE, our patient was treated with methylprednisolone, intravenous immunoglobulin, acyclovir, and plasmapheresis. AHLE is a rare and severe demyelinating disease, the mortality and morbidity of which can be decreased by early detection and treatment with steroid therapy, intravenous immunoglobulin, acyclovir, and plasmapheresis. PMID:27217610

  15. Acute Hemorrhagic Leukoencephalitis in Children: A Case Report

    Directory of Open Access Journals (Sweden)

    Gholam Reza Khademi

    2016-05-01

    Full Text Available Acute hemorrhagic leukoencephalitis (AHLE is a rare demyelinating disease characterized by an acute rapidly progressive fulminant inflammation of the white matter. In this case report, we introduce a case of AHLE in children with an interesting and lengthy process and successful treatment. A previously healthy 13-year-old girl was admitted to the hospital because of fever and loss of consciousness. After 4 days, she was referred to our pediatric intensive care unit in Mashhad, Iran. On admission, she had right-sided parotiditis. With a diagnosis of AHLE, our patient was treated with methylprednisolone, intravenous immunoglobulin, acyclovir, and plasmapheresis. AHLE is a rare and severe demyelinating disease, the mortality and morbidity of which can be decreased by early detection and treatment with steroid therapy, intravenous immunoglobulin, acyclovir, and plasmapheresis.

  16. Lateral Ventricular Meningioma Presenting with Intraventricular Hemorrhage: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Zhenyu Fu, Kan Xu, Bing Xu, Limei Qu, Jinlu Yu

    2011-01-01

    Full Text Available Lateral ventricular meningiomas presenting with primary intraventricular hemorrhage are extremely uncommon. We report here a case of primary intraventricular hemorrhage attributable to a lateral ventricular meningioma. This case concerns a 46-year-old female patient who presented with sudden onset of headache. Computed tomography (CT, computed tomography angiography (CTA and magnetic resonance imaging (MRI examinations showed hemorrhage from a ruptured tumor mass, which was pathologically confirmed as a transitional meningioma. The patient underwent surgical treatment and had a good prognosis. A retrospective review of eight previous cases of hemorrhage from ruptured lateral ventricular meningiomas revealed that hemorrhage of lateral ventricular meningiomas and hemorrhage of meningiomas at other intracranial sites have similar causes. The clinical and pathological features of ruptured lateral ventricular meningiomas are consistent with those of unruptured lateral ventricular meningiomas. As this clinical entity is extremely rare, attention is called for while performing differential diagnosis.

  17. A Case Report of Acute Hemorrhagic Edema of Infancy

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    M. Safari

    2005-10-01

    Full Text Available Introduction: Acute hemorrhagic edema of infancy is an acute and rare cutaneous disorder that affects children between 4 months to 2 years of age and characterized by cutaneous purpuric lesions with millimeters to centimeters diameter. Systemic involvement is rare. The disease is benign and spontaneously resolved in 1-3 weeks.Case Report: Here we described a 22-months old girl with acute hemorrhagic edema of infancy who hospitalized in department of pediatric with the presence of erythematous-purpuric lesions localized on the face, ears and lower limbs that developed suddenly two days before hospitalization. Laboratory examination revealed including normal cell blood counts, serum complements, serum electrolytes and creatinin. ANA was negative. Coagulation tests were normal. ESR was 45 mm/h. Urine analysis and stool examination revealed no abnormal findings. Disease resolved spontaneously without any problem.Conclusion: According to the contrast between the acuteness of the cutaneous sign, which are typical and unmistakable, and the general condition of the patient, which was good and the laboratory findings, our patient labeled as acute hemprrhagic edema of infancy.

  18. Term neonate with intracranial hemorrhage and hereditary hemorrhagic telangiectasia: a case report and review of the literature.

    Science.gov (United States)

    Delaney, H M; Rooks, V J; Wolfe, S Q; Sawyer, T L

    2012-08-01

    Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by mucocutaneous telangiectases and arteriovenous malformations (AVMs). The disease rarely presents in the neonatal period, primarily manifesting with epistaxis and gastrointestinal bleeding in adulthood. Occasionally, HHT can also present with symptoms related to AVMs in the cerebral, pulmonary or gastrointestinal vasculature. In prior reports, intracranial hemorrhage (ICH) secondary to cerebral AVM in neonates with HHT has been catastrophic and uniformly fatal. Here we report a case of a newborn with HHT and ICH from a suspected AVM who survived with aggressive medical management and surgical intervention, and provide a comprehensive review of the literature on ICH in neonates with HHT.

  19. 脑室-腹腔分流术后迟发性颅内出血8例临床分析%Clinical analysis of 8 patients with delayed intracranial hemorrhage after ventricular-peritoneal shunt for hydrocephalus

    Institute of Scientific and Technical Information of China (English)

    金浩; 张卫; 朱扬清; 邹煜; 周秋锋; 刘星; 钱伟; 左常阳

    2015-01-01

    目的:探讨脑室-腹腔分流术后出现迟发性颅内出血的类型,以及可能的防治措施。方法对72例脑室-腹腔分流术患者进行回顾性分析,分析术后发生迟发性颅内出血的规律和原因。结果本组患者中发生术后迟发性颅内血肿8例,急性硬膜下血肿2例、慢性硬膜下血肿2例及脑内血肿4例,是脑室-腹腔分流术后主要的三类迟发性颅内出血。结论选择合适的分流管、调整合适阀门压力以及熟练掌握脑室穿刺技巧可以减少及避免出现脑室-腹腔分流术后迟发性颅内出血。%Objective To explore the types of delayed intracranial hemorrhage after ventricular-peritoneal shunt for hydrocephalus , as well as effective prevention and control measures .Methods The clinical data of 72 patients suffered from delayed intracranial hemorrhage by ventricular-peritoneal shunt were analyzed retrospectively .The clinical features and factors were also analyzed .Results There were 8 cases of delayed intracranial hemorrhage after ventricular-peritoneal shunt in this group .The acute subdural hematoma , chronic subdural hematoma and intracerebral hemorrhage were the majory types of delayed intracranial emorrhage after ventricular -peritoneal shunt for hydrocephalus . Conclusion Choose the right shunt system , adjust the appropriate pressure and master the ventricle puncture techniques can reduce and avoid delayed intracranial hemorrhage .

  20. A Rare Case of Diffuse Alveolar Hemorrhage Secondary to Acute Pulmonary Histoplasmosis

    Directory of Open Access Journals (Sweden)

    Kunal Grover

    2015-01-01

    Full Text Available Diffuse alveolar hemorrhage (DAH is a rare presentation of acute pulmonary histoplasmosis. While histoplasmosis has been reported to cause hemoptysis and alveolar hemorrhage in children, the English language literature lacks any adult case reports documenting this association. We report a case of pulmonary histoplasmosis where the initial presentation was pneumonia with a subsequent diagnosis of DAH.

  1. Hypertensive thalamic hemorrhage. Clinical symptoms and outcomes in 40 cases

    Energy Technology Data Exchange (ETDEWEB)

    Munaka, Masahiro; Nishikawa, Michio; Hirai, Osamu; Kaneko, Takaaki; Watanabe, Syu; Fukuma, Jun; Handa, Hajime

    1988-12-01

    In the past six years, we have had experience with 40 patients with hypertensive thalamic hemorrhages, as verified by CT scan at our hospital within 24 hours. These patients were classified into the following three groups according to the location of the bleeding point and the size of the hematoma: (1) anteromedial (4 cases), (2) posterolateral (16 cases), and (3) massive (20 cases). The (1) and (2) hematomas were small (less than 3 cm in diameter), while those in (3) were large (more than 3 cm in diameter). Twenty cases (50% of all the thalamic hematomas) were small hematomas. The characteristic clinical symptoms of the anteromedial type were a mild disturbance of consciousness and thalamic dementia, while those of the posterolateral type were motor and sensory disturbance, and thalamic aphasia, respectively. Twenty cases (50%) were large hematomas. The clinical symptoms of these cases were mainly consciousness disturbance; 7 of them expired. Based on this experience, it may be considered that the patients whose hematoma size was larger than 3 cm had a poor prognosis and that the patients with the posterolateral type had a poor functional diagnosis.

  2. A Case of Expansion of Traumatic Choroidal Rupture with Delayed-Developed Outer Retinal Changes

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    Kun Moon

    2013-08-01

    Full Text Available Background: This study aims to report the expansion of a choroidal rupture site caused by blunt ocular trauma using scanning laser ophthalmoscope-optical coherence tomography. Case Report: The clinical course of a 15-year-old girl with a traumatic ocular injury after being hit in the eye by an elbow was evaluated. Upon the first examination, the best-corrected visual acuity was 16/20. The findings were subretinal pigment epithelial hemorrhage and vertical choroidal rupture. Three weeks after the trauma, the patient's visual acuity was reduced to counting fingers at 30 cm. On fundus examination and fluorescein angiography subretinal pigment epithelial hemorrhage decreased, while the choroidal rupture expanded; on optical coherence tomography outer retinal changes in the adjacent area were detected. Discussion: This study reveals that the delayed expansion of a choroidal rupture site and the delayed change of the adjacent outer retina improved.

  3. Uterine Artery Pseudoaneurysm in the Setting of Delayed Postpartum Hemorrhage: Successful Treatment with Emergency Arterial Embolization

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    Ankur M. Sharma

    2011-01-01

    Full Text Available Postpartum hemorrhage is a major cause of maternal mortality. Though uncommon, uterine artery pseudoaneurysm can follow uterine dilatation and curettage (D + C and needs to be considered in the differential diagnosis. This 30-year-old G1P1 woman presented with right upper quadrant pain and vaginal bleeding. She was afebrile but her white blood count was significantly increased (22.2×109 /L. One week prior, she had undergone a Cesarean delivery which was complicated by hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP, fetal dystocia, and chorioamnionitis. Uterine dilatation and curettage (D & C and placement of a Bakri intrauterine balloon, performed for suspected retained products of conception, failed to control her postpartum bleeding. The patient wished to have a hysterectomy only as a last resort in order to preserve fertility. Emergency uterine artery angiography revealed a left uterine artery pseudoaneurysm and contrast extravasation. The patient was successfully treated with selective embolization. Computed tomography (CT later revealed dehiscence of her uterine Cesarean section incision with an intra-abdominal fluid collection. This collection was drained. She also developed disseminated intravascular coagulopathy (DIC syndrome as well as multiple pulmonary emboli which were both successfully treated. We discuss this unique case of uterine artery pseudoaneurysm with associated uterine dehiscence.

  4. A case of brucellosis mimicking Crimean-Congo hemorrhagic fever.

    Science.gov (United States)

    Metin, Ozge; Teke, Turkan A; Gayretli Aydin, Zeynep G; Kaman, Ayse; Oz, Fatma N; Bayhan, Gulsum I; Tanir, Gonul

    2015-01-01

    Brucellosis is a zoonotic disease caused by Brucella spp. that is transmitted to humans by the ingestion of unpasteurized milk and other dairy products from infected animals or through close contact with secretions. Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease caused by a virus that is transmitted to humans by ixoid tick bites, contact with blood and tissue of infected animals or contact with infected humans. The symptoms of brucellosis are non-specific; it can mimic other diseases. In this paper, we present a case of brucellosis that was initially evaluated as CCHF. We emphasize that brucellosis should be considered in the differential diagnosis of CCHF, especially in endemic countries.

  5. Simulated pituitary apoplexy: report of an unusual case due to hemorrhage into hypothalamic astrocytoma.

    Science.gov (United States)

    Glew, W B

    1977-02-01

    An unusual case of acute bilateral loss of vision simulating pituitary apoplexy but due instead to a fatal hemorrhage into a hypothalamic glioma is reported. The clinician dealing with abrupt loss of vision must promptly rule out ocular and orbital causes and then proceed immediately to a consideration of the variety of intracranial lesions which may cause sudden visual loss. Uihlein and Rucker have listed them in descending order of frequency: pituitary adenoma, tumors of the optic nerve and chiasm, supraclinoid aneurysm, parasellar lesion, thrombosis of the carotid artery, hydrocephalus of the third ventricle, chiasmal arachnoiditis, fracture of the anterior cranial fossa, basofrontal tumor of the skull, and pseudotumor cerebri. Neurologic, ophthalmologic, and neuroradiologic evaluations should be obtained without delay and will usually define the lesion and point to the appropriate treatment.

  6. Clinical and pathological study on 10 cases of cerebral lobe hemorrhage related with cerebral amyloid angiopathy

    Directory of Open Access Journals (Sweden)

    Xiao-qi LI

    2015-07-01

    Full Text Available Objective To summarize the clinical data and pathological features of 10 cases of cerebral lobar hemorrhage related with cerebral amyloid angiopathy (CAA diagnosed pathologically, thereby to improve the knowledge and diagnosis of the disease. Methods The clinical data of 10 cases of cerebral lobar hemorrhage related with CAA, collected in the General Hospital of Shenyang Command from 1983 up to now, were retrospectively analyzed, and the clinical and neuropathological features of these cases were summarized. Results Of the 10 patients, 2 suffered from single lobar hemorrhage and 8 multiple lobar hemorrhage, all of them were confirmed pathologically to have ruptured into the subarachnoid space. Pathological examination revealed microaneurysm in 2 cases, "double barrel" change in 4 cases, multiple arteriolar clusters in 5 cases, obliterative onion-liked intima change in 4 cases, and fibrinoid necrosis of vessel wall in 7 cases. In addition, neurofibrillary tangles were found in 8 cases, and senile plaque was observed in 5 cases. Conclusions Cerebral lobar hemorrhage related with CAA is mainly located in the parietal, temporal and occipital lobes, readily breaking into the subarachnoid space, and it is often multiple and recurrent. The CAA associated microvasculopathy was found frequently in the autopsy sample of CAA related cerebral lobar hemorrhage, and it may contribute to the pathogenesis of cerebral hemorrhage. DOI: 10.11855/j.issn.0577-7402.2015.07.04

  7. Meta-analysis of APOE genotype and subarachnoid hemorrhage - Clinical outcome and delayed ischemia

    NARCIS (Netherlands)

    Lanterna, L. A.; Ruigrok, Y.; Alexander, S.; Tang, J.; Biroli, F.; Dunn, L. T.; Poon, S.

    2007-01-01

    Background: Emerging evidence suggests that the APOE4 allele may increase the risk of a negative outcome in patients with aneurysmal subarachnoid hemorrhage (SAH), but the results are conflicting. A genetic variable predicting the individual clinical course is currently lacking. Objective: To examin

  8. Subdural hemorrhages in acute lymphoblastic leukemia: case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Rui Yin; CaiXia Qiu; XiaoHui Dong; YeLong Chen

    2016-01-01

    Background:Acute lymphoblastic leukemia is a rare hematological malignancy.Pure subdural hemorrhages in a patient with acute lymphoblastic leukemia patient are extremely rare.Case presentation:This case presented acute spontaneous subdural hemorrhage without head trauma at first,and acute lymphoblastic leukemia was diagnosed later.The second time,the patient was admitted with multiple pure subdural hemorrhages in different locations and periods with a history of slight head trauma.Conclusions:Pure subdural hemorrhages can occur in a patient with acute lymphoblastic leukemia.More care would be needed for pure subdural hemorrhages without obvious head trauma,and patients with hematological malignancies should be protected from even mild head trauma.

  9. Risk of Delayed Intracerebral Hemorrhage in Anticoagulated Patients after Minor Head Trauma: The Role of Repeat Cranial Computed Tomography

    Science.gov (United States)

    Swap, Clifford; Sidell, Margo; Ogaz, Raquel; Sharp, Adam

    2016-01-01

    Context: Patients receiving anticoagulant medications who experience minor head injury are at increased risk of an intracerebral hemorrhage (ICH) developing, even after an initial computed tomography (CT) scan of the brain yields normal findings. Conflicting evidence exists regarding the frequency at which delayed bleeding occurs. Objective: To identify the frequency of delayed traumatic ICH in patients receiving warfarin or clopidogrel. Design: We performed a retrospective observational study of adult trauma encounters for anticoagulated patients undergoing head CT at 1 of 13 Kaiser Permanente Southern California Emergency Departments (EDs) between 2007 and 2011. Encounters were identified using structured data from electronic health and administrative records, and then records were individually reviewed for validation of results. Main Outcome Measures: The primary outcome measure was ICH within 60 days of an ED visit with a normal head CT result. Results: Our sample included 443 (260 clopidogrel and 183 warfarin) eligible ED encounters with normal findings of initial head CT. Overall, 11 patients (2.5%, 95% confidence interval [CI] = 1.4%–4.4%) had a delayed ICH, and events occurred at similar rates between the clopidogrel group (6/260, 2.3%, CI 1.1%–5.0%) and warfarin group (5/183, 2.7%, CI 1.2%–6.2%). Conclusion: Trauma patients in the ED who are receiving warfarin or clopidogrel have approximately a 2.5% risk of delayed ICH after an initial normal finding on a head CT. PMID:26901269

  10. Case report of subcapsular hemorrhage of the liver in the newborn. Diagnosed and observed by CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Nakagawa, Masao; Matsumura, Takafumi; Esumi, Noriko; Tsunamoto, Kentaro; Iino, Shigeru (Kyoto Prefectural Univ. of Medicine (Japan))

    1982-11-01

    A recent case of subcapsular hemorrhage of the liver in a newborn showed that abdominal CT scan was highly useful in the diagnosis of this disease and the follow-up of the healing mechanism of the intrahepatic hemorrhagic lesion.

  11. [Two cases of acute myelogenous leukemia with Bacillus cereus bacteremia resulting in fatal intracranial hemorrhage].

    Science.gov (United States)

    Yoshida, H; Moriyama, Y; Tatekawa, T; Tominaga, N; Teshima, H; Hiraoka, A; Masaoka, T; Yoshinaga, T

    1993-12-01

    This manuscript reports Bacillus cereus sepsis in two cases with acute myelogenous leukemia (AML) who suffered complications of fatal intracranial hemorrhage during remission induction therapy. The first case was 43-year-old male with AML (M0) receiving first consolidation chemotherapy who developed sudden diarrhea, abdominal pain and spiking fever. Two days later, he died of intracranial hemorrhage. The second case was 15-year-old male with AML (M5b) who was receiving first induction chemotherapy. He developed headache and vomiting following spiking fever and diarrhea. He died of subarachnoid hemorrhage the next day. In both cases, Bacillus cereus was isolated from blood culture. Fatal intracranial hemorrhage due to severe bleeding tendency caused rapid to death in both cases. These bleeding tendencies might have been induced by B. cereus sepsis. In addition, we should not overlook B. cereus as contamination, but rather consider it as a potential pathogen, when isolated from blood culture.

  12. An autopsy case of methanol induced intracranial hemorrhage.

    Science.gov (United States)

    Kim, Hye-Jeong; Na, Joo-Young; Lee, Young-Jik; Park, Jong-Tae; Kim, Hyung-Seok

    2015-01-01

    The major component of car washer fluid is a methanol. Intracranial hemorrhage is a rare but lethal complication in methanol poisoning. We report a case of massive bilateral basal ganglia hematoma in a 32-year-old man with methanol poisoning. He drank car washer solution twice time (about 500 ml), and was admitted to a territorial hospital 10 hours post-ingestion for depressed mental status, lower blood pressure, and high anion gap metabolic acidosis. Computed tomographic (CT) scan showed lesions in both putamen and cerebral deep white matter. Twenty-one days after methanol exposure, he suddenly developed cardiorespiratory arrest. In autopsy, external examination revealed moderate cerebral edema, but no evidence of herniation. Coronal sections of the brain showed softening and about 34 g hematoma in the bilateral putamen and 3rd ventricles. The toxic effect of methanol on the visual system has been noted in the absence of neurologic manifestations; however, there have also been a report of concomitant brain in Korea.

  13. Peripancreatic cystic lymphangioma with secondary hemorrhage: A rare case report

    Directory of Open Access Journals (Sweden)

    Kanapilly Francis Magdalene

    2016-01-01

    Full Text Available Lymphangiomas are thought to be true neoplasms, hamartomas or lymphangiectasias. Intra-abdominal lymphangiomas are rare and occur most frequently in children. This is a case report of a 27-year-old female with recurrent episodes of the left-sided upper abdominal pain of 2 years duration. She gives a history of intermittent nausea and vomiting. Liver function test and complete blood count with differential were normal. During the initial stages of illness, the serum lipase was elevated; the serum amylase level was normal all through the entire period. The upper gastrointestinal endoscopy suggested hiatal hernia and mild duodenitis. Two computed tomography scans done at 5 months interval showed a hypodense lesion in the distal tail of pancreas with irregular margins. The size of lesions had decreased from 15 mm × 14 mm to 13.5 mm × 10 mm during this period. Endoscopic ultrasound showed ill-defined area in the distal tail of pancreas and pseudocyst was suspected. Magnetic resonance cholangiopancreatography after 2 months showed a cystic lesion in the tail of pancreas of size 11 mm × 10 mm. Due to increasing severity of pain and fainting spells, the patient was taken up for a distal pancreatectomy. The histopathologic examination confirmed a diagnosis of peripancreatic cystic lymphangioma with secondary hemorrhage. During the postoperative period, the drain amylase was high suggestive of grade A pancreatic fistula. Gradually, the levels decreased, the patient became stable and discharged after pneumococcal vaccination.

  14. Postpartum hemorrhage prevention: a case study in northern rural Honduras.

    Science.gov (United States)

    Low, Lisa Kane; Bailey, Joanne Motiño; Sacks, Emma; Medina, Lilian; Piñeda, Hector Oqueli Lopez

    2008-01-01

    Postpartum hemorrhage (PPH) is the leading cause of maternal mortality globally. Safe Motherhood policies have been directed towards the reduction of PPH by recommending active management of third-stage labor as the standard of care. One component of active management involves routine use of a uterotonic agent within 1 minute of the delivery of the baby. A case study at Clínica Materno-Infantil, a free-standing public birth center in Honduras, is presented, focusing on methods to reduce PPH. The nursing staff was trained to estimate blood loss and in methods to manage PPH, including elements of active management of the third stage of labor. Medical records were reviewed and an analysis of PPH management compared to estimated blood loss (EBL) was conducted. There was no significant correlation between PPH management techniques and EBL (r = .060; P = .368). There was a statistically significant (P Materno-Infantil, routine use of a uterotonic agent appears beneficial and further implementation of active management of the third stage of labor appears warranted.

  15. Recurrent hemorrhagic pericardial effusion in a child due to diffuse lymphangiohemangiomatosis: a case report

    Directory of Open Access Journals (Sweden)

    Bakhshi Sameer

    2010-02-01

    Full Text Available Abstract Introduction Recurrent hemorrhagic pericardial effusion in children with no identifiable cause is a rare presentation. Case presentation We report the case of a 4-year-old Indian girl who presented with recurrent hemorrhagic pericardial effusion. Diffuse lymphangiomatosis was suspected when associated pulmonary involvement, soft tissue mediastinal mass, and lytic bone lesions were found. Pericardiectomy and lung biopsy confirmed the diagnosis of diffuse lymphangiohemangiomatosis. Partial clinical improvement occurred with thalidomide and low-dose radiotherapy, but our patient died from progressive respiratory failure. Conclusion Diffuse lymphangiohemangiomatosis should be considered in the differential diagnosis of hemorrhagic pericardial effusion of unclear cause.

  16. Diagnosis of chronic myeloid leukemia from acute intracerebral hemorrhage: A case report

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    Chakroun-Walha Olfa

    2015-08-01

    Full Text Available Intracerebral hemorrhage (ICH is frequent pathology in emergency departments. Coagulopathies leading to ICH are rare. We describe here the case of diagnosis of a chronic myeloid leukemia from ICH in emergencies.

  17. Risk analysis for aspirin and postoperative intracranial hemorrhage - report of 3 cases

    Institute of Scientific and Technical Information of China (English)

    YU Shu-qing; WANG Ji-sheng; JI Nan; LIU Wei; QIAN Ke

    2009-01-01

    @@ Aspirin has been widely used clinically since 1899.For patients with cerebral ischemia and implanted intravascular stents, aspirin has been used routinely for prevention of intracranial hemorrhage and for anticoagulation treatment. However, many multi-center,large sample, controlled studies have shown that aspirin may actually increase the risk of spontaneous cerebral hemorrhage, and that aspirin was an independent predictor of death shortly after cerebral hemorrhage. Here we report a case series, between July 1 2006 and January 1 2008, of 3 patients who experienced postoperative intracranial hemorrhage after receiving regular aspirin treatment before surgery in the Center of Neurosurgery,Beijing Tiantan Hospital, Capital Medical University.Two of them died. There were 86 patients in all receiving regular aspirin treatment before surgery in the same period. The incidence of intracranial hemorrhage in this group is 3.49%.

  18. Hemorrhagic cystitis with massive bleeding from nontyphoidal Salmonella infection: A case report

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    Sun-Kyung Na

    2013-06-01

    We report a case of a 41-year-old man with hemorrhagic cystitis from NTS that caused massive bleeding and shock. The patient was hospitalized for uncontrolled diabetes and obstructive uropathy related to severe cystitis. A urine culture was positive for group D NTS. This case demonstrated that hemorrhagic cystitis in a patient with a risk factor such as diabetes can be a manifestation of local extra-intestinal NTS infection.

  19. Spontaneous Perirenal Hemorrhage in Cauda Equina Syndrome: A Case Report

    OpenAIRE

    Seok, Hyun; Kim, Sang-hyun; Choi, Won Hyuck; Ko, Yong Jae

    2013-01-01

    Neurogenic bladder is a common cause of acute pyelonephritis (APN) in cauda equina syndrome (CES). Perirenal hemorrhage, a rare complication of APN, can be a life-threatening condition. To our knowledge, there is no previous report of perirenal hemorrhage as a complication of APN in CES. A 57-year-old male, diagnosed with CES, due to a L3 burst fracture 3 months earlier, was presented with fever and chills. His diagnosis was APN due to neurogenic bladder. After treatment for APN, he was trans...

  20. Response to imported case of Marburg hemorrhagic fever, the Netherlands

    NARCIS (Netherlands)

    Timen, A.; Koopmans, M.P.; Vossen, A.C.; Doornum, G.J.J. van; Gunther, S.; Berkmortel, F. van den; Verduin, K.M.; Dittrich, S.; Emmerich, P.; Osterhaus, A.D.; Dissel, J.T. van; Coutinho, R.A.

    2009-01-01

    On July 10, 2008, Marburg hemorrhagic fever was confirmed in a Dutch patient who had vacationed recently in Uganda. Exposure most likely occurred in the Python Cave (Maramagambo Forest), which harbors bat species that elsewhere in Africa have been found positive for Marburg virus. A multidisciplinar

  1. Response to imported case of Marburg hemorrhagic fever, the Netherland

    NARCIS (Netherlands)

    Timen, A.; Koopmans, M.P.G.; Vossen, A.C.T.M.; van Doornum, G.J.J.; Günther, S.; van den Berkmortel, F.; Verduin, K.M.; Dittrich, S.; Emmerich, P.; Osterhaus, A.D.M.E.; van Dissel, J.T.; Coutinho, R.A.

    2009-01-01

    On July 10, 2008, Marburg hemorrhagic fever was confirmed in a Dutch patient who had vacationed recently in Uganda. Exposure most likely occurred in the Python Cave (Maramagambo Forest), which harbors bat species that elsewhere in Africa have been found positive for Marburg virus. A multidisciplinar

  2. Response to Imported Case of Marburg Hemorrhagic Fever, the Netherlands

    NARCIS (Netherlands)

    Timen, Aura; Koopmans, Marion P. G.; Vossen, Ann C. T. M.; van Doornum, Gerard J. J.; Guenther, Stephan; van den Berkmortel, Franchette; Verduin, Kees M.; Dittrich, Sabine; Emmerich, Petra; Osterhaus, Albert D. M. E.; van Dissel, Jaap T.; Coutinho, Roel A.

    2009-01-01

    On July 10, 2008, Marburg hemorrhagic fever was confirmed in a Dutch patient who had vacationed recently in Uganda. Exposure most likely occurred in the Python Cave (Maramagambo Forest), which harbors bat species that elsewhere in Africa have been found positive for Marburg virus. A multidisciplinar

  3. Cerebral salt-wasting syndrome due to hemorrhagic brain infarction: a case report

    OpenAIRE

    Tanaka, Tomotaka; Uno, Hisakazu; Miyashita, Kotaro; Nagatsuka, Kazuyuki

    2014-01-01

    Introduction Cerebral salt-wasting syndrome is a condition featuring hyponatremia and dehydration caused by head injury, operation on the brain, subarachnoid hemorrhage, brain tumor and so on. However, there are a few reports of cerebral salt-wasting syndrome caused by cerebral infarction. We describe a patient with cerebral infarction who developed cerebral salt-wasting syndrome in the course of hemorrhagic transformation. Case presentation A 79-year-old Japanese woman with hypertension and ...

  4. A Case of Hemophilia A Associated with Spontaneous Hemorrhagic Pleural Effusion and Intracranial Hem

    Directory of Open Access Journals (Sweden)

    Nuri Tutar

    2014-03-01

    Full Text Available Hemophilia A is a sex-linked recessive coagulation disorder almost exclusively occurring in male subjects and caused by a deficiency of factor VIII. It  is a rare disorder characterized by spontaneous hemorrhages. Spontaneous bleeding in the pleural space is very rare in hemophilia both in children and adults. Here in, we present the case of a 56-year-old hemophilia A patient with hemorrhagic pleural effusion and intracranial hematoma.

  5. An intractable case of lower gastrointestinal hemorrhage due to radiation colitis. Usefulness of transcatheter arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Koichi; Koyama, Tukasa [Yoka Hospital, Hyogo (Japan); Sugamura, Kenji; Ogawa, Toshihide [Tottori Univ., Yonago (Japan). Faculty of Medicine

    2003-05-01

    We tried transcatheter arterial embolization for lower gastrointestinal hemorrhage due to radiation colitis. In this case, colostomy and endoscopic therapy were not effective. We succeeded in arresting the hemorrhage without any complications. Transcatheter embolization is a low-invasive and safe method of treatment. For prevention of inflammation and iatrogenic abscess formation, we repeated this therapy and we tried arterial injection of antibiotics and steroid. And so, this therapy is one of the effective methods. (author)

  6. Brain hemorrhage associated with maintenance hemodialysis. CT analysis of 19 cases

    Energy Technology Data Exchange (ETDEWEB)

    Kawahata, Nobuya (Narita Memorial Hospital, Chiba (Japan))

    1994-04-01

    The CT findings of 19 hemodialyzed patients with brain hemorrhage (BH) were evaluated. The 30-day mortality rate was 78.9%. The lesion locations in the 19 cases with BH were putaminal hemorrhage in 8 patients, putaminothalamic (mixed) hemorrhage in 7, thalamic hemorrhage in one, subcortical hemorrhage in one, and cerebellar hemorrhage in one. In the remaining patient, the bleeding was confined to the ventricular system. One remarkable CT finding was the formation of a massive hematoma in most cases. In some cases, the hematoma occupied the greater part of one cerebral hemisphere. Oral anticoagulants and/or antiplatelet drugs, and intravenous heparinization could produce massive accumulations of blood in the brain parenchyma. The second major finding was the low CT absorption values of the hematoma at the acute stage, as compared to that of hypertensive BH. This decreased absorption density resulted from a low hemoglobin concentration in the hematoma itself due to the severe anemia occurring in patients on long-term maintenance hemodialysis. (author).

  7. Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hee Seok; Lee, Yong Seok; Lim, Ji Hyon; Kim, Kyung Soo; Yoon, Yup [Dongguk University College of Medicine, Goyang (Korea, Republic of); Hwang, Jae Cheol [Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (Korea, Republic of)

    2007-08-15

    Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization. Hemorrhagic fever with renal syndrome (HFRS) is an acute infectious disease caused by hantavirus. HFRS is clinically characterized by fever, renal failure and hemorrhage in organs such as lung, kidney, spleen and the pituitary gland. Renal medullary hemorrhage is a well-known complication in the kidney, but spontaneous rupture of the kidney and perirenal hematoma in HFRS is rare, and patients showing continuous bleeding and massive perirenal hematoma have often been surgically treated. We report here on a case of HFRS complicated by massive perirenal hematoma, and the patient was treated with transcatheter arterial embolization. In summary, spontaneous rupture of the kidney and perirenal hematoma is a rare complication of HFRS. We report here on a case of HFRS that caused massive perirenal hematoma, and this was treated with superselective renal artery embolization.

  8. Value of Perfusion CT, Transcranial Doppler Sonography, and Neurological Examination to Detect Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Ekkehard Kunze

    2012-01-01

    Full Text Available Background. If detected in time, delayed cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH may be treated by balloon angioplasty or chemical vasospasmolysis in order to enhance cerebral blood flow (CBF and protect the brain from ischemic damage. This study was conceived to compare the diagnostic accuracy of detailed neurological examination, Transcranial Doppler Sonography (TCD, and Perfusion-CT (PCT to detect angiographic vasospasm. Methods. The sensitivity, specificity, positive and negative predictive values of delayed ischemic neurological deterioration (DIND, pathological findings on PCT-maps, and accelerations of the mean flow velocity (MVF were calculated. Results. The accuracy of DIND to predict angiographic vasospasm was 0.88. An acceleration of MFV in TCD (>140 cm/s had an accuracy of 0.64, positive PCT-findings of 0.69 with a higher sensitivity, and negative predictive value than TCD. Interpretation. Neurological assessment at close intervals is the most sensitive and specific parameter for cerebral vasospasm. PCT has a higher accuracy, sensitivity and negative predictive value than TCD. If detailed neurological evaluation is possible, it should be the leading parameter in the management and treatment decisions. If patients are not amenable to detailed neurological examination, PCT at regular intervals is a helpful tool to diagnose secondary vasospasm after aneurysmal SAH.

  9. Radiological findings in cerebral venous thrombosis presenting as subarachnoid hemorrhage: a series of 22 cases

    Energy Technology Data Exchange (ETDEWEB)

    Boukobza, Monique [APHP - Paris-Diderot University, Department of Neuroradiology and Therapeutic Angiography, Assistance publique - University Hospitals Lariboisiere-St-Louis-Fernand-Widal, Paris (France); Crassard, Isabelle; Bousser, Marie-Germaine [Assistance publique - University Hospitals Lariboisiere-St-Louis-Fernand-Widal, APHP - Paris-Diderot University Paris, France, Department of Neurology, Paris (France); Chabriat, Hugues [Assistance publique - University Hospitals Lariboisiere-St-Louis-Fernand-Widal, APHP - Paris-Diderot University Paris, France, Department of Neurology, Paris (France); INSERM UMR 1161 and DHU NeuroVasc, Paris (France)

    2016-01-15

    The main objectives of the present study are to assess the incidence of cerebral venous thrombosis (CVT) presenting as isolated subarachnoid hemorrhage (SAH) and to determine the occurrence of cortical venous thrombosis (CoVT). Among 332 patients with CVT, investigated with the same CT and MR standardized protocol, 33 (10 %) presented with SAH, associated in 11 cases with hemorrhagic infarct or intracerebral hemorrhage. This study is based on 22 cases of CVT presenting as SAH in the absence of hemorrhagic brain lesion. Diagnosis of sinus thrombosis was established on T2* and magnetic resonance venography and that of CoVT on T2* sequence. Diagnostic of SAH was based on fluid-attenuated inversion recovery (FLAIR) sequence. CVT involved lateral sinus in 18 patients, superior sagittal sinus in 16, and straight sinus in 1. Cortical veins were involved in all patients, in continuity with dural sinus thrombosis when present. SAH was circumscribed to few sulci in all cases and mainly localized at the convexity (21 cases). CoVT implied different areas on the same side in four patients and was bilateral in seven. There was no perimesencephalic or basal cisterns hemorrhage. Cortical swelling was present in 12 cases, associated with localized edema. All patients except one had a favorable outcome. This report shows that the incidence of CVT presenting as isolated SAH is evaluated to 6.4 % and that SAH is, in all cases, in the vicinity of CoVT and when dural thrombosis is present in continuity with it. (orig.)

  10. Airbag-Associated Severe Blunt Eye Injury Causes Choroidal Rupture and Retinal Hemorrhage: A Case Report

    Directory of Open Access Journals (Sweden)

    Shih Hao Wang

    2017-01-01

    Full Text Available A case of choroidal rupture caused by airbag-associated blunt eye trauma and complicated with massive subretinal hemorrhage and vitreous hemorrhage that was successfully treated with intravitreal injection of expansile gas and bevacizumab is presented. A 53-year-old man suffered from loss of vision in his right eye due to blunt eye trauma by a safety airbag after a traffic accident. On initial examination, the patient had no light perception in his right eye. Dilated ophthalmoscopy revealed massive subretinal hemorrhage with macular invasion and faint vitreous hemorrhage. We performed intravitreal injection of pure sulfur hexafluoride twice for displacement, after which visual acuity improved to 0.03. For persistent subretinal hemorrhage and suspicion of choroidal neovascularization (CNV, intravitreal bevacizumab (1.25 mg/0.05 mL injection was administered. After 3 weeks, the visual acuity of his right eye recovered to 0.4. For early-stage choroidal rupture-induced subretinal hemorrhage and complications of suspected CNV, intravitreal injection of expandable gas and intraocular injection of antiangiogenesis drugs seem to be an effective treatment.

  11. Relationship between Breteau and House indices and cases of dengue/dengue hemorrhagic fever in Kuala Lumpur, Malaysia.

    Science.gov (United States)

    Sulaiman, S; Pawanchee, Z A; Arifin, Z; Wahab, A

    1996-09-01

    The relationship between the Breteau index, the House index, and the occurrence of dengue/dengue hemorrhagic fever in the 6 zones of Kuala Lumpur was studied throughout 1994. Cases of dengue/dengue hemorrhagic fever varied between zones and between months, ranging from 0 to 21 cases. In most of the zones in Kuala Lumpur, the occurrence of dengue/dengue hemorrhagic fever has no relationship with the Breteau and House indices. Cases of dengue/dengue hemorrhagic fever occurred in all zones despite the low Breteau and House indices.

  12. Acute glomerulonephritis in dengue hemorrhagic fever: A rare case report

    Directory of Open Access Journals (Sweden)

    K R Meena

    2013-01-01

    Full Text Available An 11-year-old male child presented with fever, bodyache, swelling over the whole body, and oliguria. He had hypertension. Urine microscopy showed hematuria and glomerular casts. Renal functions were deranged and had low complement C3 level. Chest X-ray showed plural effusion and ultrasonography abdomen showed mild ascitis. The immunoglobulin (IgM and IgG enzyme-linked immunosorbent essay for dengue virus were positive. Diagnosis of dengue hemorrhagic fever with acute glomerulonephritis was made. He was managed with maintenance fluid, antihypertensive medicine and supportive care. He recovered gradually and was discharged 12 days after admission.

  13. A case of thalamic hemorrhage-induced diaschisis

    Institute of Scientific and Technical Information of China (English)

    Gang Yao; Yuhong Man; Xijing Mao; Tingmin Yu

    2011-01-01

    Diaschisis refers to a disturbance (inhibition or facilitation) of function in an area remote from the site of a primary brain lesion. Previous studies have confirmed that regional cerebral blood flow and metabolism are noticeably decreased in an infarct region. Transient excessive perfusion appears in the ischemic penumbra, and diaschisis occurs in an area remote from the lesion site, showing decreased regional cerebral blood flow and metabolism. Mirror diaschisis refers to a decrease in oxygen metabolism and blood flow in the "mirror image area" to the infarct regions in the contralateral hemisphere. In this study, a patient with right thalamic hemorrhage was affected with right arm and leg numbness. At 4 months before onset, magnetic resonance imaging of the head demonstrated lacunar infarcts in the left thalamus; therefore the right arm and leg numbness was not associated with lacunar infarcts in the left thalamus. At 8 days following onset, magnetic resonance imaging reexamination did not reveal the focus that could induce right arm and leg numbness and weakness. Thus, it is suggested in this study that the onset of this disease can be explained by mirror diaschisis. That is, right thalamic hemorrhage leads to decreased blood flow and metabolic disturbance in the contralateral thalamus, resulting in right arm and leg numbness.

  14. Hemiballismus That Develops upon Thalamic Hemorrhage: A Case Report

    Directory of Open Access Journals (Sweden)

    Aybala Neslihan Alagöz

    2016-04-01

    Full Text Available Hemichorea is characterized by sudden, spasmodic, irregular, short-term finger, hand, arm, face, tongue or head movements including one half of body. Ballismus concept defines the high-amplitude, violent, centrifugal or throwing motions. Hemichorea-hemiballismus are the most frequently reported movement disorders in patients with acute stroke. Even if it is believed to occur depending on the effect on contralateral subthalamic nucleus; it has been reported that in the following years there have been choreic and ballistic movements in various lesions intersecting the afferent and efferent subtalamopalidal paths of basal ganglion. In this article; hemiballismus, which has developed after thalamic hemorrhage, of an 63 year old female patient is presented.

  15. Mycotic brain aneurysm and cerebral hemorrhagic stroke: a pediatric case report.

    Science.gov (United States)

    Flor-de-Lima, Filipa; Lisboa, Lurdes; Sarmento, António; Almeida, Jorge; Mota, Teresa

    2013-09-01

    Endocarditis due to Abiotrophia spp. is rare and often associated with negative blood cultures, infection relapse, and high rates of treatment failure and mortality (Lainscak et al., J Heart Valve Dis 14(1):33-36, 2005). The authors describe a case of an adolescent with cerebral hemorrhagic stroke due to mycotic brain aneurysm rupture.

  16. A rare case of cervical fibroid presenting as retained placenta with postpartum hemorrhage

    Directory of Open Access Journals (Sweden)

    Meenakshi Chowdhury

    2015-04-01

    Full Text Available Fibroids during pregnancy are often asymptomatic but sometimes may lead to various complications and unusual presentations. We are reporting an unusual case of cervical fibroid during pregnancy that presented as retained placenta with postpartum hemorrhage following a full term normal vaginal delivery. [Int J Reprod Contracept Obstet Gynecol 2015; 4(2.000: 505-507

  17. [Hemorrhagic infarction of the testicle in the newborn infant. A case presentation].

    Science.gov (United States)

    Coronel Sánchez, B; Domínguez Hinarejos, C; Serrano Durbá, A; Martínez Verduch, M; Estornell Moragues, F; García Ibarra, F

    2004-05-01

    Hemorrhagic infarction of the testicle is an unusual occurrence in the newborn infant. It usually develops as a consequence of torsion of the spermatic cord. We report a case of global testicular infarction in a newborn associated with a tense hydrocele.

  18. Hemorrhagic fever with renal syndrome complicated with pregnancy: a case report.

    Science.gov (United States)

    Kim, Baek-Nam; Choi, Byung-Don

    2006-06-01

    Hantaviruses cause two forms of human disease: hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome. Hantavirus infection can occur in pregnant women and it can have an influence on the maternal and fetal outcomes, although this is a rare finding even in endemic areas. We describe here a recent case of HFRS complicating pregnancy.

  19. Hemorrhagic Fever with Renal Syndrome Complicated with Pregnancy: A Case Report

    OpenAIRE

    2006-01-01

    Hantaviruses cause two forms of human disease: hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome. Hantavirus infection can occur in pregnant women and it can have an influence on the maternal and fetal outcomes, although this is a rare finding even in endemic areas. We describe here a recent case of HFRS complicating pregnancy.

  20. Supernova hemorrhage: obliterative hemorrhage of brain arteriovenous malformations following γ knife radiosurgery.

    Science.gov (United States)

    Alexander, Matthew D; Hetts, Steven W; Young, William L; Halbach, Van V; Dowd, Christopher F; Higashida, Randall T; English, Joey D

    2012-09-01

    Hemorrhage represents the most feared complication of cerebral arteriovenous malformations (AVMs) in both untreated patients and those treated with gamma knife radiosurgery. Radiosurgery does not immediately lead to obliteration of the malformation, which often does not occur until years following treatment. Post-obliteration hemorrhage is rare, occurring months to years after radiosurgery, and has been associated with residual or recurrent AVM despite prior apparent nidus elimination. Three cases are reported of delayed intracranial hemorrhage in patients with cerebral AVMs treated with radiosurgery in which no residual AVM was found on catheter angiography at the time of delayed post-treatment hemorrhage. That the pathophysiology of these hemorrhages involves progressive venous outflow occlusion is speculated and the possible mechanistic link to subsequent vascular rupture is discussed.

  1. Numerous cerebral hemorrhages in a patient with influenza-associated encephalitis: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Ye; Seong, Su Ok; Park, Noh Hyuck; Park, Chan Sup [Dept. of Radiology, Myongji Hospital, Goyang (Korea, Republic of)

    2016-02-15

    Influenza-associated encephalitis (IAE) is a complication of a common disease that is rare even during an epidemic. Awareness of magnetic resonance imaging features of IAE is important in treatment planning and prognosis estimation. Several reports have described necrotizing encephalopathy in children with influenza. However, few reports have described multifocal hemorrhages in both cerebral hemispheres in adults with concomitant infection with influenza A and B. Here, we describe a case of influenza A- and B-associated encephalitis accompanied by numerous cerebral hemorrhages.

  2. [Role of vascular erosion in massive colonic hemorrhage of diverticular origin. Apropos of a case].

    Science.gov (United States)

    Delattre, J F; Palot, J P; Casola, M; Baudrillard, J C; Denis, J P

    1986-01-01

    A case of massive hemorrhage from colon of diverticular origin is reported. A complete study of operative specimen allowed precise localization of diverticulum responsible and guidance of histopathologists in their search for the arterial erosion. Histology showed loss of arterial substance with total communication with diverticular lumen. A literature review emphasized vascular relations of diverticuli and the role of stercoliths in the mechanical agression responsible for the massive hemorrhage. It also illustrated the predominance of arteriography in the modern diagnostic and therapeutic approach to these lesions.

  3. A rare case of infantile cerebellar pilocytic astrocytoma and thrombocytopenia presenting with intratumoral hemorrhage

    Directory of Open Access Journals (Sweden)

    Shashank R Ramdurg

    2016-01-01

    Full Text Available Incidence of gliomas presenting with hemorrhage is around 3.7–7.2%. Low-grade gliomas account for <1% tumor with hemorrhage. Infants presenting with cerebellar pilocytic astrocytomas (PAs and hemorrhage with thrombocytopenia have not been reported. We report an interesting case of a 9-month-old infant who presented to the emergency department in a drowsy state with recurrent vomiting. Laboratory investigations showed anemia, thrombocytopenia, and coagulopathy. Radiological evaluation showed a large PA with bleed. The patient was treated with retromastoid suboccipital craniotomy and tumor excision and improved postoperatively. Cerebellar PA with bleed and coagulopathy in infants has not been reported in literature till date. Their presentation seems to be acute in nature, and high index of suspicion is required for the diagnosis of these posterior fossa tumors, which can deteriorate rapidly in infants.

  4. Ultrasonographic and computed tomographic findings of hemorrhagic cholecystitis; report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bum Soo; Byun, Jae Young; Shinn, Kyung Sub [Catholic Univ. College of Medicine, Seoul (Korea, Republic of); Kim, Jong Woo [Kangnung Dongin Hospital, Kangnung (Korea, Republic of)

    1996-01-01

    Hemorrhagic cholecystitis(HC) is a rare complication of gallbladder(GB) disease characterized by mucosal and intraluminal hemorrhage of the GB. We report ultrasonographic(US) and computed tomographic(CT) findings of two cases of HC. Hemorrhagic fluid filled in the inflamed GB lumen was initially seen as homogeneous hyperdense and hyperattenuated lesion on both US and CT, respectively. As resolution of the hematoma and gangrenous change of the GB wall progress, US showed inhomogeneous mixed echogenic lesion in the GB having partially indistinct border, mimicking an invasive mass. At this stage, CT still showed homogeneous hyperdense hematoma and a small amount of fluid in the GB, without evidence of contrast enhancement.

  5. Propilthiouracil-induced diffuse pulmonary hemorrhage: a case report with the clinical and radiologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Jun; Kim, Joung Sook; Kim, Ji Young; Choi, Soo Jeon [Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2007-05-15

    Propylthiouracil (PTU) is a drug that's used to manage hyperthyroidism and it can, on rare occasions, induce antineutrophil cytoplasmic antibody-associated vasculitis that involved multiple organ systems and it can also cause extremely rare isolated or diffuse pulmonary hemorrhage. We report here on a case of a patient who develop diffuse pulmonary hemorrhage after she had been taking PTU for five years. The patient is a 33-year-old woman who presented with hemoptysis. Simple chest radiographs and the chest CT showed bilateral ground-glass opacity, consolidation and pulmonary arterial hypertension. The bronchoalveolar lavage fluid revealed alveolar hemorrhage. The laboratory values showed increased perinuclear-antineutrophil cytoplasmic antibody ({rho} - ANCA) and anti-peroxidase antibody titers.

  6. Intracerebral hemorrhage: a rare late manifestation of vitamin-K deficiency in a breastfed infant. A case report.

    Science.gov (United States)

    Soylu, H; Aslan, Y; Sari, A; Erduran, E

    1997-01-01

    Late hemorrhagic disease of the newborn (HDN) is a rare complication of vitamin-K deficiency and is especially associated with intracranial hemorrhage. It may also occur in infants who received vitamin-K prophylaxis at birth. Here, we reported a case of late HDN with frontal lobe hemorrhage due to vitamin-K deficiency. This form of intracranial hemorrhage of late HDN has been reported in the literature very rarely. We conclude that the efficiency of single-dose vitamin-K prophylaxis should be revaluated.

  7. CT perfusion during delayed cerebral ischemia after subarachnoid hemorrhage: distinction between reversible ischemia and ischemia progressing to infarction

    Energy Technology Data Exchange (ETDEWEB)

    Cremers, Charlotte H.P. [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, PO Box 85500, Utrecht, Utrecht (Netherlands); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Vos, Pieter C. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands); Schaaf, Irene C. van der; Velthuis, Birgitta K.; Dankbaar, Jan Willem [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Vergouwen, Mervyn D.I.; Rinkel, Gabriel J.E. [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, PO Box 85500, Utrecht, Utrecht (Netherlands)

    2015-09-15

    Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) can be reversible or progress to cerebral infarction. In patients with a deterioration clinically diagnosed as DCI, we investigated whether CT perfusion (CTP) can distinguish between reversible ischemia and ischemia progressing to cerebral infarction. From a prospectively collected series of aSAH patients, we included those with DCI, CTP on the day of clinical deterioration, and follow-up imaging. In qualitative CTP analyses (visual assessment), we calculated positive and negative predictive value (PPV and NPV) with 95 % confidence intervals (95%CI) of a perfusion deficit for infarction on follow-up imaging. In quantitative analyses, we compared perfusion values of the least perfused brain tissue between patients with and without infarction by using receiver-operator characteristic curves and calculated a threshold value with PPV and NPV for the perfusion parameter with the highest area under the curve. In qualitative analyses of 33 included patients, 15 of 17 patients (88 %) with and 6 of 16 patients (38 %) without infarction on follow-up imaging had a perfusion deficit during clinical deterioration (p = 0.002). Presence of a perfusion deficit had a PPV of 71 % (95%CI: 48-89 %) and NPV of 83 % (95%CI: 52-98 %) for infarction on follow-up. Quantitative analyses showed that an absolute minimal cerebral blood flow (CBF) threshold of 17.7 mL/100 g/min had a PPV of 63 % (95%CI: 41-81 %) and a NPV of 78 % (95%CI: 40-97 %) for infarction. CTP may differ between patients with DCI who develop infarction and those who do not. For this purpose, qualitative evaluation may perform marginally better than quantitative evaluation. (orig.)

  8. Accuracy of computed tomography perfusion in detecting delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage: A meta-analysis

    Directory of Open Access Journals (Sweden)

    Haogeng Sun

    2013-01-01

    Full Text Available Background and Purpose: In recent years, significant literature shows that computed tomography perfusion (CTP can provide sufficient information on cerebral hemodynamics and effectively indicate delayed cerebral ischemia (DCI before the development of infarction. We aimed at performing a meta-analysis to provide a more full and accurate evaluation of CTP and CTP parameters in detecting DCI in patients with aneurysmal subarachnoid hemorrhage. Materials and Methods: We searched the PubMed, MedLine, Embase and Cochrane databases for analysis published from February 2005 to February 2013. We extracted CTP parameters, including cerebral blood volume (CBV, cerebral blood flow (CBF, mean transit time (MTT, time to peak (TTP, interhemispheric ratios for CBV and CBF and interhemispheric differences for MTT and TTP. Pooled estimates of sensitivity, specificity, positive likelihood ratio (PLR, negative likelihood ratio (NLR, diagnostic odds ratio (DOR and the summary receiver-operating characteristic curve were determined. Results: Four research studies are met the inclusion criteria for the analysis. The pooled sensitivity, specificity, PLR, NLR and DOR of CTP for detecting the DCI were 82%, 82%, 4.56, 0.22 and 20.96, respectively. Through the evaluation of absolute CTP parameters, CBF and MTT showed diagnostic value for DCI, but CBF and TTP did not. Moreover, CBF ratio, MTT difference and TTP difference showed more diagnostic value than CBV ratio in DCI detection by the assessment of relative CTP parameters. Conclusions: As a non-invasive and short time consuming screening method, CTP own a high diagnostic value for the detection of DCI after aneurysm rupture.

  9. Nursing experience of infants with delayed-onset of vitamin K deficiency induced intracranial hemorrhage%晚发性维生素K缺乏症引起颅内出血患儿的护理

    Institute of Scientific and Technical Information of China (English)

    侍海棠

    2012-01-01

    Objective:To explore intensive care in improving delayed - onset of vitamin K caused by lack of children of the treatment of the role of intracere-bral hemorrhage effect. Methods :22 cases were analyzed retrospectively late onset vitamin K caused by lack of intracranial hemorrhage the children nursing effect. Results:22 cases cure in 18 cases,2 cases died, automatic discharge in 2 cases. Conclusion:Strengthening basic nursing is the key to improve the curative effect;At the same time,strengthen nutrition guidance, the nurse with a formula milk as the reasonable feeding artificially bred son knowledge education of the key is prevention.%目的:探讨晚发性维生素K缺乏致患儿颅内出血的护理措施.方法:回顾性分析22例晚发性维生素K缺乏所致颅内出血患儿全程护理效果.结果:治愈18例,死亡2例,自动出院2例.结论:加强基础护理是提高治愈率的关键;同时加强乳母的营养指导、以配方奶为主的人工喂养儿的合理喂养知识宣教是预防的关键.

  10. An Unusual Radiologic Manifestation of Pulmonary Tuberculosis with Bilateral Multiple Lung Nodules and Diffuse Alveolar Hemorrhage: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Seo In; Seon, Hyun Ju; Kim, Yun Hyeon [Dept. of Radiology, Chunnam National University Hospital, Gwangju (Korea, Republic of); Choi, Sung [Dept. of Radiology, Chunnam National University Hwasun Hospital, Hwasun(Korea, Republic of)

    2011-12-15

    Pulmonary tuberculosis presenting as bilateral multiple lung nodules or diffuse alveolar hemorrhage is very rare. Here, we report a case of pulmonary tuberculosis presenting as bilateral multiple lung nodules and diffuse alveolar hemorrhage mimicking granulomatous vasculitis, such as Wegener's granulomatosis.

  11. Delayed, life-threatening lower gastrointestinal hemorrhage in an infant after serial transverse enteroplasty: treatment with transcatheter n-butyl-2-cyanoacrylate embolization

    Energy Technology Data Exchange (ETDEWEB)

    Bogue, Conor O.; Alzahrani, Amin I.; John, Philip R.; Amaral, Joao G. [Hospital for Sick Children, Division of Image Guided Therapy, Department of Diagnostic Imaging, Toronto (Canada); Wales, Paul W. [Hospital for Sick Children, Department of Surgery and the Group for Improvement of Intestinal Function and Treatment (GIFT), Toronto (Canada)

    2009-10-15

    We report a case of n-butyl-2-cyanoacrylate glue embolization of life-threatening lower gastrointestinal (LGI) hemorrhage in a 10-month-old boy. The child had a history of gastroschisis and short-bowel syndrome. Six months prior to the LGI bleed, he had undergone a serial transverse enteroplasty (STEP) to lengthen his intestine. To the best of our knowledge this is both the first report of successful glue embolization for LGI bleeding in a child and also the first report of severe hemorrhage after the STEP procedure. (orig.)

  12. Factors associated with post-pancreaticoduodenectomy hemorrhage: 303 consecutive cases analysis

    Institute of Scientific and Technical Information of China (English)

    GAO Qing-xiang; LEE Hua-yu; WU Wen-han; GAO Song; YANG Yin-mo; MA Irene Teting; CAI Meng-shan

    2012-01-01

    Background Because of the complexity and severity of the surgery and its associated complications,pancreaticoduodenectomy (PD) is associated with significant morbidity and mortality,especially the hemorrhage post-PD.Exploring the factors associated with post-PD hemorrhage is very important for the patients' safety.Methods Clinical data from 303 cases of PD between January 1998 and December 2008 were analyzed retrospectively.Results The overall mortality rate was 4.95% (15/303).However,post-operative bleeding occurred in 25 patients (8.25%) with nine episodes resulting in death (36.00%).Univariate analysis was performed and identified tumor size,Child's classification,total pancreatic uncinatic process resection,and pancreatic leakage as significant risk factors for post-PD hemorrhage.In the severe hemorrhage group,incomplete resection of uncinate process of pancreas and pancreatic leakage were the main causes.The multivariate Logistic regression analysis revealed that each of these variables is an independent risk factor.Conclusions Primary prevention of bleeding complications depends on total pancreatic uncinatic process resection and meticulous hemostatic techniques during surgery.In addition,several peri-operative factors were found to contribute to post-PD bleeding.

  13. Vitreo-Retinal Hemorrhage After Thrombolysis In A Patient With Acute Ischemic Stroke: A Case Report.

    Directory of Open Access Journals (Sweden)

    Mary eHormese

    2012-05-01

    Full Text Available Purpose: Bleeding is the major side effect of thrombolysis with alteplase (tissue plasminogen activator, t-PA used for the treatment of acute ischemic stroke. Life-threatening intracranial, retroperitoneal, gastrointestinal, respiratory, and genitourinary bleeding can occur with the use of t-PA. Vitreo-retinal bleeding in the context of acute ischemic stroke treatment has not been reported in the literature before and therefore is not posed as a potential risk during decision making. Here we describe the first reported case of vitreo-retinal hemorrhage due to alteplase administration in a patient with acute ischemic stroke.Summary: An 84 year old white male presented to the emergency room with complaints of right arm and leg weakness. The onset of symptoms was approximately 30 minutes prior to presentation to the emergency room. After ruling out contraindications including the presence of hemorrhage on head CT scan, patient was administered alteplase within 2 hours of symptom onset. Four hours after the administration of alteplase, the patient developed right-sided vision changes. A repeat CT scan demonstrated a newly developed right intraocular hemorrhage. Throughout the hospital course, patient’s neurological status improved, but he continued to have right-sided visual loss.Conclusion: Clinicians should be aware of the potential for ocular hemorrhage especially in high-risk patients. The likelihood of a subsequent vision-loss needs to be therefore discussed with the patient and family in such situations.

  14. ECG pattern in reverse takotsubo cardiomyopathy demonstrated in 5 cases with intracranial hemorrhage.

    Science.gov (United States)

    Elikowski, Waldemar; Małek-Elikowska, Małgorzata; Kudliński, Bartosz; Skrzywanek, Paweł; Smól, Sławomir; Rzymski, Stanisław

    2016-09-29

    In typical takotsubo cardiomyopathy (TC) apical transient left ventricular dysfunction with concomitant ECG changes mimicking acute anterior myocardial infarction can be observed. Reverse TC (RTC) characterized by contractile disturbances in all basal and often simultaneous mid-ventricular segments is definitely less frequent. ECG pattern of RTC is less known. The authors present ECG findings in 5 cases of RTC in course of intracranial hemorrhage (ICH); 3 patients were diagnosed with subarachnoid hemorrhage (SAH) and the other two with intracerebral hemorrhage or subdural posttraumatic hematoma. In all patients, initial ECG appearance was dominated by ST segment depression in inferior leads (II, III, avF) and/or lateral leads (V4-6). In 4 patients, concurrent ST segment elevation in avR and avL leads was seen, additionally 4 patients had low QRS voltage in high lateral leads (I, avL). Potential normalization of these changes did not influence the patient`s survival. In one woman, immediately before death, early repolarization was recorded. In subjects with an increased risk of TC, for example in intracranial hemorrhage, particularly in SAH, the ECG abnormalities presented may indicate a need for further search of its atypical echocardiographic variants.

  15. A case of subarachnoid hemorrhage revealed by an acute coronary syndrome (ACS).

    Science.gov (United States)

    Hatim, Abdedaim; El Otmani, Wafae; Houssa, Mehdi Ait; Atmani, Noureddine; Moutakiallah, Younes; Haimeur, Charqui; Drissi, Mohammed

    2015-01-01

    The subarachnoid hemorrhage (SAH) is definitely the best descriptive model of the interaction between cardiovascular system and cerebral damage. The underlying mechanism of cardiovascular alterations after SAH is linked to the adrenergic discharge related to aneurysm rupture. Cardiac and pulmonary complications are common after severe brain injury, especially the aneurismal subarachnoid hemorrhage. Acute neurogenic pulmonary edema is not exceptional; it may occur in 20% of cases and commonly follows a severe subarachnoid hemorrhage. Severe myocardial damage with cardiogenic shock may possibly reveal the SAH (3% of cases) and mislead to wrong diagnosis of ACS with dramatic therapeutic consequences. The contribution of CT and cerebral angiography is essential for diagnosis and treatment. Surgical or endovascular treatment depends on location, size and shape of the aneurysm, on patient's age, neurological status and existence of concomitant diseases. We report the case of a 58 years old patient, with a past medical history of diabetes and hypertension, admitted for acute pulmonary edema with cardiogenic shock. This case illustrates an unusual presentation of aneurismal SAH in a patient presenting with an acute coronary syndrome.

  16. Severe Renal Hemorrhage in a Pregnant Woman Complicated with Antiphospholipid Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    Shohei Kawaguchi

    2011-01-01

    Full Text Available Antiphospholipid syndrome is a systemic autoimmune disease with thrombotic tendency. Consensus guidelines for pregnancy with antiphospholipid syndrome recommend low-dose aspirin combined with unfractionated or low-molecular-weight heparin because antiphospholipid syndrome causes habitual abortion. We report a 36-year-old pregnant woman diagnosed with antiphospholipid syndrome receiving anticoagulation treatment. The patient developed left abdominal pain and gross hematuria at week 20 of pregnancy. An initial diagnosis of left ureteral calculus was made. Subsequently abdominal-pelvic computed tomography was required for diagnosis because of the appearance of severe contralateral pain. Computed tomography revealed serious renal hemorrhage, and ureteral stent placement and pain control by patient-controlled analgesia were required. After treatment, continuance of pregnancy was possible and vaginal delivery was performed safely. This is the first case report of serious renal hemorrhage in a pregnant woman with antiphospholipid syndrome receiving anticoagulation treatment and is an instructive case for urological and obstetrical practitioners.

  17. Benign Sphenoid Wing Meningioma Presenting with an Acute Intracerebral Hemorrhage – A Case Report

    Science.gov (United States)

    Frič, Radek; Hald, John K.; Antal, Ellen-Ann

    2016-01-01

    BACKGROUND AND STUDY OBJECT We report an unusual case of a benign lateral sphenoid wing meningioma that presented with, and was masked by, an acute intracerebral hemorrhage. CASE REPORT A 68-year-old woman was admitted after sudden onset of coma. Computed tomography (CT) revealed an intracerebral hemorrhage, without any underlying vascular pathology on CT angiography. During the surgery, we found a lateral sphenoid wing meningioma with intratumoral bleeding that extended into the surrounding brain parenchyma. RESULTS We removed the hematoma and resected the tumor completely in the same session. The histopathological classification of the tumor was a WHO grade I meningothelial meningioma. The patient recovered very well after surgery, without significant neurological sequelae. CONCLUSIONS: Having reviewed the relevant references from the medical literature, we consider this event as an extremely rare presentation of a benign sphenoid wing meningioma in a patient without any predisposing medical factors. The possible mechanisms of bleeding from this tumor type are discussed. PMID:27127413

  18. Case Report: Postpartum hemorrhage associated with Dengue with warning signs in a term pregnancy and delivery

    OpenAIRE

    Le Phi Hung; Tran Diem Nghi; Nguyen Hoang Anh; Mai Van Hieu; Nguyen Thien Luan; Nguyen Phuoc Long; Than Trong Thach

    2015-01-01

    Background: Dengue infection during peripartum period, although rare in endemic regions, has challenged clinicians regarding its management, especially if a parturient woman experiences postpartum hemorrhage due to a classical risk factor of maternal bleeding. Case: A full-term pregnant Vietnamese woman was diagnosed with polyhydramnios and Dengue with warning signs (DWS). She was administered platelet transfusion prior to delivery and then gave birth to a healthy newborn. After active manage...

  19. Analysis of Fibrinogen relevant factors in delayed cerebral edema of cerebral hemorrhage%脑出血后迟发性脑水肿与纤维蛋白原等相关因素的分析

    Institute of Scientific and Technical Information of China (English)

    黄园园; 陈吉相; 王芳; 肖海兵

    2011-01-01

    目的 研究脑出血迟发性脑水肿与纤维蛋白原(FIB)等因素的相互联系,并探讨对脑出血预后的影响.方法 回顾性分析本院2008年1月~2011年2月接受内科保守治疗的非外伤性急性脑出血60例,其中并发迟发性脑水肿29例,未发生迟发性脑水肿31例.于发病后连续3周监测FIB值等指标,并同时期行头颅CT检查,动态观察血肿及其周围水肿的变化.行χ2检验比较迟发性脑水肿组与未发生组间FIB的升高率; logistic回归分析迟发性脑水肿与各指标的相关性,并采用多元逐步COX模型分析脑出血预后的相关影响因素.结果 迟发性脑水肿组较未发生组FIB值明显升高(P<0.005); FIB升高、脑出血量大、吸烟、高血压病史与迟发性脑水肿相关(P<0.05);迟发性脑水肿、持续升高的FIB和高血压病影响脑出血的预后,其P值均<0.05,有统计学意义.结论 脑出血者FIB持续升高、脑出血量大、吸烟、高血压与迟发性脑水肿的发生密切相关,迟发性脑水肿、FIB升高和高血压病影响预后,对疾病恢复有不良影响.%Objective To observe Pibrinogen and other related factors on delayed cerebral edema in cerebral hemorrhage, and to explore related factor impact on prognosis in cerebral hemorrhage. Methods Analyzed retrospectively the 60 cases of acute non-traumatic and conservative treated cerebral hemorrhage in January 2008- February 2011, which 29 cases complicated with delayed cerebral edema and 31 cases not complicated . Monitored FIB values and other indicators for three weeks ,and observed hematoma and the surrounding low-density changes by head CT during the same period; x2 test to compare the increase rate of FIB in two groups; Analyze related factors on delayed cerebral edema and their relationship with prognosis. Results FIB significantly increased in delayed brain edema group(P<0. 005). Elevated FIB, hematoma volume, smoking, and hypertension associated with delayed

  20. [Hemorrhagic cyst of the mandible. A case presentation].

    Science.gov (United States)

    Polastri, F; Barbero, P; Gallesio, C; Cappella, M

    1989-12-01

    Haemorrhagic mandibular cysts are quite rare and generally considered sequelae of an earlier trauma causing an overflow of blood into the bone, though a number of pathogenic theories have been put forward. Since few of these cysts involve subjective symptoms, most are discovered accidentally during radiography, while a sure diagnosis is only likely to be obtained during surgery on the discovery of a nonepithelialized cavity. The paper presents a typical case of haemorrhagic mandibular cyst which was treated by opening the cavity and scraping its walls in order to cause bleeding that would promote the growth of new bone tissue.

  1. Delayed, spontaneous conversion of type 2 closure to type 1 closure following surgery for traumatic macular hole associated with submacular hemorrhage

    Directory of Open Access Journals (Sweden)

    Pukhraj Rishi

    2012-01-01

    Full Text Available A 45-year-old man presented with diminution of vision in the left eye following a firecracker injury. Best corrected visual acuity (BCVA was 20/20 in the right eye and 20/125 in the left eye. Fundus examination revealed vitreous hemorrhage, a macular hole, and submacular hemorrhage in the left eye. The patient underwent vitrectomy, tissue plasminogen activator (tPA-assisted evacuation of the submacular hemorrhage, internal limiting membrane (ILM peeling, and 14% C3F8 gas insufflation. After two months, the BCVA remained 20/125 and optical coherence tomography (OCT showed type 2 macular hole closure. On a follow-up, seven months after surgery, BCVA improved to 20/80, N6, with type 1 closure of the macular hole. The clinical findings were confirmed on OCT. Delayed and spontaneous conversion of the traumatic macular hole could occur several months after the primary surgery and may be associated with improved visual outcome. Larger studies are required to better understand the factors implicated in such a phenomenon.

  2. DELAYED BILATERAL HYDROTHORAX AFTER CENTRAL VENOUS CATHERIZATION: A CASE REPORT

    OpenAIRE

    Arpana; Moses Charles D; Kutappa; Deepa

    2014-01-01

    : Central venous catheterization is a common procedure in anesthetic management of patients undergoing major surgery or care of critically ill patients. Delayed complication such as hydrothorax, hydromediastinum or cardiac tamponade is extremely rare with a few case reports. We report a case of bilateral hydrothorax due to migration of the tip of the central venous catheter from within the vein into the mediastinum following subclavian vein catheterization.

  3. Subdural hemorrhage: A unique case involving secondary vitamin K deficiency bleeding due to biliary atresia.

    Science.gov (United States)

    Miyao, Masashi; Abiru, Hitoshi; Ozeki, Munetaka; Kotani, Hirokazu; Tsuruyama, Tatsuaki; Kobayashi, Naho; Omae, Tadaki; Osamura, Toshio; Tamaki, Keiji

    2012-09-10

    Extrahepatic biliary atresia (EHBA) is a rare disease characterized by progressive and obliterative cholangiopathy in infants and is one of the major causes of secondary vitamin K deficiency bleeding (VKDB) due to cholestasis-induced fat malabsorption. Breast feeding increases the tendency of bleeding in EHBA patients because breast milk contains low amounts of vitamin K. A 2-month-old female infant unexpectedly died, with symptoms of vomiting and jaundice prior to death. She had been born by uncomplicated vaginal delivery and exhibited normal growth and development with breastfeeding. There was no history of trauma. She received vitamin K prophylaxis orally. In an emergency hospital, a CT scan showed a right intracranial hematoma and mass effect with midline shift to the left. In the postmortem examination, severe atresia was observed in the whole extrahepatic bile duct. Histologically, cholestasis, periductal fibrosis, and distorted bile ductules were noted. The gallbladder was not identified. A subdural hematoma and cerebellar tonsillar herniation were found; however, no traumatic injury in any part of the body was observed. Together, these findings suggest that the subdural hemorrhage was caused by secondary vitamin K deficiency resulting from a combination of cholestasis-induced fat malabsorption and breastfeeding. Subdural hemorrhage by secondary VKDB sometimes occurs even when vitamin K prophylaxis is continued. This case demonstrated that intrinsic factors, such as secondary VKDB (e.g., EHBA, neonatal hepatitis, chronic diarrhea), should also be considered in infant autopsy cases presenting with subdural hemorrhage.

  4. Spontaneous intracranial hemorrhage in children – ruptured lobar arteriovenous malformations: report of two cases

    Directory of Open Access Journals (Sweden)

    Tascu A.

    2015-03-01

    Full Text Available Brain arteriovenous malformations (AVMs are lesions thought to be primarily congenital in origin, consisting of fistulous connections of abnormal arteries and veins, without normal intervening capillary beds and no cerebral parenchyma between vessels. In the pediatric population, AVMs represent the most common cause of spontaneous intracranial hemorrhage (ICH, with a high recurrent bleeding risk. The aim of this paper is to report 2 cases of ruptured lobar AVMs in children, presenting with spontaneous ICH. Due to the patients’ neurological status, the only imaging examination performed preoperatively was a CT scan, showing intraparenchymal hemorrhage. Thus, there was no MRI/angiographic examination to prove the existence of a brain AVM prior to the surgical interventions. Also, the cerebral angiography performed after the surgery showed, in both patients, no signs of residual vascular malformations. Therefore, the diagnosis of AVM was certified by macroscopic and microscopic pathological findings, with no brain imaging suggestive of a vascular malformation.

  5. Intraperitoneal Hemorrhage in a Peritoneal Dialysis Patient Using Dabigatran: A Case Report

    Directory of Open Access Journals (Sweden)

    Egemen Cebeci

    2016-06-01

    Full Text Available Dabigatran is used for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. It is still unclear whether the use of dabigatran leads to more bleeding compared with warfarin. In this paper, we present a case of intraperitoneal hemorrhage in a 54-years-old male peritoneal dialysis patient using dabigatran for paroxysmal atrial fibrillation because international normalized ratio level could not be kept at target levels during follow-up. The use of dabigatran in atrial fibrillation has become widespread in recent years. Despite the low risk of intracranial hemorrhage, clinicians should be careful in patients with chronic kidney disease because coagulation monitoring is not possible.

  6. [Brain metastasis from papillary thyroid carcinoma with acute intracerebral hemorrhage: a surgical case report].

    Science.gov (United States)

    Chonan, Masashi; Mino, Masaki; Yoshida, Masahiro; Sakamoto, Kazuhiro

    2012-05-01

    We report a rare case of brain metastasis from papillary thyroid carcinoma with intracerebral hemorrhage. A 79-year-old woman presented with sudden headache and monoplegia of the right upper limb 10 years after diagnosis of thyroid papillary adenocarcinoma. Despite the known metastatic lesions in the cervical lymph nodes and lungs, she had been well for 10 years since thyroidectomy, focal irradiation and internal radiation of 131I. CT demonstrated intracerebral hemorrhage in the left temporal lobe. Magnetic resonance imaging showed marked signal heterogeneity. She underwent radical surgery on the day of the onset and the histological diagnosis was metastatic brain tumor of thyroid papillary carcinoma. Postoperative course was uneventful, and the monoplegia was improved. Papillary thyroid carcinoma has a relatively benign course, and surgical removal of the brain metastasis is able to contribute to longer survival times for patients.

  7. The first documented case of hemorrhagic stroke caused by Group B streptococcal meningitis

    Directory of Open Access Journals (Sweden)

    Beenish Siddiqui

    2015-01-01

    Full Text Available We report the case of a 47 year-old female with Streptococcus agalactiae (Group B beta-hemolytic streptococcus meningitis complicated by hemorrhagic stroke. The patient presented to the emergency department with altered mental status, agitation, confusion, respiratory distress and fever of one-day duration. Labs showed left shift leukocytosis. CSF exhibited a high white blood cell count with a predominant population of polymononuclear cells, high glucose and protein concentration. CSF cultures grew S. agalactiae. Despite appropriate antimicrobial treatment, her mental status did not improve and head CT showed two hemorrhages, diffuse cerebral edema and a right to left midline shift. After completing the course of her therapy, her mental status improved and the patient was discharged.

  8. A Case of Hemorrhagic Necrosis of Ectopic Liver Tissue within the Gallbladder Wall.

    LENUS (Irish Health Repository)

    Nagar, Sapna

    2012-02-01

    Ectopic liver tissue is a rare clinical entity that is mostly asymptomatic and found incidentally. In certain situations, however, patients may present with symptoms of abdominal pain secondary to torsion, compression, obstruction of adjacent organs, or rupture secondary to malignant transformation. Herein, we report a case of a 25-year-old female that presented with acute onset of epigastric pain found to have ectopic liver tissue near the gallbladder complicated by acute hemorrhage necessitating operative intervention in the way of laparoscopic excision and cholecystectomy. The patient\\'s postoperative course was uneventful. Gross pathology demonstrated a 1.2 x 2.8 x 4.5 cm firm purple ovoid structure that histologically revealed extensive hemorrhagic necrosis of benign ectopic liver tissue.

  9. [Alveolar hemorrhage].

    Science.gov (United States)

    Parrot, A; Fartoukh, M; Cadranel, J

    2015-04-01

    Alveolar hemorrhage occurs relatively rarely and is a therapeutic emergency because it can quickly lead to acute respiratory failure, which can be fatal. Hemoptysis associated with anemia and pulmonary infiltrates suggest the diagnosis of alveolar hemorrhage, but may be absent in one third of cases including patients in respiratory distress. The diagnosis of alveolar hemorrhage is based on the findings of a bronchoalveolar lavage. The causes are numerous. It is important to identify alveolar hemorrhage due to sepsis, then separate an autoimmune cause (vasculitis associated with antineutrophil cytoplasmic antibody, connective tissue disease and Goodpasture's syndrome) with the search for autoantibodies and biopsies from readily accessible organs, from a non-immune cause, performing echocardiography. Lung biopsy should be necessary only in exceptional cases. If the hemorrhage has an immune cause, treatment with steroids and cyclophosphamide may be started. The indications for treatment with rituximab are beginning to be established (forms that are not severe and refractory forms). The benefit of plasma exchange is unquestionable in Goodpasture's syndrome. In patients with an immune disease that can lead to an alveolar hemorrhage, removing any source of infection is the first priority.

  10. [Cerebral hemorrhage induced by low-dose streptokinase: a pharmacologic paradox? Report of a clinical case].

    Science.gov (United States)

    Fedeli, F; Skouse, D; Messina, A

    1997-01-01

    A case of an important intracranial hemorrhage after a low dose (approx. 500,000 UI) of streptokinase in a 60 year-old woman suffering from myocardial infarction is presented. Clinical, electrocardiographic, echocardiographic, lab and tomographic findings are described. The authors suggest a pharmacokinetic mechanism which could be responsible of a "paradox effect" (a powerful and dangerous effect of the drug when given in low dose) and they wonder whether in case of allergic reactions should it be better not to stop the infusion of the thrombolytic drug and be more liberal with the "symptomatic" drugs. Tha patient is still alive and the clinical conditions slowly progressing.

  11. Prognostic comparison of operative and non-operative therapies for intracerebral hemorrhage in a local hospital: Case retrospection

    Institute of Scientific and Technical Information of China (English)

    Deming Zhao; Zenghong Jiang; Bin Wang

    2006-01-01

    BACKGROUND: At present, it is satisfactory for micro-trauma craniopuncture therapy for cerebral hemor rhage to treat spontaneous intracerebral hemorrhage (ICH). Surgical treatment can decrease fatality rate of ICH patients; however, some reports suggest that there are no obvious differences of therapeutic effects between surgical treatment and medical therapy because of various states, operative indications, contraindi cations and operative styles.OBJECTIVE: To observe the effect of surgical treatment on ICH prognosis, especially on fatality rate. DESIGN: Retrospective-case study.SETTING: Huaibei People's Hospital. PARTICIPANTS: ① A total of 241 ICH patients selected from Huaibei People's Hospital from January 1988 to May 1989 were regarded as group A. They were all coincidence with Diagnostic Criteria of Intracerebral Hemorrhage in the National Cerebrovascular Disease Academic Meeting. There were 154 males and 87 females aged 34-94 years, and among them, 230 patients were older than 50 years (95.4%). Hemorrhage sites: Among 142 patients, 85 cases had internal capsule hemorrhage, 18 external capsule hemorrhage, 15 thalamic hemorrhage, 9 cerebellar hemorrhage, 7 brain stem hemorrhage, 7 cerebral lobe hemorrhage, and 1 corpus callosum hemorrhage. Hemorrhage volume: Among 89 clear records, 44 cases had of 1-10 mL, 35 of 11-30 mL, 5 of 31-40 mL, and 5 of 41-80 mL. Except 2 patients, other ones were treated with medical operation. ② A total of 203 ICH patients selected from the same hospital from January 2003 to December 2005 were regarded as group B. Among them, 72 cases were treated with operation, but other 131 ones were treated with non-operation. They were all diagnosed with CT. There were 113 males and 90 females aged 30-88 years, and among them, 183 patients were older than 50 years (90.1%). Hemorrhage sites: Among 203 patients, 104 cases had internal capsule hemorrhage, 17 external capsule hemorrhage, 19 thalamic hemorrhage, 9 cerebellar hemorrhage, 12 brain

  12. Leiomyomas and massive digestive hemorrhages: Case reports of patients diagnosed in 2004

    Directory of Open Access Journals (Sweden)

    Golubović Gradimir

    2007-01-01

    Full Text Available Introduction: During 2004, there were 6 patients with leiomyomas diagnosed and treated at the Department of Gastroenterology and Clinical Pathology of the Zemun Clinical Center. The most common location of these benign submucosal tumors is stomach, followed by small intestine and large intestine. Case report: The most common symptoms of these patients were massive intestinal hemorrhage, with haematemesis and melaena. Hemorrhages resulted from superficial lesions, caused by pressure of the tumour on the intestinal blood vessels. A significant contribution in reaching the final diagnosis and selecting appropriate therapeutic approach was provided by CT and arteriography. Most patients underwent surgical treatment, which provided precise diagnosis (based on histopathological findings, and at the same time a definite therapeutic procedure. Discussion and conclusion: According to the literature data, gastrointestinal leiomyomas account for 20%-30% of all types of gastrointestinal tumors. Our research revealed that the incidence of leiomyomas was significantly lower within our group of patients, accounting for 12% of all benign gastrointestinal tumors. They were also the main cause of hemodynamic instability in our patients having massive and recurrent intestinal hemorrhages, which is not often seen in practice. All of them originated either from muscularis propria or muscularis mucosae. These tumors are often an accidental finding at autopsy, especially if they are smaller than 3 centimeters and not followed by consequential complications. Presently, endoscopic ultrasonography is considered to be the the most accurate procedure in the diagnosis of leiomyoma, with a diagnostic specificity that is superior to other imaging techniques.

  13. Case of granulomatosis with polyangiitis (Wegener's granulomatosis) manifested with asymptomatic intracerebral hemorrhage.

    Science.gov (United States)

    Takaoka, Hirokazu; Hashimoto, Atsushi; Nogi, Shinichi; Iwata, Kanako; Futami, Hidekazu; Arinuma, Yoshiyuki; Shimada, Kota; Nakayama, Hisanori; Komiya, Akiko; Furukawa, Hiroshi; Matsui, Toshihiro; Tohma, Shigeto

    2013-01-01

    A 46-year-old man, who had had sinusitis, developed bilateral omalgia, petechiae on his lower extremities and a congested right eye. A blood test detected elevated serum C-reactive protein level. Computed tomography incidentally found an acute lesion of thalamic hemorrhage without neurological symptoms and no specific therapy was given at the time. Thereafter, he developed vertigo, vomiting and pneumonia for which antibiotics were ineffective. He was referred and admitted to our hospital. Further, aural and renal lesions, and presence of serum proteinase 3-antineutrophil cytoplasmic antibody (PR3-ANCA) confirmed his diagnosis of granulomatosis with polyangiitis (Wegener's) (GPA). With corticosteroid and cyclophosphamide therapy, his symptoms disappeared in two months along with faded PR3-ANCA. Afterward he showed neither new cerebral lesion nor symptom. This is a rare case of GPA manifested with asymptomatic intracerebral hemorrhage. It should be noted that GPA could cause various manifestations in central nervous system such as a fatal or an asymptomatic hemorrhagic lesion, which might respond to immunosuppressive therapy.

  14. Moyamoya disease manifested as multiple simultaneous intracerebral hemorrhages: A case report and literature review

    Science.gov (United States)

    Yu, Jinlu; Yuan, Yongjie; Li, Wei; Xu, Kan

    2016-01-01

    Multiple simultaneous intracerebral hemorrhages (MSIH) caused by Moyamoya disease (MMD) is extremely rare. To date, the clinical manifestations, imaging characteristics and mechanism of MMD-induced MSIH have not yet been elucidated. In order to improve the understanding on such cases, the present study described a rare case of MSIH caused by MMD. A 40-year-old female patient with no history of hypertension or diabetes mellitus experienced a sudden headache followed by coma. Cranial computed tomography (CT) examination revealed MSIH in the left frontal area, temporal lobe and basal ganglia. CT angiography and digital subtraction angiography examinations revealed typical characteristics of MMD. Subsequent to excluding disorders of the blood system and blood coagulation, we concluded that the present case of MSIH was caused by MMD. Hematoma evacuation and decompressive craniectomy were performed with satisfactory results. In addition, after reviewing previous MSIH cases in the literature, potential mechanisms of MMD-mediated MSIH were considered. In conclusion, MMD should be considered as a possible cause of MSIH during diagnosis and treatment. MMD can lead to pathological changes in the fragility of small arteries; therefore, rupture and hemorrhage at one site may induce a transient increase in blood pressure, causing the rupture of small arteries at other sites, and thus leading to MSIH. Hematoma evacuation and decompression should be conducted in selective cases of MMD-induced MSIH in order to achieve a good prognosis. PMID:27588064

  15. Obstetric hemorrhage in a case of hypertrophic obstructive cardiomyopathy with automatic implantable cardioverter defibrillator: Anaesthesia and intensive care management.

    Science.gov (United States)

    Mishra, Sandeep Kumar; Bhat, Ravindra R; Kavitha, Jayaram; Kundra, Pankaj; Parida, Satyen

    2016-01-01

    The physiological changes occurring during pregnancy and labor may reveal or exacerbate the symptoms of hypertrophic obstructive cardiomyopathy (HOCM). The addition of obstetric hemorrhage to this presents a unique challenge to the anesthesiologists and intensivists managing these patients in the operation theatres and the Intensive Care Units. Here we present a case of HOCM with automatic implantable cardioverter defibrillator in situ and postpartum hemorrhagic shock.

  16. Pancreatic panniculitis associated with acute pancreatitis and hemorrhagic pseudocysts: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Yong Suk; Kim, Mi Sung; Park, Chan Sub; Park, Ji Yeon; Park, Noh Hyuck [Kwandong Univ., Myongji Hospital, Goyang (Korea, Republic of)

    2012-10-15

    Pancreatic panniculitis is an inflammation and necrosis of fat at distant foci in patients with pancreatic disorders, most frequently, pancreatitis and pancreatic carcinoma. Clinically, pancreatic panniculitis is manifested by painless or painful subcutaneous nodules on the legs, buttocks, or trunk. The usual sites are the distal parts of the lower extremities. To the best of our knowledge, there have not been many reports for the radiologic findings of pancreatic panniculitis. In this article, we report a case of pancreatic panniculitis, including radiologic findings of CT and ultrasonography. The patient was presented with painful subcutaneous nodules on the trunk, and had underlying acute pancreatitis and hemorrhagic pseudocysts.

  17. [A case of fetal death resulting from a massive fetomaternal hemorrhage].

    Science.gov (United States)

    Denef, M; Capelle, X; Vanlinthout, C; Lepage, S; Emonts, P

    2015-01-01

    We report the case of a late stillbirth which unexpectedly occurred in a patient without any medical history and after a meticulous obstetrical follow up. Stillbirth is unfortunately not unusual and implies a complete etiological work up. In the present observation, the Kleihauer test and anatomoclinical examination concluded that the death was due to an acute cerebral anoxy resulting from a massive fetomaternal hemorrhage (HFM). HFM is rarely considered as the cause of a late stillbirth, but its occurrence is certainly underestimated. Yet, if HFM is identified before fetal death, an .adequate management could considerably improve the fetal prognosis and, sometines, save the child's life.

  18. Chapare virus, a newly discovered arenavirus isolated from a fatal hemorrhagic fever case in Bolivia.

    Directory of Open Access Journals (Sweden)

    Simon Delgado

    2008-04-01

    Full Text Available A small focus of hemorrhagic fever (HF cases occurred near Cochabamba, Bolivia, in December 2003 and January 2004. Specimens were available from only one fatal case, which had a clinical course that included fever, headache, arthralgia, myalgia, and vomiting with subsequent deterioration and multiple hemorrhagic signs. A non-cytopathic virus was isolated from two of the patient serum samples, and identified as an arenavirus by IFA staining with a rabbit polyvalent antiserum raised against South American arenaviruses known to be associated with HF (Guanarito, Machupo, and Sabiá. RT-PCR analysis and subsequent analysis of the complete virus S and L RNA segment sequences identified the virus as a member of the New World Clade B arenaviruses, which includes all the pathogenic South American arenaviruses. The virus was shown to be most closely related to Sabiá virus, but with 26% and 30% nucleotide difference in the S and L segments, and 26%, 28%, 15% and 22% amino acid differences for the L, Z, N, and GP proteins, respectively, indicating the virus represents a newly discovered arenavirus, for which we propose the name Chapare virus. In conclusion, two different arenaviruses, Machupo and Chapare, can be associated with severe HF cases in Bolivia.

  19. First Case Report of SAM (registered trademark) Junctional Tourniquet Use in Afghanistan to Control Inguinal Hemorrhage on the Battlefield

    Science.gov (United States)

    2014-06-02

    American medics to take some time to manage the ANA medics who were hovering at their elbows (Figure 5). There was also a brief delay in com- munication...time from the moment the SJT was brought into the ANA trauma room un- til it was secured. The small space between the trauma beds required the...of Corpo- ral “Jamie” Smith except that with the passage of 20 years, dedicated junctional hemorrhage control research has moved the trauma field

  20. [A case of brucellosis and Crimean-Congo hemorrhagic fever coinfection in an endemic area].

    Science.gov (United States)

    Karakeçili, Faruk; Çıkman, Aytekin; Akın, Hicran; Gülhan, Barış; Özçiçek, Adalet

    2016-04-01

    Brucellosis, a zoonotic disease which is especially seen in developing countries is still an important public health problem worldwide. Crimean-Congo hemorrhagic fever (CCHF) is another zoonotic disease that transmits to humans by infected tick bites as well as exposure to blood or tissue from infected animals. Both of the diseases are common among persons who live in rural areas and deal with animal husbandry. Since brucellosis usually presents with non-specific clinical symptoms and may easily be confused with many other diseases, the diagnosis of those infections could be delayed or misdiagnosed. In this report, a case of coinfection of brucellosis and CCHF has been presented to emphasize the possibility of association of these infections. A 70-year-old female patient with a history of dealing with animal husbandry in a rural area admitted to our hospital with the complaints of fever, malaise, generalized body and joint pains, and headache. Her complaints had progressed within the past two days. She also reported nausea, vomiting, abdominal pain and bloody diarrhea. She denied any history of tick bites. Her physical examination was significant for the presence of 38.8°C fever, increased bowel sounds and splenomegaly. Laboratory analysis revealed leukopenia, thrombocytopenia and high levels of liver enzymes. The patient was admitted to our service with the prediagnosis of CCHF. Serum sample was sent to the Department of Microbiology Reference Laboratory at Public Health Agency of Turkey for CCHF testing. During patient's hospitalization in service, more detailed history was confronted and it was learned that she had fatigue, loss of appetite, sweating, joint pain, and intermittent fever complaints were continuing within a month and received various antibiotic treatments. The tests for brucellosis were conducted and positive results for Brucella Rose Bengal test, tube agglutination (1/160 titers) and immune capture test with Coombs (1/320 titers) were determined

  1. Stress-induced hemorrhagic gastric ulcer after successful Helicobacter pylori eradication: two case reports

    Directory of Open Access Journals (Sweden)

    Miyamoto Mitsuaki

    2011-06-01

    Full Text Available Abstract Introduction Helicobacter pylori infection is a major cause of gastric ulcers, and Helicobacter pylori eradication drastically reduces ulcer recurrence. It has been reported, however, that severe physical stress is closely associated with gastric ulceration even in Helicobacter pylori -negative patients. Case presentation We report the cases of a 47-year-old Japanese man and a 69-year-old Japanese man who developed psychological stress-induced hemorrhagic gastric ulcers, in both of whom Helicobacter pylori had been successfully eradicated. Conclusion Our cases strongly suggest that not only physical but also psychological stress is still an important pathogenic factor for peptic ulceration and accordingly that physicians should pay attention to the possible presence of psychological stress in the management of patients with peptic ulcers.

  2. A Delayed Recrudescent Case of Sigmoidocutaneous Fistula due to Diverticulitis

    Directory of Open Access Journals (Sweden)

    Takaaki Fujii

    2007-10-01

    Full Text Available Colocutaneous fistula caused by diverticulitis is relatively rare, and a delayed recrudescent case of colocutaneous fistula is very uncommon. We herein report a rare case of a Japanese 56-year-old male with delayed recrudescent sigmoidocutaneous fistula due to diverticulitis. A colocutaneous fistula was formed after a drainage operation against a perforation of the sigmoid colon diverticulum. After 5 years from treatment, he was admitted to our hospital because of lower abdominal pain. We diagnosed the recrudescent sigmoidocutaneous fistula by abdominal computed tomography and gastrografin enema, and managed the patient with total parenteral nutrition and antibiotics. As the fistula formation did not improve, a low anterior resection with fistulectomy was performed. The postoperative course was uneventful and the patient was discharged. It has been reported that, in fistulas of the skin caused by diverticular disease, complete closure of the fistula by conservative therapy may not be possible. This case also implies the possibility of a recurrence of the fistula even if the conservative treatment was effective. In cases of colocutaneous fistulas due to diverticulitis, radical surgery is considered necessary because of possibility of recurrence of the fistula.

  3. Pathologic highlights of dengue hemorrhagic fever in 13 autopsy cases from Myanmar.

    Science.gov (United States)

    Aye, Khin Saw; Charngkaew, Komgrid; Win, Ne; Wai, Kyaw Zin; Moe, Kyaw; Punyadee, Nuntaya; Thiemmeca, Somchai; Suttitheptumrong, Aroonroong; Sukpanichnant, Sanya; Prida, Malasit; Halstead, Scott B

    2014-06-01

    Vascular permeability, thrombocytopenia, liver pathology, complement activation, and altered hemostasis accompanying a febrile disease are the hallmarks of the dengue hemorrhagic fever/dengue shock syndrome, a major arthropod-borne viral disease that causes significant morbidity and mortality throughout tropical countries. We studied tissues from 13 children who died of acute dengue hemorrhagic fever/dengue shock syndrome at the Childrens' Hospital, Yangon, Myanmar. Dengue viral RNA from each of the 4 dengue viruses (DENVs) was detected by reverse transcriptase polymerase chain reaction in 11 cases, and dengue viral proteins (envelope, NS1, or NS3) were detected in 1 or more tissues from all 13 cases. Formalin-fixed and frozen tissues were studied for evidence of virus infection using monoclonal antibodies against DENV structural and nonstructural antigens (E, NS1, and nonsecreting NS3). In the liver, DENV infection occurred in hepatocytes and Kupffer cells but not in endothelial cells. Liver damage was associated with deposition on hepatocytes of complement components of both classical and alternative pathways. Evidence of dengue viral replication was observed in macrophage-like cells in spleens and lymph nodes. No dengue antigens were detected in endothelial cells in any organ. Germinal centers of the spleen and lymph nodes showed a marked reduction in the number of lymphocytes that were replaced by eosinophilic deposits, which contained dengue antigens as well as immunoglobulins, and complement components (C3, C1q, and C9). The latter findings had previously been reported but overlooked as a diagnostic feature.

  4. Two pediatric cases of variant neurogenic stress cardiomyopathy after intracranial hemorrhage.

    Science.gov (United States)

    Wittekind, Samuel G; Yanay, Ofer; Johnson, Erin M; Gibbons, Edward F

    2014-10-01

    Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is an acquired form of left ventricular systolic dysfunction seen in the setting of physiologic stress and the absence of coronary artery disease. It is thought to be caused by excessive sympathetic stimulation. It is well described in the adult literature associated with subarachnoid hemorrhage where it is known as neurogenic stress cardiomyopathy (NSC), but few such pediatric cases have been reported. We describe our experience with 2 children (13- and 10-year-old girls) who presented with spontaneous intracranial hemorrhage followed by pulmonary edema and shock. Echocardiography revealed similar patterns of left ventricular wall motion abnormalities consistent with NSC, inverted Takotsubo variant. One child progressed to death, whereas the other made a remarkable recovery, including significant improvement in cardiac function over the course of 1 week. We argue that at least 1 of these cases represents true stress-induced cardiomyopathy. This report will alert pediatricians to this transient cardiomyopathy that is likely underdiagnosed in pediatric intensive care. We also highlight the challenges of managing both shock and elevated intracranial pressure in the setting of NSC.

  5. Acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery: a case report

    Directory of Open Access Journals (Sweden)

    Hagino Tetsuo

    2012-03-01

    Full Text Available Abstract Introduction Spinal anesthesia is a widely used general purpose anesthesia. However, serious complications, such as intracranial subdural hemorrhage, can rarely occur. Case presentation We report the case of a 73-year-old Japanese woman who had acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery. Conclusion This case highlights the need to pay attention to acute intracranial subdural hemorrhage as a complication after spinal anesthesia. If the headache persists even in a supine position or nausea occurs abruptly, computed tomography or magnetic resonance imaging of the brain should be conducted. An intracranial subdural hematoma may have a serious outcome and is an important differential diagnosis for headache after spinal anesthesia.

  6. Peritumoral hemorrhage after radiosurgery for metastatic brain tumor; A case report

    Energy Technology Data Exchange (ETDEWEB)

    Motozaki, Takahiko (Nishinomiya City General Hospital, Hyogo (Japan)); Ban, Sadahiko; Yamamoto, Toyoshiro; Hamasaki, Masatake

    1994-08-01

    An unusual case of peritumoral hemorrhage after radiosurgery for the treatment of metastatic brain tumor is reported. This 64-year-old woman had a history of breast cancer and underwent right mastectomy in 1989. She remained well until January 1993, when she started to have headache, nausea and speech disturbance, and was hospitalized on February 25, 1993. Neurological examination disclosed right hemiparesis and bilateral papilledema. CT scan and MR imaging showed a solitary round mass lesion in the left basal ganglia region. It was a well-demarcated, highly enhanced mass, 37 mm in diameter. Cerebral angiography confirmed a highly vascular mass lesion in the same location. She was treated with radiosurgery on March 8 (maximum dose was 20 Gy in the center and 10 Gy in the peripheral part of the tumor). After radiosurgery, she had an uneventful course and clinical and radiosurgical improvement could be detected. Her neurological symptoms and signs gradually improved and reduction of the tumor size and perifocal edema could be seen one month after radiosurgery. However, 6 weeks after radiosurgery, she suddenly developed semicoma and right hemiplegia. CT scan disclosed a massive peritumoral hemorrhage. Then, emergency craniotomy, evacuation of the hematoma and total removal of the tumor were performed on April 24. Histopathological diagnosis was adenocarcinoma. It was the same finding as that of the previous breast cancer. Histopathological examination revealed necrosis without tumor cells in the center and residual tumor cells in the peripheral part of the tumor. It is postulated that peritumoral hemorrhage was caused by hemodynamic changes in the vascular-rich tumor after radiosurgery and breakdown of the fragile abnormal vessels in the peripheral part of the tumor. (author).

  7. Robust generalized H2 control:time-delay case

    Institute of Scientific and Technical Information of China (English)

    刘飞

    2004-01-01

    Generalized H2 control problem is considered for a class of linear time-delay systems covering linear timeinvariant (LTI) case and time-varying but norm-bounded linear differential inclusion (NLDI) case. The issues focus on the synthesis of so-called generalized H2 controller, which guarantees internal/robust stability and a certain performance level of generalized H2 norm of resulting closed-loop system. By using Lyapunov functional technique, sufficient conditions for the existence of such a kind of controllers are obtained in terms of two linear matrix inequalities (LMIs).In the state space, for memoryless state feedback case, we treat the controller design in a unified framework for both LTI and NLDI. The presented results are illustrated by numerical examples.

  8. Multiple simultaneous intracerebral hemorrhages following accidental massive lumbar cerebrospinal fluid drainage: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Ruiz-Sandoval Jose

    2006-01-01

    Full Text Available Multiple simultaneous intracerebral hemorrhages (ICH are uncommon. We report the case of an 80-year-old woman with previous diagnosis of normal pressure hydrocephalus and who was brought to our hospital with altered mental status and urinary incontinence. Medical history of hypertension, hematological disorders or severe head trauma was absent. Platelet count and coagulation profile were unremarkable. An initial head computed tomography (CT showed sulcal enlargement and ventricular dilatation, but no evidence of ICH. A tap test indicated as a guide to case selection for shunt surgery accidentally resulted in cerebrospinal fluid (CSF overdrainage. The patient presented sudden neurological deterioration, with sluggishly responsive pupils and generalized tonic-clonic seizures. A new head CT demonstrated multiple supra and infratentorial ICH. The patient became comatose and had a fatal course. Hence, CSF overdrainage may either cause or precipitate multiple simultaneous ICHs, affecting both the infratentorial and supratentorial regions.

  9. Massive fetomaternal hemorrhage caused by an intraplacental choriocarcinoma: a case report

    DEFF Research Database (Denmark)

    Henningsen, Anna-Karina Aaris; Maroun, Lisa Leth; Havsteen, Hanne

    2010-01-01

    Background. Intraplacental choriocarcinoma is a rare but highly malignant trophoblastic neoplasm. When found near term the risk of maternal metastasis is high because of the late diagnosis. Case. We describe a case of an intraplacental choriocarcinoma diagnosed postpartum after a near-term delive...... choriocarcinoma 3 cm in diameter. The tumor had infiltrated the maternal basal plate. Conclusion. Fetomaternal bleeding is a rare form of presentation of choriocarcinoma but its presence should always warrant detailed examination of placenta, mother, and infant....... of a severely anemic infant. A fetomaternal hemorrhage resulted in a hemoglobin concentration in the infant of only 2,1 g/dL. Neither mother nor child showed signs of metastatic disease. The macroscopic examination showed a hydropic placenta weighing more than 1 kilogram. Microscopy showed an intraplacental...

  10. Case of traumatic MLF syndrome with a CT demonstration of a small hemorrhagic legion

    Energy Technology Data Exchange (ETDEWEB)

    Ban, S.; Ogata, M.; Miyamoto, T.; Tabuchi, T. (Kobe Municipal Central Hospital (Japan))

    1981-12-01

    We report a case who developed internuclear ophthalmoplegia as a result of a closed head injury. A CT scan (Delta scan 50 FSII) demonstrated a small hemorrhage (9 x 12 mm. on actual measurement) in the dorsum of the upper pons. The patient is a 40-year-old male who fell backward while chasing a fly ball, striking the back of the head. He was rendered unconcious for some ten minutes. Upon admission, mild impairment of the adduction of both eye-balls was noted; 10 hours later this became more obvious, along with cerebellar ataxia, mild dysarthria, and paresthesia of the face. A CT scan obtained immediately after admission revealed an area of increased density compatible with a hemorrhage in the dorsum of the upper pons. A follow-up CT scan on the 12th hospital day revealed a complete resolution of the initially noted high-density in the upper pons, and 2 weeks following admission, the above-noted signs started to improve. Two and a half months following the injury he returned to work as a printer, although a detailed neuro-otological examination done 29 months after the injury still demonstrated evidence of bilateral internuclear ophthalmoplegia. To the author's knowledge, only 13 cases of traumatic 'MLF syndrome' have been reported so far, and our case is the first in which a CT scan indeed demonstrated the lesion. The details of the case are presented, along with the results of the neuro-otological evaluation.

  11. Case of primary pontine hemorrhage of the young adult followed by CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Mashiyama, Shoji; Higuchi, Hiroshi; Takahashi, Akira

    1985-01-01

    A case of primary pontine hemorrhage of the young was reported. He was 22 years of age, who did not have the history of hypertension. He suddenly noticed disturbance of skilled act of his right hand and speech disturbance. He was admitted to our clinic two days after the onset. Neurological examination revealed right facial palsy, disturbance of delicate movement of his right hand and slight dysarthria. Lumbar puncture, after six days from the onset, yielded watery clear cerebrospinal fluid containing 6/3 cells/mm/sup 3/, 27mg/dl of protein and 65.1 mg/dl of sugar. An opening pressure was 75 mmH/sub 2/O. The vertebral angiography revealed no evidence of mass lesion and vascular anomalies. CT scan demonstrated a pontine hematoma, the size of this hematoma sequentially enlarged in follow-up CT scan. His clinical symptoms were gradually aggravated, i.e. cerebellar sign, urinary disturbance and involuntary movement. Conservative therapy was performed and his symptoms gradually improved. The size of hematoma was reduced in follow-up CT scan. The genesis, diagnosis and treatment of primary pontine hemorrhage of the young were discussed. (author).

  12. Cerebral hemorrhage due to tuberculosis meningitis: a rare case report and literature review.

    Science.gov (United States)

    Zou, Hai; Pan, Ke-Hua; Pan, Hong-Ying; Huang, Dong-Sheng; Zheng, Ming-Hua

    2015-12-29

    Tuberculosis (TB) is a common disease to threaten human health. TB of the central nervous system (CNS) is rare but the most serious type of systemic TB because of its high mortality rate, serious neurological complications and sequelae. In this case report, we describe a woman who presented with walking instability, intracerebral hemorrhage and leptomeningeal enhancement due to tuberculosis meningitis. The patient had no significant medical history and the initial clinical symptoms were walking instability. On analysis, the cerebrospinal fluid was colorless and transparent, the pressure was more than 400 mm H2O, there was lymphocytic pleocytosis, increased protein, and decreased glucose levels present. No tuberculosis or other bacteria were detected. The patient's brain computed tomography image showed intra-cerebral hemorrhage (ICH) and contrast magnetic resonance imaging showed ICH in the right frontal lob, and leptomeningeal enhancement. CNS TB is rare but has a high mortality rate. As this disease has no unique characteristics at first presentation such as epidemiology and obvious clinical manifestation, a diagnosis of CNS TB remains difficult.

  13. Ehrlichia Meningitis Mimicking Aneurysmal Subarachnoid Hemorrhage: A Case Study for Medical Decision-Making Heuristics.

    Science.gov (United States)

    Dredla, Brynn; Freeman, William D

    2016-04-01

    Thunderclap headache is a sudden and severe headache that can occur after an aneurysmal subarachnoid hemorrhage (SAH). Subarachnoid hemorrhage is a medical emergency that requires prompt attention and hospitalization. Patients with thunderclap headache often undergo a noncontrast head computed tomography (CT) scan to ascertain SAH bleeding and, if the scan is negative, then undergo a lumbar puncture to look for cerebrospinal fluid (CSF) red blood cells (RBCs), which would be consistent with an aneurysmal leak. If the initial CT is negative and CSF is positive for RBCs, patients are usually admitted to the hospital for evaluation of intracranial aneurysm. We encountered a patient with thunderclap headache whose initial head CT was negative for SAH and whose CSF tested positive for RBCs. The patient was referred to our center for evaluation and management of aneurysmal SAH. However, on careful review of the patient's medical history, serum laboratory values, and spinal fluid values, the patient was diagnosed with Ehrlichia chaffeensis meningitis. While Ehrlichia meningitis is rare, it is important to recognize the clinical clues that could help avoid formal cerebral angiography, a costly and potentially unnecessary procedure. We present how this case represented a cognitive framing bias and anchoring heuristic as well as steps that medical providers can use to prevent such cognitive errors in diagnosis.

  14. [Hemorrhagic Adult Unilateral Moyamoya Disease with Multiple Unruptured Intracranial Aneurysms: A Case Report].

    Science.gov (United States)

    Ozaki, Saya; Inoue, Akihiro; Miyazaki, Hajime; Onoue, Shinji; Ichikawa, Haruhisa; Fukumoto, Shinya; Iwata, Shinji; Kohno, Kanehisa

    2016-02-01

    Adult unilateral moyamoya disease with intracranial aneurysm is frequently reported in the literature, but there is much variation in its treatment. In this case report, we describe the time course and treatment regimen of a patient with moyamoya disease and review the literature regarding moyamoya disease with intracranial aneurysm. A 64-year-old man had untreated intracranial aneurysm and unilateral moyamoya disease for 10 years. He presented with sudden-onset right hemiparesis and aphasia due to a subcortical hemorrhage. He was admitted to the local neurosurgical unit, and upon resolution of symptoms, he was admitted to our hospital. A cerebral angiogram revealed the champagne bottleneck sign of the left carotid artery and obliteration of the top of the left intracranial carotid artery with a moyamoya phenomenon. Two unruptured intracranial aneurysms were identified in the anterior communicating artery(Acom A) and the right intracranial carotid artery(C3). We performed superficial temporal artery-middle cerebral artery anastomosis followed by aneurysmal neck clipping of the Acom A aneurysm. Postoperative imaging showed no new ischemic damage and improved cerebral blood flow. Although the patient experienced temporal worsening of aphasia, his function recovered a few months later and he was able to resume his normal daily life activities. The combination of direct bypass surgery and aneurysmal neck clipping might be a therapeutic option for hemorrhagic unilateral moyamoya disease with unruptured intracranial aneurysm.

  15. Hemorrhagic disorder

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930167 Relationship among changes of bloodpicture and hemorrhage to skin,fundus occuliand brain in 220 cases of hematologic disease.WU Bingquan(吴秉权),et al.Blood Dis Hosp,CMAS.Tianjin Med J 1992;20(9):515-517.Changes of blood picture related to bleedingof the skin,fundus occuli and brain were ana-lyzed in 220 cases of blood diseases.Resultsshowed,in iron deficient anemia with pro-

  16. 胰十二指肠切除术后迟发性出血诊疗分析%Delayed massive hemorrhage after pancreaticoduodenectomy

    Institute of Scientific and Technical Information of China (English)

    孟翔飞; 王敬; 王志军; 黄晓强; 夏红天; 董家鸿

    2012-01-01

    Objective To summarize our clinical experiences of delayed massive hemorrhagc (DMH),a rare but fatal complication,after pancreaticoduodenectomy (PD).Methods The clinical data of 14 DMH patients at our medical center were collected and analyzed to evaluate the risk factors and to compare the efficacies of different therapies.Results A total of 1008 PD patients were treated since April 1993.Fourteen DMHs occurred post-operatively (1.4%).In these cases,10/14 (71.4%) were complicated with pancreatic fistula. Sentinel bleeding was observed in 10 (71.4%) cases.The clinical manifestations of DMH included simple abdominal hemorrhage (n =6,42.9% ), alimentary tract hemorrhage (n =6,42.9% ) and both (n =3,21.4% ).Shock (n =2,14.3% ) might also be the initial symptom.Thirteen cases achieved post-therapeutic hemostasis while 1 patient died before re-admission.The therapeutic modalities included interventional therapy ( n =8 ) and surgery ( n =5 ).According to the therapeutic modalities,the re-bleeding rate,morbidity and final mortality of two groups were 50.0% vs 40.0% ( P =0.83 ),75.0% vs 60.0% ( P =0.96 ) and 50.0% vs 80.0% ( P =0.62) respectively.Five patients survived at the end of treatment.The mortality rate was 71.4%.Conclusion As a rare but fatal complication after PD,DMH is difficult to diagnose and treat.Postoperative pancreatic fistula remains a possible but undetermined risk factor. Sentinel bleeding is of great predicative value for DMH. Regular interventional arteriography is an effective method of improving diagnosis and treatment.Both interventional therapy and surgery may be used to treat DMH.%目的 总结胰十二指肠切除术(PD)后迟发性出血(DMH)的诊疗经验和文献观点,提高对该并发症的诊治水平.方法 对解放军总医院14例DMH患者的临床数据进行回顾性分析,初步分析其危险因素,并对不同治疗方式的效果进行比较.结果 1993年3月-2011年4月共有1008例患者于解放

  17. Plasma level of sFas and sFasL in acute cerebral hemorrhage with delayed cerebral edema%脑出血后迟发性脑水肿血浆sFas和sFasL水平分析

    Institute of Scientific and Technical Information of China (English)

    王兆平; 王文静; 王前友; 潘健; 孙一兵

    2011-01-01

    目的:探讨可溶性Fas (sFas)和可溶性Fas配体(sFasL)的变化与急性脑出血(ACH)后迟发性脑水肿的关系.方法:ACH后迟发性脑水肿患者12例,其中男性9例;随机选取同期ACH无迟发性脑水肿组12例,其中男性8例;同期年龄和性别相匹配的12例健康体检合格者作为对照组,其中男性8例.采用酶联免疫吸附法( ELISA)法测定血浆sFas和sFasL浓度,比较各组之间sFas和sFasL浓度差异.结果:ACH后迟发性脑水肿组14d血浆sFas和sFasL水平明显高于ACH无迟发性脑水肿组和对照组(P<0.01),ACH后迟发性脑水肿组较ACH无迟发性脑水肿组于发病7d后血浆sFas和sFasL水平下降速度缓慢,血浆sFasL水平稍有上升.结论:sFas和sFasL可能参与脑出血后迟发性脑水肿的形成,动态性检测血浆sFas和sFasL水平,可对于发现潜在的ACH后迟发性脑水肿具有一定的意义.%Objective To investigate the relationship between the changes of the plasma levels of soluble Fas (sFas) , soluble Fas-ligand(sFasL) and delayed cerebral edema following acute cerebral hemorrhage ( ACH). Methods Our study included 12 cases of ACH with delayed cerebral edema patients (male 9) and 12 cases of ACH without delayed cerebral edema (male 8) and 12 cases of the age and sex matched healthy subjects( male 8). The plasma levels of sFas and sFasL were measured by enzyme-linked immunosorbent assay ( ELISA) method in these groups and the difference in the levels of sFas and sFasL were compared among each groups. Results The levels of serum sFas and sFasL at 14d after onset in ACH with delayed cerebral edema group were significantly higher than that of the ACH without delayed cerebral e-dema and control groups(P <0.01) and that in ACH with delayed cerebral edema group was slow rate of decline at 7d after onset. The levels of serum sFasL in ACH with delayed cerebral edema group were increased slightly 7d after onset. Conclusion The sFas and sFasL probably take roles in the

  18. Pheochromocytoma complicated by intracerebral hemorrhage - a case report; Feocromocitoma complicado com acidente vascular encefalico hemorragico - relato de um caso

    Energy Technology Data Exchange (ETDEWEB)

    Nogueira, Aline Silva; Marchiori, Edson; Almeida, Fabiola Assuncao de; Martins, Renata Romano; Sales, Anderson Ribeiro; Santos, Tereza Cristina C.R.S. dos; Reis, Simone Teixeira [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia; Silveira, Sonia Marcelino T. da

    1999-06-01

    The authors report a case of pheochromocytoma that was complicated by intracerebral hemorrhage in a 17-year-old female patient. Computed tomography showed a solid mass, heterogeneous, on the right adrenal. The patient underwent a right adrenalectomy. She is being observed by our out-patients clinic, presenting normal blood pressure levels and a left hemiparesis. (author)

  19. Percutaneous transhepatic obliteration of stomal variceal hemorrhage from an ileal conduct: Case report and brief literature review

    Energy Technology Data Exchange (ETDEWEB)

    Park, Seung Hyun; Lee, Shin Jae; Won, Jong Yun; Park, Sung Il; Lee, Do Yun; Kim, Man Deuk [Dept. of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Do Young [Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-11-15

    Variceal bleeding is an unusual complication of ileal conduits. We report a case in which recurrent stomal variceal hemorrhage from an ileal conduit for bladder cancer was successfully treated by percutaneous transhepatic obliteration (PTO) using microcoils and N-butyl cyanoacrylate. Therefore, PTO can be one treatment option to prevent recurrent stomal variceal bleeding from ileal conduits.

  20. Spontaneous intracranial hemorrhage as an initial manifestation of primary Sjögren’s syndrome: a case report

    OpenAIRE

    2013-01-01

    Background Sjögren’s syndrome can involve the central nervous system; however, spontaneous intracranial hemorrhage has rarely been reported as the initial manifestation. Case presentation We report a 39-year-old woman with primary Sjögren’s syndrome presenting with intracranial hemorrhage. The diagnosis of primary Sjögren’s syndrome was based on the presence of ocular dryness, salivary gland secretory and excretory dysfunction confirmed with dynamic tracer emission CT, and positive anti-Sjögr...

  1. Vasospasm on transcranial Doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.

    Science.gov (United States)

    Kumar, Gyanendra; Shahripour, Reza Bavarsad; Harrigan, Mark R

    2016-05-01

    OBJECT The impact of transcranial Doppler (TCD) ultrasonography evidence of vasospasm on patient-centered clinical outcomes following aneurysmal subarachnoid hemorrhage (aSAH) is unknown. Vasospasm is known to lead to delayed cerebral ischemia (DCI) and poor outcomes. This systematic review and meta-analysis evaluates the predictive value of vasospasm on DCI, as diagnosed on TCD. METHODS MEDLINE, Scopus, the Cochrane trial register, and clinicaltrials.gov were searched through September 2014 using key words and the terms "subarachnoid hemorrhage," "aneurysm," "aneurysmal," "cerebral vasospasm," "vasospasm," "transcranial Doppler," and "TCD." Sensitivities, specificities, and positive and negative predictive values were pooled by a DerSimonian and Laird random-effects model. RESULTS Seventeen studies (n = 2870 patients) met inclusion criteria. The amount of variance attributable to heterogeneity was significant (I(2) > 50%) for all syntheses. No studies reported the impact of TCD evidence of vasospasm on functional outcome or mortality. TCD evidence of vasospasm was found to be highly predictive of DCI. Pooled estimates for TCD diagnosis of vasospasm (for DCI) were sensitivity 90% (95% confidence interval [CI] 77%-96%), specificity 71% (95% CI 51%-84%), positive predictive value 57% (95% CI 38%-71%), and negative predictive value 92% (95% CI 83%-96%). CONCLUSIONS TCD evidence of vasospasm is predictive of DCI with high accuracy. Although high sensitivity and negative predictive value make TCD an ideal monitoring device, it is not a mandated standard of care in aSAH due to the paucity of evidence on clinically relevant outcomes, despite recommendation by national guidelines. High-quality randomized trials evaluating the impact of TCD monitoring on patient-centered and physician-relevant outcomes are needed.

  2. Surgical reduction in a delayed case of traumatic testicular dislocation.

    Science.gov (United States)

    Phuwapraisirisan, Samart; Lim, Meechai; Suwanthanma, Weerapat

    2010-11-01

    A 27-year-old Thai male was admitted with left groin pain and he felt that he lost his left testis three weeks after his motorcycle accident-car collision. He had not been diagnosed after four days of admission at the previous hospital. Surgical reduction was performed without acute and delayed complications after three months of follow-up. Traumatic testicular dislocation is an uncommon sequel of trauma usually related to straddle injury from motorcycle accidents. Diagnosis depends on the awareness of the physician of its possibility of occurrence. Physical examination is the most helpful in diagnosis. CT scan or Doppler ultrasound, if available, may be helpful in diagnosis, particularly locating the extrascrotal testicle and detecting testicular viability. Manual reduction is the treatment of choice for acute traumatic dislocation of testis. Open reduction is indicated for the delayed case, or if there are (1) difficulty in determining the integrity of dislocated testis, (2) possibility of torsion, (3) failure of close reduction, or (4) the minimal morbidity of an inguinal exploration.

  3. Delayed intracranial hematoma following stereoelectroencephalography for intractable epilepsy: case report.

    Science.gov (United States)

    Derrey, Stéphane; Lebas, Axel; Parain, Dominique; Baray, Marie Gilles; Marguet, Christophe; Freger, Pierre; Proust, François

    2012-12-01

    Intracranial bleeding following stereoelectroencephalography (sEEG) is rare and commonly occurs early after electrode implantation. The authors report the case of a delayed intracranial hematoma following sEEG. This 10-year-old boy was referred to the authors' department to undergo an sEEG study for intractable epilepsy, with the hypothesis of a single localized epileptic zone in the left precentral region. To perform the exploration, 14 depth electrodes were implanted under stereotactic conditions. The results of a postoperative CT scan performed routinely at the end of the surgical procedure were normal. Eight days later, following an epileptic seizure, the child's condition worsened. The neurological examination revealed a left hemiparesis, agitation, and coma due to a right subdural hematoma with intraparenchymal bleeding. Despite a surgical evacuation followed by a decompressive craniectomy, the curative treatments were stopped 1 week later due to severe diffuse ischemic lesions found on MRI studies. This is the first observation of a delayed hematoma following an sEEG procedure. The mechanism underlying this complication remains unclear, but the rupture of a growing pseudoaneurysm caused by the electrode's implantation or the tearing of a neighboring vessel by an electrode were suspected. In consequence, physicians must remain vigilant during the entire sEEG recording period and probably also several days after electrode removal.

  4. Delayed geochemical hazard: Concept, digital model and case study

    Institute of Scientific and Technical Information of China (English)

    CHEN Ming; FENG Liu; Jacques Yvon

    2005-01-01

    Delayed Geochemical Hazard (DGH briefly) presents the whole process of a kind of serious ecological and environmental hazard caused by sudden reactivation and sharp release of long-term accumulated pollutant from stable species to active ones in soil or sediment system due to the change of physical-chemical conditions (such as temperature, pH, Eh, moisture, the concentrations of organic matters, etc.) or the decrease of environment capacity. The characteristics of DGH are discussed. The process of a typical DGH can be expressed as a nonlinear polynomial. The points where the derivative functions of the first and second orders of the polynomial reach zero, minimum and maximum are keys for risk assessment and harzard pridication.The process and mechanism of the hazard is due to the transform of pollutant among different species principally. The concepts of "total releasable content of pollutant", TRCP, and "total concentration of active specie", TCAS, are necessarily defined to describe the mechanism of DGH. The possibility of the temporal and spatial propagation is discussed. Case study shows that there exists a transform mechanism of "gradual release" and "chain reaction" among the species of the exchangeable and the bounds to carbonate, iron and manganese oxides and organic matter, thus causing the delayed geochemical hazard.

  5. Uterine artery embolization for hemorrhage resulting from second-trimester abortion in women with scarred uterus: report of two cases.

    Science.gov (United States)

    Shen, Yunfeng; Liao, Yumei; Feng, Guangsen; Gu, Xiaoli; Wan, Shi

    2015-01-01

    This study was conducted to investigate the effect of uterine artery embolization for the treatment of hemorrhage following second-trimester labor induction for women with scarred uterus. Two cases of second-trimester abortion were retrospectively reviewed, both of which had a history of caesarean delivery and were complicated by gestational anemia. One was at 18 weeks' gestation and presented with persistent vaginal bleeding for two months resulting in relatively large area of blood clot in uterine cavity. The other was at 25 weeks' gestation with partial hydatidiform mole and presented with intermittent vaginal bleeding. Both patients presented with continuous and heavy vaginal bleeding after oral administration of mifepristone for labor induction, with one cervix left unopened, while the other cervix 3 cm left dilatation, yet felt obstructed by pregnant tissue. Both patients were immediately treated with uterine artery embolization (UAE). Both patients presented with alleviated hemorrhage and regular uterine contraction after UAE, followed by smooth induction of labor. No hemorrhage occurred since then during the follow-up. The results suggest that UAE is safe and effective for the treatment of massive hemorrhage of second-trimester abortion in women with scarred uterus. It can reduce time period of labor induction and alleviate hemorrhage, which not only rescues patients but also avoids cesarean sections and retains fertility for the pregnant.

  6. Pediatric acute otitis media: the case for delayed antibiotic treatment.

    Science.gov (United States)

    Johnson, Nicholas C; Holger, Joel S

    2007-04-01

    Acute otitis media (AOM) is both a commonly diagnosed condition and a frequent indication for antibiotic use in children. Recent literature suggests that antibiotics are not needed in many children with AOM, as most cases resolve spontaneously without complication. However, a majority of AOM infections in children are still treated with antibiotics. The American Academy of Pediatrics and American Academy of Family Physicians released a guideline for treatment of AOM in children. We review the guideline as well as scientific evidence related to AOM treatment options. We support a set of evidence-based guidelines employing a delayed prescription option for antibiotic therapy in selected children. If used appropriately, these cost-effective guidelines will reduce the amount of antibiotics prescribed, increase parental satisfaction, and may lower rates of antibiotic resistance while producing similar rates of resolution of AOM.

  7. Segmental Arterial Mediolysis: A Case of Mistaken Hemorrhagic Pancreatitis and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Jennifer L Horsley-Silva

    2014-01-01

    Full Text Available Context Segmental arterial mediolysis is an uncommon, non-atherosclerotic, non-inflammatory arteriopathy that involvesareas of dissecting aneurysms and strictures that are caused by outer media lysis of the arterial wall from areas of medialnecrosis of uncertain pathogenesis. It has a predilection for splanchnic arteries and often presents as abdominal pain orhemorrhage in late middle-aged and elderly patients. Diagnosis can be established by computed tomography angiography,magnetic resonance angiography, or angiogram by visualizing typical abnormalities, in addition to excluding othervasculitides. Histological confirmation is the gold standard but is not easily accessible and, as such, is not frequentlyperformed. Case report Here we present an updated review of the literature and a case of segmental arterial mediolysis thatpresented with spontaneous intra-abdominal bleeding near the pancreas that was originally misdiagnosed as hemorrhagicpancreatitis. Conclusion Diagnosis is important because immunosuppressants for vasculitis can worsen the arteriopathy.Segmental arterial mediolysis can be self-limiting without treatment or may require urgent surgical or endovascular therapyfor bleeding and carries a 50% mortality rate. Therefore, it should be included in the differential of causes of abdominal painas well as in cases of unexplained abdominal hemorrhage.

  8. [Primary gastrointestinal follicular lymphoma of the small intestine with massive hemorrhage: a report of three cases].

    Science.gov (United States)

    Sato, Akiyasu; Tsujimura, Hideki; Sugiyama, Takahiro; Maruyama, Satoshi; Yamada, Shuhei; Ono, Keiko; Wang, Xiaofei; Sugawara, Takeaki; Ise, Mikiko; Itami, Makiko; Kumagai, Kyouya

    2016-03-01

    Primary gastrointestinal follicular lymphoma (FL) has an indolent clinical presentation and many of cases are diagnosed incidentally during routine endoscopic examinations. Herein, we present 3 cases with FL of the small intestine developed massive intestinal hemorrhage that necessitated blood transfusion. In all three patients, upper and lower endoscopic examinations failed to detect the bleeding sites. Eventually, video capsule endoscopies identified ulcerative lesions in the jejunum and biopsies using single- or double-balloon endoscopy confirmed the FL diagnosis in our three cases. The respective clinical stages according to the Lugano system were I, II-1 and II-1. PET-CT did not play a significant role in identifying the gastrointestinal lesions. Two patients received rituximab monotherapy and achieved a complete response. The other remains under observation after termination of antiplatelet drug therapy. Generally, the macroscopic appearance of multiple whitish nodules and the absence of symptoms represent the typical clinical picture of gastrointestinal FL. However, this study demonstrates that patients with ulcerative lesions may be at risk for massive bleeding. Further discussion is required to determine the optimal indications for total endoscopic examination of the small intestine.

  9. Use of Hypoprothrombinemia-Inducing Cephalosporins and the Risk of Hemorrhagic Events: A Nationwide Nested Case-Control Study.

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    Li-Ju Chen

    Full Text Available Existing data regarding the risk of hemorrhagic events associated with exposure to hypoprothrombinemia-inducing cephalosporins are limited by the small sample size. This population-based study aimed to examine the association between exposure to hypoprothrombinemia-inducing cephalosporins and hemorrhagic events using National Health Insurance Research Database in Taiwan.A nationwide nested case-control study.National Health Insurance Research database.We conducted a nested case-control study within a cohort of 6191 patients who received hypoprothrombinemia-inducing cephalosporins and other antibiotics for more than 48 hours. Multivariable conditional logistic regressions were used to calculate the adjusted odds ratio (aOR and 95% confidence interval (CI for hemorrhagic events associated with exposure to hypoprothrombinemia-inducing cephalosporins (overall, cumulative dose measured as defined daily dose (DDD, and individual cephalosporins.Within the cohort, we identified 704 patients with hemorrhagic events and 2816 matched controls. Use of hypoprothrombinemia-inducing cephalosporins was associated with increased risk of hemorrhagic events (aOR, 1.71; 95% CI, 1.42-2.06, which increased with higher cumulative doses (5 DDDs, aOR 1.89. The aOR for individual cephalosporin was 2.88 (95% CI, 2.08-4.00, 1.35 (1.09-1.67 and 4.57 (2.63-7.95 for cefmetazole, flomoxef, and cefoperazone, respectively. Other risk factors included use of anticoagulants (aOR 2.08 [95% CI, 1.64-2.63], liver failure (aOR 1.69 [1.30-2.18], poor nutritional status (aOR 1.41 [1.15-1.73], and history of hemorrhagic events (aOR 2.57 [1.94-3.41] 6 months prior to the index date.Use of hypoprothrombinemia-inducing cephalosporins increases risk of hemorrhagic events. Close watch for hemorrhagic events is recommended when prescribing these cephalosporins, especially in patients who are at higher risk.

  10. Genome Sequence of Ex-Afghanistan Crimean-Congo Hemorrhagic Fever Virus SCT Strain, from an Imported United Kingdom Case in October 2012.

    Science.gov (United States)

    Chamberlain, John; Atkinson, Barry; Logue, Christopher H; Latham, Jennie; Newman, Edmund N C; Hewson, Roger

    2013-05-16

    Crimean-Congo hemorrhagic fever (CCHF) virus is a serious human pathogen causing severe hemorrhagic disease with a fatality rate of up to approximately 30%. We have determined the viral genomic sequence from an isolate that caused a fatal case of imported CCHF in the United Kingdom in October 2012.

  11. [A case presenting with trochlear nerve palsy and segmental sensory disturbance due to circumscribed midbrain and upper pontine hemorrhage].

    Science.gov (United States)

    Ishihara, Kenji; Furutani, Rikiya; Shiota, Jun-ichi; Kawamura, Mitsuru

    2003-07-01

    We describe a patient presenting with trochlear nerve palsy and segmental sensory disturbance due to circumscribed mesencephalic hemorrhage. A 36-year-old man with no past illness visited our hospital complaining of sudden onset of diplopia, dysesthesia of the left face and upper extremity, and acuphenes of the left ear. Neurological examination revealed left trochlear nerve palsy and segmental sensory disturbance of the left side almost above T11 level. Pain and temperature sensation were disturbed, but vibration, joint position, graphesthesia, kinesthesia, and discrimination sensation were spared. Magnetic resonance imaging of the head, performed 7 days after onset, revealed acute to subacute phase hemorrhage at the right inferior colliculus. No abnormalities were identified on cerebral angiography. Symptoms gradually improved with conservative therapy. After about ten weeks, diplopia disappeared and area of sensory disturbance was reduced (disturbance of pain sensation reduced to about T4 level, temperature sensation to about T9). Segmental sensory disturbance usually accompanies spinal cord lesion. However, several cases of similar symptoms following cerebrovascular disease of the brainstem have been reported. Conversely, some reports have indicated that trochlear nerve palsy due to midbrain hemorrhage accompanies sensory disturbance contralateral to the lesion. The nature of sensory disturbance is thus variable. The present case suggests that segmental sensory disturbance might accompany trochlear nerve palsy caused by hemorrhage of the inferior colliculus, as intramedullary fibers of the trochlear nerve and spinothalamic tract are located nearby and somatotopy of the spinothalamic tract is preserved even at the level of the midbrain.

  12. Activation of nuclear factor-κB in the brain after experimental subarachnoid hemorrhage and its potential role in delayed brain injury.

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    Wan-Chun You

    Full Text Available It has been reported that inflammation is involved in brain injury after subarachnoid hemorrhage (SAH. Nuclear factor-κB (NF-κB is a key transcriptional regulator of inflammatory genes. Here, we used pyrrolidine dithiocarbamate(PDTC, an inhibitor of NF-κB, through intracisternal injection to study the role of NF-κB in delayed brain injury after SAH. A total of 55 rabbits were randomly divided into five groups: the control group; the SAH groups including Day-3, 5, and 7 SAH groups (the rabbits in these groups were sacrificed at 3, 5, 7 days after SAH, respectively; and the PDTC group (n = 11 for each group. Electrophoretic mobility shift assay (EMSA was performed to detect NF-κB DNA-binding activity. The mRNA levels of tumor necrosis factor (TNF-α, interleukin (IL-1β, and intercellular adhesion molecule (ICAM-1 were evaluated by RT-PCR analysis. Deoxyribonucleic acid fragmentation was detected by TUNEL and p65 immunoactivity was assessed by immunohistochemistry. Our results showed the activation of NF-κB after SAH, especially at day 3 and 5. The activated p65 was detected in neurons. NF-κB DNA-binding activity was suppressed by intracisternal administration of PDTC. Increased levels of the TNF-α, IL-1β, and ICAM-1 mRNA were found in the brain at day 5 after SAH, and which were suppressed in the PDTC group. The number of TUNEL-positive cells also decreased significantly in the PDTC group compared with that in the Day-5 SAH group. These results demonstrated that the activated NF-κB in neurons after SAH plays an important role in regulating the expressions of inflammatory genes in the brain, and ultimately contributes to delayed brain injury.

  13. Posttraumatic delayed tension pneumocephalus: Rare case with review of literature

    Science.gov (United States)

    Kankane, Vivek Kumar; Jaiswal, Gaurav; Gupta, Tarun Kumar

    2016-01-01

    Pneumocephalus is commonly seen after head and facial trauma, ear infections, and tumors of the skull base or neurosurgical interventions. In tension pneumocephalus, the continuous accumulation of intracranial air is thought to be caused by a “ball valve” mechanism. In turn, this may lead to a mass effect on the brain, with subsequent neurological deterioration and signs of herniation. Tension pneumocephalus is considered a life-threatening, neurosurgical emergency burr-hole evacuation was performed and he experienced a full recovery. However, more invasive surgery was needed to resolve the condition. Delayed tension pneumocephalus is extremely rare and considered a neurosurgical emergency. Pneumocephalus is a complication of head injury in 3.9–9.7% of the cases. The accumulation of intracranial air can be acute (trauma and underwent urgent surgical intervention. Burr-hole placement in the right frontal region, evacuation of tension pneumocephalus. Tension pneumocephalus is a life-threatening neurosurgical emergency case, which needs to undergo immediate surgical intervention.

  14. Influence of Fever and Hospital-Acquired Infection on the Incidence of Delayed Neurological Deficit and Poor Outcome after Aneurysmal Subarachnoid Hemorrhage

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    G. Logan Douds

    2012-01-01

    Full Text Available Although fever and infection have been implicated in the causation of delayed neurological deficits (DND and poor outcome after aneurysmal subarachnoid hemorrhage (SAH, the relationship between these two often related events has not been extensively studied. We reviewed these events through of our retrospective database of patients with SAH. Multivariate logistic regression was used to determine independent predictors of DND and poor outcome. A total of 186 patients were analyzed. DND was noted in 76 patients (45%. Fever was recorded in 102 patients (55%; infection was noted in 87 patients (47%. A patient with one infection was more likely to experience DND compared to a patient with no infections (adjusted OR 3.73, 95% CI 1.62, 8.59. For those with more than two infections the likelihood of DND was even greater (adjusted OR 4.24, 95% CI 1.55, 11.56. Patients with 1-2 days of fever were less likely to have a favorable outcome when compared to their counterparts with no fever (adjusted OR 0.19, 95% CI 0.06, 0.62. This trend worsened as the number of days febrile increased. These data suggest that the presence of infection is associated with DND, but that fever may have a stronger independent association with overall outcome.

  15. Roller coaster-associated subarachnoid hemorrhage--report of 2 cases.

    Science.gov (United States)

    Rutsch, Sebastian; Niesen, Wolf-Dirk; Meckel, Stephan; Reinhard, Matthias

    2012-04-15

    The most common neurological injuries associated with roller coaster rides are subdural hematoma and cervical artery dissection. We report two cases of roller-coaster associated subarachnoid hemorrhage (SAH). A 40-year-old healthy man developed a strong, holocephalic headache during a roller coaster ride. SAH Hunt & Hess grade II and Fisher grade 3 was diagnosed. An underlying aneurysm of the anterior communicating artery was successfully treated with coil embolization. A 41-year-old female (smoker, otherwise healthy) experienced a sudden, strong headache and diplopia during a roller coaster ride. A perimesencephalic SAH (Hunt & Hess grade II, Fisher grade 3) was disclosed by a CT scan. No aneurysm was detected on angiography. Both patients were discharged without neurological disability. In conclusion, SAH is a rare but relevant differential diagnosis in cases of acute headache during roller coaster rides. Both aneurysmal and non-aneurysmal perimesencephalic SAH can occur. A combination of mechanical factors and excessive blood pressure rises in vulnerable persons is discussed.

  16. Intrauterine skull depression and intracranial hemorrhage in a premature infant

    Energy Technology Data Exchange (ETDEWEB)

    Batton, G.D.; DiCarmine, F.; Boal, D.K.

    1988-04-01

    The authors describe a case of a premature infant born with a parietal skull depression who suffered an intraventricular hemorrhage and an ipsilateral intracerebral injury. At 21 months of life the infant's gross motor milestones were delayed and he had moderate spastic hemiplegia. Although skull depressions at birth are usually benign, they may be associated with long-term neurologic sequelae.

  17. [A case of brucellosis misdiagnosed as Crimean-Congo hemorrhagic fever].

    Science.gov (United States)

    Almiş, Habip; Yakıncı, Cengiz

    2012-07-01

    Brucellosis which is a zoonotic infection, is an important public health problem in Turkey and all over the world. The disease may involve many organs and systems. Since the symptoms of brucellosis are non-specific, difficulties in differential diagnosis and misdiagnosis are frequent. In this case report we present a case of brucellosis, misdiagnosed as Crimean-Congo hemorrhagic fever (CCHF). A 13-year-old boy was referred from another medical center with preliminary diagnosis of CCHF and admitted to our clinic with fever and a history of presence of a tick on his back. His physical observation only included splenomegaly. The laboratory results on admission were anemia, thrombocytopenia, elevation of acute phase reactants and liver transaminase levels. Abdominal ultrasonography revealed splenomegaly. Since the patient had anemia, epistaxis, fever and thrombocytopenia, he was initially diagnosed as CCHF. Meantime serum sample of the patient had been sent to Refik Saydam National Public Health Agency for CCHF PCR test. The fever of the patient could not be controlled. His detailed medical history revealed stockbreeding and consumption of raw milk products. Patient's signs and symptoms were also compatible with brucellosis and standard tube agglutination test for brucellosis was positive at 1/1280 titer in serum. The patient was diagnosed as brucellosis and the treatment was started with combination of rifampicin (1 x 600 mg/day) and doxycycline (2 x 100 mg/day). Blood cultures yielded negative result. The PCR tests for CCHF was found also negative. His fever and other complaints improved with treatment which was completed in six weeks and the follow-up was without complications. Turkey is endemic both for brucellosis and CCHF. This case was reported to emphasize that the cases of brucellosis could mimic other diseases and brucellosis should also be considered in the differential diagnosis of CCHF.

  18. Acute-onset severe gastrointestinal tract hemorrhage in a postoperative patient taking rivaroxaban after total hip arthroplasty: a case report

    LENUS (Irish Health Repository)

    Boland, Michael

    2012-05-14

    AbstractIntroductionRivaroxaban, a new oral anticoagulant, is currently licensed for use in patients undergoing orthopedic surgery. It is more efficacious than other anticoagulants such as low molecular weight heparin and does not require daily monitoring. It has also been shown to be efficacious in patients with venous thromboembolism and acute coronary syndrome. Although hemorrhage is a known side effect of this new anticoagulant, we could find no case reports in the literature of patients suffering severe hemorrhage whilst taking rivaroxaban. Thus, we describe the first case of potentially fatal hemorrhage in a patient taking rivaroxaban.Case presentationWe report the case of a 58-year-old Caucasian man with acute-onset severe per rectal bleeding who had undergone total hip arthroplasty four weeks prior to the onset of symptoms and was taking rivaroxaban in the postoperative period. Rivaroxaban was discontinued immediately but, having required nine units of packed red blood cells in a peripheral hospital due to a rapidly decreasing hemoglobin level, our patient was transferred to our tertiary referral center where he required a further eight units of packed red blood cells over a 48-hour period to manage his ongoing hemorrhage and maintain hemodynamic stability. No source of bleeding was found on computed tomography angiography and our patient’s condition improved over the following 48 hours with cessation of the hemorrhage. Our patient was discharged home well several days later. A follow-up colonoscopy one week after his discharge was normal.ConclusionAlthough advantageous with regard to its oral availability and ongoing use without the need for daily monitoring, rivaroxaban does not come without rare but severe side effects. When severe per rectal bleeding occurs in a patient taking rivaroxaban, discontinuation of the offending agent and aggressive hematological replacement are the mainstays of treatment, especially when no source of bleeding can be found

  19. A complicated case of antepartum eclamptic fit with HELLP syndrome, acute renal failure and multiple intracranial hemorrhages: A mortality report

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    Ahmed Samy El-agwany

    2016-04-01

    Full Text Available HELLP is an acronym for hemolysis, elevated liver enzymes and low platelets count, affecting 0.2–12% of all pregnancies or 4–12% of those with preeclampsia. The maternal mortality reported from the literature is up 4% due to disseminated intravascular coagulation, placental abruption, acute renal failure, eclampsia, and cerebral hemorrhage. A 20 year old, G2P1, at 36 weeks of gestation, was referred to our hospital because of postictal coma state with bilateral mydriasis and epistaxis due to repeated antepartum eclamptic fits. Elevated blood pressure level 170/110 mmHg was accompanied with massive proteinuria. Cesarean section was performed and female newborn were delivered. Laboratory findings were characteristic of preeclampsia, HELLP syndrome and renal failure. The patient developed an intraventricular hematoma and an intracerebral hemorrhage with subarachnoid one, which were not suitable to neurosurgical treatment. The patient died from refractory hemolytic anemia, spontaneous bleeding of multiple organs, renal failure and intracranial hemorrhage. Preeclampsia, HELLP syndrome, and acute fatty liver of pregnancy might overlap and be associated with potentially fatal complications, including intracranial hemorrhage, as in the present case. Early detection and diagnosis are crucial to ensure appropriate management and treatment success.

  20. Acromegaly With Cardiomyopathy, Cardiac Thrombus and Hemorrhagic Cerebral Infarct: A Case Report of Therapeutic Dilemma With Review of Literature

    Science.gov (United States)

    Mendoza, Erick; Malong, Chandy Lou; Tanchee-Ngo, Mary Jane; Mercado-Asis, Leilani

    2015-01-01

    Introduction: Cardiomyopathy with congestive heart failure (CHF) is a rare complication of growth hormone (GH)-secreting pituitary adenoma occurring in 3% of cases. We report a case of acromegaly complicated not only by CHF but also by the presence of intracardiac thrombus and cardioembolic stroke with hemorrhagic formation. Case Presentation: A 46-year-old Filipino female presented with amenorrhea, progressive coarsening of facial features, deepening of voice and enlargement of digits. She experienced easy fatigability, orthopnea and bipedal edema. The cardiac apex beat was sustained and displaced. Growth hormone was nonsuppressible. Cranial magnetic resonance imaging showed pituitary macroadenoma with hemorrhage. Incidentally, there was a left frontal lobe cortical infarct with hemorrhagic component. The echocardiogram demonstrated cardiomyopathic changes with a left ventricular thrombus. Conclusions: The primary treatment for GH-producing adenoma is surgery; however, this patient has high surgical risk from her severe cardiomyopathy. Radiotherapy poses a greater risk because of increased cerebrovascular mortality. Somatostatin receptor ligands are significantly associated with improvement of cardiovascular and hemodynamic parameters. Dopamine agonists must be considered regardless of prolactin level and immunostaining. The risks and benefits of any treatment must be emphasized in the presence of conflicting clinical features such as in the case reported. PMID:25926851

  1. Hereditary hemorrhagic telangiectasia with bilateral pulmonary vascular malformations: A case report

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    Lončarević Olivera

    2016-01-01

    Full Text Available Introduction. Hereditary hemorrhagic telangiectasia (HHT also known as Osler-Weber-Rendu syndrome is an autosomal dominant disease that occurs due to vascular dysplasia associated with the disorder in the signaling pathway of transforming growth factor β (TGF-β. The clinical consequence is a disorder of blood vessels in multiple organ systems with the existence of telangiectasia which causes dilation of capillaries and veins, are present from birth and are localized on the skin and mucosa of the mouth, respiratory, gastrointestinal and urinary tract. They can make a rupture with consequent serious bleeding that can end up with fatal outcome. Since there is a disruption of blood vessels of more than one organic system, the diagnosis is very complex and requires a multidisciplinary approach. Case report. We reported a 40-year-old female patient with a long-time evolution of problems, who was diagnosed and treated at the Clinic for Lung Diseases of the Military Medical Academy in Belgrade, Serbia, because of bilaterally pulmonary arteriovenous malformations associated with HHT. Embolization was performed in two acts, followed with normalization of clinical, radiological and functional findings with the cessation of hemoptysis, effort intolerance with a significant improvement of the quality of life. Conclusion. HHT is a rare dominant inherited multisystem disease that requires multidisciplinary approach to diagnosis and treatment. Embolization is the method of choice in the treatment of arteriovenous malformations with minor adverse effects and very satisfying therapeutic effect.

  2. A case report of crimean congo hemorrhagic Fever in ostriches in iran.

    Science.gov (United States)

    Mostafavi, Ehsan; Chinikar, Sadegh; Moradi, Maryam; Bayat, Neda; Meshkat, Mohsen; Fard, Mohammad Khalili; Ghiasi, Seyyed Mojtaba

    2013-01-01

    Crimean Congo hemorrhagic fever (CCHF) is a viral zoonosis, which is usually transmitted via tick bites or close contact with infected blood or tissue. This disease can cause a case fatality rate of up to 25%-30% in humans. CCHF Infection in birds is less documented. An ostrich can reproduce viruses and can also play the role of a mechanical vector, by transporting infected ticks without becoming ill. In March 2007, three butchers and one worker in an ostrich farm were infected with CCHF in central part of Iran. Considering the role ostriches play in transmitting the disease, serum samples from five ostriches of that farm were taken and sent to the laboratory for CCHF ELISA tests. The result of the IgG test was positive for one (20%) of the ostriches. At the same time, serum samples of eight sheep from the same farm were sent for IgG testing, two (25%) of which were positive. This was the first report of CCHF infection of an ostrich in Iran and tracing CCHF IgG against this ostrich and the afore-mentioned sheep may have revealed that the disease in the worker was the cause of transmission of this disease from these animals or their ticks.

  3. Morphological and histochemical changes in the brain stem in case of experimental hemispheric intracerebral hemorrhage

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    S. I. Tertishniy

    2015-10-01

    Full Text Available Aim. Investigation of the extent of morphological changes and activity of biogenic amines (according to the intensity of luminescence in the neurons of the brain stem in intracerebral hemorrhage (ICH. Methods and results. ICH was designed on 29 white rats of Vistar line by the administration of autologous blood in the cerebral hemisphere. It was revealed that increased luminescence intensity by 18.4±5.5% was registered in monoaminergic neurons in 1–6 hours after experimental ICH. After 12 hours – 1 day development of dislocation syndrome leads to mosaic focal ischemic neuronal injuries with maximum reduction in the level of catecholamines by 29.5±5.0% compared with control cases. Three–6 days after ICH on a background of selective neuronal necrosis in substantial number of neurons in the nuclei of the brainstem the level of catecholamines is significantly reduced. Conclusion. Disclosed observations reflect significant functional pathology of neurons responsible for the regulation of cardiorespiratory function and may underlie disturbances of integrative activity in the brain stem in general.

  4. Hereditary hemorrhagic telangiectasia with oral manifestations. Report of periodontal treatment in two cases.

    Science.gov (United States)

    Austin, G B; Quart, A M; Novak, B

    1981-03-01

    The periodontal conditions of two patients with hereditary hemorrhagic telangiectasia were successfully treated by a two-phase plan. The first phase of treatment eliminated inflammation from local etiologic factors by removing plaque and plaque-retaining factors. The second phase eliminated the residual anatomic defects of periodontal disease. Gingival bleeding has been indicated as a symptomatic factor of hereditary hemorrhagic telangiectasia, but such bleeding is more likely the result of periodontal inflammation.

  5. Primary antiphospholipid antibody syndrome with adrenal hemorrhage in a child : a case report

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    Kim, Dong Hun; Lee, Soo Hyun; Kim, Hyun Joo; Yoo, Han Wook; Yoon, Chong Hyun [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-11-01

    Primary antiphospholipid antibody syndrome is a disease that is clinically diagnosed if a patient suffers recurrent thromboses, stroke, recurrent fetal loss, livedo reticularis, and thrombocytopenia, without evidence of systemic lupus erythematosus or other connective diseases. Adrenal hemorrhage in a patient with primary antiphospholipid antibody syndrome is a rarely recognized, but potentially catastrophic disorder. We recently encountered bilateral adrenal hemorrhaging in a child with antiphospholipid antibody syndrome and casem as well as reviewing the literature.

  6. Infarction of the entire corpus callosum as a complication in subarachnoid hemorrhage: A case report

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    Satoru Takahashi, M.D.

    2017-03-01

    Full Text Available The corpus callosum is the major commissural pathway connecting the cerebral hemispheres. This pathway receives its blood supply from anterior communicating artery, pericallosal artery, and posterior pericallosal artery. However, in some cases, the entire corpus callosum is supplied by median callosal artery; thus, occlusion of this artery can lead to infarction of the entire corpus callosum. Few reports have described this type of infarction, and no reports after subarachnoid hemorrhage (SAH exist. Here, we report on a 42-year-old female who was diagnosed with SAH after two aneurysms were discovered in bifurcation of left anterior cerebral artery (A1-A2. After successful clipping was performed, the patient was alert and had no neurological deficits; moreover, the computed tomography images that were acquired after the operation showed no evidence of infarction. Nine days after admittance to the hospital, drowsiness and weakness of the left limbs with brain swelling appeared and decompressive hemi-craniectomy was performed. Diagnostic cerebral angiography revealed vasospasms in both anterior and middle cerebral arteries, thus fasudil hydrochloride was administered intra-arterially. While blood flow in all arteries improved, diffusion-weighted magnetic resonance imaging detected infarction along the entire length of the corpus callosum and in the medial region of the right frontal lobe. We believe this infarction was due to secondary ischemia of median callosal artery. This case reminded us of the anatomical variation wherein median callosal artery is the sole blood supply line for the corpus callosum and demonstrated that infarction of the entire corpus callosum is possible.

  7. Treatment delay period: the case of arsenicosis in rural Bangladesh.

    Science.gov (United States)

    Paul, Bimal Kanti; Brock, Vicki L Tinnon

    2006-12-01

    Arsenic concentrations of tubewell water that exceed acceptable limits poses a serious health problem in Bangladesh. Many Bangladeshis are now suffering from arsenic-related diseases. The objectives of this paper are to examine the extent of delay in seeking medical treatment by victims of arsenic poisoning and to identify factors contributing to this delay. Questionnaire survey successfully administered to 663 victims living in two rural areas of Bangladesh provided the major data source for this study. Analysis of survey data reveal that median delay period was 12 months, but the delay period ranged from 1 month to 18 years. Because of this extremely large range, the mean delay period was about 22 months. The study identified time of identification of symptoms of arsenicosis as the most significant determinant of treatment delay followed by treatment sought from members of mobile medical teams, perceived threat, and level of education. Based on the study findings, it is recommended that the Bangladesh government and NGOs involved in arsenic mitigation and prevention efforts should educate individuals at risk for arsenic poisoning about the benefits of seeking early treatment. This study also recommends to continue to dispatch mobile medical teams to the arsenic-impacted areas.

  8. Pancreatitis and myocarditis followed by pulmonary hemorrhage, a rare presentation of leptospirosis- A case report and literature survey

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    Ranawaka Nuwan

    2013-01-01

    Full Text Available Abstract Background Leptospirosis is a potentially fatal disease which can cause multi-organ dysfunction. It can rarely present as acute pancreatitis. This is the first ever report of leptospirosis presenting with acute pancreatitis and myocarditis followed by diffuse pulmonary hemorrhages to the best of our knowledge. Case presentation A 15-year-old South Asian boy presented with high grade fever, epigastric discomfort and was anicteric on admission. He developed tachycardia, transient hypotension, changes of electro-cardiogram and positive troponin I suggestive of myocarditis. Acute pancreatitis was diagnosed with 12 fold high serum amylase and with the evidence of computerized tomography. Then he developed diffuse pulmonary hemorrhages and later acute renal failure. Leptospirosis was confirmed by positive leptospira IgM, negative IgG and strongly positive Microscopic Agglutination Test. Other possible infective and autoimmune causes were excluded. Patient recovered completely with antibiotics and the supportive care. Conclusion This case illustrates diagnostic difficulties especially in resource poor settings where leptospirosis is common. Additionally it highlights the fact that leptospirosis should be considered in patients presenting with pancreatitis which can be complicated with myocarditis and diffuse pulmonary hemorrhages. We hypothesize that Toll like receptors may play a role in such systemic involvement.

  9. 晚发性维生素K缺乏致颅内出血与低血钙的关系%The relation between the intracranial hemorrhage caused by delayed vitamin k deficiency and hypocalcemia

    Institute of Scientific and Technical Information of China (English)

    刘化英

    2014-01-01

    目的:探讨16例晚发性维生素K缺乏所致颅内出血(其中10例伴有低血钙)的诊治方法。方法:观察其临床表现、血常规、出凝血时间、头部CT或MRI进行综合分析。结果:本组治愈14例,2例自动出院。结论:低血钙惊厥可诱发或加剧维生素K缺乏所致颅内出血、在治疗时应给予补充钙剂。%Objective To explore the diagnosis and treatment of the intracranial hemorrhage and hypocalcemia by researching 16 intracranial hemorrhage children caused by delayed vitamin k deficiency with 10 children found hypocalcemia. Methods The results wound be got by analyzing the clinical manifestation ,blood routine, PT , APTT , brain CT or MRI. Results 14 children clinical cured, 2 children discharged voluntarily during therapy. Conclusion The hypocalcemia can induce or aggravate the intracranial hemorrhage caused by delayed vitamin k deficiency.

  10. Rapid tumor necrosis and massive hemorrhage induced by bevacizumab and paclitaxel combination therapy in a case of advanced breast cancer

    Directory of Open Access Journals (Sweden)

    Ono M

    2013-10-01

    Full Text Available Mayu Ono, Tokiko Ito, Toshiharu Kanai, Koichi Murayama, Hiroshi Koyama, Kazuma Maeno, Yasuhiro Mochizuki, Asumi Iesato, Toru Hanamura, Toshihiro Okada, Takayuki Watanabe, Ken-ichi ItoDivision of Breast and Endocrine Surgery, Department of Surgery (II, Shinshu University School of Medicine, Matsumoto, JapanAbstract: Bevacizumab when combined with chemotherapy exerts significant activity against many solid tumors through tumor angiogenesis inhibition; however, it can induce severe side effects. We report the rare case of a 27-year-old premenopausal woman with locally advanced breast cancer that was marked by rapid tumor necrosis followed by massive hemorrhage shortly after bevacizumab and paclitaxel administration. On the basis of histopathological examination of a biopsy specimen and computed tomography findings, she was diagnosed with stage IV estrogen and progesterone receptor-negative and human epidermal growth factor receptor type 2-positive breast cancer with multiple organ metastases when she had entered gestational week 24. Cyclophosphamide, Adriamycin®, fluorouracil therapy was initiated, but multiple liver metastases continued to progress. A healthy fetus was delivered by induced delivery and trastuzumab-based treatment was initiated. Although the multiple liver metastases were controlled successfully by trastuzumab combined with paclitaxel, the primary tumor continued to expand even after subsequent administration of three other treatment regimens including anti-human epidermal growth factor receptor type 2 agents and cytotoxic drugs. To inhibit primary tumor growth, a combination therapy with paclitaxel and bevacizumab was subsequently initiated. Following therapy initiation, however, the large tumor occupying the patient's entire left breast became necrotic and ulcerated rapidly. Furthermore, massive hemorrhage from the tumor occurred 5 weeks after bevacizumab-based therapy initiation. Although hemostasis was achieved by manual

  11. Treatment of radiation-induced hemorrhagic gastritis with prednisolone: A case report

    Institute of Scientific and Technical Information of China (English)

    Lan Zhang; Xiao-Ying Xie; Yan Wang; Yan-Hong Wang; Yi Chen; Zheng-Gang Ren

    2012-01-01

    Radiation-induced gastritis is an infrequent cause of gastrointestinal bleeding.It is a serious complication arising from radiation therapy,and the standard treatment method has not been established.The initial injury is characteristically acute inflammation of gastric mucosa.We presented a 46-year-old male patient with hemorrhagic gastritis induced by external radiotherapy for metastatic retroperitoneal lymph node of hepatocellular carcinoma.The endoscopic examination showed diffuse edematous hyperemicmucosa with telangiectasias in the whole muscosa of the stomach and duodenal bulb.Mlultiple hemorrhagic patches with active oozing were found over the antrum.Anti-secretary therapy was initiated for hemostasis,but melena still occurred off and on.Finally,he was successfully treated by prednisolone therapy.We therefore strongly argue in favor of perdnisolone therapy to effectively treat patients with radiation-induced hemorrhagic gastritis.

  12. [A case of hemorrhagic cholecystitis associated with Churg-Strauss syndrome].

    Science.gov (United States)

    Koizumi, Satomi; Kamisawa, Terumi; Kuruma, Sawako; Chiba, Kazuro; Tabata, Taku; Koizumi, Koichi; Kurata, Masanao; Horiguchi, Shinichiro; Hishima, Tsunekazu

    2016-01-01

    A woman in her 70s with Churg-Strauss syndrome presented with epigastric pain. She was being treated with steroids at the time of admission. Computed tomography showed swelling of the gallbladder, and percutaneous transhepatic cholangiography revealed bloody secretion. On duodenoscopy, bleeding was observed from the orifice of the major duodenal papilla. Emergency cholecystectomy was performed under a diagnosis of hemorrhagic cholecystitis;intraoperatively, extensive hematoma was detected in the thickened wall of the gallbladder. Subsequent histopathological examination revealed mucosal ulceration with infiltration of inflammatory cells, torn small vessels, and extensive transmural bleeding and abscess formation in the thickened wall of the gallbladder. We considered that the hemorrhagic cholecystitis was induced by either vasculitis or corticosteroid therapy. To the best of our knowledge, this is the first report of hemorrhagic cholecystitis associated with Churg-Strauss syndrome.

  13. Delayed esophageal perforation occurring with endoscopicsubmucosal dissection: A report of two cases

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    We report two cases of delayed esophageal perforationoccurring with endoscopic submucosal dissection. Ourcases involved delayed perforation after 10 d in case1 and after 6 d in case 2. Both cases were related tosolid food. We performed subtotal esophagectomywith gastric tube reconstruction of the esophagus viathe subcutaneous route anterior to the thoracic wallwithout conservative treatment because both casesinvolved chest pain and major leakage of food intothe mediastinum. Postoperative complications were alocal factor (including suture failure and esophagealstricture) in case 1, and we performed endoscopicballoon dilatation five times for esophageal stricture.There was no intrathoracic and mediastinal infection ineither case. Surgical treatment for delayed esophagealperforation can be performed safely and surely ifdiagnosis and assessment are not delayed.

  14. Absence of viral hemorrhagic septicemia virus (VHSV) and infectious hemorrhagic necrosis virus (INHV) in a Tunisian fish farm: a case study.

    Science.gov (United States)

    Cherif, N; Hammami, S

    2012-01-01

    Beyond the obvious problems related to the sustainable management of wild stocks, current fish farming practices in the Mediterranean area entail important environmental risks and potential outbreaks of fish diseases linked to massive translocations across regional boundaries. Viral haemorrhagic septicaemia (VHS) and infectious hematopoietic necrosis (IHN) are well-known fish diseases caused by the VHSV and IHNV viruses, and positive cases are subject to obligatory reporting to the World Organisation for Animal Health (OIE). In August 2004, the OIE published the first record of a VHS outbreak in a sea bass (Dicentrarchus labrax) aquaculture facility on the coast of the Mediterranean Sea. However, D. labrax is not considered as a susceptible host species for viral hemorrhagic septicaemia according to OIE's International Aquatic Animal Health Code (2009) and VHSV was not previously reported in the Mediterranean. In this sense and given the high risk of disease translocation associated with farmed fish in marine aquaculture, the present study was aimed at investigating the presence of VHSV and IHNV in stocks of sea bass and sea bream (Sparus aurata) reared inside a Tunisian coastal fish farm. Cell culture, IFAT and RT-PCR were applied to screen for both VHSV and IHNV in 69 pooled samples of sea bass and 24 pooled samples of sea bream. All three techniques showed the absence of both viruses within fish at the selected site.

  15. [Delayed discovery of congenital diaphragmatic hernia: diagnostic difficulties. A report of two cases].

    Science.gov (United States)

    Coste, C; Jouvencel, P; Debuch, C; Argote, C; Lavrand, F; Feghali, H; Brissaud, O

    2004-08-01

    Delayed revelation of congenital diaphragmatic hernias (CDH) is not uncommon and can represent 5-30% of total CDHs. Time before diagnosis may be prolonged, sometimes to the adult period. Respiratory and gastrointestinal symptoms are frequent but not specific. The clinical presentation of delayed CDH may thus mislead the practitioner. Diagnosis can be approached and/or confirmed by plain radiography. Outcome is usually favorable after surgery. We report two cases of delayed CDH and we discuss the difficulty of diagnosis.

  16. 急性外伤性颅内血肿患者术后发生迟发性脑出血的临床分析%Clinical analysis of acute traumatic intracranial hematoma with postoperative delayed cerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    蔡亮

    2013-01-01

    目的:探讨急性外伤性颅内血肿患者的临床特征与术后迟发性脑出血发生的相关性,寻找防治措施。方法:回顾分析58例急性外伤性颅内血肿患者开颅血肿清除术后再出血的临床资料,其中23例患者术后发生迟发性脑出血( DTIH组),35例未发生( NDTIH)组。对2组患者的临床特征进行总结归纳,分析寻找再出血原因,对迟发性脑出血患者行再次手术治疗,并随访行GOS评分。结果:与NDTIH组比较DTIH组有如下特征:术前GCS评分<8分(p<0.05);术前头颅CT提示多有多发脑挫伤,对冲伤,合并颅骨骨折等,并予及时再次手术治疗,术后随访行GOS评估≥4分18例。结论:根据急性外伤性颅内血肿开颅术后患者的临床特征,及时发现迟发性脑出血,并清除迟发性颅内血肿,是提高疗效的关键。%Objective:To explore the corelation between the clinical features of patients with incidence of acute traumatic intracranial hematoma and late postoperative hemorrhage occurs and to make prevention and control measures .Methods:The clinical data of 58 cases divided two groups,postoperative delayed cerebral hemorrhage (DTIH,n=23) and did not occur (NDTIH,n=35),of acute traumatic in-tracranial hematoma in patients with invasive hematoma removal were retrospectively analyzed ,which to invastigate the reason of rehaemor-rhagia and did surgical treatment again ,to follow up through GOS score .Results:Compared with the NDTIH group ,the DTIH had the fol-lowing characteristics:preoperative GCS score <8 points ( p <0.05);Preoperative skull CT indicated that multiple cerebral contusion , hedge, skull fractures, etc,which to timely surgery again , there were18 cases those value of GOS evaluation were four points or more . Conclusion:According to the clinical features of patients with acute traumatic intracranial hematoma after craniotomy , timely detected the late-onset cerebral

  17. 蛛网膜下腔出血后游离脂肪酸与迟发性脑缺血的关系%Relation between free fatty aid and delayed cerebral ischemia after subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    崔晓梅; 韩冰; 张玉镇; 尹红蕾; 李金凤; 乔娜娜; 王运良

    2014-01-01

    目的:探讨蛛网膜下腔出血后血清游离脂肪酸浓度变化与迟发性脑缺血的关系。方法选取75例蛛网膜下腔出血患者,发病14 d内进行间接热量测定法检查全身耗氧量和液相色谱法测定游离脂肪酸浓度;应用多变量广义估计方程模型验证游离脂肪酸浓度与蛛网膜下腔出血的关系,Cox风险比例模型证实迟发性脑缺血的时间关系。结果75例蛛网膜下腔出血患者进行249项检查,发现n-6FFA和n-3FFA浓度与全身耗氧和改良的Fisher评分有关;21例(28%)患者出血后平均7 d发生迟发性脑缺血,迟发性脑缺血病人改良的Fisher评分,平均n-6FFA :n-3FFA比例和平均耗氧量较高;在Cox风险比例模型中,平均n-6FFA :n-3FFA比例、年轻和改良的Fisher评分与迟发性脑缺血的时间有关。结论蛛网膜下腔出血后脑损伤的严重性和耗氧代谢亢进与n-FFA浓度增高有关,n-6FFA :n-3FFA比例增加与迟发性脑缺血有关,提示调节氧耗和FFA浓度能减少DCI发生。%Objective To explore the relation between in serum free fatty acid levels changes and delayed cerebral ischemia after subarachnoid hemorrhage.Methods In 75patients with subarachnoid hemorrhage ,we performed measurement of system oxygen consumption by indirect calorimetry and free fatty acid levels by liquid chromatography in the first 14days after ic-tus.Multivariable generalized estimating equation models identified associations with free fatty acid levels and subarachnoid hemorrhage.Cox proportional hazards model was used to identify associations with time to delayed cerebral ischemia.Results There were 249 measurements in 75 patients with subarachnoid hemorrhage ,and n-6FFAand n-3FFA levels were found to be associated with oxygen consumption and the modified Fisher score.Twenty one (28% ) patients developed delayed cerebral is-chemia on median 7days after subarachnoid hemorrhage.In patients who developed delayed

  18. Hemorrhagic Stroke

    Science.gov (United States)

    A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Hemorrhagic stroke is the less common type. It happens when ... an artery wall that breaks open. Symptoms of stroke are Sudden numbness or weakness of the face, ...

  19. Use of the novel hemostatic textile Stasilon® to arrest refractory retroperitoneal hemorrhage: a case report

    Directory of Open Access Journals (Sweden)

    Jones Samuel W

    2010-01-01

    Full Text Available Abstract Introduction Stasilon® is a novel hemostatic woven textile composed of allergen-free fibers of continuous filament fiberglass and bamboo yarn. The development of this product resulted from controlled in vitro thrombogenic analysis of an array of potentially hemostatic textile materials and it has been cleared for both external and internal use by the United States Food and Drug Administration for the arrest of hemorrhage. The goal of the study was to assess the hemostatic and adhesive properties of Stasilon® in the setting of life-threatening refractory hemorrhage. Case presentation A 39-year-old Caucasian man presented with severe necrotic pancreatitis that failed multiple aggressive attempts to control associated bleeding with electrocautery, suture ligation, and sequential anatomic packing with cotton-based sponges. Subsequent retroperitoneal packing with Stasilon® produced a non-adherent wound-dressing interface and resulted in the achievement of persistent hemostasis in the operative field. Conclusion In our patient, Stasilon® was demonstrated to be effective in the arrest of refractory hemorrhage.

  20. Clinical Analysis of 50 Cases of Postpartum Hemorrhage%50例产后出血临床分析

    Institute of Scientific and Technical Information of China (English)

    黄红琴

    2012-01-01

      目的:探讨产后出血的相关因素与防治措施,降低产后出血的发生率。方法:回顾分析2010-2011年本院发生的50例产后出血患者的病例资料。结果:子宫收缩乏力仍为产后出血的首位原因,占72%,胎盘因素占20%,软产道损伤占6%,凝血功能障碍占2%。结论:做好计划生育宣教,加强孕期健康教育及孕期管理,促进自然分娩,降低剖宫产率,提高全科医务人员助产技术水平,对降低产后出血发生率起着重要作用。%  Objective:To discussion on the correlative factors of postpartum hemorrhage and prevention measures,reduce the incidence of postpartum haemorrhage.Method:Review analysis of the 2010-2011 50 cases of patients with postpartum hemorrhage information.Result:Uterine atony was the result for the first cause of postpartum hemorrhage,72%,placental factors 20%,soft birth canal injuries 6%,dysfunction of blood coagulation and 2%.Conclusion:Completes the family planning mission,strengthen the health education and management during pregnancy,promote natural childbirth, reducing cesarean section rate and improve the general medical personnel midwifery technical level,to reduce the incidence of postpartum hemorrhage plays an important role.

  1. Application of fibrin glue to damaged bladder mucosa in a case of BK viral hemorrhagic cystitis.

    Science.gov (United States)

    Purves, J Todd; Graham, Michael L; Ramakumar, Sanjay

    2005-09-01

    BK virus is a common cause of severe hemorrhagic cystitis refractory to standard treatment. We describe a technique to achieve hemostasis after failed conservative therapy using fibrin glue applied suprapubically while visualizing and insufflating the bladder through a cystoscope. Long-term hemostasis was achieved using this novel procedure.

  2. Spontaneous acute hemorrhage of intraspinal canal cellular schwannoma with paraplegia: A case report.

    Science.gov (United States)

    Zhang, Heng-Zhu; Li, Yuping; Han, Yang; Wang, Xiaodong; She, Lei; Yan, Zhengcun; Dong, Lun

    2015-06-01

    Cellular schwannoma, an unusual histological subtype of schwannoma, is a benign hypercellular variant of a peripheral nerve sheath tumor. We report a 48-year-old woman with sudden onset of paraplegia. The complete surgical resection was achieved. This is the first report about intraspinal canal cellular schwannoma following spontaneous acute hemorrhage and paraplegia.

  3. Massive fetomaternal hemorrhage caused by an intraplacental choriocarcinoma: a case report

    DEFF Research Database (Denmark)

    Henningsen, Anna-Karina Aaris; Maroun, Lisa Leth; Havsteen, Hanne;

    2010-01-01

    of a severely anemic infant. A fetomaternal hemorrhage resulted in a hemoglobin concentration in the infant of only 2,1 g/dL. Neither mother nor child showed signs of metastatic disease. The macroscopic examination showed a hydropic placenta weighing more than 1 kilogram. Microscopy showed an intraplacental...

  4. Intracranial hemorrhagic infarct after local anesthesia on nasal mucosa: A case report

    Directory of Open Access Journals (Sweden)

    Murat Koçyiğit

    2015-01-01

    Conclusion: We want to emphasize that all surgeons especially the ENT surgeons should be careful while using local anesthetic medicines which contains adrenaline for rare complication of intracranial hemorrhagic infarction. Another fact is that the patients must sign an informed consent form including those situations even for all minor surgical procedures to avoid a medicolegal problem.

  5. Hemorrhagic ovarian cyst without peritoneal bleeding in a patient with ovarian hyperstimulation syndrome: case report

    Institute of Scientific and Technical Information of China (English)

    Hiroko Kurioka; Kentaro Takahashi; Nobuyuki Kita; Yoichi Noda

    2005-01-01

    @@ Gynecologic and obstetric disorders presenting with abdominal pain are ectopic pregnancy, rupture of endometrial cysts, mature cystic teratoma and torsion of the adnexae. Hemorrhagic ovarian cysts, which included among the functional cysts, are often involved in acute abdomen leading to laparotomy intervention.

  6. Diagnosis and treatment of postpartum hemorrhage 75 cases%产后出血75例诊疗分析

    Institute of Scientific and Technical Information of China (English)

    陈洁

    2011-01-01

    目的 探讨产后出血的原因、治疗方法以及预防措施.方法 回顾性分析75例产后出血患者的临床资料.结果 子宫收缩乏力50例,占66.7%;胎盘因素10例,占13.3%;产道损伤6例,占8%;凝血功能障碍4例,占5.3%;其他5例,占6.7%.41例行子宫按摩,9例行清宫术,6例缝合损伤产道,3例宫腔填塞纱布,2例行子宫切除术,无1例产妇死亡.结论 产后出血是产科严重的并发症,积极预防是关键,发生以后要根据出血原因迅速采取相应的措施治疗,方能保证产妇的安全和健康.%Objective To investigate the causes of postpartum hemorrhage, treatment and preventive measures.Methods A retrospective analysis of 75 cases of postpartum hemorrhage in our hospital clinical data.Results Totally 50 cases of uterine inertia, accounting for 66.7%, placental factors in 10 cases, 13.3%, birth canal injury in 6 cases, 8%, coagulation disorders in 4 cases, 5.3%, other 5 cases, accounting for 6.7%.41 cases of uterine massage, curettage in 9 cases, 6 cases of suture damaged birth canal, uterine cavity packing gauze in 3 cases, 2 cases with hysterectomy, no 1 case maternal deaths.Conclusions Postpartum hemorrhage is a serious obstetric complication, active prevention is the key, according to the causes of bleeding occurred and rapid treatment of appropriate measures taken in order to ensure the safety and health of mothers.

  7. HIMALAIA (Hypertension Induction in the Management of AneurysmaL subArachnoid haemorrhage with secondary IschaemiA) : a randomized single- blind controlled trial of induced hypertension vs. no induced hypertension in the treatment of delayed cerebral ischemia after subarachnoid hemorrhage

    NARCIS (Netherlands)

    Gathier, C. S.; van den Bergh, W. M.; Slooter, A. J. C.

    2014-01-01

    RationaleDelayed cerebral ischemia (DCI) is a major complication after aneurysmal subarachnoid hemorrhage (SAH). One option to treat delayed cerebral ischemia is to use induced hypertension, but its efficacy on the eventual outcome has not been proven in a randomized clinical trial. This article des

  8. 小剂量糖皮质激素治疗脑出血迟发性脑水肿临床分析%Clinical analysis of low dose glucocorticoidin treatment of delayed cerebral edema after cerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    林茵

    2014-01-01

    ObjectiveTo observe the clinical efifcacy of low dose glucocorticoidin treatment of delayed cerebral edema after cerebral hemorrhage.MethodsRetrospective analysis was performed on the clinical data of 13 patients, who were of delayed cerebral edema after cerebral hemorrhage and treated with small-dosed glucocorticoid. The efficacy of glucocorticoid treatment on these patients was probed.ResultsAfter treatment, the condition of patients was improved in various degrees; the activities of daily living were signiifcantly improved. Ultimately, all the 13 patientswere discharged with better health condition while three of them were improved dramatically. ConclusionsLow dose glucocorticoid is effective in treating delayed cerebral edema after cerebral hemorrhage with no serious side effects.%目的:观察糖皮质激素对脑出血迟发性脑水肿的治疗效果。方法回顾分析13例经小剂量糖皮质激素治疗的脑出血后迟发性脑水肿患者的临床资料,探讨糖皮质激素治疗对迟发性脑水肿的效用。结果治疗后脑出血迟发性脑水肿患者病情不同程度好转,生活能力明显改善,最终13例均好转出院,其中3例症状明显改善。结论小剂量糖皮质激素对于脑出血迟发性脑水肿有明显的治疗作用,无严重不良反应。

  9. Early neonatal complications from pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: case report and review of the literature.

    Science.gov (United States)

    Gludovacz, Karoy; Vlasselaer, Jozef; Mesens, Tinne; Van Holsbeke, Caroline; Van Robays, Johan; Gyselaers, Wilfried

    2012-08-01

    Hereditary hemorrhagic telangiectasia (HHT) is a rare but life-threatening disease characterized by multi system telangiectasias and arteriovenous malformations (AVM). Complications in adults have been reported extensively, but neonatal (NN) complications have only been published in incidental case reports. In this paper, we present a literature review on NN pulmonary AVM related to HHT, following our own experience with a NN death due to this disease. As prenatal diagnosis of pulmonary AVM is feasible, we recommend that a family history of HHT should be an indication for expertise prenatal anomaly scanning, in order to organise optimal NN support at birth.

  10. Fatal hemorrhage following trans--sphenoidal resection of a pituitary adenoma: a case report and review of the literature.

    Science.gov (United States)

    Kepron, C; Cusimano, M; Pollanen, M S

    2010-12-01

    A 58-year-old woman with acromegaly developed massive epistaxis 7 days following trans-sphenoidal resection of a growth hormone-secreting pituitary adenoma. At autopsy, it was determined that the source of the hemorrhage was a rupture of the intracavernous segment of the internal carotid artery secondary to a bacterial arteritis. We describe the gross dissection and histologic examination undertaken in this unusual case, discuss the possible etiology of the infection and review the potential complications of this surgical approach with a view to improving forensic examination of these patients.

  11. Postpartum Hemorrhage in 149 Cases of Clinical Study%产后出血149例临床探讨

    Institute of Scientific and Technical Information of China (English)

    谢国秋

    2013-01-01

    Objective To investigate the causes of postpartum hemorrhage and the prevention measures. Method According to dif erent causes bleeding anti-infection, application of oxytocin, fil ing the uterine cavity, laceration of suture, blood transfusion, rehydration treatment. Results Contractions fatigue in 107 cases, of which the second lasting 8 cases; Placenta factors in 25 cases, of which 18 cases of placenta previa, placenta adhesion in 5 cases, 2 cases of placental residues; 14 cases had soft birth canal laceration;Blood coagulation dysfunction in 3 patients. Bleeding time in postpartum 131 cases within 2h,2h,18 cases. Conclusion Postpartum hemorrhage is the key to rescue in time, measure is proper, thus the obstetrician must have good technology, in order to timely discover and deal with al kinds of unfavorable factors, in order to reduce the occurrence of postpartum hemorrhage.%目的探讨产后出血的原因及预防措施。方法针对不同病因予以止血抗感染、应用缩宫素、填塞宫腔、缝合裂伤、输血补液等处理。结果宫缩乏力107例,其中第二产程延长8例;胎盘因素25例,其中前置胎盘18例,胎盘粘连5例,胎盘残留2例;软产道裂伤14例;凝血功能障碍3例。出血时间发生在产后2h以内131例,2h以外18例。结论产后出血的关键是抢救及时,措施得当,因此产科医生必须有过硬的技术,才能及时发现并处理各种不利因素,以减少产后出血的发生。

  12. Delayed neutralization of interleukin 6 reduces organ injury, selectively suppresses inflammatory mediator, and partially normalizes immune dysfunction following trauma and hemorrhagic shock.

    Science.gov (United States)

    Zhang, Yong; Zhang, Jinxiang; Korff, Sebastian; Ayoob, Faez; Vodovotz, Yoram; Billiar, Timothy R

    2014-09-01

    An excessive and uncontrolled systemic inflammatory response is associated with organ failure, immunodepression, and increased susceptibility to nosocomial infection following trauma. Interleukin 6 (IL-6) plays a particularly prominent role in the host immune response after trauma with hemorrhage. However, as a result of its pleiotropic functions, the effect of IL-6 in trauma and hemorrhage is still controversial. It remains unclear whether suppression of IL-6 after hemorrhagic shock and trauma will attenuate organ injury and immunosuppression. In this study, C57BL/6 mice were treated with anti-mouse IL-6 monoclonal antibody immediately prior to resuscitation in an experimental model combining hemorrhagic shock and lower-extremity injury. Interleukin 6 levels and signaling were transiently suppressed following administrations of anti-IL-6 monoclonal antibody following hemorrhagic shock and lower-extremity injury. This resulted in reduced lung and liver injury, as well as suppression in the levels of key inflammatory mediators including IL-10, keratinocyte-derived chemokine, monocyte chemoattractant protein 1, and macrophage inhibitory protein 1α at both 6 and 24 h. Furthermore, the shift to TH2 cytokine production and suppressed lymphocyte response were partly prevented. These results demonstrate that IL-6 is not only a biomarker but also an important driver of injury-induced inflammation and immune suppression in mice. Rapid measurement of IL-6 levels in the early phase of postinjury care could be used to guide IL-6-based interventions.

  13. Organophosphorus agent induced delayed neuropathy: a case report

    Directory of Open Access Journals (Sweden)

    Harshit Acharya

    2016-02-01

    Full Text Available A 40-year old male, was presented with complaint of difficulty in walking with inability to flex foot and toes in bilateral feet ( and ldquo;foot drop and rdquo;, which was acute at the onset and gradually progressive since the past 7 days. The patient's wife and their 2 children had similar complaint with the same period of onset. At home, his family used cottonseed oil as cooking oil with wheat grain mixed with castor oil. On neurological examination, he was found to have lower motor neuron weakness with spasticity. After ruling out other common causes of polyneuropathy and lower motor weakness; due to high suspicion of poisoning by food adulterant, RBC acetyl cholinesterase (AChE and plasma cholinesterase (BuChE were tested at National Institute of Occupational Health (NIOH, which came low and confirmed diagnosis of Organophosphorus (OP poisoning. Nerve conduction study was done; which showed decreased amplitude of conduction in bilateral peroneal and right tibial nerve along with decreased mean nerve conduction velocity of bilateral median nerve. Thus patient was diagnosed with organophosphorus agent induced delayed axonal type of polyneuropathy and physiotherapy was started as treatment. OP compounds are a diverse group of chemicals which are principally used as insecticides in agriculture. Following organophosphate poisoning (OPP, 3 well-defined neurological syndromes are recognised: cholinergic crisis, intermediate syndrome and delayed polyneuropathy. Some organophosphates, particularly triorthocresyl phosphate (TOCP and tricresyl phosphate (TCP, produce delayed neuropathy. On ingestion, they do not produce significant cholinergic crisis, but 7 to 20 days later it leads to a pure motor axonal neuropathy with wrist and foot drop. The mechanism may involve inhibition of neuropathy target esterase (NTE, which is found in the brain, peripheral nerves, and lymphocytes. This form of toxicity has been seen occasionally in small epidemics in

  14. The Danish eID Case: Twenty years of Delay

    DEFF Research Database (Denmark)

    Hoff, Jens Villiam; Hoff, Frederik Villiam

    2010-01-01

    of intergovernmental coordination and lack of cooperation between public and private sector. However, with the recent tender on digital signatures won by the PBS and the roll-out of the NemID it seems that Denmark will finally - after twenty years of delay - have an eID which can be widely used in the public as well...... as the private sector. ** ** The research reported here is based on the analysis of documents and personal experience of the authors. It has been conducted under contract with the Institute for Information Management Bremen (ifrib), Germany, funded by Volkswagen Foundation, Germany....

  15. Hemorrhagic disease in a newborn due to inadequate vitamin K prophylaxis: case report.

    Science.gov (United States)

    Su, C T; Hung, F C; Huang, C B

    2000-05-01

    Vitamin K prophylaxis for all neonates has been recommended to prevent hemorrhagic disease of the newborn (HDN), but it is still an uncommon practice in most developing countries throughout the world. In the United States and Canada, where vitamin K injections continue to be recommended in the newborn period, HDN is not a major concern. The risk factors for HDN include inadequate vitamin K prophylaxis, exclusively breast-fed infants, diarrhea, and alternative causes of vitamin K deficiency, such as liver disease and cystic fibrosis. We present an exclusively breast-fed 3-week-old infant with diarrhea for 2 days who died from intracranial hemorrhage related to HDN despite having received a single intramuscular injection of 0.2 mg of vitamin K at birth. Hemorrhage in the infant from vitamin K deficiency should be a concern for pediatricians and obstetricians. We emphasize the importance of administering an adequate dosage of vitamin K for prevention of HDN, particularly in an exclusively breast-fed infant.

  16. Reversible coma and Duret hemorrhage after intracranial hypotension from remote lumbar spine surgery: case report.

    Science.gov (United States)

    Bonow, Robert H; Bales, James W; Morton, Ryan P; Levitt, Michael R; Zhang, Fangyi

    2016-03-01

    Intracranial hypotension is a rare condition caused by spontaneous or iatrogenic CSF leaks that alter normal CSF dynamics. Symptoms range from mild headaches to transtentorial herniation, coma, and death. Duret hemorrhages have been reported to occur in some patients with this condition and are traditionally believed to be associated with a poor neurological outcome. A 73-year-old man with a remote history of spinal fusion presented with syncope and was found to have small subdural hematomas on head CT studies. He was managed nonoperatively and discharged with a Glasgow Coma Scale score of 15, only to return 3 days later with obtundation, fixed downward gaze, anisocoria, and absent cranial nerve reflexes. A CT scan showed Duret hemorrhages and subtle enlargement of the subdural hematomas, though the hematomas remained too small to account for his poor clinical condition. Magnetic resonance imaging of the spine revealed a large lumbar pseudomeningocele in the area of prior fusion. His condition dramatically improved when he was placed in the Trendelenburg position and underwent repair of the pseudomeningocele. He was kept flat for 7 days and was ultimately discharged in good condition. On long-term follow-up, his only identifiable deficit was diplopia due to an internuclear ophthalmoplegia. Intracranial hypotension is a rare condition that can cause profound morbidity, including tonsillar herniation and brainstem hemorrhage. With proper identification and treatment of the CSF leak, patients can make functional recoveries.

  17. Syringomyelia and spinal arachnoiditis resulting from aneurysmal subarachnoid hemorrhage: Report of two cases and review of the literature

    Directory of Open Access Journals (Sweden)

    Taylor J Abel

    2014-01-01

    Full Text Available Syringomyelia resulting from arachnoiditis secondary to aneurysmal subarachnoid hemorrhage (SAH is an extremely rare clinical entity with few cases reported in the literature. The presentation, management, and pathogenesis of syringomyelia in this setting is poorly understood. We describe the presentation, radiology, management, and outcomes in two patients with syringomyelia resulting from arachnoiditis secondary to aneurysmal SAH and review the literature on this rare condition. Case number 1 was treated successfully with syrinx-subarachnoid shunt after extensive lysis of adhesions. Case number 2 was treated with syringoperitoneal shunt. Both patients had radiographic decreased syrinx size postoperatively. These patients add to the small literature on syringomyelia occurring secondary to SAH-associated arachnoiditis. The radiographic outcomes demonstrate that in the appropriately selected patient, syrinx-subarachnoid or syringoperitoneal shunting are viable options.

  18. A case of delayed radionecrosis of the larynx

    Energy Technology Data Exchange (ETDEWEB)

    Kunibe, Isamu; Harabuchi, Yasuaki [Asahikawa Medical School, Hokkaido (Japan); Tosho, Takuro; Takahashi, Mitsuaki

    2001-05-01

    A 65-year-old male, who had a history of radiotherapy to the neck for cervical metastasis of nasopharyngeal carcinoma 8 years previously, newly complained of severe throat pain and dysphagia. He was found to have diffuse pharyngitis and pharyngo-cutaneous fistula. A CT examination showed a necrotic shadow of the thyroid cartilage. A recurrence of the carcinoma was ruled out based on the findings of a biopsy specimen. Both the clinical course as well as the local and histologic features led to a diagnosis of delayed radionecrosis of the larynx. The necrotic thyroid cartilage was resected and the pharyngocutaneous fistula was closed using a deltopectoral flap and, as a result, the laryngeal functions were preserved. (author)

  19. Mortality after hemorrhagic stroke

    DEFF Research Database (Denmark)

    González-Pérez, Antonio; Gaist, David; Wallander, Mari-Ann

    2013-01-01

    , 54.6% for 80-89 years; SAH: 20.3% for 20-49 years, 56.7% for 80-89 years; both p-trend stroke patients...... = 0.03). CONCLUSIONS: More than one-third of individuals die in the first month after hemorrhagic stroke, and patients younger than 50 years are more likely to die after ICH than SAH. Short-term case fatality has decreased over time. Patients who survive hemorrhagic stroke have a continuing elevated...

  20. A Hemoglobin Based Oxygen Carrier, Bovine Polymerized Hemoglobin (HBOC-201) versus Hetastarch (HEX) in an Uncontrolled Liver Injury Hemorrhagic Shock Swine Model with Delayed Evacuation

    Science.gov (United States)

    2004-10-01

    using Seldinger technique and a 7.5 F pulmonary artery catheter (PAC; Edwards Life Sciences, Irvine, CA,) was inserted for continuous hemodynamic and...to identify and isolate the lower left lobe. All surgical procedures were performed under aseptic techniques . Injury, Hemorrhage, and Resuscitation

  1. Delayed onset of nemaline myopathy: a case report

    Institute of Scientific and Technical Information of China (English)

    韩燕; 郑惠民; 丁素菊

    2003-01-01

    @@ Nemaline myopathy (NM), first reported by Shy et al1 in 1963, is characterized by the presence of nemaline rods in myofibers and in the nucleus in severe cases. NM is a clinically rare, heterogeneous congenital muscle disorder, displaying dominant or recessive autosomal forms, and in rare cases, sporadic as well. Its chief manifestations are proximal muscle weakness and atrophy followed by further progress to generalized weakness and weakness of facial muscles, tongue muscles and throat muscles. Below is the case of an adult onset nemaline myopathy.

  2. Report of the first case of Crimean Congo hemorrhagic fever in Qazvin Province (2016

    Directory of Open Access Journals (Sweden)

    AR. Nikoonejad

    2016-12-01

    Full Text Available Crimean Congo hemorrhagic fever is a potentially fatal disease that is reported from Asia, Africa and Europe. In May, 2016 a 42 year-old female is admitted to Buali-Sina hospital with epistaxis and within a few hours got loss of consciousness and shock. The patient was put on supportive care and oral Ribavirin. From the sixth admission day, the general condition of the patient improved and on the eleventh day she was discharged without an important sequela. Consequently, it is necessary to consider this disease in the differential diagnosis of all patients presented with fever and acute bleeding diathesis.

  3. Cross-Layer Control with Worst Case Delay Guarantees in Multihop Wireless Networks

    Directory of Open Access Journals (Sweden)

    Shu Fan

    2016-01-01

    Full Text Available The delay guarantee is a challenge to meet different real-time requirements in applications of backpressure-based wireless multihop networks, and therefore, researchers are interested in the possibility of providing bounded end-to-end delay. In this paper, a new cross-layer control algorithm with worst case delay guarantees is proposed. The utility maximization algorithm is developed using a Lyapunov optimization framework. Virtual queues that ensure the worst case delay of nondropped packets are designed. It is proved through rigorous theoretical analyses and verified by simulations that the time average overall utility achieved by the new algorithm can be arbitrarily close to the optimal solution with finite queue backlogs. The simulation results evaluated with Matlab show that the proposed algorithm achieves higher throughput utility with fewer data dropped compared with the existing work.

  4. First reported case of Alcaligenes faecalis isolated from bronchoalveolar lavage in a patient with dengue hemorrhagic fever

    Directory of Open Access Journals (Sweden)

    Arun Agarwal

    2017-01-01

    Full Text Available Bacterial co-infections have been reported in association with dengue fever (DF and can exacerbate dengue infections. However, DF with acute respiratory distress syndrome and co-infection with Alcaligenes faecalis (A. faecalis has not been reported earlier. Most infections caused by A. faecalis are opportunistic. Urinary tract infection, bacterial keratitis, postoperative endophthalmitis, skin and soft tissue infections, bacteremia, meningitis, wound infections, and peritonitis in patients undergoing peritoneal dialysis have been described in association with A. faecalis. A. faecalis, a Gram-negative environmental organism rarely cause significant infections. Treatment can be difficult in some cases due to the high level of resistance to commonly used antibiotics. We report a case of fatal bronchopneumonia caused by extensively drug resistance A. faecalis in a patient of dengue hemorrhagic fever.

  5. Apical Revascularization after Delayed Tooth Replantation: An Unusual Case

    Science.gov (United States)

    Nelson-Filho, Paulo; Silva, Lea Assed Bezerra; Silva, Raquel Assed Bezerra; de Carvalho, Fabricio Kitazono; de Queiroz, Alexandra Mussolino

    2016-01-01

    The aim of this paper is to present the clinical and radiological outcome of the treatment involving a delayed tooth replantation after an avulsed immature permanent incisor, with a follow-up of 1 year and 6 months. An 8-year-old boy was referred after dental trauma that occurred on the previous day. The permanent maxillary right central incisor (tooth 11) had been avulsed. The tooth was hand-held during endodontic therapy and an intracanal medication application with calcium hydroxide-based paste was performed. An apical plug with mineral trioxide aggregate (MTA) was introduced into the apical portion of the canal. When the avulsed tooth was replanted with digital pressure, a blood clot had formed within the socket, which moved the MTA apical plug about 2 mm inside of the root canal. These procedures developed apical revascularization, which promoted a successful endodontic outcome, evidenced by apical closure, slight increase in root length, and absence of signs of external root resorption, during a follow-up of 1 year and 6 months. PMID:27882250

  6. Apical Revascularization after Delayed Tooth Replantation: An Unusual Case

    Directory of Open Access Journals (Sweden)

    Marília Pacífico Lucisano

    2016-01-01

    Full Text Available The aim of this paper is to present the clinical and radiological outcome of the treatment involving a delayed tooth replantation after an avulsed immature permanent incisor, with a follow-up of 1 year and 6 months. An 8-year-old boy was referred after dental trauma that occurred on the previous day. The permanent maxillary right central incisor (tooth 11 had been avulsed. The tooth was hand-held during endodontic therapy and an intracanal medication application with calcium hydroxide-based paste was performed. An apical plug with mineral trioxide aggregate (MTA was introduced into the apical portion of the canal. When the avulsed tooth was replanted with digital pressure, a blood clot had formed within the socket, which moved the MTA apical plug about 2 mm inside of the root canal. These procedures developed apical revascularization, which promoted a successful endodontic outcome, evidenced by apical closure, slight increase in root length, and absence of signs of external root resorption, during a follow-up of 1 year and 6 months.

  7. A case of delayed hemolytic transfusion reaction in sickle cell disease patient

    Science.gov (United States)

    Dogra, Ashu; Sidhu, Meena

    2016-01-01

    Sickle cell disease (SCD) is autosomal recessive, genetically transmitted hemoglobinopathy responsible for considerable morbidity and mortality. It is prevalent in many parts of India including Central India, where the prevalence in different communities has ranged from 9.4% to 22%. Perioperative management may include transfusion of red blood cells. Hemolytic transfusion reactions can occur, and these can be either acute or delayed. We present a case of delayed hemolytic transfusion reaction in a patient with SCD. PMID:27605854

  8. Crimean-Congo hemorrhagic fever nosocomial infection in a immunosuppressed patient, Pakistan: case report and virological investigation.

    Science.gov (United States)

    Hasan, Zahra; Mahmood, Faisal; Jamil, Bushra; Atkinson, Barry; Mohammed, Murtaza; Samreen, Azra; Altaf, Lamia; Moatter, Tariq; Hewson, Roger

    2013-03-01

    Crimean-Congo hemorrhagic fever (CCHF) is endemic in the Baluchistan province, Pakistan. Sporadic outbreaks of CCHF occur throughout the year especially in individuals in contact with infected livestock. Nosocomial transmission remains a risk due to difficulties in the diagnosis of CCHF and limited availability of facilities for the isolation of suspected patients. Rapid diagnosis of CCHF virus infection is required for early management of the disease and to prevent transmission. This study describes the case of a 43-year-old surgeon who contracted CCHF during a surgical procedure in Quetta, Baluchistan and who was transferred to a tertiary care facility at the Aga Khan University Hospital, Karachi within 1 week of contracting the infection. Diagnosis of CCHF was made using a rapid real-time reverse transcription polymerase chain reaction (RT-PCR) assay for CCHF viral RNA. The patient had chronic hepatitis B and hepatitis D infection for which he had previously received a liver transplant. He proceeded to develop classic hemorrhagic manifestations and succumbed to the infection 14 days post-onset of disease. There was no further nosocomial transmission of the CCHF during the hospital treatment of the surgeon. Early diagnosis of CCHF enables rapid engagement of appropriate isolation, barrier nursing and infection control measures thus preventing nosocomial transmission of the virus.

  9. A case of acutely developed delayed radiation myelopathy

    Energy Technology Data Exchange (ETDEWEB)

    Hayashi, Shintaro; Amari, Masakuni [Geriatrics Research Inst., Maebashi (Japan). Hospital; Fukuda, Toshio; Okamoto, Koichi [Gunma Univ., Maebashi (Japan). School of Medicine

    2002-08-01

    A 66-year-old man with a history of hypertension received radiation therapy on his neck at age 61 because of laryngeal cancer (T1bN0M0). Five years after the radiation, he acutely developed dysuria, tetraparesis and dissociated sensory disturbances below bilateral Th4 level. T2 weighted MRI showed a high signal lesion affecting the central area of the spinal cord extending from C1 to C7. On the second clinical day, he developed respiratory arrest and was ventilated. The cerebrospinal fluid contained 20/mm{sup 3} (monocyte 15, neutorophil 5) white cells; protein was 52.5 mg/dl; IgG index 0.54; Q albumin was 9.6; tests for oligoclonal band and myelin basic protein were negative; a culture yielded no microorganism. He was treated with steroids and supportive measures without improvement, and died of a sudden cardiac arrest on the 8th clinical day. postmortem examination confirmed conspicuous focal spongy changes with many axonal swellings, especially in the posterior and lateral columns at cervical and Th1 levels. The pathological findings were considered to be compatible with those of delayed radiation myelopathy (DRM). In the anterior horn of the cervical cord there were lesions of diffuse racification and the proliferation of small vessels. There were no findings of hyaline vascular changes, infarction or metastasis of laryngeal cancer at the spinal cord. It is considered that hyperintensity of signals on T2-weighted may originate from racification and proliferation of small vessels in the gray matter, and these pathological changes would be intimately associated with the severe neurologic morbidity of this patient. Acute development of neurological findings and the pathological changes in the gray matter of the spinal cord are rare manifestations of DRM. (author)

  10. Case Report: Postpartum hemorrhage associated with Dengue with warning signs in a term pregnancy and delivery [version 1; referees: 2 approved, 1 not approved

    Directory of Open Access Journals (Sweden)

    Le Phi Hung

    2015-12-01

    Full Text Available Background: Dengue infection during peripartum period, although rare in endemic regions, has challenged clinicians regarding its management, especially if a parturient woman experiences postpartum hemorrhage due to a classical risk factor of maternal bleeding. Case: A full-term pregnant Vietnamese woman was diagnosed with polyhydramnios and Dengue with warning signs (DWS. She was administered platelet transfusion prior to delivery and then gave birth to a healthy newborn. After active management of the third stage of labor, the patient suffered a postpartum hemorrhage which was caused by uterine atony and accompanied with thrombocytopenia. Therefore, we decided to administer uterotonic drugs and additionally transfuse platelets. Conclusion: We describe a case of postpartum hemorrhage caused by uterine atony and coinciding with Dengue infection during delivery period, which is a rare clinical entity. With timely detection and management, the patient was finally discharged without complications.

  11. Effect of surgery on delayed inhaled foreign body: a case report

    Institute of Scientific and Technical Information of China (English)

    XUE Lei; PAN Tie-wen; ZHAO Xue-wei; WU Bin; XU Zhi-fei; ZHONG Lei

    2011-01-01

    The occurrence of foreign body is uncommon in youths and adults. We report here a case of 16-year-old boy who inhaled a foreign body which was overlooked for 6 months. The patient suffered productive cough and received antibiotic treatment for 10 days. But the symptoms did not improve. Chest radiography and CT scan revealed a 1-cm-long needle-like foreign object in the right inferior lobar bronchus. Wedge resection of lung was finally performed because of severe hemorrhage caused by prior bronchoscopy.

  12. [Complete remission of consciousness disturbances and spasticity due to a severe subarachnoid hemorrhage after intrathecal baclofen therapy: a case report].

    Science.gov (United States)

    Asahi, Takashi; Kashiwazaki, Daina; Koh, Masaki; Matsumura, Nobuhisa; Kuroda, Satoshi

    2015-03-01

    Typically, intrathecal baclofen therapy(ITB)for spasticity is continuously required because the spasticity can recur if the ITB is stopped. Thus, an infusion pump for the ITB is permanently implanted. Some sporadic cases exhibiting remarkable improvements in their spasticity and consciousness disturbances have been reported after implanting the ITB pump. We experienced a rare case involving removal of the ITB pump after the spasticity resolved and the consciousness disturbances markedly improved. A 15-year-old girl developed a subarachnoid hemorrhage due to rupture of an aneurysm in the right anterior cerebral artery. Her initial Glasgow Coma Scale score was 4(E1V1M2). Trapping of the aneurysm and decompression craniotomy were performed. Subsequently, she underwent a tracheotomy, and a percutaneous gastrostomy(PEG)tube was implanted because of persistent consciousness disturbances. Cranioplasty and lumbar-peritoneal shunt for normal pressure hydrocephalus were performed after 1 month. An ITB pump was implanted to improve the spasticity observed mainly in the lower extremities 61 days after hemorrhage onset. Right hemiparesis remained due to Kernohan's notch. After transfer to the rehabilitation hospital, her consciousness disturbances and spasticity remarkably improved(1.9 to 1.0 and 3.5 to 1.0 on the Ashworth scale for the upper and lower extremities, respectively). The tracheostomy and PEG tubes were removed, and the baclofen dose was gradually reduced. She was completely off baclofen after 7 months, and she was discharged with a short leg brace and a cane for walking. The baclofen pump was then removed. In this case, temporary ITB improved the spasticity and consciousness disturbances.

  13. A case of hypoxic encephalopathy with delayed exacerbation

    OpenAIRE

    2008-01-01

    Takeshi Hayashi, Kimihiko HattoriDepartment of Neurology, Fuji Heavy Industries Health Insurance Corporation, Ota General Hospital, Ota, Gunma, JapanAbstract: Most patients contract hypoxic encephalopathy after suffering a cardiac arrest. They usually endure severe neurological sequelae and the temporal profile of the disease progression remains unclear. This case study shows how the effects of hypoxic encephalopathy continue to progress for several years after the initial event. Up to eight ...

  14. A Hemoglobin-based Oxygen Carrier, Bovine Polymerized Hemoglobin (HBOC-201) Versus Hetastarch (HEX) in a Moderate Severity Hemorrhagic Shock Swine Model with Delayed Evacuation

    Science.gov (United States)

    2005-03-23

    vein using Seldinger technique and a 7.5 F pulmonary artery catheter (PAC; Edwards Life Sciences, Irvine, CA,) was inserted for continuous hemodynamic...using aseptic techniques . lood volume (ml) was estimated as: EBV = animal weight kg)× 65 ml/kg. .2. Pre-hospital phase: tissue injury, hemorrhage and...Pentra 60 C+, ABX, France) and serum chemistries including lactate (Vitros 250 Analyzer, Ortho). 2.5. Statistical analysis The statistical techniques were

  15. [Unusual cause of upper digestive hemorrhage: gastric lipoma. Report of a case].

    Science.gov (United States)

    Roncolini, G; Capaldi, M; Calabrese, P; Giordani, M; Pietrafesa, A; Gatto, A

    1999-01-01

    Lipomas are benign tumors that are common in other sites but rare in the stomach. They are usually submucosal and, when symptomatic, are most often accompanied by gastrointestinal bleeding from ulceration of gastric mucosa overlying the mass or by symptoms of obstruction. A 55-year-old male with epigastric abdominal pain and upper gastrointestinal hemorrhage due to a gastric lipoma is presented; endoscopic and x-ray examinations revealed a submucosal tumor on the posterior wall of the gastric corpus, with ulceration in the mucosa covering it. Biopsies of the mass were nondiagnostic. The patient underwent a complete submucosal excision: the intraoperative histologic study established the diagnosis of gastric lipoma. The post operative period was uneventful. A review of the clinical, diagnostic and therapeutic aspects of this rare disease is reported.

  16. Intracranial Hemorrhage in Full Term Infants; A Follow-Up Study

    Directory of Open Access Journals (Sweden)

    Mehmet Şah İpek

    2012-12-01

    Full Text Available Introduction: The aim of this study was to determine the risk factors related to, clinical presentation and outcome of intracranial hemorrhage among full-term newborn infants.Materials and Methods: Full-term newborn infants who were diagnosed with intracranial hemorrhage in the neonatal intensive care unit of Dr. Sami Ulus Maternity and Children’s Hospital, between 2005 and 2010, were reviewed retrospectively. Cases were diagnosed with ultrasonography, computed tomography, or magnetic resonance imaging. The infants followed an average of 36 months had been underwent neurologic evaluations. Results: Fourteen full-term infants with intracranial hemorrhage were identified. The half of cases presented within the first week of life (7/14, and the most common presenting sign was seizure (8/14. Bleeding were placed frequently intraventricular (9/14 and subarachnoid (7/14, while 8 patients had two or more hemorrhage areas. The majority of cases (11/14 had a causal or contributory risk factor for intracranial hemorrhage. Only one patient required neurosurgical intervention. Two patients died during the neonatal period, and another with severely handicapped at ten months of age. Of the survivors, two patients showed severe neurodevelopmental delay, while one patient showed mild. The remaining 8 patients had a favorable outcome. Conclusions: Intracranial hemorrhage in the term newborn is usually associated with perinatal risk factors. Because of neurodevelopmental outcome may surprisingly be normal, despite severe hemorrhage, the long-term outcome is difficult to predict. (Journal of Current Pediatrics 2012; 10: 85-91

  17. Trivial trauma and delayed rupture of a normal spleen: a case report

    Directory of Open Access Journals (Sweden)

    Sowers Nicholas

    2011-12-01

    Full Text Available Abstract Introduction Although a majority of splenic ruptures present acutely with a known mechanism of injury, a minority of patients present days to weeks following trauma with a delayed rupture. Also uncommon is the atraumatic rupture, the vast majority of which occur in patients with underlying splenic pathology. A handful of cases of apparently spontaneous rupture of a normal spleen are reported; however, there is debate about whether these actually represent delayed ruptures following a history of trauma that is not elicited. Although a few cases of delayed rupture of the spleen following trivial trauma have been reported, the majority of these present evidence of an underlying disease process. We found only two such cases that documented a normal spleen and three cases where underlying splenic pathology was not reported. We review the literature and discuss the phenomenon of delayed rupture of the normal spleen following trivial trauma. Case presentation A 27-year-old Caucasian man with no underlying splenic pathology presented with splenic rupture one week after playfully wrestling with his partner. The patient did not present at the time of the injury and only recalled it upon repeated questioning after computed tomography diagnosis. Conclusions This case lends support to the theory that the normal spleen can rupture some time after trivial trauma, which seems like a more plausible explanation than rupture without cause. However, given the dearth of similar reports in the literature, the possibility remains that the association we have observed is not causational.

  18. Intracerebral Hemorrhage. A Case Presentation Hemorragia intracerebral. Presentación de un caso

    Directory of Open Access Journals (Sweden)

    Inti Santana Carballosa

    Full Text Available A 70 year-old female patient suffering from a cerebrovascular disease intracerebral hemorrhage type and presented as Le Roux 2 cerebromeningeal hemorrhage subtype with factors for a bad prognosis of neurologic causes and, for diverse complications which evolved in the clinical intensive care service at the University hospital ¨Dr. Gustavo Aldereguia Lima¨ in Cienfuegos city. According to the management stated in the clinical practice guideline of the protocol intervention of this health institution an achievement was obtained when the patient passed from a Rankin 5 state at the admission of the hospital to a Rankin 3 state at the time of discharging from the institution. The survival rate at the time of the last evolution was a Rankin 2.
    Se presenta el caso de una paciente femenina, de 70 años de edad, portadora de enfermedad cerebrovascular tipo hemorragia intracerebral y forma de presentación como subtipo hemorragia cerebromeníngea Le Roux 2, con factores agravantes para mal pronóstico de causa neurológica y por diversas complicaciones, que evolucionó en el servicio de Terapia Intensiva Clínica del Hospital Universitario ¨Dr. Gustavo Aldereguía Lima¨ de Cienfuegos. Con la conducta asumida según guías de prácticas clínicas por protocolo de actuación de la citada institución asistencial se logró que de un estado por escala de Rankin de 5, al ingreso, egresara con Rankin 3 y una supervivencia hasta el momento con última evaluación de Rankin 2.

  19. Clinical therapeutic effect analysis of delayed hydrocephalus after intraventricular hemorrhage%脑室出血后延期性脑积水的临床治疗效果分析

    Institute of Scientific and Technical Information of China (English)

    任光辉

    2015-01-01

    目的:探讨脑室出血后延期性脑积水的临床治疗效果。方法:收治脑室内出血患者50例,随机分为对照组和观察组,对照组给予非手术治疗,观察组在灌注尿激酶和脑室外引流的基础上,再将生理盐水和尿激酶注入蛛网膜下隙,比较两组治疗效果。结果:观察组延期性脑积水的发生率12%明显低于对照组的36%(P<0.05)。结论:对脑室出血患者治疗时,一定要密切关注患者的脑室血肿量变化,并及时给予针对性治疗,尽量降低延期性脑积水的发生率,确保治疗效果。%Objective:To explore the clinical therapeutic effect of delayed hydrocephalus after intraventricular hemorrhage. Methods:50 patients with intraventricular hemorrhage were selected.They were randomly divided into the control group and the observation group.The control group was given the non operation treatment,and the observation group was given physiological saline and urokinase into the subarachnoid space on the basis of infusion of urokinase and external ventricular drainage,then we compared two groups of treatment effect.Results:In the observation group,the incidence of delayed hydrocephalus of 12% was significantly lower than 36% in the control group(P<0.05).Conclusion:For the treatment of patients with intraventricular hemorrhage,we must pay close attention to changes in patients with intraventricular hematoma volume,and give them timely and targeted therapy,as far as possible to reduce the incidence of delayed hydrocephalus and ensure the treatment effect.

  20. Imaging manifestations and diagnosis of a case of adult cerebral paragonimiasis with the initial symptom of hemorrhagic stroke.

    Science.gov (United States)

    Wang, Hong; Shao, Bei

    2015-01-01

    This study is to investigate the clinical features, neuroimaging and diagnosis of adult cerebral paragonimiasis. One case of patient with cerebral paragonimiasis as retrospectively analyzed in this study. Analysis included medical history, clinical manifestations and neuroimaging. Blood test, body fluid examination, immunological test, stool examination and imaging examination were performed. Many symptoms such as headache, hemiplegia, chest pain, cough, and pleural effusion were detected in the patient. The features of "tunnel-like shape" and "ring-like shape", the intracranial hemorrhage and edema were shown by CT and MRI imaging. Chest CT examination revealed pleural effusion. Eosinophil count of peripheral blood and pleural effusion increased. Lung fluke ELISA test was positive and anti-parasitic treatment was effective. The typical clinical manifestations of MRI of cerebral paragonimiasis, such as the "tunnel-like shape" and "ring-like shape", were of high diagnostic value. And, blood eosinophil count examination and paragonimiasis antibody test could also help the diagnosis value.

  1. Capacity building permitting comprehensive monitoring of a severe case of Lassa hemorrhagic fever in Sierra Leone with a positive outcome: case report.

    Science.gov (United States)

    Grove, Jessica N; Branco, Luis M; Boisen, Matt L; Muncy, Ivana J; Henderson, Lee A; Schieffellin, John S; Robinson, James E; Bangura, James J; Fonnie, Mbalu; Schoepp, Randal J; Hensley, Lisa E; Seisay, Alhassan; Fair, Joseph N; Garry, Robert F

    2011-06-20

    Lassa fever is a neglected tropical disease with a significant impact on the health care system of endemic West African nations. To date, case reports of Lassa fever have focused on laboratory characterisation of serological, biochemical and molecular aspects of the disease imported by infected individuals from Western Africa to the United States, Canada, Europe, Japan and Israel. Our report presents the first comprehensive real time diagnosis and characterization of a severe, hemorrhagic Lassa fever case in a Sierra Leonean individual admitted to the Kenema Government Hospital Lassa Fever Ward. Fever, malaise, unresponsiveness to anti-malarial and antibiotic drugs, followed by worsening symptoms and onset of haemorrhaging prompted medical officials to suspect Lassa fever. A recombinant Lassa virus protein based diagnostic was employed in diagnosing Lassa fever upon admission. This patient experienced a severe case of Lassa hemorrhagic fever with dysregulation of overall homeostasis, significant liver and renal system involvement, the interplay of pro- and anti-inflammatory cytokines during the course of hospitalization and an eventual successful outcome. These studies provide new insights into the pathophysiology and management of this viral illness and outline the improved infrastructure, research and real-time diagnostic capabilities within LASV endemic areas.

  2. Capacity building permitting comprehensive monitoring of a severe case of Lassa hemorrhagic fever in Sierra Leone with a positive outcome: Case Report

    Directory of Open Access Journals (Sweden)

    Fonnie Mbalu

    2011-06-01

    Full Text Available Abstract Lassa fever is a neglected tropical disease with a significant impact on the health care system of endemic West African nations. To date, case reports of Lassa fever have focused on laboratory characterisation of serological, biochemical and molecular aspects of the disease imported by infected individuals from Western Africa to the United States, Canada, Europe, Japan and Israel. Our report presents the first comprehensive real time diagnosis and characterization of a severe, hemorrhagic Lassa fever case in a Sierra Leonean individual admitted to the Kenema Government Hospital Lassa Fever Ward. Fever, malaise, unresponsiveness to anti-malarial and antibiotic drugs, followed by worsening symptoms and onset of haemorrhaging prompted medical officials to suspect Lassa fever. A recombinant Lassa virus protein based diagnostic was employed in diagnosing Lassa fever upon admission. This patient experienced a severe case of Lassa hemorrhagic fever with dysregulation of overall homeostasis, significant liver and renal system involvement, the interplay of pro- and anti-inflammatory cytokines during the course of hospitalization and an eventual successful outcome. These studies provide new insights into the pathophysiology and management of this viral illness and outline the improved infrastructure, research and real-time diagnostic capabilities within LASV endemic areas.

  3. Late-form hemorrhagic disease of the newborn: a fatal case report with illustration of investigations that may assist in avoiding the mistaken diagnosis of child abuse.

    Science.gov (United States)

    Rutty, G N; Smith, C M; Malia, R G

    1999-03-01

    Hemorrhagic disease of the newborn (HDN) is usually a self-limiting hemorrhagic disorder of childhood that occurs as a result of vitamin K deficiency. It may be defined as early or late form depending on the time of onset related to birth. HDN is recognized as one of several bleeding disorders that can mimic the findings of nonaccidental head injury and may lead to a mistaken diagnosis of child abuse. We present a single fatal case of late-onset HDN with illustration of hematologic assays that can be performed to assist the pathologist in making the correct diagnosis of HDN.

  4. One Nursing Case of Brain-stem Hemorrhage from Newborn Infant%1例新生儿脑干出血的护理

    Institute of Scientific and Technical Information of China (English)

    杜爱红

    2011-01-01

    The paper summarizes a nursing case of infant patient who suffers from brainstem hemorrhage through an emergency cure and carefillly nursing of brainstem hemorrhage from newborn infant.%通过对l例新生儿脑干出血的急救治疗,并进行了精心细致的护理,患者康复出院,并安全度过新生儿期。本文对其护理进行总结介绍。

  5. Hemorrhagic Onset of Hemangioblastoma Located in the Dorsal Medulla Oblongata Presenting with Tako-Tsubo Cardiomyopathy and Neurogenic Pulmonary Edema: A Case Report

    Directory of Open Access Journals (Sweden)

    Masayuki Gekka

    2014-03-01

    Full Text Available Here, we present a case of dorsal medulla oblongata hemangioblastoma with fourth ventricular hemorrhage. A 23-year-old female developed sudden consciousness disturbance, and CT revealed hemorrhage in all cerebral ventricles and a hyperdense mass in the cisterna magna. Although the reddish tumor located in the dorsal medulla oblongata was successfully removed, she suffered from severe tako-tsubo cardiomyopathy (TTC and neurogenic pulmonary edema (NPE because of baroreflex failure and damage to the solitary tract nuclei. After intensive care for 12 weeks following surgery, she was discharged without any neurological or radiological deficits. Pathogenesis of TTC/NPE is discussed in this paper.

  6. Semiquantitative regional cerebral blood flow evaluation using sup 123 I-IMP SPECT in a case showing transient ischemic attack caused by putaminal hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Tsuda, Y.; Ayada, Y.; Takahashi, T.; Toyama, Y.; Matsuo, H. (Second Department of Internal Medicine, Kagawa Medical School (Japan)); Katsuragawa, M.; Tanabe, M. (Department of Radiology, Kagawa Medical School (Japan))

    1991-01-01

    A 69-year-old woman presented a transient cerebral ischemic attack, showing left arm weakness and slurred speech which recovered within 4 h of onset, while computed tomography indicated a putaminal hemorrhage. The regional cerebral blood flow distribution, measured semiquantitatively by use of {sup 123}I amphetamine emission tomography, was disturbed, which persisted more than one month up to a maximum of 4.5 months from the onset of symptoms. the case illustrates a variety of putaminal hemorrhage of good functional and vital prognosis, and provides and example in which the regional cerebral blood flow disturbances might persist for more than one month up to 4.5 months after the occurrence of a transient ischemic attack caused by a putaminal hemorrhage. (author).

  7. Severe Hemorrhagic Syndrome After Lonomia Caterpillar Envenomation in the Western Brazilian Amazon: How Many More Cases Are There?

    Science.gov (United States)

    Santos, João Hugo A; Oliveira, Sâmella S; Alves, Eliane C; Mendonça-da-Silva, Iran; Sachett, Jacqueline A G; Tavares, Antonio; Ferreira, Luiz Carlos; Fan, Hui Wen; Lacerda, Marcus V G; Monteiro, Wuelton M

    2017-03-01

    Contact with Lonomia caterpillars can cause a hemorrhagic syndrome. In Brazil, Lonomia obliqua and Lonomia achelous are known to cause this venom-induced disease. In the Brazilian Amazon, descriptions of this kind of envenomation are scarce. Herein, we report a severe hemorrhagic syndrome caused by Lonomia envenomation in the Amazonas state, Western Brazilian Amazon. The patient showed signs of hemorrhage lasting 8 days and required Lonomia antivenom administration, which resulted in resolution of hemorrhagic syndrome. Thus, availability of Lonomia antivenom as well as early antivenom therapy administration should be addressed across remote areas in the Amazon.

  8. “REBOA” – Is it Really Safe? A Case with Massive Intracranial Hemorrhage Possibly due to Endovascular Balloon Occlusion of the Aorta (REBOA)

    Science.gov (United States)

    Uchino, Hayaki; Tamura, Nobuichiro; Echigoya, Ryosuke; Ikegami, Tetsunori; Fukuoka, Toshio

    2016-01-01

    Patient: Female, 86 Final Diagnosis: Polytrauma Symptoms: Shock Medication: — Clinical Procedure: Resuscitative endovascular balloon occlusion of the aorta Specialty: Orthopedics and Traumatology Objective: Unusual or unexpected effect of treatment Background: Non-compressible torso hemorrhage continues to be the leading cause of preventable death in trauma patients. Recent case series report that resuscitative endovascular balloon occlusion of the aorta (REBOA) in the trauma population is a technically feasible method to manage the patients with exsanguinating hemorrhage. On the other hand, it seems that REBOA is being widely promoted prematurely. Complications due to REBOA haven’t been reported much in the literature, and they could have been underestimated. Case Report: An 86-year-old female presented to our emergency department following a pedestrian-vehicle accident. On admission, she was hemodynamically unstable with systolic blood pressure (SBP) of 78 mm Hg. She responded to fluid administration, and computed tomography (CT) scan showed cerebral contusion, subarachnoid hemorrhage, pelvic fracture with contrast extravasation, and thoracic spine fracture. Her condition deteriorated after the CT scan, and she became hemodynamically unstable. REBOA was inserted and inflated. Her blood pressure recovered and even became as high as SBP of 180 mm Hg. Transarterial embolization for pelvic fracture was successfully performed. A subsequent head CT scan showed massive intracranial hemorrhage with penetration to the ventricle, which was fatal. She died on the same day due to cerebral herniation. Conclusions: REBOA is now considered as an alternative to resuscitative thoracotomy or even widely indicated to control hemorrhage. We should be more cautious about using REBOA for polytrauma patients since it could make hemorrhage worse. Further research, assessing its potential complications and safety, will be required to elucidate clear indications for REBOA in trauma

  9. [Delay in diagnosis of common variable immunodeficiency: a paradigmatic case report].

    Science.gov (United States)

    Iebba, Filippo; Di Sora, Fiorella; Leti, Wilma; Montella, Tatiana; Corea, Francesco; Montella, Francesco

    2015-11-01

    This case report highlights the frequent delay in diagnosis of common variable immunodeficiency. The patient, 84 years old, had over 30 years of recurrent infections. At the first visit serum IgG were less than 134 mg/dl. From the review of previous examinations strong hypogammaglobulinemia was present for over 14 years.

  10. Lupus vulgaris diagnosed after 37 years: a case of delayed diagnosis.

    Science.gov (United States)

    Turan, Enver; Yurt, Nurdan; Yesilova, Yavuz; Celik, Ozgur Ilhan

    2012-05-15

    Lupus vulgaris is the most common chronic, progressive form of cutaneous tuberculosis. Lesions are generally solitary and found on the head and neck region. Cutaneous tuberculosis can present with different clinical appearances. Therefore, it does not necessarily have characteristic findings and can be difficult to diagnose. Although there were typical clinical findings, the diagnosis of our case was delayed because of its asymptomatic course.

  11. IMMEDIATE AND DELAYED HYPERSENSITIVITY REACTIONS TO LATEX GLOVES IN A DENTAL STUDENT. A case report.

    Directory of Open Access Journals (Sweden)

    Iliyana Stoeva

    2011-08-01

    Full Text Available The article presents a case of dental student with immediate and delayed hypersensitivity reaction to latex gloves. Symptoms appeared during the second year of regularly using of latex gloves. The student was with no history of allergies and no previous exposure to latex products.

  12. Delayed Esophageal Pseudodiverticulum after Anterior Cervical Spine Fixation: Report of 2 Cases

    Directory of Open Access Journals (Sweden)

    Ali Sadrizadeh

    2015-03-01

     Conclusion:  In cases with delayed perforation, fistula, or diverticulum removal of anterior fixation instruments, gentle repair of the esophageal wall without persistence on definitive and optimal perforation closure, wide local drainage, early enteral nutrition via NGT, and antibiotic prescription is suggested.

  13. Clinical Analysis of 45 Cases of Ancylostomatic Upper Digestic Tract Massive Hemorrhage%钩(虫虫虫)性上消化道大出血45例临床分析

    Institute of Scientific and Technical Information of China (English)

    沈维柏; 朱余良; 廖金辉

    2002-01-01

    Objective To study clinical characteristic diagnosis and treatment for ancylostomatic upper digestic tracthemorrhage. Methods Analysing prospectively 45 cases of clinical characteristic and treatment. Results Oversevere anemiaaccount for 11.1% severe anemia 55.6%. Moderate anemia 33.3% among all cases except 13 cases of misdiagnosis, 40patients from countryside with 100% cure rate. Conclusion Major cases are chronic hemorrhage and some severe infectioncan result in massive hemorrhage and be liable to misdiagnosis.

  14. Dengue hemorrhagic fever: A rare cause of pituitary tumor hemorrhage and reversible vision loss

    Directory of Open Access Journals (Sweden)

    Vimal Kumar

    2011-01-01

    Full Text Available Dengue hemorrhagic fever leading to hemorrhage in pituitary adenoma is not reported till date: We herein report the first case of bilateral visual loss secondary to pituitary adenoma hemorrhage associated with dengue hemorrhagic fever. Urgent transnasal trans sphenoidal decompression of the macroadenoma prevented permanent visual loss in this patient. Pituitary apoplexy should be considered as differential diagnosis of visual deterioration apart from retinal hemorrhage, maculopathy, and optic neuropathy in cases of dengue hemorrhagic fever. Early decompression of optic nerves helped in the restoration of vision.

  15. Tamponade of presacral hemorrhage with hemostatic sponges fixed to the sacrum with endoscopic helical tackers: report of two cases.

    NARCIS (Netherlands)

    Vurst, T.J. van der; Bodegom, M.E.; Rakic, S.

    2004-01-01

    Presacral venous hemorrhage is a severe complication in low rectal surgery. This complication was encountered in 5 of 165 patients (3 percent) who underwent a presacral dissection for rectal mobilization. Conventional hemostatic measures often are ineffective to arrest this hemorrhage, and a number

  16. Delayed myelopathy secondary to stab wound with a retained blade tip within the laminae: case report.

    Science.gov (United States)

    Wang, Hui; Ma, Lei; Ding, Wen-Yuan

    2015-01-01

    Delayed neurologic deficit after a stab wound with a retained foreign body near the spinal canal is unusual, adequate radiological examination is fundamental in detecting retained foreign bodies, especially the CT scan, surgical extraction of the foreign body is the primary task and the surgical outcome is satisfactory. Here, we report a rare case of delayed myelopathy caused by spinal stenosis secondary to broken blade tip within thoracic laminae in an old man, who was injured in a knife attack 39 years ago. The incidence, clinical presentation, diagnosis and prognosis are discussed.

  17. An unusual presentation of non pathological delayed splenic rupture: a case report.

    LENUS (Irish Health Repository)

    Khan, Suhail Aslam

    2009-01-01

    The diagnosis of Delayed Splenic Rupture poses a major challenge to even the most astute clinician, as it can mimic other medical emergencies. We present a case of an unusual presentation of delayed splenic rupture in a 23-year-old Caucasian man, who presented to the emergency department with a 2 day history of left upper quadrant pain. He initially denied any history of trauma. There were no signs of generalized peritonisim on examination but his haemoglobin level was low (8.9 gm\\/dl) for which there was no obvious cause identified. He was resuscitated and a computed tomography of the abdomen was performed. This revealed complete rupture of the splenic capsule with haemorrhagic fluid in the abdomen. With the computed tomography abdomen findings and further questioning of the patient, the only potential precipitating event that he could remember was a minor kick to the left upper quadrant more than 2 weeks ago while playing football. An urgent splenectomy was performed and histology confirmed complete rupture of the splenic capsule with a large adherent haematoma to the capsule. This case illustrates the difficulty in diagnosing delayed splenic rupture especially when accurate history is not available. A high index of suspicion is essential as delay in diagnosis can be fatal. Early diagnosis in suspected cases can be achieved by performing computed tomography of the abdomen.

  18. Tentorial hemorrhage associated with vacuum extraction

    Energy Technology Data Exchange (ETDEWEB)

    Huang, L.T. [Dept. of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung (Taiwan, Province of China); Lui, C.C. [Diagnostic Radiology, Chang Gung Memorial Hospital, Kaohsiung (Taiwan, Province of China)

    1995-11-01

    Neuroimages of tentorial hemorrhage associated with vacuum extraction have been rarely reported. The authors present the case of a 5-day-old newborn with this entity. CT showed retrocerebellar hemorrhage and MRI demonstrated tentorial hemorrhage extending inferiorly over the cerebellum and superiorly over the occipital regions. We believe that these imaging modalities are helpful in delineating the extent of the hemorrhage and assessing the prognosis. (orig.)

  19. Symptomatic Tarlov Cyst Following Spontaneous Subarachnoid Hemorrhage

    OpenAIRE

    Kong, Woo Keun; Cho, Keun-Tae; Hong, Seung-Koan

    2011-01-01

    Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage.

  20. Symptomatic tarlov cyst following spontaneous subarachnoid hemorrhage.

    Science.gov (United States)

    Kong, Woo Keun; Cho, Keun-Tae; Hong, Seung-Koan

    2011-08-01

    Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage.

  1. 宫缩乏力性产后出血62例临床分析%Clinical analysis of 62 cases with uterine atony postpartum hemorrhage

    Institute of Scientific and Technical Information of China (English)

    宋海琴

    2014-01-01

    目的:探讨宫缩乏力性产后出血的原因,分析产后出血与机体神经内分泌调节的关系。方法:2013年1月-2014年3月收治孕产妇3867例,其中剖宫产2496例,阴道分娩1371例。对有可能产后出血的高危人群或已发生产后出血者立即进行应急预案。结果:62例患者均治疗成功,无一例行子宫切除及死亡病例发生。结论:治疗子宫收缩性产后出血时除及时补充缩宫物质外,加强对子宫刺激,促进神经反射冲动的传导也是至关重要的。%Objective:To investigate the causes of postpartum hemorrhage caused by uterine inertia,and analyze the relationship between postpartum hemorrhage and the neuroendocrine regulation.Methods:3867 pregnant women were selected from January 2013 to 2014 March,includ 2496 cases of cesarean section and 1371 cases of vaginal delivery.We took the emergency plan for the high-risk groups of who may occur postpartum hemorrhage or who had occurred postpartum hemorrhage immediatelyResults:62 patients were treated successfully.1 cases underwent hysterectomy and no deaths occurred.Conclusion:When we treat the postpartum hemorrhage of uterine contraction,in addition to replenish the oxytocin substances,strengthen the uterine stimulation and promote the nerve impulse conduction is crucial too.

  2. Analysis of 178 postpartum hemorrhage cases in caesarean section%178例剖宫产产后出血病例分析

    Institute of Scientific and Technical Information of China (English)

    董渭盈; 陈敏

    2015-01-01

    目的:探讨剖宫产产后大出血的原因,分析相关高危因素,以减少剖宫产大出血的发生率。方法回顾分析178例剖宫产产后大出血患者的临床资料。结果109例发生子宫收缩乏力性出血,62例发生胎盘植入大出血,7例系宫缩乏力合并胎盘植入;54例经一线治疗成功止血,87例经各种二线治疗成功止血,37例切除子宫,无死亡产妇。结论宫缩乏力、前置胎盘、胎盘植入仍是产后出血的主要原因,积极的一、二线治疗可降低子宫切除率,提高产妇的远期生活质量。%Objective To investigate causes of postpartum massive hemorrhage of caesarean section, and to analyze related factors, in order to reduce incidence of massive hemorrhage of caesarean section. Methods Clinical data of 178 patients with postpartum massive hemorrhage of caesarean section were retrospectively analyzed. Results There were 109 cases with uterine inertia hemorrhage, 62 cases with placenta implantation massive hemorrhage, and 7 cases with uterine inertia complicated with placenta implantation. There were 54 cases received first-line treatment for successful hemostasis, 87 cases received second-line treatment, and 37 cases received hysterectomy, and no death cases. Conclusion The main causes of postpartum hemorrhage include uterine inertia, placenta previa, and placenta implantation. Implement of active first-line and second-line treatment can reduce hysterectomy rate and improve long-term life quality of puerperal.

  3. Ectopic banking of amputated great toe for delayed thumb reconstruction: case report.

    Science.gov (United States)

    Valerio, Ian L; Hui-Chou, Helen G; Zelken, Jonathan; Basile, Patrick L; Ipsen, Derek; Higgins, James P

    2014-07-01

    Ectopic banking of amputated parts is a recognized technique for delayed replantation of an amputated part when the amputation stump will not permit immediate replantation. This is conventionally performed with the intent of transferring the injured part back to its anatomic position when the amputation stump is more appropriate for replantation. Current warfare conditions have led to a commonly encountered military trauma injury pattern of multiple extremity amputations with protected trunk and core structures. This pattern poses many challenges, including the limit or absence of donor sites for immediate or delayed flap reconstructive procedures. We describe a case in which we ectopically banked the great toe of an amputated lower extremity for delayed thumb reconstruction.

  4. The estimated magnitude of AIDS in Brazil: a delay correction applied to cases with lost dates

    Directory of Open Access Journals (Sweden)

    Barbosa Maria Tereza S.

    2002-01-01

    Full Text Available The number of HIV-infected people is an important measure of the magnitude of the AIDS epidemic in Brazil and allows for comparison with epidemic patterns in other countries. This quantity can be estimated from the number of reported AIDS cases, which in turn needs to be corrected for the distribution of reporting delays and under-recording of cases. These distributions are unknown and must also be estimated from the recorded dates, which were missed to the Brazilian National AIDS registry. This paper estimates the number of AIDS cases diagnosed by imputing the lost information based on an estimate of the pattern in registration delay until 1996. We first fitted a non-stationary bivariate Poisson regression model to estimate the pattern in reporting delay. In the subsequent steps these models were applied to impute new data, thus replacing the missing information, and to estimate the magnitude of the AIDS epidemic in the country. Model estimates ranged from 36,000 to 50,000 AIDS cases diagnosed in Brazil and still unreported. Therefore, the epidemic was 20 to 30% greater than known from the available information as of February 1999. To be useful to health policy-makers, the surveillance system based on officially reported AIDS cases must be continuously improved.

  5. Massive antenatal fetomaternal hemorrhage

    DEFF Research Database (Denmark)

    Dziegiel, Morten Hanefeld; Koldkjaer, Ole; Berkowicz, Adela

    2005-01-01

    Massive fetomaternal hemorrhage (FMH) can lead to life-threatening anemia. Quantification based on flow cytometry with anti-hemoglobin F (HbF) is applicable in all cases but underestimation of large fetal bleeds has been reported. A large FMH from an ABO-compatible fetus allows an estimation...

  6. The health seeking trajectories of Malaysian women and their husbands in delay cases of breast cancer: a qualitative study.

    Science.gov (United States)

    Yusoff, Nasir; Taib, Nur Aishah Mohd; Ahmad, Aini

    2011-01-01

    The aim of this study was to assess why women delay in getting treatment (i.e. surgery) for breast cancer, as well as to explore on what type of issues are involved in such delay cases. Basic interpretative of qualitative methodology was applied to construct the reality of delay phenomena, and its interaction with social worlds. Six themes were identified: new conception of breast cancer treatment, psychological defenses, health support system, symtomatology experience, model and barriers. The delay issue in breast cancer requires attention as a multidimensional problem as this will facilitate more comprehensive and effective intervention to reduce delay.

  7. Diagnostic test of endometrial cytobrush in cases of perimenopausal and postmenopausal hemorrhage

    Directory of Open Access Journals (Sweden)

    Andrijono Andrijono

    2005-06-01

    Full Text Available Perimenopausal menopausal hemorrhage can be due to by a variety of causative factors. One of its dangerous causes is atypical hyperplasia and endometrial carcinoma. There are a number of risk factors for the occurrence of endometrial carcinoma. The group that has this risk belongs to high-risk group. In this high-risk group, it is necessary to have a method to identify the changes in endometrial abnormality. One of the alternatives is the examination of endometrial cytology. The objective of this study was to evaluate the sensitivity, specificity and correlation test between endometrial cytology and endometrial histology. This study was a diagnostic test of cytological examination of the endometrium as compared with endometrial histology. Endometrial cytology was performed with a modification of cytubrush and IUD shell. Specimen was dissolved into the centrifuged NaCl, and its deposits were then processed for cytological examination with Papanicolaou and Giemsa staining. After the taking of cytology, the process was continued with curettage of the endometrium, and the specimens were processed for cytological examination. Both of them were examined by anatomic pathologist. Statistical analysis used diagnostic test using histological examination of curetage specimens as gold standard. During the period of study 45 study samples were collected, among which 12 (26.66% were endometrial adenocarcinoma, 6 (13.33% with atypical hyperplasia, 11 (24.44% with non-atypical hyperplasia, 15 (33.33% were samples without abnormality, and one sample with endometritis. Actual correlation value was 57.8%, correlation because of possibility 3.38%, and correlation not because of possibility 54.42%, potential correlation not because of possibility 96.62%, and Kappa value 0.56. It was concluded that cytological examination of the endometriurn with cytobrush could be employed as a screening method in the abnormalities of endometrial thickness, with

  8. Sampson’s Artery Hemorrhage after Inguinal Hernia Repair: Second Case Reported

    Directory of Open Access Journals (Sweden)

    Joseph Adjei Boachie

    2016-01-01

    Full Text Available Sampson artery is normally obliterated in postembryonic development. In rare cases it can remain patent and complicate a routine outpatient herniorrhaphy when severed. This is the second reported case in the available English literature of hemoperitoneum due to bleeding from a patent Sampson’s artery following an open inguinal hernia repair.

  9. Delayed Esophageal Pseudodiverticulum after Anterior Cervical Spine Fixation: Report of 2 Cases

    Directory of Open Access Journals (Sweden)

    Ali Sadrizadeh

    2015-03-01

    Full Text Available Introduction: Although perforation of the esophagus, in the anterior cervical spine fixation, is well established, cases with delayed onset, especially cases that present pseudodiverticulum, are not common. In addition, management of the perforation in this situation is debated.  Case Report:   Delayed esophageal pseudodiverticulum was managed in two patients with a history of anterior spine fixation. Patients were operated on, the loose plate and screws were extracted, the wall of the diverticulum was excised, the perforation on the nasogastric tube was suboptimally repaired, and a closed suction drain was placed there. The NGT was removed on the 7th day and barium swallow demonstrated no leakage at the operation site; therefore, oral feeding was started without any problem.  Conclusion:  In cases with delayed perforation, fistula, or diverticulum removal of anterior fixation instruments, gentle repair of the esophageal wall without persistence on definitive and optimal perforation closure, wide local drainage, early enteral nutrition via NGT, and antibiotic prescription is suggested.

  10. Hemorrhagic Lacrimation and Epistaxis in Acute Hemorrhagic Edema of Infancy

    Directory of Open Access Journals (Sweden)

    Shireen Mreish

    2016-01-01

    Full Text Available Acute hemorrhagic edema of infancy is an uncommon benign cutaneous vasculitis. Despite its worrisome presentation, it carries good prognosis with rarely reported systemic involvement. Management of these cases has been an area of debate with majority of physicians adopting conservative modalities. We report a case that presented with classic triad of rash, low grade fever, and peripheral edema along with two rarely reported manifestations in literature: hemorrhagic lacrimation and epistaxis.

  11. Delayed diagnosis of a heterotopic pregnancy as a cause of acute abdomen: A case report

    Directory of Open Access Journals (Sweden)

    Fatma Turkan Ayan

    2013-09-01

    Full Text Available Introduction: Heterotopic pregnancy is a life threating condition of intrauterine and extrauterine gestations which occur at the same time. We report a delayed diagnosed case of heterotopic pregnancy. Case: A 31 year-old primigravida was referred to our Emergency Gynaecology Service complicated by acute abdomen. She had been treated with clomiphene citrate and on admission intrauterine a missed abortus of about 8 weeks complicated by a large subchorionic hematoma was detected. Emergency laparotomy was performed because of diffuse intra-abdominal haemorrhage. A right-sided ectopic focus was recognized and excised, and dilatation - curettage was performed. Coclusion: Delay in diagnosing the condition can be fatal to both the mother and the intrauterine fetus. [J Contemp Med 2013; 3(3.000: 207-208

  12. Lassa hemorrhagic fever in a late term pregnancy from northern sierra leone with a positive maternal outcome: case report

    Directory of Open Access Journals (Sweden)

    Bangura James J

    2011-08-01

    Full Text Available Abstract Lassa fever (LF is a devastating viral disease prevalent in West Africa. Efforts to take on this public health crisis have been hindered by lack of infrastructure and rapid field deployable diagnosis in areas where the disease is prevalent. Recent capacity building at the Kenema Government Hospital Lassa Fever Ward (KGH LFW in Sierra Leone has lead to a major turning point in the diagnosis, treatment and study of LF. Herein we present the first comprehensive rapid diagnosis and real time characterization of an acute hemorrhagic LF case at KGH LFW. This case report focuses on a third trimester pregnant Sierra Leonean woman from the historically non-endemic Northern district of Tonkolili who survived the illness despite fetal demise. Employed in this study were newly developed recombinant LASV Antigen Rapid Test cassettes and dipstick lateral flow immunoassays (LFI that enabled the diagnosis of LF within twenty minutes of sample collection. Deregulation of overall homeostasis, significant hepatic and renal system involvement, and immunity profiles were extensively characterized during the course of hospitalization. Rapid diagnosis, prompt treatment with a full course of intravenous (IV ribavirin, IV fluids management, and real time monitoring of clinical parameters resulted in a positive maternal outcome despite admission to the LFW seven days post onset of symptoms, fetal demise, and a natural still birth delivery. These studies solidify the growing rapid diagnostic, treatment, and surveillance capabilities at the KGH LF Laboratory, and the potential to significantly improve the current high mortality rate caused by LF. As a result of the growing capacity, we were also able to isolate Lassa virus (LASV RNA from the patient and perform Sanger sequencing where we found significant genetic divergence from commonly circulating Sierra Leonean strains, showing potential for the discovery of a newly emerged LASV strain with expanded geographic

  13. Lassa hemorrhagic fever in a late term pregnancy from northern Sierra Leone with a positive maternal outcome: case report.

    Science.gov (United States)

    Branco, Luis M; Boisen, Matt L; Andersen, Kristian G; Grove, Jessica N; Moses, Lina M; Muncy, Ivana J; Henderson, Lee A; Schieffellin, John S; Robinson, James E; Bangura, James J; Grant, Donald S; Raabe, Vanessa N; Fonnie, Mbalu; Zaitsev, Eleina M; Sabeti, Pardis C; Garry, Robert F

    2011-08-15

    Lassa fever (LF) is a devastating viral disease prevalent in West Africa. Efforts to take on this public health crisis have been hindered by lack of infrastructure and rapid field deployable diagnosis in areas where the disease is prevalent. Recent capacity building at the Kenema Government Hospital Lassa Fever Ward (KGH LFW) in Sierra Leone has lead to a major turning point in the diagnosis, treatment and study of LF. Herein we present the first comprehensive rapid diagnosis and real time characterization of an acute hemorrhagic LF case at KGH LFW. This case report focuses on a third trimester pregnant Sierra Leonean woman from the historically non-endemic Northern district of Tonkolili who survived the illness despite fetal demise. Employed in this study were newly developed recombinant LASV Antigen Rapid Test cassettes and dipstick lateral flow immunoassays (LFI) that enabled the diagnosis of LF within twenty minutes of sample collection. Deregulation of overall homeostasis, significant hepatic and renal system involvement, and immunity profiles were extensively characterized during the course of hospitalization. Rapid diagnosis, prompt treatment with a full course of intravenous (IV) ribavirin, IV fluids management, and real time monitoring of clinical parameters resulted in a positive maternal outcome despite admission to the LFW seven days post onset of symptoms, fetal demise, and a natural still birth delivery. These studies solidify the growing rapid diagnostic, treatment, and surveillance capabilities at the KGH LF Laboratory, and the potential to significantly improve the current high mortality rate caused by LF. As a result of the growing capacity, we were also able to isolate Lassa virus (LASV) RNA from the patient and perform Sanger sequencing where we found significant genetic divergence from commonly circulating Sierra Leonean strains, showing potential for the discovery of a newly emerged LASV strain with expanded geographic distribution

  14. Bakri balloon placement in the successful management of postpartum hemorrhage in a bicornuate uterus: A case report

    Directory of Open Access Journals (Sweden)

    Cynthia Abraham

    2017-01-01

    Conclusion: In the management of postpartum hemorrhage, Bakri balloon placement is associated with success in the presence of a bicornuate uterus. Care should be taken to direct insertion of the balloon in the appropriate location.

  15. Dengue Hemorrhagic Fever Mapping: Study Case in Karawang District, West Java Indonesia

    Directory of Open Access Journals (Sweden)

    Tris Eryando

    2013-12-01

    Full Text Available The DHF prevention efforts have been continually conducted by the local health office, but some technical obstacles such as surveillance system is still very weak, and this is known as an important part in decision making process to handle the problem using evidence based information. The research objective is to obtain information on dengue endemic mapping through GIS (Geographic Information Systems to strengthen district surveillance system in district level. Most DHF cases occur in the productive age and located in urban areas with the larva-free rate is low. The direction of movement of the case are local diffusion. Karawang district is a low-lying areas prone to flooding. The rainy season occurs in late October to early May, but the rise of dengue cases at the turn of the rainy season to dry season, this indicates that the humidity in Karawang district supports the mosquito vector breeding. Foging will only kill adult mosquitoes, dengue control programs need to involve community participation and emphasized on public areas like schools and offices because a lot of dengue cases occurred in the productive age. GIS is capable of producing a map factors of risk and map of the case to allow for planning and evaluation of area-based dengue eradication program. GIS is useful in surveillance environmentally based disease, health interventions, and disease prevention strategies.

  16. Diffuse alveolar hemorrhage due to valproic acid: Case report and review of the literature

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    Francesco Inzirillo

    2015-01-01

    Full Text Available Valproic acid (VPA is one of the most frequently used antiepileptic drugs for the treatment of focal and generalized epilepsies, absence seizures, and Lennox-Gastaut syndrome (LGS. VPA has been demonstrated to have a negative effect on both the intrinsic and extrinsic coagulation systems and controversy exists about the clinical relevance of such hematological abnormalities. We describe a case of reversible lung hemorrage due to VPA. In English-language literature only two other similar cases (one of which fatal have been described so far.

  17. Severe Hyponatremia with Hypouricemia in a Patient with Medullary Hemorrhage: A Case Report

    Science.gov (United States)

    Banerjee, Tapas K

    2012-01-01

    Hyponatremia is the commonest electrolyte abnormality in hospitalized patients and occurs due to various causes. Here we present a case of SIADH who was diagnosed using commonly available biochemical tests. This case report also discusses the interaction of the laboratory physician with the treating clinician and the approach needed to arrive at a correct diagnosis. It highlights the importance of serum uric acid and fractional excretion of urinary uric acid in the diagnosis of SIADH. It also discusses the approach needed to distinguish SIADH from Cerebral Salt wasting syndrome, where the presenting feature is also hyponatremia. PMID:27683402

  18. Phenylpropanolamine and cerebral hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    McDowell, J.R.; LeBlanc, H.J.

    1985-05-01

    Computerized tomography, carotid angiograms, and arteriography were used to diagnose several cases of cerebral hemorrhage following the use of phenylpropanolamine. The angiographic picture in one of the three cases was similar to that previously described in association with amphetamine abuse and pseudoephedrine overdose, both substances being chemically and pharmacologically similar to phenylpropanolamine. The study suggests that the arterial change responsible for symptoms may be due to spasm rather than arteriopathy. 14 references, 5 figures.

  19. Introducing time delay in the evolution of new technology: the case study of nanotechnology

    Science.gov (United States)

    Georgalis, Evangelos E.; Aifantis, Elias C.

    2013-12-01

    Starting with Feynman's "There's Plenty of Room at the Bottom" prophetic lecture at Caltech in the 1960s, the term "nanotechnology" was first coined in the scientific literature in the 1980s. This was followed by the unprecedented growth in the corresponding scientific field in 2000 due to the financial incentive provided by President Clinton in the US, followed up by similar efforts in Europe, Japan, China and Russia. Today, nanotechnology has become a driving force for economic development, with applications in all fields of engineering, information technology, transport and energy, as well as biology and medicine. Thus, it is important to forecast its future growth and evolution on the basis of two different criteria: (1) the government and private capital invested in related activities, and (2) the number of scientific publications and popular articles dedicated to this field. This article aims to extract forecasts on the evolution of nanotechnology, using the standard logistic equation that result in familiar sigmoid curves, as well as to explore the effect of time delay on its evolution. Time delay is commonly known from previous biological and ecological models, in which time lag is either already known or can be experimentally measured. In contrast, in the case of a new technology, we must first define the method for determining time delay and then interpret its existence and role. Then we describe the implications that time delay may have on the stability of the sigmoidal behavior of nanotechnology evolution and on the related oscillations that may appear.

  20. Analysis of 83 Cases of Postpartum Hemorrhage Causes and Countermeasure%产后出血83例原因分析及应对措施

    Institute of Scientific and Technical Information of China (English)

    霍玲; 王伟

    2014-01-01

    Objective:To explore the causes of postpartum hemorrhage and countermeasures .Methods:From January 2009 to January 2013 in Fenyang, Shanxi Province People's Hospital of Obstetrics and Gynecology , childbirth occurs after 83 cases of maternal postpartum hemorrhage were retrospectively analyzed .Results:There are four factors of postpartum hemorrhage , uterine inertia which accounted for 78.31%of the total number of postpartum hemorrhage is the most common cause of postpartum hemorrhage , placental factors accounted for 15.66%, the soft birth canal injury accounted for 4.82%, coagulation disorders accounted for 1.20%.Conclusion:The Clinical e-mergence of many of the causes of postpartum hemorrhage , these factors can exist alone can also be reciprocal causation .Prenatal,intrap-artum, postpartum work can reduce the incidence of postpartum hemorrhage .%目的:探讨产后出血的原因及应对措施。方法:对2009年1月~2013年1月在山西省汾阳市人民医院妇产科分娩后出现产后出血的83例产妇进行回顾性研究分析。结果:发生产后出血有4大因素,其中子宫收缩乏力占产后出血总数的78.31%,是产后出血最常见原因,胎盘因素占15.66%,软产道损伤占4.82%,凝血功能障碍占1.20%。结论:临床上出现产后出血的原因很多,这些因素可单独存在也可互为因果。做好产前﹑产时﹑产后预防工作,可减少产后出血的发生率。

  1. A case of intra-abdominal hemorrhage secondary to peliosis hepatis

    Directory of Open Access Journals (Sweden)

    Ross O. Downes

    2015-01-01

    Conclusion: We examine the literature and subsequently discuss the etiology and management of peliosis. Peliosis is a rare vascular condition of the liver characterized by the presence of cystic blood filled cavities. Causes are associated with a number of conditions, however, etiology is largely unknown. Management is overwhelmingly conservative except in a handful of cases.

  2. Hemosuccus Pancreaticus: An Uncommon Cause of Gastrointestinal Hemorrhage. A Case Report

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    Chattopadhyay TK

    2004-09-01

    Full Text Available CONTEXT: Pseudoaneurysms of peripancreatic arteries usually arise as a complication of acute and chronic pancreatitis. These pseudoaneurysms may either bleed intra abdominally following rupture or may erode into the adjacent hollow viscera and manifest as gastrointestinal bleeding. Pseudoaneurysms rarely communicate with the pancreatic duct and bleeding occurs from the ampulla of Vater in the form of hemosuccus pancreaticus. CASE REPORT: We report a patient with chronic pancreatitis who presented with hemosuccus pancreaticus. Contrast enhanced computerized tomography and angiography revealed bleeding from a left gastric artery pseudoaneurysm. Despite multiple attempts, embolization was unsuccessful due to arterial spasm. The patient was successfully managed at emergency surgery by excision of the pseudoaneurysm sac and ligation of the left gastric artery. CONCLUSION: Bleeding from visceral artery pseudoaneurysms rarely manifests itself as hemosuccus pancreaticus. Most cases can be managed by angio-embolization. However, in patients with recurrent bleeding or failed embolization, emergency surgery is required.

  3. Delayed spinal extradural hematoma following thoracic spine surgery and resulting in paraplegia: a case report

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    Parthiban Chandra JKB

    2008-05-01

    Full Text Available Abstract Introduction Postoperative spinal extradural hematomas are rare. Most of the cases that have been reported occured within 3 days of surgery. Their occurrence in a delayed form, that is, more than 72 hours after surgery, is very rare. This case is being reported to enhance awareness of delayed postoperative spinal extradural hematomas. Case presentation We report a case of acute onset dorsal spinal extradural hematoma from a paraspinal muscular arterial bleed, producing paraplegia 72 hours following surgery for excision of a spinal cord tumor at T8 level. The triggering mechanism was an episode of violent twisting movement by the patient. Fresh blood in the postoperative drain tube provided suspicion of this complication. Emergency evacuation of the clot helped in regaining normal motor and sensory function. The need to avoid straining of the paraspinal muscles in the postoperative period is emphasized. Conclusion Most cases of postoperative spinal extradural hematomas occur as a result of venous bleeding. However, an arterial source of bleeding from paraspinal muscular branches causing extradural hematoma and subsequent neurological deficit is underreported. Undue straining of paraspinal muscles in the postoperative period after major spinal surgery should be avoided for at least a few days.

  4. Brain hemorrhage after electrical burn injury: Case report and probable mechanism

    Science.gov (United States)

    Axayacalt, Gutierrez Aceves Guillermo; Alejandro, Ceja Espinosa; Marcos, Rios Alanis; Inocencio, Ruiz Flores Milton; Alfredo, Herrera Gonzalez Jose

    2016-01-01

    Background: High-voltage electric injury may induce lesion in different organs. In addition to the local tissue damage, electrical injuries may lead to neurological deficits, musculoskeletal damage, and cardiovascular injury. Severe vascular damage may occur making the blood vessels involved prone to thrombosis and spontaneous rupture. Case Description: Here, we present the case of a 39-year-old male who suffered an electrical burn with high tension wire causing intracranial bleeding. He presented with an electrical burn in the parietal area (entry zone) and the left forearm (exit zone). The head tomography scan revealed an intraparenchimatous bleeding in the left parietal area. In this case, the electric way was the scalp, cranial bone, blood vessels and brain, upper limb muscle, and skin. The damage was different according to the dielectric property in each tissue. The injury was in the scalp, cerebral blood vessel, skeletal muscle, and upper limb skin. The main damage was in brain’s blood vessels because of the dielectric and geometric features that lead to bleeding, high temperature, and gas delivering. Conclusion: This is a report of a patient with an electric brain injury that can be useful to elucidate the behavior of the high voltage electrical current flow into the nervous system. PMID:27904757

  5. A Rare Case of Gastric Variceal Hemorrhage Secondary to Infiltrative B-Cell Lymphoma

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    Adrienne Lenhart

    2016-10-01

    Full Text Available Portal hypertension commonly arises in the setting of advanced liver cirrhosis and is the consequence of increased resistance within the portal vasculature. Less commonly, left-sided noncirrhotic portal hypertension can develop in a patient secondary to isolated obstruction of the splenic vein. We present a rare case of left-sided portal hypertension and isolated gastric varices in a patient with large B-cell lymphoma, who was treated with splenic artery embolization. The patient is a 73-year-old male with no previous history of liver disease, who presented with coffee ground emesis and melena. On admission to hospital, he was found to have a hemoglobin level of 3.4 g/l. Emergent esophagogastroduodenoscopy showed isolated bleeding gastric varices (IGV1 by Sarin classification in the fundus and cardia with subsequent argon plasma coagulation injection. He was transferred to our tertiary center where work-up revealed normal liver function tests, and abdominal ultrasound showed patent hepatic/portal vasculature without cirrhosis. MRI demonstrated a large heterogeneously enhancing mass in the pancreatic tail, with invasion into the spleen and associated splenic vein thrombosis. Surgery consultation was obtained, but urgent splenectomy was not recommended. The patient instead underwent splenic artery embolization to prevent future bleeding from his known gastric varices. Pathology from a CT-guided biopsy was consistent with diffuse large B-cell lymphoma. PET imaging showed uptake in the splenic hilum/pancreatic tail region with no additional metastatic involvement. He was evaluated by the Hematology Department to initiate R-CHOP chemotherapy. During his outpatient follow-up, he reported no further episodes of melena or hematemesis. To the best of our knowledge, there have only been two published case reports of large B-cell lymphoma causing upper gastrointestinal bleeding from isolated gastric varices. These cases were treated with splenectomy or

  6. Delayed-onset heparin-induced thrombocytopenia presenting with multiple arteriovenous thromboses: case report

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    Omran Abbas

    2007-11-01

    Full Text Available Abstract Background Delayed-onset heparin-induced thrombocytopenia with thrombosis, albeit rare, is a severe side effect of heparin exposure. It can occur within one month after coronary artery bypass grafting (CABG with manifestation of different thrombotic events. Case presentation A 59-year-old man presented with weakness, malaise, bilateral lower limb pitting edema and a suspected diagnosis of deep vein thrombosis 18 days after CABG. Heparin infusion was administered as an anticoagulant. Clinical and paraclinical work-up revealed multiple thrombotic events (stroke, renal failure, deep vein thrombosis, large clots in heart chambers and 48 ×103/μl platelet count, whereupon heparin-induced thrombocytopenia was suspected. Heparin was discontinued immediately and an alternative anticoagulant agent was administered, as a result of which platelet count recovered. Heparin-induced thrombocytopenia, which causes thrombosis, is a serious side effect of heparin therapy. It is worthy of note that no case of delayed-onset heparin-induced thrombocytopenia with thrombosis associated with cardiopulmonary bypass surgery has thus far been reported in Iran. Conclusion Delayed-onset heparin-induced thrombocytopenia should be suspected in any patient presenting with arterial or venous thromboembolic disorders after recent heparin therapy, even though the heparin exposure dates back to more than a week prior to presentation; and it should be ruled-out before the initiation of heparin therapy.

  7. Frey’s syndrome - unusually long delayed clinical onset post-parotidectomy: a case report

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    Inchien Chamisa

    2010-04-01

    Full Text Available Frey’s syndrome is a complication of parotidectomy that is thought to occur as a result of aberrant regeneration of the postganglionic parasympathetic nerve fibres supplying the parotid gland to severed postganglionic sympathetic fibres which innervate the sweat glands of the face. Frey’s syndrome is difficult to treat but is a preventable phenomenon and surgeons must be aware of the available preventative methods during the initial surgery. An unusual case is presented involving a patient with delayed onset of Frey’s syndrome 40 years after parotidectomy in childhood. The potential for this long-delayed clinical presentation should be discussed with the patient before surgery in the parotid gland. Diagnostic methods, preventive measures and management options are briefly discussed.

  8. A delayed hypersensitivity reaction to a stainless steel crown: a case report.

    Science.gov (United States)

    Yilmaz, A; Ozdemir, C E; Yilmaz, Y

    2012-01-01

    Stainless steel crowns are commonly used to restore primary or permanent teeth in pediatric restorative dentistry. Here, we describe a case of a delayed hypersensitivity reaction, which manifested itself as perioral skin eruptions, after restoring the decayed first permanent molar tooth of a 13-year-old Caucasian girl with a preformed stainless steel crown. The eruptions completely healed within one week after removal of the stainless steel crown. The decayed tooth was then restored with a bis-acryl crown and bridge. Since no perioral skin eruptions occurred during the six-month follow-up, we presume that the cause of the perioral skin eruptions was a delayed hypersensitivity reaction, which was triggered by the nickel in the stainless steel crown.

  9. Thunderclap headache: It is always sub-arachnoid hemorrhage. Is it? - A case report and Review

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    Raghunath Aladakatti

    2014-01-01

    Full Text Available Background: Spontaneous intracranial hypotension (SIH is one of the relatively misdiagnosed pathophysiological entities by virtue of its presentation. SIH is a condition involving reduced intracranial pressure usually secondary to dural tear. There is recent increase in reporting of its varied presentation in literature.Critical care physicians and neurosurgeons are recognizing it in higher numbers than before. SIH is characterized by sudden onset of orthostatic headache and may be associated with neck stiffness, nausea, vomiting, tinnitus, deafness, and cognitive abnormalities. Since its imaging characteristics resemble classic subdural hematoma from other causes wrong diagnosis and intervention might have devastating outcome. Case Description: Here we discuss a case presented to us with severe headache of sudden onset without any associated problems. Patient was initially being treated as sinusitis and later diagnosed as bilateral subdural hematoma and surgical intervention was being considered. Thorough history taking and physical examination lead to strong suspicion of intracranial hypotension (IH and patient showed dramatic improvement with epidural blood patch. Conclusion: S IH is a commonly misdiagnosed entity. A high index of suspicion is required for timely diagnosis, in order to minimize unwanted therapeutic interventions that can worsen the patient′s condition and to help initiate early and simple interventions.

  10. A rare case of digestive hemorrhage in an elderly patient: diagnosis and treatment difficulties.

    Science.gov (United States)

    Jinga, Mariana; Jurcuţ, C; Vasilescu, Florina; Becheanu, G; Stancu, Simona Hildegard; Ciobaca, L; Mircescu, G; Jinga, V

    2012-01-01

    Abdominal pain represents one of the most common clinical conditions. However, there are some challenging cases in which an extensive work-up is mandatory for the diagnosis. We present the case report of a 65-year-old man admitted to our department for diffuse abdominal pain, nausea, vomiting, diarrhea, painful joints and rectal tenesmus. He initially had an urticarial rash, followed by palpable purpura involving the lower extremities. The diarrheic stools evolved towards melena. Endoscopic examination of the upper gastrointestinal tract showed hiatal hernia, superficial erosions in the stomach and multiple areas of deep and superficial ulcerations disseminated from the second to the third portion of the duodenum. Terminal ileum intubation at colonoscopy showed redness, edema, swelling, petechiae and ecchymosis, irregular erosions and ulcers. Endoscopic biopsy specimens showed non-specific inflammation. Computed tomography showed moderate ascites, small pleural effusion, mesenteric lymphadenopathy and small bowel wall thickening at the level of the second duodenum, proximal jejunum and segments of ileum. The urine analysis revealed microscopic hematuria with nephrotic range proteinuria, red cells and cellular casts. Therapy with corticosteroids and pulses of cyclophosphamide was started with significant clinical improvement. Three weeks after the first admission, the patient developed an acute peritonitis due to an intestinal perforation and acute mesenteric ischemia of the small bowel. We concluded that the patient had a Henoch-Schönlein type vasculitis with acute mesenteric ischemia and perforation of the small bowel.

  11. An uncommon clinical feature of IAN injury after third molar removal: a delayed paresthesia case series and literature review.

    Science.gov (United States)

    Borgonovo, Andrea; Bianchi, Albino; Marchetti, Andrea; Censi, Rachele; Maiorana, Carlo

    2012-05-01

    After an inferior alveolar nerve (IAN) injury, the onset of altered sensation usually begins immediately after surgery. However, it sometimes begins after several days, which is referred to as delayed paresthesia. The authors considered three different etiologies that likely produce inflammation along the nerve trunk and cause delayed paresthesia: compression of the clot, fibrous reorganization of the clot, and nerve trauma caused by bone fragments during clot organization. The aim of this article was to evaluate the etiology of IAN delayed paresthesia, analyze the literature, present a case series related to three different causes of this pathology, and compare delayed paresthesia with the classic immediate symptomatic paresthesia.

  12. Unusual primary HIV infection with colonic ulcer complicated by hemorrhagic shock: a case report

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    Emonet Stephane

    2010-08-01

    Full Text Available Abstract Introduction Timely diagnosis of primary HIV infection is important to prevent further transmission of HIV. Primary HIV infection may take place without symptoms or may be associated with fever, pharyngitis or headache. Sometimes, the clinical presentation includes aseptic meningitis or cutaneous lesions. Intestinal ulceration due to opportunistic pathogens (cytomegalovirus, Epstein-Barr virus, Toxoplasma gondii has been described in patients with AIDS. However, although invasion of intestinal lymphoid tissue is a prominent feature of human and simian lentivirus infections, colonic ulceration has not been reported in acute HIV infection. Case description A 42-year-old Caucasian man was treated with amoxicillin-clavulanate for pharyngitis. He did not improve, and a rash developed. History taking revealed a negative HIV antibody test five months previously and unprotected sex with a male partner the month before admission. Repeated tests revealed primary HIV infection with an exceptionally high HIV-1 RNA plasma concentration (3.6 × 107 copies/mL and a low CD4 count (101 cells/mm3, seven percent of total lymphocytes. While being investigated, the patient had a life-threatening hematochezia. After angiographic occlusion of a branch of the ileocaecal artery and initiation of antiretroviral therapy, the patient became rapidly asymptomatic and could be discharged. Colonoscopy revealed a bleeding colonic ulcer. We were unable to identify an etiology other than HIV for this ulcer. Conclusion This case adds to the known protean manifestation of primary HIV infection. The lack of an alternative etiology, despite extensive investigations, suggests that this ulcer was directly caused by primary HIV infection. This conclusion is supported by the well-described extensive loss of intestinal mucosal CD4+ T cells associated with primary HIV infection, the extremely high HIV viral load observed in our patient, and the rapid improvement of the ulcer after

  13. Therapeutic High-Density Barium Enema in a Case of Presumed Diverticular Hemorrhage

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    Nonthalee Pausawasdi

    2011-02-01

    Full Text Available Many patients with lower gastrointestinal bleeding do not have an identifiable source of bleeding at colonoscopy. A significant percentage of these patients will have recurrent bleeding. In many patients, the presence of multiple diverticula leads to a diagnosis of presumed diverticular bleeding. Current treatment options include therapeutic endoscopy, angiography, or surgical resection, all of which depend on the identification of the diverticular source of bleeding. This report describes a case of recurrent bleeding in an elderly patient with diverticula but no identifiable source treated successfully with barium impaction therapy. This therapeutic modality does not depend on the identification of the bleeding diverticular lesion and was well tolerated by our 86-year-old patient.

  14. [A rare case of digestive tract hemorrhage of extraluminal origin after total gastrectomy].

    Science.gov (United States)

    Caprino, Paola; Alfieri, Sergio; Rotondi, Fabio; Di Miceli, Dario; Sofo, Luigi; Pacelli, Fabio; Battista Doglietto, Giovanni

    2003-01-01

    The authors report on a case of digestive bleeding (melaena and enterorrhagia) in a patient undergoing total gastrectomy for gastric cancer and later splenectomy for subcapsular haematoma in a different hospital. The source of bleeding was not intraluminal; the bleeding arose from double erosion of the gastroduodenal artery in the tract above the anterior surface of the pancreas, close to the dehiscent duodenal stump. The blood flowed mainly into the enteric district through the open stump thus causing the clinical signs described. The diagnosis was made during an emergency surgical operation for haemorrhagic shock. The patient underwent haemostasis with two stitches on the gastroduodenal artery, external drainage of the duodenum with a Petzer tube, laparostomy of the infected area and ileostomy. After three months he had completely recovered.

  15. 20 cases of Postpartum Hemorrhage Hysterectomy Treatment Study%产后出血子宫切除20例诊疗探讨

    Institute of Scientific and Technical Information of China (English)

    石恒; 刘利; 陈圣莲

    2013-01-01

    目的探讨产后出血子宫切除的病因及处理措施。方法回顾性分析20例产科子宫切除病例的病因及诊治过程。结果产后出血子宫切除的主要有宫缩乏力、胎盘因素(早剥、粘连、植入、嵌顿等)、产道裂伤、凝血功能障碍四大病因[1];产后出血子宫切除发生率与产前检查、孕产次、产科并发症的诊治水平密切相关。结论加强围生期保健,密切观察产程,防治产科并发症、积极处理,保守治疗无效时立即切除子宫,可有效治疗急性产后大出血,挽救产妇生命。降低孕产妇死亡率。%Objective To investigate the cause of postpartum hemorrhage hysterectomy and treatment measures. Methods A retrospective analysis of 20 cases of obstetric hysterectomy cases the cause and treatment process. Results postpartum hemorrhage hysterectomy are uterine inertia, placenta (abruption, adhesions, implants, incarcerated, etc.), birth canal laceration, four major causes coagulation dysfunction [1]; hysterectomy incidence of postpartum hemorrhage and productivity before the examination, motherhood, diagnosis and treatment of obstetric complications are closely related. Conclusion Strengthening perinatal care, close observation of the birth process, preventing obstetric complications, active treatment, conservative treatment fails Immediate removal of the uterus, which can ef ectively treat acute postpartum hemorrhage, save maternal life. Reducing maternal mortality.

  16. [MASSIVE HEMORRHAGE FROM THE FISTULA FORMATION BETWEEN CUTANEOUS URETEROSTOMY AND INFERIOR EPIGASTRIC ARTERY: A CASE REPORT].

    Science.gov (United States)

    Fujinami, Hiroyuki; Shibuya, Tadamasa; Mori, Kenichi; Shin, Toshitaka; Sumino, Yasuhiro; Sato, Fuminori; Mimata, Hiromitsu; Sato, Yoshiyasu; Matsubara, Takanori; Sakamoto, Sadaaki; Kamei, Noritaka; Hongo, Tetsuo

    2015-04-01

    A 87-year-old man received radical nephroureterectomy for right renal pelvic cancer in 2009 and left cutaneous ureterostomy after radical cystectomy for bladder cancer in 2013. He visited the hospital for exchanging a 7 or 8 Fr single-J catheter every 2 to 4 weeks. Eleven months after the 2nd operation, massive bleeding from the stoma occurred when ureteral catheter was exchanged. Contrast-enhanced computed tomography showed that left inferior epigastric artery was located close to left ureter. Angiography of the left inferior epigastric artery didn't show an obvious fistula, but revealed the stoma was surrounded by ramified new blood vessels from left inferior epigastric artery. We suspected a rupture of the vessels and performed embolization for the branch of inferior epigastric artery to left ureter. This embolization made it possible for the bleeding to be controlled. Massive bleeding from the branch of inferior epigastric artery is very rare, and we report the case and review the literature.

  17. Suprasellar pilocytic astrocytoma in an adult with hemorrhage and leptomeningeal dissemination: case report and review of literature.

    Science.gov (United States)

    Soliman, Radwa K; Budai, Caterina; Mundada, Pravin; Aljohani, Bakar; Rushing, Elisabeth J; Kollias, Spyros S

    2016-12-01

    Pilocytic astrocytoma (PA) is a low-grade tumor. It has an excellent prognosis after total resection. Leptomeningeal dissemination and hemorrhage are very rare to be associated with PA and lead to unfavorable prognosis. A 35-year-old man was diagnosed with a hemorrhagic suprasellar PA in 2006. Subsequent examination in 2007 revealed another large subdural hemorrhagic lesion in the sacral region, which proved to be PA by histopathologic assessment. Other leptomeningeal foci were discovered mainly at the craniocervical junction. The patient underwent subtotal resection and received chemotherapy with disease control for 7 years. Progression of the disseminated disease has recently occurred; however, the patient is still alive with stable disease after radiotherapy. The radiological features, management, and relevant literature are also presented. Our report heightens the awareness of PA in the adult population and the importance of close surveillance for the leptomeningeal spread, especially for sellar region tumors.

  18. Observation on the Effect of Early Puncture Drainage in the Treatment of Patients with Intracranial Hemorrhage Caused by Delayed Vitamin K1 Deficiency%早期穿刺引流在迟发维生素K1缺乏致颅内出血中的疗效观察

    Institute of Scientific and Technical Information of China (English)

    栾劲; 杨皎莹

    2014-01-01

    目的:观察早期穿刺引流在迟发维生素K1缺乏致颅内出血中的疗效。方法:选取2010年1月-2013年4月于本院进行常规治疗的27例迟发维生素K1缺乏致颅内出血患儿为对照组,27例进行早期穿刺引流治疗的患儿为观察组,然后将两组患儿的治疗总有效率、出血停止时间、住院时间、并发症发生率及不同时间的NABA评分进行比较。结果:观察组患儿的治疗总有效率高于对照组,出血停止时间及住院时间均短于对照组,并发症发生率低于对照组,不同时间的NABA评分均优于对照组,差异均有统计学意义( P<0.05)。结论:早期穿刺引流在迟发维生素K1缺乏致颅内出血中的疗效较好,可有效改善患儿的预后。%Objective:To observe the effect of early puncture drainage in the treatment of patients with intracranial hemorrhage caused by delayed vitamin K1 deficiency.Method:27 newborns with intracranial hemorrhage caused by delayed vitamin K1 deficiency who were treated with routine treatment in our hospital from January 2010 to April 2013 were the control group,27 cases who were treated with early puncture drainage were the observation group,then the total effective rate,stopping time of bleeding,hospitalization time,rate of complications and NABA score at different time of two groups were compared.Result:The total effective rate of observation group was higher than that of control group,stopping time of bleeding and hospitalization time were shorter than those of control group,rate of complications was lower than that of control group,ABA score at different time were better than those of control group,there were all significant differences(P<0.05).Conclusion:The effect of early puncture drainage in the treatment of patients with intracranial hemorrhage caused by delayed vitamin K1 deficiency is better,and it can effectively improve the prognosis of newborns.

  19. 产科出血致71例孕产妇死亡分析%The analysis of 71 case of maternal death caused by obstetric hemorrhage

    Institute of Scientific and Technical Information of China (English)

    刘春华

    2009-01-01

    目的 寻找产科出血致孕产妇死亡的影响因素,制定切实可行的干预措施,降低茂名市孕产妇死亡率.方法对茂名市2001-2008年产科出血致孕产妇死亡个案及评审结果资料进行分析.结果8年来茂名市孕产妇死亡157例,孕产妇死亡率为24.40/10万,产科出血在孕产妇死亡构成比中占45.22%,子宫收缩乏力性产后出血占产后出血首位,占63.38%.结论应严历打击非法接生,提高住院分娩率;加强高危妊娠的管理和孕产妇的三级转诊,提高孕产妇系统管理质量;提高产科危重症抢救能力,降低产科出血的发生率.%Objective Find out the maternal mortality obstetric hemorrhage causes of ob-stetric hemorrhage, make the practical interventions,in order to reduce the rate maternal mortality in Maoming city.Methdos Investigate the assessment results of the maternal mortality caused by obstetric hemorrhage of Maoming city during 2008 to 2009.Results Among 8 years,there were 157 cases of maternal mortality, the maternal mortality rate were 24.40/100000, of which obstetric hemorrhage in the constituent ratio of maternal deaths accounted for 45.22%.Weak uterine contraction was the major factor causing postpartum hemorrhage, it accounts 63.38%.Conclusions It should be harsh against illegal midwifery,increase the rate of hospital delivery,to strengthen the management of high-risk pregnancies and maternal tertiary referral, to improve the quality of management systems for the pregnant, to improve the ability of emergency obstetric, to reduce the incidence of obstetric hemorrhage.

  20. A Case of Delayed Myelopathy Caused by Atlantoaxial Subluxation without Fracture

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    Ryo Takamatsu

    2013-01-01

    Full Text Available We report a case of delayed myelopathy caused by atlantoaxial subluxation without fracture. The patient was a 38-year-old male who became aware of weakness in extremities. The patient had a history of hitting his head severely while diving into a swimming pool at the age of 14 years old. At that time, cervical spine plain X-ray images showed no fracture, and the cervical pain disappeared after use of a collar for several weeks. At his first visit to our department, X-ray images showed an unstable atlantoaxial joint. After surgery, weakness of the extremities gradually improved. At 6 months after surgery, bone union was completed and the symptoms disappeared. This case shows that atlantoaxial ligament injuries are difficult to diagnose and may easily be missed. A high level of suspicion is important in such cases, since neurological compromise or deterioration may occur many years after the injury.

  1. Clinical Analysis of 38 Cases with Postpartum Hemorrhage%产后出血38例临床分析

    Institute of Scientific and Technical Information of China (English)

    杨红亚

    2011-01-01

    Objective To approach the reasons and effective diagnosis and treatment methods of postpar-tum hemorrhage. Methods The clinical data of 38 lying-in women with postpartum hemorrhage who were ac-cepted by our hospital from January to December 2010 were retrospectively analyzed. Results The incidence rate of puerperal hemorrhage was 3.06 %. With the increase of parity, incidence of postpartum hemorrhage was increased;with the increase of fetal weight,incidence of postpartum hemorrhage was significantly increased. The postpartum hemorrhage incidence of vaginal delivery was significantly higher than cesarean section. Conclusion Postpartum hemorrhage is relevant to parity,mode of delivery,fetal weight and so on;the primary causes in-clude uterine inertia,placenta factors,injury of soft birth canal and coagulation functions. Therefore,to enhance perinatal care, correctly handle the birth process, and enhance postnatal observation can effectively reduce the incidence of postpartum hemorrhage and maternal mortality.%目的 探讨产后出血的原因及有效诊疗方法.方法 回顾性分析我院2010年1月至2010年12月38例产妇产后出血的临床资料.结果 产后出血发生率3.06%,随着胎次的增多,产后出血发生率增高,随着胎儿体质量的增高,产后出血发生率也明显增高,阴道分娩产后出血发生率明显高于剖宫产.结论 产后出血与胎次、分娩方式、胎儿体质量等有明显关系,主要原因与宫缩乏力、胎盘因素、软产道损伤及凝血功能有关.故加强围生期保健,正确处理产程,加强产后观察能有效降低产后出血发生率及孕产妇病死率.

  2. Clinical experiences of delayed contrast enhancement with cardiac computed tomography: case series

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    Sidhu Manavjot S

    2013-01-01

    Full Text Available Abstract Background Myocardial delayed enhancement (MDE by gadolinium-enhanced cardiac MRI is well established for myocardial scar assessment in ischemic and non-ischemic heart disease. The role of MDE by cardiac CT (CT-MDE is not yet defined. Findings We reviewed all clinical cases of CT-MDE at a tertiary referral center to present the cases as a case series. All clinical cardiac CT exams which utilized CT-MDE imaging between January 1, 2005 and October 1, 2010 were collected as a series and their findings were also compared with available myocardial imaging to assess for myocardial abnormalities, including echocardiography (wall motion, morphology, cardiac MRI (delayed enhancement, morphology, SPECT MPI (perfusion defects. 5,860 clinical cardiac CT exams were performed during the study period. CT-MDE was obtained in 18 patients and was reported to be present in 9 patients. The indications for CT-MDE included ischemic and non-ischemic heart diseases. In segments positive for CT-MDE, there was excellent agreement of CT with other modalities: echocardiography (n=8 demonstrated abnormal morphology and wall motion (k=1.0 and k=0.82 respectively; prior MRI (n=2 demonstrated abnormal delayed enhancement (MR-MDE (k=1.0; SPECT MPI (n=1 demonstrated fixed perfusion defects (k=1.0. In the subset of patients without CT-MDE, no abnormal segments were identified by echocardiography (n=8, MRI (n=1 and nuclear MPI (n=0. Conclusions CT-MDE was performed in rare clinical situations. The indications included both ischemic and non-ischemic heart disease and there was an excellent agreement between CT-MDE and abnormal myocardium by echocardiography, cardiac MRI, and nuclear MPI.

  3. Predictors of delayed recovery following pediatric sports-related concussion: a case-control study.

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    Miller, Joseph H; Gill, Clarence; Kuhn, Elizabeth N; Rocque, Brandon G; Menendez, Joshua Y; O'Neill, Jilian A; Agee, Bonita S; Brown, Steven T; Crowther, Marshall; Davis, R Drew; Ferguson, Drew; Johnston, James M

    2016-04-01

    OBJECT Pediatric sports-related concussions are a growing public health concern. The factors that determine injury severity and time to recovery following these concussions are poorly understood. Previous studies suggest that initial symptom severity and diagnosis of attention deficit hyperactivity disorder (ADHD) are predictors of prolonged recovery (> 28 days) after pediatric sports-related concussions. Further analysis of baseline patient characteristics may allow for a more accurate prediction of which patients are at risk for delayed recovery after a sports-related concussion. METHODS The authors performed a single-center retrospective case-control study involving patients cared for at the multidisciplinary Concussion Clinic at Children's of Alabama between August 2011 and January 2013. Patient demographic data, medical history, sport concussion assessment tool 2 (SCAT2) and symptom severity scores, injury characteristics, and patient balance assessments were analyzed for each outcome group. The control group consisted of patients whose symptoms resolved within 28 days. The case group included patients whose symptoms persisted for more than 28 days. The presence or absence of the SCAT2 assessment had a modifying effect on the risk for delayed recovery; therefore, stratum-specific analyses were conducted for patients with recorded SCAT2 scores and for patients without SCAT2 scores. Unadjusted ORs and adjusted ORs (aORs) for an association of delayed recovery outcome with specific risk factors were calculated with logistic regression analysis. RESULTS A total of 294 patients met the inclusion criteria of the study. The case and control groups did not statistically significantly differ in age (p = 0.7). For the patients who had received SCAT2 assessments, a previous history of concussion (aOR 3.67, 95% CI 1.51-8.95), presenting SCAT2 score recovery (aOR 4.41, 95% CI 1.93-10.07 and aOR 3.87, 95% CI 1.13-13.24, respectively). Concussions resulting from playing a

  4. Delayed Descemet's membrane detachment after successful cataract surgery: a case report

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    Aileen Walsh

    2012-10-01

    Full Text Available The detachment of Descemet's membrane can be a serious complication following cataract surgery, leading to severe corneal edema and reduced visual acuity. This report describes an unusual case of Descemet's membrane detachment 6 months after successful phacoemulsification, documented by anterior segment optic coherence tomography (OCT; RTVue, Optovue. The eye was treated successfully with pneumatic descemetopexy and transcorneal suturing, with reattachment of Descemet's membrane. This report should alert physicians that delayed corneal edema can be related to late-onset Descemet's membrane detachment, which requires proper treatment to avoid permanent corneal decompensation.

  5. Delayed interval delivery after intrauterine infection and immature birth of twin 1--a case report and literature review.

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    de Jong, M W; Pinas, I M; van Eijck, J

    1995-11-01

    We report a case of delayed interval delivery in a twin pregnancy complicated by rupture of membranes, intrauterine infection and birth of one twin at 21 weeks gestation. Tocolysis combined with antibiotics and corticosteroids successfully prolonged pregnancy for 73 days, allowing the second twin to mature and reach viability. At 31.5 weeks gestation, a 1890 g healthy male neonate was born with good Apgar scores. His postnatal course was uneventful. A literature review of several other cases of delayed interval delivery is presented. When multifetal pregnancies are complicated by immature birth of one fetus, delayed interval delivery may offer survival chances and favourable outcome for the remaining fetus(es).

  6. Polybrominated diphenyl ethers in relation to autism and developmental delay: a case-control study

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    Pessah Isaac

    2011-01-01

    Full Text Available Abstract Background Polybrominated diphenyl ethers (PBDEs are flame retardants used widely and in increasing amounts in the U.S. over the last few decades. PBDEs and their metabolites cross the placenta and studies in rodents demonstrate neurodevelopmental toxicity from prenatal exposures. PBDE exposures occur both via breastfeeding and hand-to-mouth activities in small children. Methods Participants were 100 children from the CHARGE (CHildhood Autism Risk from Genetics and the Environment Study, a case-control epidemiologic investigation of children with autism/autism spectrum disorder, with developmental delay and from the general population. Diagnoses of autism were confirmed by the Autism Diagnostic Observation Schedule and Autism Diagnostic Inventory-Revised, and of developmental delay using the Mullen's Scales of Early Learning and the Vineland Adaptive Behavior Scales. Typically developing controls were those with no evidence of delay, autism, or autism spectrum disorder. Eleven PBDE congeners were measured by gas chromatography/mass spectrometry from serum specimens collected after children were assessed. Logistic regression was used to evaluate the association between plasma PBDEs and autism. Results Children with autism/autism spectrum disorder and developmental delay were similar to typically developing controls for all PBDE congeners, but levels were high for all three groups. Conclusions Plasma samples collected post-diagnosis in this study may not represent early life exposures due to changes in diet and introduction of new household products containing PBDEs. Studies with direct measurements of prenatal or infant exposures are needed to assess the possible causal role for these compounds in autism spectrum disorders.

  7. Encefalopatia hemorrágica hipernatrêmica: relato de caso e revisão da literatura Hypernatremic hemorrhagic encephalopaty: case report and literature review

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    Lucas Sampaio Mata

    2010-09-01

    Full Text Available Hipernatremia é um distúrbio hidro-eletrolítico frequente em pessoas nas quais o mecanismo da sede ou o acesso à água está comprometido podendo causar desde morbidades mínimas até coma. Entre as morbidades causadas pela hipernatremia, a hemorragia do sistema nervoso central é infreqüente e pouco estudada. Relatamos um caso de paciente admitido na unidade de terapia intensiva com redução do nível de consciência, hipernatremia e tomografia computadorizada de crânio evidenciando hemorragia intraparenquimatosa bilateral. Foi realizada revisão de literatura de encefalopatia hemorrágica hipernatrêmica.Hypernatremia is a common electrolyte disorder in people with impaired thirst control mechanism or access to water, and may lead from minimal disorders until coma. Among the hypernatremia morbidities, central nervous system hemorrhage is uncommon and poorly studied. We report a case involving a patient admitted to the intensive care unit with reduced consciousness level, hypernatremia and head computed tomography scan showing bilateral parenchyma hemorrhage. A literature review of hypernatremia hemorrhagic encephalopathy was conducted.

  8. Pathogenesis of arenavirus hemorrhagic fevers.

    Science.gov (United States)

    Moraz, Marie-Laurence; Kunz, Stefan

    2011-01-01

    Viral hemorrhagic fevers (VHFs) caused by arenaviruses belong to the most devastating emerging human diseases and represent serious public health problems. Arenavirus VHFs in humans are acute diseases characterized by fever and, in severe cases, different degrees of hemorrhages associated with a shock syndrome in the terminal stage. Over the past years, much has been learned about the pathogenesis of arenaviruses at the cellular level, in particular their ability to subvert the host cell's innate antiviral defenses. Clinical studies and novel animal models have provided important new information about the interaction of hemorrhagic arenaviruses with the host's adaptive immune system, in particular virus-induced immunosuppression, and have provided the first hints towards an understanding of the terminal hemorrhagic shock syndrome. The scope of this article is to review our current knowledge on arenavirus VHF pathogenesis with an emphasis on recent developments.

  9. Delayed-Onset Post-Stroke Delusional Disorder: A Case Report

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    Raíssa B. Barboza

    2013-01-01

    Full Text Available Although the prevalence of neuropsychiatric disorders among patients with cerebrovascular illness is relatively high, there are only few case reports describing post-stroke psychotic symptoms. In general, post-stroke psychoses have been reported to emerge few days after the vascular event and to vanish soon afterwards. In this report, we describe delayed-onset post-stroke delusional disorder, persecutory type. A middle-aged female patient developed a persistent delusional disorder with homicidal behavior about one year after a cerebrovascular accident affecting the right fronto-temporo-parietal region and a long period of chronic post-stroke mixed anxiety and depressive symptoms. Our case suggests that there might be long intervals between stroke and the appearance of psychotic symptoms.

  10. Delayed presentation of traumatic cerebrospinal fluid rhinorrhea: Case report and literature review.

    Science.gov (United States)

    Guyer, Richard A; Turner, Justin H

    2015-01-01

    Cerebrospinal fluid (CSF) leak is one of several complications that can occur after traumatic skull base injury. Although most patients present soon after the injury occurs, some can present years later, with resulting morbidity and the need for additional procedures. We present a case of a patient with a sphenoid sinus CSF leak who presented 12 years after a closed head injury that included a sphenoethmoid skull base fracture. We also reviewed the literature on this topic, with a discussion of previous reports of CSF leaks that occurred months, years, or decades after trauma. A late onset CSF leak appears to be a rare but important complication of traumatic skull base injury. This case highlights the need for clinicians to remain vigilant to the possibility of delayed CSF rhinorrhea, even years after traumatic head injury.

  11. 产后大出血22例临床分析体会%Experience of Clinical analysis of 22 cases of postpartum hemorrhage

    Institute of Scientific and Technical Information of China (English)

    义兰花

    2014-01-01

    目的:对造成产后大出血的相关因素进行分析,为提出合理的预防措施奠定理论基础;探讨子宫动脉栓塞法治疗产后大出血的临床疗效。方法收集我院于2011年1月至2013年1月收治的22例产后大出血患者,对每例大出血患者发生大出血的原因进行追踪和分析。并对每例产后大出血患者的治疗措施进行归纳分析,其中9例患者在常规治疗的基础上还进行了子宫动脉栓塞术治疗,将其视为试验A组;其余13例患者仅给予了常规治疗,我们将其视为试验B组,通过对两组患者的阴道出血时间、平均出血量、有效止血例数以及阴道出血复发的情况进行统计来评价两组的临床疗效。结果在22例产后大出血患者中,宫缩乏力、胎盘因素和巨大胎儿占据了导致其大出血原因的前三位,分别占总人数的31.8%、27.3%和18.2%,属于导致产后大出血的高危因素。试验A组的阴道出血时间和平均出血量较试验B组显著降低(P<0.05);试验A组13例患者中有11例有效止血,2例止血失败,且有1例出现阴道出血复发情况;而试验B组中9例患者均达到有效止血,没有阴道出血复发情况出现。结论宫缩乏力、胎盘因素和巨大胎儿是导致产妇产后大出血的主要原因,应引起医护人员的高度重视,做好防护措施;与常规治疗方法相比,子宫动脉栓塞法治疗产后大出血临床疗效更好,建议临床医生推广使用。%objective To analyze the related factors causing postpartum hemorrhage and laying the theoretical foundation for reasonable precautions; To investigate the clinical efficacy of uterine artery embolization treatment of postpartum hemorrhage. Method Colecting 22 cases of postpartum hemorrhage patients in our hospital from January 2011 to January 2013 were treated, tracking and analyze the reasons of each of the cases of bleeding in patients with bleeding

  12. 鼻咽癌放疗后大出血43例%Clinical analysis of 43 cases nasopharyngeal massive hemorrhage with nasopharyngeal carcinoma after radiotherapy

    Institute of Scientific and Technical Information of China (English)

    蒋军; 张宁

    2010-01-01

    目的 探讨鼻咽癌放疗后大出血的相关因素及预防措施.方法 回顾性分析43例鼻咽癌放疗后大出血的临床资料.结果 43例中,肿瘤广泛侵及颅底39例(90.7%),继往曾接受高剂量放疗36例(83.7%),接受后程大分割放疗10例(23.3%),伴有糖尿病者13例(30.2%).结论 肿瘤发生部位是鼻咽癌大出血最主要的因素;放疗剂量、分割方式、糖尿病则是次要的相关因素.对于伴有上述高危因素的患者,应尽量采用超分割,控制总剂量、血糖等.积极地预防比抢救更重要.%Objective To investigate the related factors and preventive measures of nasopharyngeal massive hemorrhage in patients with nasopharyngeal carcinoma after radiotherapy. Methods Clinical data of 43 nasopharyngeal massive hemorrhage patients with nasopharyngeal carcinoma after radiotherapy were analyzed retrospectively. Results Thirty-nine cases(90.7 %) had abroad skull base invasion due to tumor, 36 cases (83.7%) received high dose of radiation, and 13 cases (30.2 %) were accompanied by diabetes. Conclusion Tumor location is the major factor for nasopharyngeal massive hemorrhage, while radiation dosage, fractionation patterns and diabetes are the secondary factors. The measures in cluding hyperfractionation, overall dose control and blood sugar regulation should be taken for the high risk patients. Prevention is more important than salvage.

  13. Gitelman syndrome manifesting in early childhood and leading to delayed puberty: a case report

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    Raza Farhan

    2012-10-01

    Full Text Available Abstract Introduction Gitelman syndrome is an inherited autosomal recessive renal salt-wasting disorder. It presents with variable clinical symptoms including muscle weakness and fatigue, and the diagnosis is based on metabolic alkalosis, hypokalemia, hypomagnesemia and hypocalciuria. It is usually diagnosed incidentally in early adulthood. There are rare cases of Gitelman syndrome presenting in early childhood; however, to the best of our knowledge it has not previously been associated with delayed puberty. Case presentation A 17-year-old South Asian man with recurrent episodes of generalized muscle weakness, fatigue and cramps from the age of two years was admitted for further workup. Before the age of 12 years, the episodes had been mild, but they then got progressively worse. Other symptoms include polyuria, polydipsia, nocturia, paresthesia and occasional watery diarrhea. He also had a history of short stature, poor weight gain and delayed developmental landmarks. His family history was unremarkable except for the consanguineous marriage of his parents. An examination revealed a thin and lean man with blood pressure of 95/60mmHg. His height and weight were below the third percentile and his sexual development was at Tanner Stage II. Laboratory work revealed serum sodium of 124mmol/L, potassium 2.4mmol/L, calcium 6.5mmol/L and magnesium of 1.2mg/dL. His testosterone level was low (0.85ng/mL, normal for his age 2.67 to 10.12ng/mL with normal levels of luteinizing hormone and follicle-stimulating hormone. The sex hormone findings were attributed to delayed puberty. A 24-hour urinary analysis revealed decreased excretion of calcium (25.9mg/24 hours. Based on the findings of hypokalemic metabolic alkalosis without hypertension, severe hypomagnesemia and hypocalciuria, a diagnosis of Gitelman syndrome was made. Treatment was started with oral supplementation of potassium, magnesium and calcium along with spironolactone and liberal salt intake

  14. Clinical features of spinal cord hemangioblastoma complicated by hematomyelia and subarachnoid hemorrhage: Description of a clinical case and review of literature

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    G. Yu. Evzikov

    2015-01-01

    Full Text Available The paper describes subarachnoid hemorrhage (SAH and hematomyelia resulting from bleeding from spinal hemangioblastoma. SAH is encountered in spinal pathology extremely rarely and results from bleeding from malformations in most cases. The described case demonstrates that the tumors may also cause spinal SAH even there is no clinical evidence of gradually progressive spinal cord compression in the history. Patients with hemangioblastoma are at the highest risk for clinically relevant massive bleeding in intramedullary tumors. In this case, of special attention is its clinical picture: SAH began with neck and arm pain, rather than headache, which indicates the primarily spinal level of bleeding. Head and arm pains were joined by SAH -typical headache, nausea, and vomiting in only a few minutes, which was associated with retrograde blood flow into the basal cisterns of the brain and the fourth ventricle. Primary MRI of the cervical spine was a more rational diagnostic scheme in this case.

  15. Successful surgical treatment of descending aorta interruption in a 29-year-old woman with acute paraplegia and subarachnoid hemorrhage: a case report.

    Science.gov (United States)

    Bai, Shutang; Wang, Zhiheng; Zhang, Liang; Fu, Hongdu; Zhuang, Huanwei; Cao, Xianjun; Liang, Liming; Yang, Yanqi

    2015-06-06

    Interruption of the descending aorta is an extremely rare great vessel malformation. In this report, we describe a very unusual case of a 29-year-old female with a 13-year history of hypertension who was found to have an interruption of the descending aorta when she was hospitalized with a subarachnoid hemorrhage and symptoms of acute paraplegia. We successfully surgically corrected the defect using a Gore-Tex® graft to bypass the aortic interruption. The patient's blood pressure postoperatively returned to normal, and the patient recovered completely from her paraplegia by the time of her 5-month follow-up visit.

  16. Computed tomography and intracranial hemorrhages in the neonate

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    Shibata, Iekado; Kushida, Yoshimasa; Shishido, Masaru; Nagasawa, Sadatsugu; Seiki, Yoshikatsu (Toho Univ., Tokyo (Japan). School of Medicine)

    1983-02-01

    Thirty-two of 290 neonates admitted to the Perinatal Intensive Care Unit, Toho University Medical School, were examined by CT scan because of tentative clinical diagnosis of intracranial hemorrhage. CT scanner employed in this study was TCT-60 A from the Toshiba The Electric Co., Ltd. Fourteen cases (44%) were confirmed by the CT scan to have intracranial hemorrhage. Four cases had hemorrhage in the ventricle, while the remaining ten cases had subarachnoid hemorrhage. Subdural hemorrhage was not revealed in our series. Three of the four cases with intraventricular hemorrhage showed a typical subependymal germinal matrix hemorrhage. The prognosis of intraventricular hemorrhage in neonates seemed to be poor; two of the four cases died within a week. Their body weight at birth was apparently under the standard, and their Apgar score was 3 points. The subarachnoid hemorrhage was the main type of intracranial neonatal hemorrhages. In our series, it was constituted approximately 70% of the intracranial hemorrhages. The CT images of the subarachnoid hemorrhage in neonate were greatly different from those in adults. An irregular, wide high-density area around the falxtentorial junction was characteristic of the CT in many neonatal subarachnoid hemorrhages. In severe subarachnoid hemorrhages, a characteristic Y-shaped, high-density figure was demonstrated. In cases of subarachnoid hemorrhage from the deep venous system, high-density spreading immediately ventral to the falx-tentrium junction was demonstrated. These high-density areas due to blood in the subarachnoid space rapidly disappeared with the lapse of time. On the other hand, high-density areas in cerebral cisterns and/or fissures were rarely demonstrated in neonatal subarachnoid hemorrhages. The prognosis of subarachnoid hemorrhage in neonates was fairly good in the sense of life and cerebral functions.

  17. Clinical analysis of 130 cases of postpartum hemorrhage%产后出血130例的临床分析

    Institute of Scientific and Technical Information of China (English)

    古玉棉

    2013-01-01

    Objective To analyze the risk factors of the causes of postpartum hemorrhage, and the prevention measures. Methods retrospective analysis in our hospital from 2002 January to 2012 December in hospital childbirth 130 cases of postpartum hemorrhage, bleeding in patients with high risk factors and treatment measures. Results the causes of hemorrhage in uterine atony accounted for 72.31%, 14.62%of placental factors, the soft birth canal injury accounted for 10.77%, accounting for 2.31%of coagulation dysfunction. Effect of risk factor of postpartum hemorrhage is mainly advanced maternal age, gestational diseases in Department of internal medicine, hypertensive disorder complicating pregnancy, uterine scar, floating population, twins or multiple pregnancy, uterine fibroids, polyhydramnios, fetal macrosomia, placenta, placental abruption. Conclusion postpartum haemorrhage is caused by many reasons and many risk factors, should be targeted at the specific etiology combined application of medication, when necessary, all kinds of conservative treatment and operation treatment is the effective measures of postpartum hemorrhage.%目的综合分析产后出血的原因、危险因素与防治措施。方法回顾分析我院2002年1月至2012年12月住院分娩的130例产后出血患者的出血原因、高危因素及治疗措施。结果出血原因中宫缩乏力占72.31%,胎盘因素占14.62%,软产道损伤占10.77%,凝血功能障碍占2.31%。影响产后出血的危险因素主要是高龄孕妇、妊娠合并内科疾病、妊娠高血压疾病、疤痕子宫、流动人口、双胎或多胎妊娠、子宫肌瘤、羊水过多、巨大儿、前置胎盘、胎盘早剥等。结论产后出血是多种原因和多种高危因素所致,应针对具体病因综合应用药物治疗,必要时进行各种保守性治疗及手术是治疗产后出血的有效措施。

  18. Atypical teratoid/rhabdoid tumor of the velum interpositum presenting as a spontaneous intraventricular hemorrhage in an infant: case report with long-term survival.

    Science.gov (United States)

    Donovan, Daniel J; Smith, Alice B; Petermann, Gregory W

    2006-01-01

    Atypical teratoid/rhabdoid tumors (ATRT) of infancy are highly malignant neoplasms that are most common in the first 2 years of life. We present the case of a 3-month-old girl who presented with the acute onset of generalized seizures and was found to have a large spontaneous intraventricular hemorrhage. The blood masked an underlying ATRT of the velum interpositum in the midline of the lateral ventricles and roof of the third ventricle, the first reported case in this location. Serial imaging studies and two ventriculoscopic biopsies were required to establish the diagnosis of the tumor in this unique location and in the midst of an evolving hematoma. After surgical resection, the patient received adjuvant chemotherapy. At 4-year follow-up, the child is neurologically intact, meeting normal developmental milestones, and imaging studies show no evidence of tumor. ATRT were previously associated with an extremely poor prognosis, but more recent evidence with complete surgical resection and adjuvant chemotherapy shows extended survival in some cases, supporting an aggressive and comprehensive approach to give these patients the best chance for a good outcome. Spontaneous brain hemorrhage in a full-term infant requires a diligent and persistent search to rule out an underlying neoplasm.

  19. Cerebral infarction following intracranial hemorrhage in pediatric Moyamoya disease - A case report and brief review of literature

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    Soumya Patra

    2012-01-01

    Full Text Available Moyamoya disease is a clinical entity characterized by progressive cerebrovascular occlusion with spontaneous development of a collateral vascular network called Moyamoya vessels. This disease mainly manifests as cerebral ischemia. Intracranial bleeding is another major presentation of patients with Moyamoya disease. We report here a 12-year-old male child who presented with severe headache, vomiting and meningismus. Initial neuroimaging study with noncontrast computed tomography scan revealed fresh intraventricular hemorrhage in right-sided lateral ventricle. Magnetic resonance imaging with angiography of brain was done 5 days later when the child developed right-sided hemiparesis, and the diagnosis of Moyamoya disease was confirmed along with lacunar infarction of right posterior peri and paraventricular area and in the left paraventricular area and centrum semiovale. Simultaneous presence of cerebral infarction along with intraventricular hemorrhage in adult with bleeding-type Moyamoya disease is reported in literature, but it is a rare entity in a child.

  20. Acute Retinal Necrosis Presenting in Developmentally-delayed Patients with Neonatal Encephalitis: A Case Series and Literature Review.

    Science.gov (United States)

    Okafor, Kingsley; Lu, Jonathan; Thinda, Sumeer; Schwab, Ivan; Morse, Lawrence S; Park, Susanna S; Moshiri, Ala

    2016-05-18

    We report three cases of patients with developmental-delay from neonatal herpetic encephalitis and/or meningitis who presented years later with acute retinal necrosis due to herpes simplex virus. The diagnosis was delayed in all cases due to the patients' inability to verbalize their ocular complaints and cooperate with eye examinations. This case series documents the clinical course, pathophysiologic mechanism, and treatment of acute retinal necrosis in this patient population. Clinicians should understand the importance of prudent consideration of acute retinal necrosis in patients with a history of neonatal herpetic encephalitis and/or meningitis presenting with a red eye.

  1. 丘脑出血76例临床与CT分析%The Thalamus Hemorrhage in 76 Cases of Clinical and CT Analysis

    Institute of Scientific and Technical Information of China (English)

    冯彦琦

    2013-01-01

    Objective To summarize clinical manifestation,CT changes of thalamic hemorrhage and its relationship with prognosis. Methods Retrospective analysis the clinical data of 76 cases of thalamic hemorrhage and CT examination results. With over 60 years of age 51 cases (67.1%),always hypertension 66 cases (86.8%). Clinical manifestations of 61 cases with hemiplegia (80.3%),and partial body feels obstacle of 57 cases (75%),sleep disorder,41 cases (53.9%),language impairment,38 cases (50%),disturbance of consciousness,35 cases (46.1%),fever,32 cases (42.1%),eye movement disorder,22 cases (29%),multiple,often have elevated blood sugar 30 cases (39.5%),pulmonary infection,29 cases (38.2%),upper gastrointestinal bleeding in 17 cases (22.4%),electrocardiogram (ecg) obvious change in 12 cases (15.8%).The bleeding 14 cases of 31~50 ml,midline structure shift 5~10 mm,14 cases had broken into the ventricle,8 cases died (57.1%);The bleeding>50 ml in 7 cases,midline structure shift 10 mm,breaking into the ventricles7cases (100%),7cases died (100%). Results 76 patients were cured,23 cases (30.3%),34 cases (44.7%).Death 19 cases (25%). Conclusion The thalamus as the common parts of the cerebral hemorrhage,complex and varied performance,much complications,high mortality rate.%目的:总结分析丘脑出血的临床表现、CT改变及其与预后的关系。方法回顾性分析76例丘脑出血的临床资料及 CT检查结果。本组以60岁以上51例(67.1%)、既往高血压病66例(86.8%)为主。临床表现以偏瘫61例(80.3%)、偏身感觉障碍57例(75%)、睡眠障碍41例(53.9%)、语言功能障碍者38例(50%)、意识障碍35例(46.1%)、发热32例(42.1%)、眼球运动障碍22例(29%)为多见,常有血糖升高30例(39.5%)、肺部感染29例(38.2%)、上消化道出血17例(22.4%)、心电图明显改变12例(15.8%)。出血量31~50ml者14例,中线结构移位5~10mm,破入脑室14例,死亡8

  2. Delayed diagnosis of central skull-base osteomyelitis with abscess: case report and learning points.

    Science.gov (United States)

    Chawdhary, G; Hussain, S; Corbridge, R

    2017-01-01

    Central skull-base osteomyelitis (CSBO) is a rare life-threatening infection, usually resulting from medial spread of necrotising otitis externa. Here, we describe a case with no identifiable source of infection, causing a delay in diagnosis. An 80-year-old man with Crohn's disease treated with mesalazine presented with collapse and tonic-clonic seizure. Computed tomography and magnetic resonance imaging showed a nasopharyngeal mass that was initially thought to be a neoplasm. Awaiting formal biopsy, he represented with collapse and repeat imaging showed features of abscess formation. Review of previous scans revealed skull-base erosion and the diagnosis was revised to skull-base osteomyelitis. This is the first reported case of CSBO associated with mesalazine use, an aminosalicylate used in Crohn's disease. It is only the second reported case with abscess formation. We discuss the learning points in making a timely diagnosis and examine the potential association of factors such as mesalazine use and abscess formation in this case.

  3. Pulmonary Hemorrhagic Infarction due to Fat Embolism and Thromboembolism after Maxillofacial Plastic Surgery: a Rare Case Report

    Institute of Scientific and Technical Information of China (English)

    ZOU Dong-hua; SHAO Yu; ZHANG Jian-hua; QIN Zhi-qiang; LIU Ning-guo; HUANG Ping; CHEN Yi-jiu

    2012-01-01

    Pulmonary fat embolism (PFE) and pulmonary thromboembolism (PTE) are common post-operative complications of orthopedic surgical procedures,but are reported less often following maxillofacial plastic surgical procedures,especially with respect to PFE.Thrombi,or together with fat emboli in pulmonary vessels can induce hemorrhagic infarction and cause death.Herein this report introduced a death due to pulmonary hemorrhagic infarction following maxillofacial plastic surgery.The female patient underwent several osteotomies of the mandible,zygomas and autologous bone grafting within a single operation.The operative time was longer than normal and no preventive strategies for pulmonary embolism were implemented.The patient died 20 days after hospital discharge.The autopsy confirmed pulmonary hemorrhagic infarction.The fat emboli and thrombi were also noted in the pulmonary vessels,which were thought to have resulted from the maxillofacial osteotomy.Suggestions were offered to forensic pathologists that risk factors of PFE and PTE,such as the type and length of surgery,the surgical sites,and the preventive strategies,should be considered when handling deaths after maxillofacial operations.

  4. Delayed radiation necrosis of the brain following radiotherapy for a pituitary adenoma; A case report

    Energy Technology Data Exchange (ETDEWEB)

    Miyata, Samon; Demachi, Hiroshi; Terabayashi, Tadashi; Sugiyama, Yoshiaki; Miwa, Atsuo (Toyama Prefectural Central Hospital (Japan))

    1992-10-01

    The authors report a case of a 37-year-old woman who was given a surgical resection, using a transsphenoidal approach, for a pituitary chromophobe adenoma (a prolactinoma) and postoperative radiotherapy with parallel-opposed lateral portals (a total dose of 50.8 Gy/26 fractions/37 days; TDF: 81). Seventeen months after this radiotherapy, however, she experienced vertigo and nausea, and a CT scan revealed decreased attenuation in the white matter of the bilateral temporal lobes, although cerebral angiograms showed no abnormalities. Delayed radiation necrosis of the temporal lobes was diagnosed and these clinical symptoms improved with the administrations of steroids and glyceol. Ten years after this radiation, the patient is alive and shows no neurological abnormalities. (author).

  5. Delayed presentation of a sigmoid colon injury following blunt abdominal trauma: a case report

    Directory of Open Access Journals (Sweden)

    Ertugrul Gokhan

    2012-08-01

    Full Text Available Abstract Introduction The low incidence of colon injury due to blunt abdominal trauma and the lack of a definitive diagnostic method for the same can lead to delays in diagnosis and treatment, subsequently resulting in high morbidity and mortality. Case presentation A 66-year-old woman with sigmoid colon injury was admitted to our emergency department after sustaining blunt abdominal trauma. Her physical examination findings and laboratory results led to a decision to perform a laparotomy; exploration revealed a sigmoid colon injury that was treated by sigmoid loop colostomy. Conclusions Surgical abdominal exploration revealed gross fecal contamination and a perforation site. Intra-abdominal irrigation and a sigmoid loop colostomy were performed. Our patient was discharged on post-operative day six without any problems. Closure of the sigmoid loop colostomy was performed three months after the initial surgery.

  6. [Sheehan's syndrome after obstetric hemorrhage].

    Science.gov (United States)

    Ramos-López, L; Pons-Canosa, V; Juncal-Díaz, J L; Núñez-Centeno, M B

    2014-12-01

    Sheehan's syndrome is described as panhypopituitarism secondary to a pituitary hypoperfusion during or just after obstetric hemorrhage. Advances in obstetric care make this syndrome quite unusual, but some cases are reported in underdeveloped countries. Clinical presentation may change depending on the severity of the hormone deficiencies. The diagnosis is clinical, but abnormalities are observed in the magnetic resonance in up to 70% of patients. We present a case of a woman with hypotension, hypothermia and edemas in relation to a previous massive postpartum hemorrhage. Failure in lactation was the clue to the diagnosis. A review of its main features, its diagnosis and treatment in the current literature is also presented.

  7. Clinical analysis of 18 cases with severe postpartum hemorrhage%产后严重出血18例临床分析

    Institute of Scientific and Technical Information of China (English)

    陈惠萍; 朱月华; 曹卉

    2011-01-01

    目的 探讨产后严重出血的临床特点及治疗方法.方法 对1986年12—2010年12月的18例产后严重出血病例的临床资料进行回顾性分析.结果 本组病例出血量2 000~8 000 ml.7例产后DIC患者以分娩后子宫出血不凝伴低血压及肾功能衰竭为主要特征,其中2例在产后数分钟内出现胸闷、呼吸困难及心搏骤停.11例有失血性休克,伴有不同程度的凝血及器官功能障碍.经心肺复苏、抗休克、纠正凝血功能障碍、手术止血等处理,抢救成功15例,死亡3例.结论 重视对高危妊娠的防治,积极抗休克,早期诊断产科DIC并合理使用肝素,掌握子宫切除的指征和时机,采用有效的止血方法,注意补充凝血因子是提高救治成功率的关键.%Objective To analyze the clinical characteristics and effective treatments of severe postpartum hemorrhage. Methods 18 cases with severe postpartum hemorrhage and their clinical data from December 1987 to December 2010 were retrospectively analyzed. Results This group of cases presented with heavily bleeding 2 000 to 8 000ml. 7 cases of postpartum DIC patients presented with the main characteristics of no-coagulating uterine bleeding with low blood pressure and renal failure after childbirth. 2 cases presented with chest tightness, dyspnea and cardiac arrest within minutes after childbirth. Another 11 patients had hemorrhagic shock accompanied by different levels of blood coagulation and organ dysfunction. After the cardiopulmonary resuscitation, resistance to shock, correcting coagulant function obstacle, surgical hemostatic processing, 15 cases were rescued successfully, 3 cases dead. Conclusion The key of improving success rate is to attach importance to high-risk pregnancy prevention, positive antishock treatment, early diagnosis and reasonable use obstetric DIC heparin, grasps the hysterectomy indications and timing methods of uterine artery embolization bleeding, and pay attention to

  8. 小脑出血 32例致残性特点分析%Disabling character analysis of 32 cases of cerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    苏赤; 侯廷平

    2001-01-01

    @@Background: The clinical manifestation of the cerebral hemorrhage is complex and the disabilities are different. According to the hemorrhage amount and the sites, the treating and rehabilitation methods are different also. So, to ensure amount and position and to master its disabling characters is important for the treatment and rehabilitation of patients with cerebral hemorrhage Objective:According to its amount and position, to analyse its disabling characters for the treatment and rehabilitation of patients with cerebral hemorrhage .

  9. Spontaneous bilateral adrenal hemorrhage following cholecystectomy.

    Science.gov (United States)

    Dahan, Meryl; Lim, Chetana; Salloum, Chady; Azoulay, Daniel

    2016-06-01

    Postoperative bilateral adrenal hemorrhage is a rare but potentially life-threatening complication. This diagnosis is often missed because the symptoms and laboratory results are usually nonspecific. We report a case of bilateral adrenal hemorrhage associated with acute primary adrenal insufficiency following laparoscopic cholecystectomy. The knowledge of this uncommon complication following any abdominal surgery allows timey diagnosis and rapid treatment.

  10. Hemorragia intracerebral espontânea: estudo retrospectivo de 72 casos operados Primary intracerebral hemorrhage: retrospective study of 72 operated cases

    Directory of Open Access Journals (Sweden)

    JOSÉ CORREIA DE FARIAS BRITO

    2000-06-01

    Full Text Available Realizamos estudo retrospectivo de 72 casos de hemorragia intracerebral espontânea (HICE operados no período de 1970 a 1999. Foram excluídos do grupo os casos de hemorragias cerebrais decorrentes de traumatismos cranianos, tumores, malformações vasculares e doenças hematológicas. A idade variou de 20 a 81 anos com média de 58,2 anos. A maioria dos pacientes era do gênero masculino e de cor branca. Em um terço deles, a pressão arterial estava elevada, e os hematomas lobares ocorreram em maior número de vezes que os ganglionares. A sintomatologia dominante resultou do aumento da pressão intracraniana e das lesões cerebrais focais. Em 52 (72,7% casos, foi possível realizar tomografia computadorizada de crânio. A avaliação dos resultados cirúrgicos foi dirigida para cada década, em separado, mostrando taxas de mortalidade com significativas diferenças.We analysed 72 cases of primary intracranial hemorrhage surgically treated from 1970 to 1999. The hemorrhages were diagnosed by computerized axial tomography in 52 pacients. Most hematomas were situated in the cerebral hemispheres (30 percent in thalamus-basal ganglia region and 50 percent in the subcortical matter. There were 10 patients with cerebellar hemorrhage. Hypertension (based in blood pressure recordings in the hospital and history was found in 24 patients (33 percent. The most frequent findings were coma, intracranial hypertension and hemimotor deficit. The death rate registred was 27.7 percent; however, it was found a significant difference in the mortality index when considering the 70-79 decade (62.7 percent and the 90-99 decade (20.7 percent. A critical analysis was made about depth hematomas, consciousness state and intracranial hypertension with herniation related to surgical procedure.

  11. [Infratentorial hemorrhage following supratentorial surgery].

    Science.gov (United States)

    Tomii, M; Nakajima, M; Ikeuchi, S; Ogawa, T; Abe, T

    1999-10-01

    Hemorrhage in regions remote from the site of initial intracranial operations is rare, but does occur. We report three cases of cerebellar hemorrhage that developed after supratentorial surgery, all of which had similar clinical findings and CT images. The first case was a 37-year-old man with a craniopharyngioma in the suprasellar lesion. Partial removal of the tumor was performed through frontal craniotomy and the translaminaterminals approach. A large quantity of cerebospinal fluid (CSF) was suctioned from the third ventricle during the operation, resulting in marked brain shrinkage. The second and third cases were 34- and 51-year-old women with unruptured right middle cerebral aneurysms. Clipping of the aneurysms through the pterional approach was performed in both cases. In the second case, CSF was suctioned in large quantity from the carotid and prechiasmal cistern at the operation, resulting in marked brain shrinkage. In the third case, however, only a small volume of CSF was suctioned from the carotid and prechiasmal cistern during the operation, and no marked brain shrinkage was observed. CT scan showed that the hematomas were located mainly in the subdural or the subarachnoid spaces over the cerebellar hemisphere and partially extending into the cerebellar cortex. The mechanism of cerebellar hemorrhage in these series of patients was thought to be multifactorial. The possible etiology for cerebellar hemorrhage in the three cases presented was examined, including the role of CSF suction during surgery and disturbance of venous circulation in the posterior fossa. Suction of the CSF may cause intracranial hypotension. Further reduction of intracranial pressure leads to an increased transluminal venous pressure. There was no episode of hypertension or disturbed blood coagulation during or after the operation. The preoperative angiogram also revealed no abnormality at the region of the posterior fossa. Neuroimaging of infratentorial hemorrhage after

  12. 产后出血102例原因分析%Analysis of 102 Cases of Postpartum Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    张春兰

    2014-01-01

    Objective To analyze the related factors of postpartum hemorrhage, put forward reasonable measures. Methods In 2008 January~2013 May our hospital number 3164 people, 102 people of postpartum hemorrhage.Results The production of uterine atony bleeding after 43.27%;36.23% the placental factors; the soft birth canal injury in 17.64% of the 2.94% coagulation disorders.Conclusion The main causes of postpartum hemorrhage and the general condition of the women concerned. Such as: complications of pregnancy, the maternal, primipara, mode of delivery, single, multiple births, fetal macrosomia, birth process, psychological factors, prenatal risk factors such as abortion, induced labor, ring and other uterine cavity operation, and genital infections such as endometrial inflammation and other relevant.%目的:分析产后出血相关因素,提出合理措施。方法2008年1月~2013年5月我院分娩人数3164例,产后出血102例。结果引出产后出血:①子宫收缩乏力43.27%,②胎盘因素36.23%,③软产道损伤17.64%,④凝血功能障碍2.94%。结论产后出血原因与产妇一般情况有关。如:妊娠合并症与并发症,经产妇、初产妇、分娩方式、单胎、多胎、巨大儿、产程、心理因素,产前高危因素如流产、引产、取环等宫腔操作,还有生殖器的感染如宫内膜炎等有关。

  13. Tight Sylvian cisterns associated with hyperdense areas mimicking subarachnoid hemorrhage on computed tomography--four case reports.

    Science.gov (United States)

    Shimizu, S; Endo, M; Kan, S; Kitahara, T; Ohwada, T; Fujii, K

    2001-11-01

    Four patients with supratentorial mass lesions (two chronic subdural hematomas, one acute epidural hematoma, and one acute subdural hematoma) showed hyperdense sylvian cisterns on computed tomography (CT). Association of subarachnoid hemorrhage was suspected initially, but was excluded by intraoperative observation or postoperative lumbar puncture. CT showed disappearance of the hyperdense areas just after evacuation of the mass lesions. The hyperdense areas are probably a result of the partial volume phenomenon or concentrations of calcium deposits rather than abnormally high hematocrit levels, which were not found in these patients.

  14. 慢性化脓性中耳炎伴蛛网膜下腔出血病例分析%Chronic suppurative otitis media induced subarachnoid hemorrhage: case analysis

    Institute of Scientific and Technical Information of China (English)

    王冠楠; 杨文强; 张怡; 孙圣荣

    2012-01-01

    Summary We present a case of subarachnoid hemorrhage induced by chronic suppurative otitis media, and discuss the possible mechanism here. Chronic suppurnlive otitis media is a common suppurative inflammation of middle ear, which can cause sorts of extracranial and intracranial complications in the situation of lower resistance or higher virulence. However, the condition of subarachnoid heamorrhage casued by chronic suppurative otitis media is quite rare. According to this case and previously published articles, we consider that meningitis may be the main reason of subarachnoid hemorrhage induced by chronic suppurative otitis media.

  15. Clinical Observation in 45 Cases of Hemorrhagic Apoplexy of the Acute Stage Treated by Promoting Blood Circulation and Removing Blood Stasis

    Institute of Scientific and Technical Information of China (English)

    孙国柱

    2003-01-01

    To explore the therapeutic effects of the method of promoting blood circulation and removing blood stasis on hemorrhagic apoplexy of acute stage, 45 cases were treated by the method and observed for their conscious state and motor function, which were compared with 40 cases treated with regular western drugs. The results showed that the effective rate in the treated group was 82.2% and that in control group 60% with a significant difference (P<0.05) between the two groups. In the treated group, the scores of the conscious state and the motor function after treatment were elevated dramatically (P<0.01), indicating a much better effect in the treated group than in the control group.

  16. Nursing experience of patients with epidemic hemorrhagic fever

    Directory of Open Access Journals (Sweden)

    Ling-yan ZHANG

    2014-04-01

    Full Text Available Objective: To explore the nursing methods of patients with epidemic hemorrhagic fever. Methods: Through careful nursing, 1 case of patients with epidemic hemorrhagic fever, summed up the experience. Results: Patients with epidemic hemorrhagic fever were 2 days later improved, within 6 months to fully recover. Conclusion: With proper treatment and careful nursing, patients with epidemic hemorrhagic fever are able to fully recover.

  17. Effects of nimodiping on delayed cerebral vasospasm after traumatic subarachnoid hemorrhage%尼莫地平治疗外伤性蛛网膜下腔出血后脑血管痉挛的疗效观察

    Institute of Scientific and Technical Information of China (English)

    曹永胜; 程宏伟; 冯春国

    2011-01-01

    Objective: To investigate the clinical efficacy and safety of nimodiping on delayed cerebral vasospasm after traumatic subarachnoid hemorrhage ( tSAH) . Methods: Eighty patients with tSAH were randomly divided into nimodiping treatment group and control group. While the routine treatments of decreasing intracranial pressure, stopping bleeding, nutrition for nerve and so on, were used in two groups, the nimodiping was added through intravenous administration ( 1 mg/h) in treatment group. Two weeks later, nimodiping were continuously used through oral administration ( 30 mg tid) for 12 - 24 weeks. And then, the examination of color doppler were performed to observe hemodynamic changes of the middle cerebral artery at 24 hours, 72 hours, the seventh, fourteenth day. Glasgow outcome scale after three months of the treatments was observed and analysed. Results: The levels of cerebral vasospasm and prognosis were significant difference between nimodiping treatment group and control group (P < 0. 05). Conclusions: Nimodiping can obviously prevent cerebral vasospasm and improve outcome of patient's after tSAH.%目的:观察尼莫地平对治疗外伤性蛛网膜下腔出血(tSAH)后脑血管痉挛的疗效.方法:80例tSAH患者随机分为对照组和尼莫地平组各40例.均进行常规降颅压、止血、营养神经等治疗,尼莫地平组在常规治疗基础上加用尼莫地平1 mg/h微量泵入,2周后改为尼莫地平片剂30 mg,每天3次持续使用12~24周.并于治疗后24 h和72 h、7 d和14 d应用经颅多普勒观察伤后大脑中动脉血流动力学变化及3个月后哥拉斯哥昏迷预后评分.结果:尼莫地平组脑血管痉挛程度及预后与对照组差异有统计学意义(P<0.05).结论:尼莫地平对tSAH后脑血管痉挛的防治效果明显,并改善患者预后.

  18. Analysis of Delays in Hard Rock Mine Lateral Development: A Case Study

    Directory of Open Access Journals (Sweden)

    P.A. Eshun

    2011-11-01

    Full Text Available The aim of this study is to identify and isolate the major causes of delays in underground lateral development at AngloGold Ashanti (AGA, Obuasi Mine, Ghana. It uses fishbone analysis to identify and present 20 possible causes of delays in lateral development at the mine. By employing Pareto analysis, 7 major causes of delays have been isolated. They are: scoop problems, low compressed air, labour shortages, bad ground, flood, power outages and waste pass getting full. The study concludes that, should management concentrate in minimising the 7 major causes of delays, it will be solving about 80% of the problems associated with delays in underground lateral development at AGA, Obuasi mine. The study further gives specific recommendations to reduce delays in lateral development at the mine.

  19. Analysis of Delays in Hard Rock Mine Lateral Development: A Case Study

    OpenAIRE

    P.A. Eshun; V.A. Temeng

    2011-01-01

    The aim of this study is to identify and isolate the major causes of delays in underground lateral development at AngloGold Ashanti (AGA), Obuasi Mine, Ghana. It uses fishbone analysis to identify and present 20 possible causes of delays in lateral development at the mine. By employing Pareto analysis, 7 major causes of delays have been isolated. They are: scoop problems, low compressed air, labour shortages, bad ground, flood, power outages and waste pass getting full. The study concludes th...

  20. Diagnostic and therapeutic value of emergency colonoscopy in delayed hemorrhage following colonic electrocoagulation resection of colorectal polyps%急诊肠镜对结肠息肉电凝切除术后并发迟发性出血的诊疗价值

    Institute of Scientific and Technical Information of China (English)

    孙彩龙; 周兰芳; 金国文; 谢秀丽

    2013-01-01

    目的:探讨急诊肠镜在大肠息肉电凝切除术后迟发性出血诊治中的价值.方法:对972例大肠息肉经电凝切除术后发生肠道迟发性出血的3例患者急诊进行结肠镜检查和治疗.结果:急诊肠镜找到出血部位后立即分别进行结肠镜下电凝、注射治疗和钛夹结扎等处置,全部病例出血停止,内镜诊疗未发生任何并发症.结论:在大肠息肉高频电凝切除术后迟发性出血并发症中进行急诊肠镜检查和治疗是一种安全、有效的手段.%AIM:To assess the value of emergency colonoscopy in the diagnosis and therapy of delayed hemorrhage following colonic electrocoagulation resection of colorectal polyps.METHODS:Three of 972 patients who underwent colonic electrocoagulation resection for colorectal polyps developed delayed hemorrhage and underwent emergency colonoscopy.RESULTS:Immediately after bleeding sites were identified by emergency endoscopy,colonoscopic electrocoagulation,injection therapy and titanium clip ligation treatment were given.Bleeding was stopped in all patients,and no complications developed.CONCLUSION:Emergency colonoscopy is a safe,effective method for the diagnosis and treatment of delayed hemorrhage following high-frequency electrocoagulation resection of colorectal polyps.

  1. Embolization for gastrointestinal hemorrhages

    Energy Technology Data Exchange (ETDEWEB)

    Kraemer, S.C.; Goerich, J.; Rilinger, N.; Aschoff, A.J.; Vogel, J.; Brambs, H.J. [Dept. of Diagnostic Radiology, University of Ulm (Germany); Siech, M. [Dept. of Abdominal Surgery, University of Ulm (Germany)

    2000-05-01

    Retrospective evaluation of interventional embolization therapy in the treatment of gastrointestinal hemorrhage over a long-term observation period from 1989 to 1997. Included in the study were 35 patients (age range 18-89 years) with gastrointestinal bleeding (GI) referred for radiological intervention either primarily or following unsuccessful endoscopy or surgery. Sources of GI bleeding included gastric and duodenal ulcers (n = 7), diverticula (n = 3), erosion of the intestinal wall secondary to malignancy (n = 6), vascular malformations (n = 4), and hemorrhoids (n = 2), as well as from postoperative (n = 6), posttraumatic (n = 2), postinflammatory (n = 4) or unknown (n = 1) causes. Ethibloc (12 cases) or metal coils (14 cases) were predominantly used as embolisates. In addition, combinations of tissue adhesive and gelfoam particles and of coils and Ethibloc were used (six cases). Finally, polyvinyl alcohol particles, a coated stent, and an arterial wire dissection were utilized in one case each. Bleeding was stopped completely in 29 of 35 cases (83 %). In one case (3 %) the source of bleeding was recognized but the corresponding vessel could not be catheterized. In five other cases (14 %) there was partial success with reduced, though still persistent, bleeding. The rate of complications was 14 %, including four instances of intestinal ischemia with fatal outcome in the first years, and, later, one partial infarction of the spleen without serious consequences. Gastrointestinal hemorrhage can be controlled in a high percentage of patients, including the seriously ill and those who had previously undergone surgery, with the use of minimally invasive interventional techniques. The availability of minicoils instead of fluid embolization agents has reduced the risk of serious complications. (orig.)

  2. Continuous EEG Monitoring in Aneurysmal Subarachnoid Hemorrhage

    DEFF Research Database (Denmark)

    Kondziella, Daniel; Friberg, Christian Kærsmose; Wellwood, Ian

    2015-01-01

    BACKGROUND: Continuous EEG (cEEG) may allow monitoring of patients with aneurysmal subarachnoid hemorrhage (SAH) for delayed cerebral ischemia (DCI) and seizures, including non-convulsive seizures (NCSz), and non-convulsive status epilepticus (NCSE). We aimed to evaluate: (a) the diagnostic...

  3. Delayed geochemical hazard: a tool for risk assessment of heavy metal polluted sites and case study.

    Science.gov (United States)

    Zheng, Mingxia; Feng, Liu; He, Juanni; Chen, Ming; Zhang, Jiawen; Zhang, Minying; Wang, Jing

    2015-04-28

    A concept of delayed geochemical hazard (DGH) was proposed instead of chemical time bomb to represent an ecological and environmental hazard caused by sudden reactivation and release of long-term accumulated pollutants in soil/sediment system due to the change of physicochemical conditions or the decrease of environmental capacity. A DGH model was also established to provide a quantitative tool to assess and predict potential environmental risk caused by heavy metals and especially its dynamic evolutions. A case study of DGH was carried out for a mercury-polluted area in southern China. Results of soil column experiment showed that DGH was directly resulted from the transformation and release of pollutant from the releasable species to the active ones through a mechanism of chain reaction. The most possible chain reaction was summarized as HgE+C+F+O+R→HgE+C+F+O→HgE+C+F→HgE+C→HgE. Although 8.3% of the studied area with the total releasable content of mercury (TRCPHg) exceeded the DGH critical point value of 16.667mg/kg, with the possibility of DGH burst, the area was classified as low-risk of DGH. This confirmed that DGH model could contribute to the risk assessment and early warning of soil/sediment pollution.

  4. Factors Contribute to Delay Project Construction in Higher Learning Education Case Study UKM

    Directory of Open Access Journals (Sweden)

    N.M. Tawil

    2013-05-01

    Full Text Available The delay in construction project completion is a common phenomenon that occurs in the construction industry, especially where the government projects are concerned. This survey will center on the Ninth Malaysia Plan project delay as evidenced in the Universiti Kebangsaan Malaysia campus. It will generally examine delay-related issues, which include the definition, type and category of delay, as well as the contributing factors (theoretically or practically that lead to delay in the project implementation. Data was compiled from literature review, interview and survey. Data obtained from the survey was analysed using the ‘relative Important Index (RII’ whereby the source with the highest RII is one that mostly influences the delay. The critical source of delay is due to the fact that the project contractor does not have enough working capital, the late advance payment, the delay in the client or consultant endorsing the study, issues involving contractor management, the scarcity of construction materials and new instructions for additional construction work.

  5. Viral Hemorrhagic Fevers

    Science.gov (United States)

    ... 4 viruses that cause two other hemorrhagic fevers, dengue hemorrhagic fever and yellow fever. Virus Families Information ... 2014 Content source: Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases ( ...

  6. Hemorrhage in cerebral metastasis from angiosarcoma of the heart: case report Hemorragia em metástase cerebral de angiossarcoma cardíaco: relato de caso

    Directory of Open Access Journals (Sweden)

    Pasquale Gallo

    2001-09-01

    Full Text Available The purpose of this article is to describe the clinical and pathological features of metastatic angiosarcoma in the central nervous system. Only a few cases of cerebral metastasis from angiosarcoma of the heart have been recorded in the literature; particulary related to intracerebral hemorrhage. A case of secondary cerebral angiosarcoma of the heart in a 33 years old man is presented. The initial symptoms were headache, vomiting, lethargy and aphasia. There was a mass in the left temporal lobe with hemorrhage and edema on the computerized tomography (CT. After 24 hours the neurological status worsened and another CT scan showed rebleeding on the tumor area. He underwent an emergency craniotomy but died two days after. Considering the longer survival of sarcoma patients with new modalities of treatment, the incidence of brain metastasis may increase, demanding a bether preventive and more aggressive approach. Besides, due to the hemorrhagic nature of such lesions, we suggest the imediate surgery to prevent a fast and lethal evolution because rebleeding.O propósito deste artigo é descrever os achados clínicos e patológicos das metástases de angiossarcoma no sistema nervoso central. Apenas poucos casos de metástases cerebrais de angiossarcoma cardíaco foram relatados na literatura, menos ainda relacionados a hemorragia intracerebral. Relatamos o caso de um tumor cerebral secundário a angiossarcoma cardíaco em um paciente masculino de 33 anos. Os sintomas iniciais foram: cefaléia, vômitos, letargia e afasia. A tomografia computadorizada mostrou massa no lobo temporal esquerdo associada a hemorragia e edema. Após 24 horas houve piora do estado neurológico e nova tomografia demonstrou ressangramento no leito tumoral. Foi submetido a uma craniotomia de urgência mas faleceu dois dias após. Considerando a longa sobrevida dos pacientes com sarcoma devido às novas modalidades terapêuticas, poderá aumentar a incidência de met

  7. Emergency surgical treatment of an ulcerative and hemorrhagic congenital/infantile fibrosarcoma of the lower leg: case report and literature review.

    Science.gov (United States)

    Kraneburg, Ursula M; Rinsky, Lawrence A; Chisholm, Karen M; Khosla, Rohit K

    2013-05-01

    Fibrosarcomas are rare malignant soft-tissue tumors occurring mostly in infants younger than 1 year of age. Fibrosarcomas can ulcerate and cause various complications, which could threaten a fetus in utero or a child in the early neonatal period. We report a unique case of congenital infantile fibrosarcoma of the lower leg, its treatment and pathology. The large expansive and destructive lesion was not appreciated on routine prenatal ultrasound exams at 20 and 33 weeks gestation. The newborn required immediate emergency surgical intervention after delivery to prevent death by hemorrhagic shock. Initial debulking of the tumor was performed and hemostasis was attained on the day of birth. The child was resuscitated and definitive treatment of the leg was deferred until a pathologic diagnosis was obtained. Given the extent of the fibrosarcoma, the lower leg was not salvageable and the patient received a through-the-knee amputation in the neonatal period. The patient is free of disease at 2 years of age.

  8. Imaging findings of arteriovenous malformations involving lung and liver in hereditary hemorrhagic telangiectasia(Osler-weber-rendu disease): two cases report

    Energy Technology Data Exchange (ETDEWEB)

    Yi, Jeong Geun; Lee, Joo Hyuk; Seong, Su Ok [Cheongju St. Mary' s Hospital, Cheongju (Korea, Republic of)

    1999-09-01

    Hereditary hemorrhagic telangiectasia (HHT) or Osler-Weber-Rendu disease is an autosomal dominant disorder characterized by repeated episodes of bleeding. Multiple telangiectases consisting of thin-walled, dilated vascular channels with arteriovenous communication may involve, for example, mucocutaneous tissue, the gastrointestinal tract, and the liver, lung, and brain. We report the imaging findings of two cases of HHT involving arteriovenous malformation of both the lungs and liver, a rare condition. Chest radiography revealed a round mass, while helical CT showed a feeding artery and draining vein with arteriovenous malformation in the lung. Color Doppler sonography revealed an enlarged and tortuous hepatic artery with high systolic velocity. CT demonstrated an enlarged hepatic artery, arteriovenous shunt, and early draining hepatic vein in the liver. Celiac angiography showed arteriovenous malformation.

  9. Visual disorders, the prosopometamorphopsia and prosopagnosia type in the early days after the onset of brain hemorrhagic stroke--a case report.

    Science.gov (United States)

    Bala, Aleksandra; Iwański, Szczepan; Żyłkowski, Jarosław; Jaworski, Maciej; Seniów, Joanna; Marchel, Andrzej

    2015-01-01

    Presented case report illustrates symptoms of prosopometamorphopsia (PM) and prosopagnosia, observed in the early days after the onset of a hemorrhagic stroke resulting from a complication of endovascular treatment of intracranial aneurysms and the use of anticoagulation therapy. PM is a visual disorder in which faces are perceived as distorted. The female patient described in the present study reported that faces she looked at seemed younger or older than in reality or as if they were dirty, swollen, or with a grimace. She also experienced symptoms of prosopagnosia, which is difficulty of recognizing familiar faces of people (e.g., of her husband and daughter). In the interview 6 months after the first examination, the patient reported spontaneous withdrawal of the visual disturbances.

  10. Successful treatment with intravesical cidofovir for virus-associated hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation: A case report and a review of the literature.

    Science.gov (United States)

    Sakurada, Maki; Kondo, Tadakazu; Umeda, Masayuki; Kawabata, Hiroshi; Yamashita, Kouhei; Takaori-Kondo, Akifum

    2016-07-01

    Virus-associated hemorrhagic cystitis (VAHC) is a formidable complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The standard management of severe VAHC after allo-HSCT has not been established. Intravenous administration of cidofovir (CDV), an acyclic nucleoside analogue with broad-spectrum activity against DNA viruses, has been reported to be effective for VAHC, but it can cause severe renal toxicity. Here we report four cases who achieved clinical responses with intravesical instillation of CDV for severe VAHC after allo-HSCT. Median age was 57 years (40-63), and all were male. The underlying diseases were hematological malignancies. Three had received bone marrow transplantation, and one received cord blood transplantation twice. Conditioning regimen was myeloablative for one, and reduced-intensity for three. The viral types were BK virus and/or adenovirus. Two patients had received CDV intravenously prior to the intravesical therapy. A dose of intravesical CDV was 2-5 mg/kg. In all cases, symptoms of cystitis improved dramatically within a few days without showing any systemic adverse effects. The virological response was observed in two cases. This local therapy was effective even in the cases refractory to the intravenous CDV and a case with severe renal failure. Along with the review of literature, we propose that the intravesical instillation of CDV can be a therapeutic option for severe VAHC after allo-HSCT.

  11. The first clinical case due to AP92 like strain of Crimean-Congo Hemorrhagic Fever virus and a field survey

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    Midilli Kenan

    2009-06-01

    Full Text Available Abstract Background Crimean-Congo Hemorrhagic Fever (CCHF is a fatal infection, but no clinical case due to AP92 strain was reported. We described the first clinical case due to AP92 like CCHFV. Methods A case infected by a AP92 like CCHFV was detected in Balkanian part of Turkey. Diagnosis was confirmed by RT-PCR and sequencing. A human serologic and tick survey studies were performed in the region, where the case detected. Results Thirty eight individuals out of 741 were found to be anti CCHFV IgM positive. The attack rate for overall CCHFV was calculated as 5.2%. In univariate analyses, CCHFV IgM positivity was found to be associated with the age (p Conclusion This is the first human case with AP92 like CCHFV infection. Furthermore, this is the first report of AP92 like strain in Turkey. In the region, elderly males carry the highest risk for CCHFV infection.

  12. The first clinical case due to AP92 like strain of Crimean-Congo Hemorrhagic Fever virus and a field survey

    Science.gov (United States)

    2009-01-01

    Background Crimean-Congo Hemorrhagic Fever (CCHF) is a fatal infection, but no clinical case due to AP92 strain was reported. We described the first clinical case due to AP92 like CCHFV. Methods A case infected by a AP92 like CCHFV was detected in Balkanian part of Turkey. Diagnosis was confirmed by RT-PCR and sequencing. A human serologic and tick survey studies were performed in the region, where the case detected. Results Thirty eight individuals out of 741 were found to be anti CCHFV IgM positive. The attack rate for overall CCHFV was calculated as 5.2%. In univariate analyses, CCHFV IgM positivity was found to be associated with the age (p < 0.001), male gender (p = 0.001), agricultural activity (p = 0.036), and history of tick bite (p = 0.014). In multivariate analysis, older age (OR: 1.03, CI:1.01–1.05, p < 0.001), male gender were found to be the risk factors (OR: 2.5, CI:1.15–5.63, p = 0.020) for CCHFV infection. Conclusion This is the first human case with AP92 like CCHFV infection. Furthermore, this is the first report of AP92 like strain in Turkey. In the region, elderly males carry the highest risk for CCHFV infection. PMID:19515251

  13. Nontraumatic intracranial hemorrhage.

    Science.gov (United States)

    Fischbein, Nancy J; Wijman, Christine A C

    2010-11-01

    Nontraumatic (or spontaneous) intracranial hemorrhage most commonly involves the brain parenchyma and subarachnoid space. This entity accounts for at least 10% of strokes and is a leading cause of death and disability in adults. Important causes of spontaneous intracranial hemorrhage include hypertension, cerebral amyloid angiopathy, aneurysms, vascular malformations, and hemorrhagic infarcts (both venous and arterial). Imaging findings in common and less common causes of spontaneous intracranial hemorrhage are reviewed.

  14. Previously undiagnosed hemophilia patient with intracerebral hemorrhage

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    Eray Atalay

    2015-09-01

    Full Text Available Intracranial bleeding in hemophilia patients is a rare but a mortal complication. Diagnosis of hemophilia in adulthood is an uncommon occurrence. In this case report an adult patient with intracranial hemorrhage is presented.

  15. Migraine and risk of hemorrhagic stroke

    DEFF Research Database (Denmark)

    Gaist, David; González-Pérez, Antonio; Ashina, Messoud

    2014-01-01

    BACKGROUND: We investigated the association between hemorrhagic stroke and migraine using data from The Health Improvement Network database. FINDINGS: We ascertained 1,797 incident cases of intracerebral hemorrhage (ICH) and 1,340 of subarachnoid hemorrhage (SAH). Density-based sampling was used...... to select 10,000 controls free from hemorrhagic stroke. Using unconditional logistic regression models, we calculated the risk of hemorrhagic stroke associated with migraine, adjusting for age, sex, calendar year, alcohol, body mass index, hypertension, previous cerebrovascular disease, oral contraceptive...... use, and health services utilization.The risk (odds ratio [OR]) of ICH among migraineurs was 1.2 (95% confidence interval [CI] 0.9-1.5), and of SAH was (1.2, 95% CI 0.9-1.5). The association with ICH was stronger for migraine diagnosed ≥20 years prior to ICH (OR 1.6, 95% CI 1.0-2.4), but not with SAH...

  16. Pulmonary hemorrhage resulting from roller coaster.

    Science.gov (United States)

    Yin, Ming; Tian, Qing; Shen, Hong

    2011-03-01

    Roller coasters are probably one of the more popular rides at amusement parks around the world, and there are few reported injuries. We report a case of symmetric diffuse upper lobe hemorrhage resulting from roller coaster in a previously healthy woman. The clinical course, management, and etiology of her case are discussed; and the literature is reviewed. To our knowledge, pulmonary hemorrhage in this setting has not yet been described.

  17. Isolated trochlear nerve palsy with midbrain hemorrhage

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    Raghavendra S

    2010-01-01

    Full Text Available Midbrain hemorrhage causing isolated fourth nerve palsy is extremely rare. Idiopathic, traumatic and congenital abnormalities are the most common causes of fourth nerve palsy. We report acute isolated fourth nerve palsy in an 18-year-old lady due to a midbrain hemorrhage probably due to a midbrain cavernoma. The case highlights the need for neuroimaging in selected cases of isolated trochlear nerve palsy.

  18. Takotsubo Cardiomyopathy as a Delayed Complication with a Herbicide Containing Glufosinate Ammonium in a Suicide Attempt: A Case Report

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    Keiichiro Tominaga

    2012-01-01

    Full Text Available Background. Glufosinate ammonium has a famous delayed complication as respiratory failure, however, delayed cardiogenic complication is not well known. Objectives. The aim of this study is to report a takotsubo cardiomyopathy as a delayed complication of glufosinate ammonium for suicide attempt. Case Report. A 75-year-old woman ingested about 90 mL of Basta, herbicide for suicide attempt at arousal during sleep. She came to our hospital at twelve hours after ingesting. She was admitted to our hospital for fear of delayed respiratory failure. Actually, she felt down to respiratory failure, needing a ventilator with intubation at 20 hours after ingesting. Procedure around respiratory management had smoothly done with no delay. Her vital status had been stable, however, she felt down to circulatory failure and diagnosed as Takotsubo cardiomyopathy at about 41 hours after ingestion. There was no trigger activities or events to evoke mental and physical stresses. Conclusion. We could successfully manage takotsubo cardiomyopathy resulted in circulatory failure in a patient with glufosinate poisoning for suicide attempt. Takotsubo cardiomyopathy should be taken into consideration if circulatory failure is observed for unexplained reasons.

  19. Analysis on the proportion of incidence of etiological agents in 133 cases with constitutional delayed puberty%青春发育延迟133例病因构成比分析

    Institute of Scientific and Technical Information of China (English)

    刘德云; 杨琍琦; 胡静; 戴瑞

    2011-01-01

    Objective To analyze the proportion of incidence of etiological agents in 133 cases with constitutional delayed puberty.Methods Clinical data of etiological agents in 133 patients with constitutional delayed puberty were retrospectively analyzed.Results Etiological agents in 133 cases with constitutional delayed puberty were as follows:Hypo-gonadotrophic hormone group(56.39%,n=75):39 cases with unknown reason(idiopathy,3 cases were female),intrapartum asphyxia/hypoxia or hemorrhage(n=23),pituitary glands dysplasia(n=6),cephal trauma(n=3),postoperative craniopharyngioma(n=2),empty sella turciea(n=2),combined hormone deficiency(n=59).Hyper-gonadotrophic hormone group(17.29%,n=23):17 cases with chromosomal disorders(n=17,male:female=7:16),3 cases with unknown reason(idiopathy).31 cases with constitutional delayed puberty(23.31%),4 cases with functional delayed puberty(3.01%).Conclusion Many etiological agents could result in delayed puberty,different origins of delayed puberty had different therapies.Classification of etiological agents in patients with constitutional delayed puberty phyed an important role in guiding option of clnical treatment.%目的 分析青春发育延迟(constitu tionaldelayed puberty,CDP)病因构成比并指导治疗.方法 对符合青春发育延迟的患者133例,进行病因分析.结果 133例青春发育延迟患者依据病因分为:低促性腺激索性青春发育延迟组(HH)占56.39%(75/133):其中病因未明(特发性)39例(包括女性3例),另外36例分别为:出生时缺氧窒息、出血(23例)、垂体发育不良(6例)、头颅外伤(3例)、颅咽管瘤术后(2例)、空泡蝶鞍2例,75例中同时有联合激素缺乏(2种及以上垂体激素缺乏)患者59例,占HH组总数的78.3%;高促性腺激素性青春发育延迟组占17.29%(23/133),其中有染色体异常者17例,男性7例中:染色体病变4例、睾丸病变3例.女:16例中,13例为染色体病变,另外3例(女)病因未明(特发性).体质

  20. Maternal mortality from hemorrhage.

    Science.gov (United States)

    Haeri, Sina; Dildy, Gary A

    2012-02-01

    Hemorrhage remains as one of the top 3 obstetrics related causes of maternal mortality, with most deaths occurring within 24-48 hours of delivery. Although hemorrhage related maternal mortality has declined globally, it continues to be a vexing problem. More specifically, the developing world continue to shoulder a disproportionate share of hemorrhage related deaths (99%) compared with industrialized nations (1%). Given the often preventable nature of death from hemorrhage, the cornerstone of effective mortality reduction involves risk factor identification, quick diagnosis, and timely management. In this monograph we will review the epidemiology, etiology, and preventative measures related to maternal mortality from hemorrhage.

  1. 子宫填塞球囊导管治疗产后出血10例临床分析%Clinical treatment analysis of uterine tamponade balloon catheter on 10 cases of postpartum hemorrhage

    Institute of Scientific and Technical Information of China (English)

    韩静; 秦永丽

    2014-01-01

    目的:评价子宫填塞球囊导管对治疗产后出血,挽救产妇生命,保留子宫的影响。方法:2013年3-8月收治产后出血患者10例,并完善随访的临床资料及产后康复追踪。结果:10例产后出血治疗成功率100%,无一例子宫切除。结论:子宫球囊填塞是宫缩乏力继发重度产后出血的有效辅助治疗措施,尤其当药物治疗失败时更显其价值。%Objective:To explore the effect of uterine tamponade balloon catheter in the treatment of postpartum hemorrhage, rescuing maternal life,retaining uterine.Methods:10 cases with postpartum hemorrhage were selected from March to August 2013. Follow-up clinical data were completed and postpartum rehabilitation was traced.Results:The treatment success rate of 10 cases of postpartum hemorrhage was 100%.No case was hysterectomy. Conclusion: Uterine tamponade balloon catheter is secondary effective auxiliary treatment for severe postpartum hemorrhage caused by uterine inertia, especially show its value when drug treatment is failure.

  2. Survival of immediately versus delayed loaded short implants: a prospective case series study

    OpenAIRE

    Alvira González, Joaquín; Díaz Campos, Erick; Sánchez Garcés, María Angeles; Gay Escoda, Cosme

    2015-01-01

    Background To assess and compare survival rates of immediately and delayed loaded short implants (7 mm) in free ends of a partially edentulous jaw with moderate-severe alveolar bone resorption. Material and Methods 24 patients with atrophic edentulous free-ends were included in this prospective study. Four study groups were monitored monthly and their behavior was evaluated: bridges supported only by short implants and mixed short and long implant bridge groups, both with immediate and delaye...

  3. CONTROLLABILITY OF A CLASS OF HYBRID DYNAMIC SYSTEMS ( Ⅱ )--SINGLE TIME-DELAY CASE

    Institute of Scientific and Technical Information of China (English)

    谢广明; 王龙; 叶庆凯

    2003-01-01

    The controllability for switched linear systems with time-delay in controls isfirst investigated. The whole work contains three parts. This is the second part. The definition and determination of controllability of switched linear systems with single time-delay in control functions is mainly investigated. The sufficient and necessary conditions for the oneperiodic, multiple-periodic controllability of periodic-type systems and controllability of periodic systems are presented, respectively.

  4. Adrenal hemorrhage in a newborn.

    Science.gov (United States)

    Abdu, Arebu T; Kriss, Vesna M; Bada, Henrietta S; Reynolds, Eric W

    2009-09-01

    Sometimes in the course of care in a neonatal intensive care unit, there may be a rush to intervene in cases where limited intervention is actually the correct course. One such example is that of neonatal adrenal hemorrhage. We present the case of a male term neonate with shock, metabolic acidosis, distended abdomen, and falling hematocrit. His prenatal and delivery histories were uneventful except for a nuchal cord. Apgar scores were 9 and 9. Because of his dramatic presentation, certain members of the medical team suggested immediate surgical intervention. However, a calm and careful evaluation revealed the true diagnosis and course of action. Ultrasound of the abdomen showed a mass between the liver and kidney, but the origin was difficult to identify. A computed tomography scan supported the diagnosis of right adrenal hemorrhage. His serum cortisol level was normal. The patient was managed conservatively and discharged home after a 1-week stay in the hospital. Subsequent abdominal ultrasound showed resolving adrenal hemorrhage with minimal calcification. A review of the pertinent literature is presented. Physicians should remember adrenal hemorrhage when evaluating a newborn infant with shock, acidosis, abdominal distention, and falling hematocrit and that conservative management is usually indicated.

  5. The return of an old worm: cerebral paragonimiasis presenting with intracerebral hemorrhage.

    Science.gov (United States)

    Koh, Eun Jung; Kim, Seung-Ki; Wang, Kyu-Chang; Chai, Jong-Yil; Chong, Sangjoon; Park, Sung-Hye; Cheon, Jung-Eun; Phi, Ji Hoon

    2012-11-01

    Paragonimiasis is caused by ingesting crustaceans, which are the intermediate hosts of Paragonimus. The involvement of the brain was a common presentation in Korea decades ago, but it becomes much less frequent in domestic medical practices. We observed a rare case of cerebral paragonimiasis manifesting with intracerebral hemorrhage. A 10-yr-old girl presented with sudden-onset dysarthria, right facial palsy and clumsiness of the right hand. Brain imaging showed acute intracerebral hemorrhage in the left frontal area. An occult vascular malformation or small arteriovenous malformation compressed by the hematoma was initially suspected. The lesion progressed for over 2 months until a delayed surgery was undertaken. Pathologic examination was consistent with cerebral paragonimiasis. After chemotherapy with praziquantel, the patient was monitored without neurological deficits or seizure attacks for 6 months. This case alerts practicing clinicians to the domestic transmission of a forgotten parasitic disease due to environmental changes.

  6. Impaired Fracture Healing after Hemorrhagic Shock

    Directory of Open Access Journals (Sweden)

    Philipp Lichte

    2015-01-01

    Full Text Available Impaired fracture healing can occur in severely injured patients with hemorrhagic shock due to decreased soft tissue perfusion after trauma. We investigated the effects of fracture healing in a standardized pressure controlled hemorrhagic shock model in mice, to test the hypothesis that bleeding is relevant in the bone healing response. Male C57/BL6 mice were subjected to a closed femoral shaft fracture stabilized by intramedullary nailing. One group was additionally subjected to pressure controlled hemorrhagic shock (HS, mean arterial pressure (MAP of 35 mmHg for 90 minutes. Serum cytokines (IL-6, KC, MCP-1, and TNF-α were analyzed 6 hours after shock. Fracture healing was assessed 21 days after fracture. Hemorrhagic shock is associated with a significant increase in serum inflammatory cytokines in the early phase. Histologic analysis demonstrated a significantly decreased number of osteoclasts, a decrease in bone quality, and more cartilage islands after hemorrhagic shock. μCT analysis showed a trend towards decreased bone tissue mineral density in the HS group. Mechanical testing revealed no difference in tensile failure. Our results suggest a delay in fracture healing after hemorrhagic shock. This may be due to significantly diminished osteoclast recruitment. The exact mechanisms should be studied further, particularly during earlier stages of fracture healing.

  7. Delayed post-traumatic spinal cord infarction in an adult after minor head and neck trauma: a case report

    Directory of Open Access Journals (Sweden)

    Bartanusz Viktor

    2012-09-01

    Full Text Available Abstract Introduction Delayed post-traumatic spinal cord infarction is a devastating complication described in children. In adults, spinal cord ischemia after cardiovascular interventions, scoliosis correction, or profound hypotension has been reported in the literature. However, delayed spinal cord infarction after minor head trauma has not been described yet. Case presentation We report the case of a 45-year-old Hispanic man who had a minor head trauma. He was admitted to our hospital because of paresthesias in his hands and neck pain. A radiological workup showed cervical spinal canal stenosis and chronic cervical spondylotic myelopathy. Twelve hours after admission, our patient became unresponsive and, despite full resuscitation efforts, died. The autopsy revealed spinal cord necrosis involving the entire cervical spinal cord and upper thoracic region. Conclusions This case illustrates the extreme fragility of spinal cord hemodynamics in patients with chronic cervical spinal canal stenosis, in which any further perturbations, such as cervical hyperflexion related to a minor head injury, can have catastrophic consequences. Furthermore, the delayed onset of spinal cord infarction in this case shows that meticulous maintenance of blood pressure in the acute post-traumatic period is of paramount importance, even in patients with minimal post-traumatic symptoms.

  8. Three cases of enterovirus 71 infection with pulmonary edema or pulmonary hemorrhage as the early clinical manifestation%肠道病毒71型感染首发肺水肿与肺出血三例报告

    Institute of Scientific and Technical Information of China (English)

    何时军; 王霞; 郑晓群; 王传夏; 黄爱蓉; 金益梅; 杨好妹; 周爱华

    2008-01-01

    Objective To investigate the clinical features of the enterovirus 71 ( EV71 ) infection complicated with pulmonary edema or pulmonary hemorrhage as a fulminant and often fatal illness.Methods The medical records of three cases with EV71 infection were retrospectively reviewed for clinical manifestations, laboratory data, medications, and outcome.Results All the cases were infants and died of the infection. These infants had no skin or mucosal lesions, however, they had sudden onset of cyanosis and tachypnea 1 to 2 days after the onset of the febrile disease with vomiting. All these 3 cases were misdiagnosed and were treated for shock on admission. Pulmonary hemorrhage was not considered in any of the cases on admission. All the cases received tracheal intubation when foamy secretions were discharged from the mouth and nose of the patients and notable cyanosis occurred. After intubation, pink foamy fluid flew out from the endotracheal tube in all the 3 cases. The patients had hyperglycemia and limb weakness, two had tachycardia, and hypertension was found in one case. Chest X-ray showed bilateral or unilateral widespread air space opacity, but the cardiac size and shape were normal. All the patients had leukocytosis. Enterovirus 71 infection was confirmed by detection of specific nucleic acid sequences of the virus from throat swab and tracheal secretions samples and in one case in cerebrospinal fluid.Conclusions Pulmonary edema or pulmonary hemorrhage occurred in the 3 cases with EV71 infection. The initial presentation was nonspecific with fever and vomiting, and sudden appearance of cyanosis, tachypnea, tachycardia, hypertension or hypotension, limb weakness, which may suggest pulmonary edema or hemorrhage. Excessive fluid resuscitation may deteriorate the illness, on the contrary, fluid restriction and inotropic agents, and early intubation with positive pressure mechanical ventilation may be the proper treatment.

  9. Hemorrhagic Cholecystitis in an Elderly Patient Taking Aspirin and Cilostazol

    Directory of Open Access Journals (Sweden)

    David S. Morris

    2008-06-01

    Full Text Available Hemorrhage is a rare complication of acute cholecystitis. Patients who develop this complication often are receiving anticoagulation therapy or have a pathologic coagulopathy. We present a case of an elderly patient who developed hemorrhagic cholecystitis while taking aspirin and cilostazol, a phosphodiesterase inhibitor. The patient underwent an emergent abdominal exploration. A large, blood-filled gallbladder was found along with a large hematoma between the liver and gallbladder. We also briefly review the literature regarding hemorrhagic cholecystitis, hemorrhage into the biliary tree, and hemorrhage as a complication of aspirin and phosphodiesterase inhibitor therapy.

  10. Combination therapy with rituximab and cyclophosphamide in the treatment of anti-neutrophil cytoplasmic antibodies (ANCA positive pulmonary hemorrhage: case report

    Directory of Open Access Journals (Sweden)

    Lehman Thomas JA

    2011-10-01

    Full Text Available Abstract Anti-neutrophil cytoplasmic antibody (ANCA-associated vasculitis (AAV with pulmonary hemorrhage is rare in childhood. Standard treatment includes corticosteroids and cyclophosphamide (CYC, which is associated with a high level of toxicity. We report a white female with ANCA positive pulmonary hemorrhage who was treated with cyclophosphamide (CYC and rituximab (RTX combination therapy.

  11. Unpredicted Sudden Death due to Recurrent Infratentorial Hemangiopericytoma Presenting as Massive Intratumoral Hemorrhage: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Toshihide Tanaka

    2014-01-01

    Full Text Available Unpredicted sudden death arising from hemangiopericytoma with massive intracranial hemorrhage is quite rare. We encountered a patient with recurrent infratentorial hemangiopericytoma presenting as life-threatening massive intracerebral hemorrhage. A 43-year-old man who had undergone craniotomy for total resection of an infratentorial hemangiopericytoma 17 months earlier presented with morning headache and generalized convulsions. Computed tomography revealed a massive hematoma in the right infratentorial region causing tonsillar herniation and emergency surgery was performed to evacuate the hematoma. Histological findings revealed hemangiopericytoma with hemorrhage. Neurological status remained unimproved and brain death was confirmed postoperatively. Hemangiopericytoma presenting as massive hemorrhage is quite rare. Since the risk of life-threatening massive hemorrhage should be considered, careful postoperative long-term follow-up is very important to identify tumor recurrences, particularly in the posterior cranial fossa, even if the tumor is completely removed.

  12. Unpredicted Sudden Death due to Recurrent Infratentorial Hemangiopericytoma Presenting as Massive Intratumoral Hemorrhage: A Case Report and Review of the Literature.

    Science.gov (United States)

    Tanaka, Toshihide; Kato, Naoki; Hasegawa, Yuzuru; Murayama, Yuichi

    2014-01-01

    Unpredicted sudden death arising from hemangiopericytoma with massive intracranial hemorrhage is quite rare. We encountered a patient with recurrent infratentorial hemangiopericytoma presenting as life-threatening massive intracerebral hemorrhage. A 43-year-old man who had undergone craniotomy for total resection of an infratentorial hemangiopericytoma 17 months earlier presented with morning headache and generalized convulsions. Computed tomography revealed a massive hematoma in the right infratentorial region causing tonsillar herniation and emergency surgery was performed to evacuate the hematoma. Histological findings revealed hemangiopericytoma with hemorrhage. Neurological status remained unimproved and brain death was confirmed postoperatively. Hemangiopericytoma presenting as massive hemorrhage is quite rare. Since the risk of life-threatening massive hemorrhage should be considered, careful postoperative long-term follow-up is very important to identify tumor recurrences, particularly in the posterior cranial fossa, even if the tumor is completely removed.

  13. Postpartum Hemorrhage Resulting from Pelvic Pseudoaneurysm: A Retrospective Analysis of 588 Consecutive Cases Treated by Arterial Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Dohan, Anthony, E-mail: anthony.dohan@lrb.aphp.fr; Soyer, Philippe, E-mail: philippe.soyer@lrb.aphp.fr; Subhani, Aqeel, E-mail: drsubhani07@gmail.com [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France); Hequet, Delphine, E-mail: delphine.hequet@gmail.com [Universite Paris-Diderot (France); Fargeaudou, Yann, E-mail: yannfargeaudou4@hotmail.com [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France); Morel, Olivier, E-mail: olivier.morel17@gmail.com [Maternite Universitaire de Nancy, Universite Henri Poincare Nancy 1 (France); Boudiaf, Mourad, E-mail: mourad.boudiaf@lrb.aphp.fr [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France); Gayat, Etienne, E-mail: etienne.gayat@9online.fr [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Anesthesiology and Intensive Care Medicine (France); Barranger, Emmanuel, E-mail: emmanuel.barranger@lrb.aphp.fr [Universite Paris-Diderot (France); Dref, Olivier Le, E-mail: olivier.ledref@lrb.aphp.fr; Sirol, Marc, E-mail: marc.sirol@lrb.aphp.fr [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France)

    2013-10-15

    Objective: This study was designed to determine the incidence of arterial pseudoaneurysm in patients presenting with postpartum hemorrhage (PPH), to analyze the angiographic characteristics of pseudoaneurysms that cause PPH, and to evaluate the effectiveness of pelvic arterial embolization for the treatment of this condition.Study designEighteen women with pelvic arterial pseudoaneurysm were retrieved from a series of 588 consecutive patients with PPH treated by arterial embolization. Clinical files, angiographic examinations, and procedure details were reviewed. Results: The incidence of pseudoaneurysm was 3.06 % (18/588; 95 % confidence interval (CI): 1.82-4.8 %). A total of 20 pseudoaneurysms were found; 15/20 (75 %) were located on the uterine arteries. Angiography revealed extravasation of contrast material from pseudoaneurysm indicating rupture in 9 of 18 (50 %) patients. Arterial embolization was performed using gelatin sponge alone in 12 of 18 (67 %) patients or in association with metallic coils in 5 of 18 (28 %) patients or n-butyl-2-cyanoacrylate in 1 of 18 (6 %) patients. Arterial embolization allowed controlling the bleeding in all patients after one or two embolization sessions in 17 of 18 (94 %) and 1 of 18 patients (6 %) respectively, without complications, obviating the need for further surgery. Conclusions: Pseudoaneurysm is rarely associated with PPH. Arterial embolization is an effective and safe procedure for the treatment of PPH due to uterine or vaginal artery pseudoaneurysm. Our results suggest that gelatin sponge is effective for the treatment of ruptured pseudoaneurysms, although we agree that our series does not contain sufficient material to allow drawing definitive conclusions with respect to the most effective embolic material.

  14. Meckel's cave meningiomas with subarachnoid hemorrhage.

    Science.gov (United States)

    Rosenberg, G A; Herz, D A; Leeds, N; Strully, K

    1975-06-01

    Two patients with Meckel's Cave meningiomas were initially hospitalized as a result of subarachnoid hemorrhage. Four-vessel angiography was necessary to exclude other causes of bleeding while demonstrating these lesions. Apoplectic presentation in both cases led to early diagnosis and successful surgical therapy. A review of the literature reveals subarachnoid hemorrhage to be a rarity in association with meningiomas. The two patients currently reported are believed to be the only examples on record of hemorrhagic meningiomas arising from the region of Meckel's Cave.

  15. Economy with the time delay of information flow—The stock market case

    Science.gov (United States)

    Miśkiewicz, Janusz

    2012-02-01

    Any decision process requires information about the past and present state of the system, but in an economy acquiring data and processing it is an expensive and time-consuming task. Therefore, the state of the system is often measured over some legal interval, analysed after the end of well defined time periods and the results announced much later before any strategic decision is envisaged. The various time delay roles have to be crucially examined. Here, a model of stock market coupled with an economy is investigated to emphasise the role of the time delay span on the information flow. It is shown that the larger the time delay the more important the collective behaviour of agents since one observes time oscillations in the absolute log-return autocorrelations.

  16. Case report of 5 siblings: malnutrition? Rickets? DiGeorge syndrome? Developmental delay?

    Directory of Open Access Journals (Sweden)

    Harris William

    2006-01-01

    Full Text Available Abstract Background Parents of six children are facing a trial on charges of aggravated manslaughter in the care a 5 1/2 month old infant who died suddenly and neglect of their four older children for causing them to be malnourished by feeding them all an exclusively raw foods vegan diet. Both parents declined plea bargains and plan to defend themselves in court. Case presentation The fifth child born to a married couple was breast-fed until 2 1/2 months. Subsequently, the parents fed the baby an exclusively raw foods diet prepared in a blender at home. The four older children, ages 18 months – 6 1/2 years also ate an exclusively raw foods vegan diet. None of the four older children had significant previous injuries or serious illnesses. At autopsy, the infant weighed 3180 mg (6.99 pounds and appeared emaciated. The thymus gland was absent and parathyroid glands were not located. The lungs were "congested." DiGeorge anomaly cannot be ruled out from these findings. Although, the coroner ruled that "malnutrition" was the sole cause of death, malnutrition, according to the World Health Organization definition, cannot be diagnosed in this infant. Compared with standard growth charts, the older children fell 2.1–4.1 standard deviations below the mean for North American children in height and weight. Labs were normal except for a low cholesterol level in all and a low prealbumin in one of three children tested. Therefore, malnutrition cannot be diagnosed in these children. The pediatrician diagnosed rickets in the four-year-old. However, chest x-rays were normal in all and long bone x-rays showed minimal changes in one child – no sign of rickets. The clinical diagnosis of rickets was not confirmed by the Center for Disease Control's criteria. A psychologist diagnosed the 18-month-old as developmentally delayed to the level of a 15-month-old, but this diagnosis is questionable. Conclusion The raw foods vegan diet and possibly inherited small

  17. Use Of Noninvazive Positive Pressure Ventilation in a Case of Diffuse Alveolar Hemorrhage Due to Goodpasture%u2019s Syndrome

    Directory of Open Access Journals (Sweden)

    Bunyamin Sertogullarindan

    2014-03-01

    Full Text Available Antiglomerular basement membrane antibody disease is manifested by progressive glomerulonephritis, intraalveolar hemorrhage and antiglomerular basement membrane antibodies. It is frequently characterized by mortality. We present a case of a 18 year-old  young showing remission by early diagnosis. The patient was admitted to emergency department with symptoms and findings of atypic pneumonia with bloody sputum. Chest radiography detected patchy alveolar opacities (Figure A. An ampric antibacterial treatment was given including macrolide, and bronchodilators because of bronchospasm. The patient was suspected for goodpasture’s syndrome (GPS. Anti-glomerular basement membrane (AGBM antibodies test was send. He developed massive alveolar haemorrhage in the resolution phase of atypic pneumonia. Laboratory examination revealed proteinuria of 20 mg/ dl, anemia Hb of 8 g/dl, hematocrit of 25%, microscopic hematuria of 350 erythrocite /HPF. AGBM antibodies was found as positive. GPS was diagnosed. Early immunosuppressive treatment with pulse methylprednisolone and cyclophosphamide and plazmaferez was started. Noninvasive positive pressure ventilation (NPPV was used for severe hypoxemia. Haemolytic anemia and thrombocytopenia developed under plasmaphresis treatment. Early treatment resulted with remmission. In conclusion, the current case showed that Goodpasture’s syndrome may have a favorable prognosis with early diagnosis and proper treatments including NPPV.

  18. Characterization of hemorrhages in the tenderloins of slaughter pigs

    DEFF Research Database (Denmark)

    Dich-Jørgensen, Kristine; McEvoy, Fintan; Larsen, Helle Daugaard;

    2016-01-01

    Muscle hemorrhages are regularly observed in especially the tip of the tenderloin muscles of slaughter pigs. In order to characterize the hemorrhages, a macro- and microscopic examination of tenderloins with (n = 5) and without (n = 4) hemorrhages and the associated vertebral column was carried out....... Furthermore, all columns were radiographed and two were CT scanned. Histologically, the muscle hemorrhages contained cells from bone marrow and growth line cartilage. Ventral epiphysiolysis in either the cranial or caudal epiphysis of the first lumbar vertebrae (L1) in 8 out of the 9 vertebral columns...... was present. In the 5 cases with tenderloin hemorrhage, similar hemorrhage with growth line cartilage was found within the fracture of the epiphysis. The hemorrhages develop secondarily to epiphysiolysis in the lumbar vertebrae, where the tenderloin attaches to the spine. The lesions probably develop around...

  19. Management of hemodynamically unstable pelvic fracture in pregnancy:a case report and review of literature

    Institute of Scientific and Technical Information of China (English)

    ZHANG Peng; ZHOU Dong-sheng; HU Jing-mei; LI Lian-xin; MU Wei-dong

    2012-01-01

    We present an unusual case of an unstable pelvic fracture during pregnancy period,who suffered fetal death and splenic rupture simultaneously which developed massive delayed hemorrhage in abdomen.When considering potential causes of fetal death,direct trauma to the uterus,placenta,or fetus was not associated with a higher fetal mortality rate,compared with maternal hemorrhage.A cesarean section and splenectomy could rescue the maternal life from the hemorrhage situation.Successful treatment of these rare cases is possible with careful pre-,peri-,and post-operative evaluation of the mother and fetus by a multidisciplinary team.

  20. Spontaneous Splenic Hemorrhage in the Newborn

    OpenAIRE

    2015-01-01

    Spontaneous splenic hemorrhage in the newborn is a rare entity. The presentation is usually with a triad of bleeding, abdominal distension, and hemoperitoneum. Rapid diagnosis is essential as left untreated, death is inevitable. We present a case with an unusual initial presentation of a scrotal hematocele and ultrasonography suggesting an adrenal hemorrhage. At laparotomy, splenic preservation was unsuccessful, and therefore, splenectomy was performed. The child recovered well from the proce...

  1. Reperfusion hemorrhage following superior mesenteric artery stenting.

    LENUS (Irish Health Repository)

    Moore, Michael

    2012-02-03

    Percutaneous transluminal angioplasty and stent placement is now an established treatment option for chronic mesenteric ischemia and is associated with low mortality and morbidity rates. We present a case of reperfusion hemorrhage complicating endovascular repair of superior mesenteric artery stenosis. Although a recognized complication following repair of carotid stenosis, hemorrhage has not previously been reported following mesenteric endovascular reperfusion. We describe both spontaneous cessation of bleeding and treatment with coil embolization.

  2. Delayed Closure of Giant Omphaloceles in West Africa: Report of Five Cases

    Science.gov (United States)

    El Ezzi, Oumama; Bossou, Raymond; Reinberg, Olivier; Maurer, Sabine Vasseur; Roessingh, Anthony de Buys

    2017-01-01

    Giant omphalocele (GO) management is controversial and not easy. Conservative management at birth and delayed surgical closure is usually mandatory. Postponed surgery may be challenging and carry the risk of intensive care treatment. We report on five children who were treated in our department for GO between 2000 and 2010. Initially, the patients were managed conservatively in West Africa. Delayed closure of the ventral hernia was performed in Switzerland after patient transfer through a nongovernmental organization. Fascial closure was performed at the median age of 23 months. Median diameter of the hernias was 10 × 10 cm ranging from 10 × 8 cm to 24 × 15 cm. Four (80%) patients had associated anomalies. Three children needed mechanical ventilation in the intensive care unit after surgery. Median hospitalization was 19 days. Complications were seen in two patients. The follow-up showed no recurrence of ventral hernia. There was no mortality. This report shows that conservative management of a GO at birth with delayed closure of the ventral hernia after transferring the patients to a European center is a safe approach for West African children and avoids life-threatening procedures. Delayed closure of a GO may be nevertheless challenging everywhere.

  3. Delayed hydrocephalus associated with traumatic atlanto-occipital dislocation: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Ashish Sharma

    2016-01-01

    Conclusion: Manifestations of hydrocephalus after AOD can be variable, ranging from interval ventricular dilatation to pseudomeningoceles and syringomyelia. In addition, the timing of presentation can be acute, requiring emergent external ventricular drainage, or delayed, requiring ongoing vigilance. Consequently, as more patients survive this once thought to be fatal injury, caution for hydrocephalus is stressed.

  4. Post-thyroidectomy hemorrhage

    DEFF Research Database (Denmark)

    Godballe, Christian; Madsen, Anders Rørbaek; Pedersen, Henrik Baymler;

    2009-01-01

    risk factors for hemorrhage. Increased hospital stay and infection rates were found in patients treated with drainage. The median time for onset of postoperative hemorrhage was 3 h (range 0-105). Compared with international literature our incidence of post-thyroidectomy hemorrhage is relatively high....... Improvement might be reached by the exchange of experience between departments with focus on adequate surgical technique and careful hemostasis....

  5. Delay in diagnosis of cancer as a patient safety issue - a root cause analysis based on a representative case report

    Directory of Open Access Journals (Sweden)

    Mansour Paul

    2011-07-01

    Full Text Available Abstract Background It is well known in the literature that imaging has almost no value for diagnosis of superficial bladder cancer. However, wide gap exists between knowledge on diagnosis of bladder cancer and actual clinical practice. Case presentation Delay in diagnosis of bladder cancer in a male person with tetraplegia occurred because of reliance on negative flexible cystoscopy and single biopsy, negative ultrasound examination of urinary bladder, and computerised tomography of pelvis. Difficulties in scheduling cystoscopy also contributed to a delay of nearly ten months between the onset of haematuria and establishing a histological diagnosis of vesical malignancy in this patient. The time interval between transurethral resection and cystectomy was 42 days. This delay was mainly due to scheduling of surgery. Conclusion We learn from this case that doctors should be aware of the limitations of negative flexible cystoscopy and single biopsy, cytology of urine, ultrasound examination of urinary bladder, and computed tomography of pelvis for diagnosis of bladder cancer in spinal cord injury patients. Random bladder biopsies must be considered under general anaesthesia when there is high suspicion of bladder cancer. Spinal cord injury patients with lesions above T-6 may develop autonomic dysreflexia; therefore, one should be extremely well prepared to prevent or manage autonomic dysreflexia when performing cystoscopy and bladder biopsy. Spinal cord injury patients, who pass blood in urine, should be accorded top priority in scheduling of investigations and surgical procedures.

  6. A case study on multi-lane roundabouts under congestion: Comparing software capacity and delay estimates with field data

    Directory of Open Access Journals (Sweden)

    Xuanwu Chen

    2016-04-01

    Full Text Available Existing studies on modern roundabouts performance are mostly based on data from singe lane roundabouts that are not heavily congested. For planners and designers interested in building multilane roundabouts for intersections with potential growth in future traffic, there has been a lack of existing studies with field data that provide reference values in terms of capacity and delay measurements. With the intent of providing such reference values, a case study was conducted by using the East Dowling Road Roundabouts in Anchorage, Alaska, which are currently operating with extensive queues during the evening peak hours. This research used multiple video camcorders to capture vehicle turning movements at the roundabouts as well as the progression of vehicle queues at the roundabout entrance approaches. With these video records, the number of vehicles in the queues can be accurately counted in any single minute during the peak hours. This study shows that unbalanced entrance flow patterns (i.e., one entrance has significant higher flow than others can intensify the queue and delay for the overall roundabouts. Then various software packages including RODEL, SIDRA and VISSIM were used to estimate several performance measurements, such as capacity, queue length, and delay, compared with the collected field data. With the comparison, it is found that all the three software packages overestimate multi-lane roundabout capacity before calibration. With default parameters, SIDRA and VISSIM tend to underestimate delays and queue lengths for the multi-lane roundabouts under congestion, while RODEL results in higher delay and queue length estimations at most of the entrance approaches.

  7. Ultrasound diagnosis of adrenal gland hemorrhage in newborn; Diagnostyka ultrasonograficzna krwawien do nadnerczy u noworodkow

    Energy Technology Data Exchange (ETDEWEB)

    Bieganowska-Klamut, Z.; Dybiec, E.; Wieczorek, P.; Charanicz-Bartler, H. [Zaklad Radiologii Pediatrycznej, Akademia Medyczna, Lublin (Poland)

    1995-12-31

    4 cases of adrenal gland hemorrhage in the newborns diagnosed by ultrasound examination were described. In 3 cases the hemorrhage was in one adrenal gland and in one the hemorrhage was in both. In 1 newborn control ultrasound and CT examination performed after 7 weeks demonstrated pseudocyst of right adrenal gland. In 2 other cases control ultrasound examination showed normalization of adrenal glands. The authors suggest differential diagnosis between the adrenal hemorrhage and neuroblastoma of adrenal gland. (author) 7 refs, 2 figs

  8. Intraventricular hemorrhage of the newborn

    Science.gov (United States)

    ... bleeding. Grade 1 is also referred to as germinal matrix hemorrhage (GMH). Grades 3 and 4 involve ... Saunders; 2015:chap 60. Volpe JJ. Intracranial hemorrhage: germinal matrix-intraventricular hemorrhage. In Volpe JJ, ed. Neurology ...

  9. Delayed Encephalopathy of Carbon Monoxide Intoxication and Treatment with Hyperbaric Oxygen: A Case Report

    Directory of Open Access Journals (Sweden)

    Fatma Polat

    2012-09-01

    Full Text Available Delayed encephalopathy (DE is a neuropsychiatric syndrome that can arise generally within 20 days of acute carbon monoxide (CO intoxication after apparent recovery and involves variable degrees of cognitive deficits, personality changes, movement disorders and focal neurologic deficits. We report a 35-year-old female patient with delayed encephalopathy due to CO intoxication, presenting with cognitive impairment and mild parkinsonism despite receiving hyberbaric oxigen therapy (HBO. Magnetic resonance imaging showed abnormal signal intensity and decreased diffusivity at both caudate nuclei and globus pallidus. She continued to receive additional HBO therapy and complete recovery was reached within six months. The positive effect of early HBO therapy of selected patients in reversing the acute effects of CO intoxication is appearant. We here also review the beneficial effect of HBO in preventing or limitating the late neurocognitive deficits associated with severe CO intoxication.

  10. CT appearance of renal hemorrhage after extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kanazawa, Susumu; Araki, Toru; Takamoto, Hitoshi; Hata, Kazuhiro

    1988-07-01

    Computed Tomography (CT) was performed in three patients who were suspicious of renal hemorrhage after extracorporeal shock wave lithotripsy (ESWL). Post-ESWL scans demonstrated subcapsular hematoma in all three cases, and intrarenal hemorrhage in two cases, one of which had fluid collection in the pararenal space and hemorrhage in the posterior pararenal space on CT. Thickening of gerota fascia and bridging septa in the perirenal space was visualized on CT in all of them. CT demonstrated clearly the anatomic distribution and extent of renal hemorrhage, and it is important to comprehend the imaging anatomy of the perirenal area for CT evaluation.

  11. Cerebral hemorrhage associated with sildenafil (Revatio) in an infant.

    Science.gov (United States)

    Samada, Kazunori; Shiraishi, Hirohiko; Aoyagi, Jun; Momoi, Mariko Y

    2009-10-01

    A case of cerebral hemorrhage associated with sildenafil (Revatio) use in an infant is presented. Sildenafil is increasingly used in the treatment of primary and secondary pulmonary arterial hypertension and pulmonary arteriovenous fistula. In the reported case, sildenafil used to treat pulmonary arteriovenous fistula improved right-to-left shunting across the pulmonary fistula but resulted in cerebral hemorrhage. Cerebral hemorrhage, a previously reported complication of sildenafil, developed in an infant after a rapid increase in dose, to 4.7 mg/kg/day. Therefore, sildenafil doses must be increased only with care, and cerebral hemorrhage must be considered a potential complication.

  12. 埃博拉出血热患儿二例的护理%Nursing Practice of 2 Cases of Children Patients with Ebola Hemorrhagic Fever

    Institute of Scientific and Technical Information of China (English)

    杨力敏; 吴晓倩; 邹徳莉; 姜雪梅; 骆宁; 吴琼; 陈红; 卢天舒

    2015-01-01

    目的:总结埃博拉出血热(Ebola hemorrhagic fever,EHF)患儿的临床特点和护理措施.方法回顾性分析2014年12月在利比里亚首都蒙罗维亚中国埃博拉治疗中心(Ebola Treatment Center,ETC)留观病区收治的2例 EHF患儿的临床资料,分析并总结护理措施.结果 EHF患儿的临床症状主要以发热、精神差、食欲减退、恶心、呕吐、腹泻,甚至不能进食,意识不清或昏迷等为主,心理问题主要表现为焦虑、恐惧、孤独、无助、自卑和绝望.2例患儿确诊为 EHF后转至治疗区,1例治愈出院,1例死亡.结论护士应在确保自身安全的前提下采取有针对性的护理干预方法,以促进EHF患儿早日康复出院.%Objective To summarize the characteristics of the clinical and nursing measures of EHF(Ebola hemor-rhagic fever,EHF)in children.Methods Clinical data of 2 kids with EHF which were observed in China EHF(Ebola Treatment Center,ETC)in epidemic areas of Liberia capital Monrovia in December 2014 were analyzed retrospectively, and the nursing measures were analyzed and concluded.Results The symptoms of EHF in children include fever,poor spirit,loss of appetite,nausea,vomiting,diarrhea,decrease consciousness or coma,etc.Mental problems mainly include anxiety,fear,loneliness,helplessness,low self-esteem and despair,etc.After the treatment,a case of kid with suspected EHF was cured and leaved hospital,and the other one died.Conclusion The nurse should be in the premise of ensuring own safety to take targeted nursing intervention methods,in order to promote the early recovery of the patients.

  13. A case of delayed methotrexate clearance following administration of a complementary medication containing chlorophyll.

    Science.gov (United States)

    Brooks, Sally L; Sanders, Julie; Seymour, John F; Mellor, James D

    2014-06-01

    A 54-year-old male with relapsed primary cerebral lymphoma and normal renal function was treated with methotrexate (MTX) 3 g/m(2) monthly by intravenous infusion. Throughout treatment the patient self-administered a complementary medicine (Jason Winter's chlorophyll®), which he was advised to cease during methotrexate treatment due to the potential for unknown interactions. For the first four cycles, chlorophyll was ceased two days prior to commencement of methotrexate and withheld until clearance. These cycles were administered without complication, and the methotrexate level reduced to chlorophyll was not ceased and there were no changes to concomitant medications. A literature search found no documented interactions between methotrexate and chlorophyll and the chemotherapy was administered without a delay in treatment. The methotrexate level three days post-administration was 0.36 µmol/L and did not reduce to chlorophyll 48 h prior to methotrexate administration until clearance. There were no further episodes of delayed methotrexate clearance. No impurities were detected in a sample of Jason Winter's chlorophyll®. It is therefore likely that the patient's delayed methotrexate clearance was due to an interaction with chlorophyll. It is recommended that such chlorophyll containing preparations be avoided in patients treated with methotrexate.

  14. A rare case of delayed presentation of congenital diaphragmatic hernia with gastric volvulus

    Directory of Open Access Journals (Sweden)

    Bajrang Tak

    2016-05-01

    Full Text Available A Bochdalek hernia is a posterior congenital defect of the diaphragm, usually on the left hemidiaphragm, caused by a lack of closure of the pleuroperitoneal canal between the eighth and tenth week of fetal life during the embryonic development. It typically presents in the neonatal period with severe respiratory failure. Here we present a 28 year old man with history of episodes of severe dyspnea, pain in epigastric region who arrived to the emergency room, having tachypnoea with oxygen saturation 80% on room air. During his medical work-up we incidentally found gastric volvulus with diaphragmatic hernia. It was managed with reduction of the herniated and rotated stomach and spleen back to the peritoneal cavity and closed the defect by open approach. This type of hernia is uncommon in adults. In this age group, there are two different clinical presentations: asymptomatic patients who are diagnosed incidentally when abdominal organs are found in the thorax in a chest X-ray, and symptomatic patients due to side effects of incarceration, strangulation, hemorrhage and visceral perforation in the chest cavity. [Int J Res Med Sci 2016; 4(5.000: 1749-1751

  15. Bilateral putaminal hemorrhage related to methanol poisoning: a complication of hemodialysis? Case report Hemorragia putaminal bilateral em intoxicação por metanol: uma complicação de hemodiálise? Relato de caso

    OpenAIRE

    Miguel Giudicissi Filho; Holanda,Carlos V. M.; Nader,Nelson A.; Sergio R. P. Gomes; Bertolucci, Paulo H.F.

    1995-01-01

    A case of acute methanol intoxication is presented, in which bilateral putaminal hemorrhage developed after hemodialysis. Even though the patient was initially comatose and profoundly acidotic, favorable outcome was achieved, with long-term neurologic impairments essentially restricted to mild crural paraparesis, retrograde amnesia, and marked visual deficit. A comparative literature review is evaluated.Um caso de intoxicação aguda por metanol é relatado, no qual o paciente desenvolveu hemorr...

  16. [Hemorrhagic complications of anti-vitamin K].

    Science.gov (United States)

    Al-Hajje, A; Calop, N; Bosson, J L; Calop, J; Allenet, B

    2009-03-01

    Adverse events related to oral anticoagulants represent a major public health problem. Hemorrhagic episodes are the most frequent complications and can be life-threatening. A 10 month prospective survey on all cases treated with anti-vitamin K (AVK), and admitted to emergency room of CHU Grenoble, was conducted to identify the hemorrhagic adverse drug events (HADE). The evaluation support was a directive questionnaire and consisted of 3 parts: patient characteristics, patient's medicated treatment and the hemorrhagic event. 216 patients treated with AVK were identified and 68 of them presented a hemorrhagic adverse drug event. 60 patients older than 65 years out of 158, presented HADE (38%); versus 8 patients or = 5, 79% developed HADE versus 16% in the group who had their INR AVK were significant. Concerning missed dose, 48 patients declared taking the missed dose with the next dose or when they remembered: 35% of them developed HADE (p = 0.49).

  17. Hemorrhagic prepatellar bursitis

    Energy Technology Data Exchange (ETDEWEB)

    Donahue, F. [Dept. of Radiology, Musculoskeletal Section, Univ. of Miami/Jackson Memorial Hospital, Miami, FL (United States); Turkel, D. [Dept. of Radiology, Musculoskeletal Section, Univ. of Miami/Jackson Memorial Hospital, Miami, FL (United States); Mnaymneh, W. [Dept. of Orthopedics, Univ. of Miami/Jackson Memorial Hospital, Miami, FL (United States); Ghandur-Mnaymneh, L. [Dept. of Pathology, Univ. of Miami/Jackson Memorial Hospital, Miami, FL (United States)

    1996-04-01

    Simple prepatellar bursitis is easily diagnosed both clinically and by MRI. MRI shows the typical T1 and T2 lengthening of fluid within the bursa. However, because of complex MRI appearance of hemorrhage, chronic hemorrhagic bursitis and the size of the prepatellar mass the clinical and MRI appearance can be very different. (orig.)

  18. 县级保健机构产后出血108例临床分析%Health care institutions at or above the county level postpartum hemorrhage in 108 cases clinical analysis

    Institute of Scientific and Technical Information of China (English)

    赵光明

    2012-01-01

      Objective:to explore the cause of postpartum hemorrhage and related risk factors. Methods:a retrospective analysis of 2006 January 2009-January of 4826 cases in our hospital childbirth puerpera, including 108 cases of postpartum hemorrhage. Results:the incidence of postpartum hemorrhage was 2.24%, leading to the cause of postpartum hemorrhage is contractions weakness is occupied 69.45%, placenta factor 19.44%, soft birth canal damage accounted for 9.26%, blood coagulation dysfunction accounted for 1.85%. Conclusion:through the retrospective case analysis, found that postpartum hemorrhage is mainly caused by the contractions fatigue, placenta factors, soft birth canal injury, blood coagulation dysfunction, and take effective preventive measures, can reduce the occurrence of postpartum hemorrhage, reduce the maternal mortality rate.%  目的:探讨产后出血的原因及相关高危因素.方法:回顾性分析2006年1月—2009年1月在我院分娩的4826例产妇,其中产后出血108例.结果:产后出血的发生率为2.24%,导致产后出血的原因是宫缩乏力占69.45%,胎盘因素占19.44%,软产道损伤占9.26%,凝血功能障碍占1.85%.结论:通过回顾性病例分析,发现产后出血的原因主要有宫缩乏力、胎盘因素、软产道损伤、凝血功能障碍,采取有效预防措施,可降低产后出血的发生,降低孕产妇死亡率.

  19. Two cases of delayed cardiac tamponade due to pericarditis after pulmonary vein (PV) isolation for atrial fibrillation.

    Science.gov (United States)

    Torihashi, Sadayoshi; Shiraishi, Hirokazu; Hamaoka, Tetsuro; Imai, Mikimasa; Kuroyanagi, Akira; Nakanishi, Naohiko; Nakamura, Takeshi; Yamano, Tetsuhiro; Matsumuro, Akiyoshi; Shirayama, Takeshi

    2015-01-01

    Catheter ablation is an established treatment for atrial fibrillation (AF). The incidence of major complications related to the procedure is reported to be 4.5%, and delayed cardiac tamponade (DCT) is a rare, although recently recognized, complication. However, the mechanisms underlying the development of DCT remain unclear. We herein report the cases of two men, both 49 years of age, who developed cardiac tamponade requiring pericardiocentesis a few weeks after undergoing pulmonary vein isolation for persistent AF. Physicians should explain to the patient the potential for DCT as a complication prior to performing catheter ablation and provide careful follow-up for at least a few weeks after the session.

  20. Spontaneous expulsive suprachoroidal hemorrhage caused by decompensated liver disease

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    Krishnagopal Srikanth

    2013-01-01

    Full Text Available Expulsive suprachoroidal hemorrhage can be surgical or spontaneous. Spontaneous expulsive suprachoroidal hemorrhage (SESCH is a rare entity. Most of the reported cases of SESCH were caused by a combination of corneal pathology and glaucoma. We are reporting a rare presentation of SESCH with no pre-existing glaucoma or corneal pathology and caused by massive intra- and peri-ocular hemorrhage due to decompensated liver disease.

  1. 某三级医院1194例脑出血病例统计分析%Statistical Analysis of 1 194 Cases of Patients with Cerebral Hemorrhage in Some AAA Hospital

    Institute of Scientific and Technical Information of China (English)

    孙义峰

    2016-01-01

    Objective To know the incidence of patients with cerebral hemorrhage and provide scientific reference for the further prevention and treatment of cerebral hemorrhage. Methods 1 194 cases of patients with cerebral hemorrhage diag-nosed in our hospital were counted and analyzed by the case management system according to the national disease classifi-cation code ICD-10. Results The proportion of cerebral hemorrhage in the cerebrovascular disease in our hospital took on an increasing trend from 2010 to 2015, and the number of patients with cerebral hemorrhage obviously increased, and the proportion increased from 16.6% in 2010 to 24.3% in 2015, and the growth rate per annum of patients with cerebral hem-orrhage was 14.5%, and the proportion of male and female was 1.20:1, and the male patients were more than the female pa-tients, and the patients were mainly more than 60 years old, 787 cases in total (65.91%), and the onset time of the disease was mostly from September to February of next year, accounting for 58.3%. Conclusion The patients with cerebral hemor-rhage takes on an increasing trend in our hospital, in addition to treatment for patients with cerebral hemorrhage, various forms of health education should be adopted to popularize the preventive common knowledge of cerebral hemorrhage, advo-cate the healthy lifestyle and good dieting habits, and we should focus on the initial prevention and first-class prevention, and the elderly population (older than 50 years) is the key objects.%目的:了解脑出血患者的发病情况,为进一步预防和治疗脑出血发病提供科学参考。方法以国际疾病分类编码ICD-10为标准,采用病案管理系统对该院2010-2015年出院病案主要诊断为脑出血的1194例进行统计分析。结果2010-2015年该院脑出血在脑血管病中所占比例呈上升趋势,脑出血患者数量明显增加,构成比由2010年的16.6%增至2015年的24.3%,脑出血病人的年平均增长速度是14.5%

  2. Organophosphate-induced delayed neuropathy: case report Neuropatia tardia por organofosforado: relato de caso

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    Luiz Felipe R Vasconcellos

    2002-12-01

    Full Text Available Organophosphate induced delayed neuropathy (OPIDN is an uncommon clinical condition. It occurs in association with the ingestion of great amounts of organophosphate after the stimulation of cholinergic receptor. The clinical picture is characterized by a distal paresis in lower limbs associated with sensitive symptoms. Electrodiagnostic studies show a motor axonal neuropathy. Involvement of the central nervous system may occur. We describe a 39 years-old female patient who developed hyperesthesia associated with lower limbs paresis, fourteen days after she had ingested a Dichlorvos-based insecticide. Electrophysiological study was characterized by an axonal polyneuropathy pattern. Pyramidal tract dysfunction was observed later in upper limbs. Considering that both peripheral and central nervous systems are involved we believe that the more appropriated term would be organophosphate induced delayed neuropathy (OPIDN instead of organophosphate induced delayed polyneuropathy (OPIDP.A neuropatia tardia dos organofosforados (NTOF é condição clinica incomum. Geralmente ocorre após a intoxicação aguda por organofosforados, seguindo-se a fase de hiperestimulação colinérgica. O quadro clínico é caracterizado por déficit motor distal nos membros inferiores associado a sintomas sensitivos. O estudo eletroneuromiográfico tem demonstrado padrão axonal motor na maioria dos casos. Podem ocorrer sinais de comprometimento do sistema nervoso central. Descrevemos o caso de uma paciente de 39 anos que ingeriu inseticida a base de Dichlorvos e quatorze dias após apresentou quadro de hiperestesia associado a paresia distal nos membros inferiores. Realizou eletroneuromiografia que se caracterizou por padrão compatível com polineuropatia axonal. Sinais piramidais, de aparecimento mais tardio, foram observados nos membros superiores. Diante do comprometimento do sistema nervoso periférico e central, também consideramos o termo neuropatia tardia por

  3. A rare case of solitary brain Langerhans cell histiocytosis with intratumoral hemorrhage in a patient affected by Turner syndrome

    Science.gov (United States)

    Granata, Francesca; Morabito, Rosa; Grasso, Giovanni; Alafaci, Elisabetta; Salpietro, Francesco M.; Alafaci, Concetta

    2016-01-01

    Background: Langerhans cell histiocytosis (LCH) is a rare disease involving clonal proliferation of cells with characteristics similar to bone marrow-derived Langerhans cells. The case of a young woman, affected by Turner syndrome and a solitary intraparenchymal LCH associated with an osteolytic lesion of the overlying skull, is presented. Case Description: The patient, with an insidious history of headache and a growing soft mass in the left frontal region, presented with a sudden generalized tonic-clonic epileptic seizure. Neuroradiological investigations showed an osteolytic lesion of the left frontal bone and an underlying brain lesion associated with recent signs of bleeding. The patient was operated on with a complete removal of the lesion. The postoperative course was uneventful. Conclusions: The clinical, neuroradiological, and intraoperative findings are presented, along with a review of the literature. Although rare, LCH should be considered in the differential diagnosis when a scalp lesion occurs with a progressive growing. PMID:27127696

  4. A case of life-threatening obstetrical hemorrhage secondary to placental abruption at 17 weeks of gestation

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    Toshihiko Kinoshita

    2014-03-01

    Full Text Available A 40-year old woman, gravida 4, para 4, presented with sudden lower abdominal pain and severe vaginal bleeding at 17 weeks of gestation. Clinical symptoms and ultrasonographic finding revealed placental abruption. The volume of bleeding was heavy and led to disseminated intravascular coagulation and hypovolemic shock. We performed blood transfusion and therapy to treat the critical condition. However, the mother’s condition continued to worsen. Therefore, we performed a hysterotomy and aborted the pregnancy to save the mother. Since heavy bleeding caused by placental abruption leading to a life-threatening condition for a mother before the 20 weeks of gestation is very rare, the present case is an important case study.

  5. Stump appendicitis is a rare delayed complication of appendectomy: A case report

    Institute of Scientific and Technical Information of China (English)

    Mehmet Uludag; Adnan Isgor; Muzaffer Basak

    2006-01-01

    Stump appendicitis is an acute inflammation of the residual appendix and one of the rare complications after appendectomy. Paying attention to the possibility of stump appendicitis in patients with right lower abdominal pain after appendectomy can prevent the delay of diagnosis and treatment. In patients with stump appendicitis,CT scan not only assists in making an accurate preoperative diagnosis but also excludes other etiologies. We report a 47-year old man with preoperatively diagnosed stump appendicitis by CT, who underwent an open appendectomy 20 years ago.

  6. 老年性蛛网膜下腔出血非典型症状30例分析%Analysis of atypical symptoms in 30 cases of senile Subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    李秋茹; 王晓明; 龙存国

    2003-01-01

    @@ CLINICAL DATA Subjects came from 30 patients with senile subarachnoid hemrrhagetreated in our hospital from January 1999 to December 2001 in-cluding 12 males and 18 females aged 60-78(mean: 65) yearsold. 24 patients presented with onset in action, 6 patients at rest; 26cases presented with acute onset and 4 cases subacute onset. Acuteheadache as first symptom was in 13 cases; pain at neck, waist,sacral as first symptom in 7 cases. 3 patients searched medical ser-vice for headache within 1 week; 2 patients for severe pain of bothlimbs and unable to walk; 2 patients for headache and vomiting at 2week. 7 patients were once treated out of our hospital and sciaticawas diagnosed in 4 cases, cold in 3 cases. Pain at shoulder, back,upper limb in action occurred in 2 cases as first symptom, consciousdisturbance was the first symptom in 4 cases, grand mal of epilepsyas first symptom in 3 cases. 1 patient searched medical service forright head pain, auricle pain for 20 days. Stiff neck ( + ) appeared in25 patients at hospitalization and (-) in 5 patients. 24 patientspresented with positive Kernig' s sign. 21 patients were complicatedwith hypertension, 1 patient was complicated with peripheral facialparalysis and left hemihypoesthesia, 3 patients with transient hemi-paresis of both lower limhs, 2 cases with bilateral ptosis, 1 case withexotropia of bilateral eyeball, pupil dilation, 6 cases with consciousdisturbance. Auxilliary examination: (1) Skull CT scanning: Sub-arachnoid hemorrhage was found in 20 cases, no abnormality in 7cases and 3 cases didn't undergo CT scanning. (2) Examination ofspinal fluid: patients with positive CT findings didn' t undergo lumbarpuncture, even hemic spinal fluid was found in 6 patients and yellowspinal fluid and shrinking red blood cell in 4 cases. Prognosis: Allcases were treated according to subarachnoid hemorrhage, 6 patientsdied and other 24 patients were cured after 6 - 8 weeks of treatment.

  7. Delayed emergence after anesthesia.

    Science.gov (United States)

    Tzabazis, Alexander; Miller, Christopher; Dobrow, Marc F; Zheng, Karl; Brock-Utne, John G

    2015-06-01

    In most instances, delayed emergence from anesthesia is attributed to residual anesthetic or analgesic medications. However, delayed emergence can be secondary to unusual causes and present diagnostic dilemmas. Data from clinical studies is scarce and most available published material is comprised of case reports. In this review, we summarize and discuss less common and difficult to diagnose reasons for delayed emergence and present cases from our own experience or reference published case reports/case series. The goal is to draw attention to less common reasons for delayed emergence, identify patient populations that are potentially at risk and to help anesthesiologists identifying a possible cause why their patient is slow to wake up.

  8. 新生儿颅内高压伴消化道大出血1例的护理体会%Nursing experience of neonatal intracranial hypertension complicated with hemorrhage of digestive tract of 1 case

    Institute of Scientific and Technical Information of China (English)

    郭睿

    2015-01-01

    Based on 1 case of nursing of neonatal intracranial hypertension complicated with hemorrhage of digestive tract,we analyzed the nursing experience of massive hemorrhage of digestive tract caused by intracranial hypertension with stress ulcer,to accumulate experience in order to improve the cure rate of the rescue success rate and disease in children.%通过对1例新生儿颅内高压伴消化道大出血的护理,分析颅内高压引起应激性溃疡导致消化道大出血患儿的护理体会,为提高患儿的救护成功率及疾病的治愈率积累经验。

  9. Delayed immune mediated adverse effects to hyaluronic acid fillers: report of five cases and review of the literature

    Directory of Open Access Journals (Sweden)

    Ora Bitterman-Deutsch

    2015-03-01

    Full Text Available Hyaluronic acid (HA fillers in cosmetic medicine have been considered relatively safe, though fillers used in European countries and throughout the world are not necessarily approved by the Food and Drug Administration. As their use continues to expand worldwide, physicians in a wide range of medical specialties are authorized to perform HA injections, including general medicine practitioners and even dentists. An increasing number of reports have appeared regarding side effects to these products. It is now known that reactions to Hyaluronic acid are related not only to technical faults of the injections, but also to immune responses, including delayed hypersensitivity and granulomatous reactions. Herein, we describe five cases treated by a variety of treatment modalities, all with delayed reactions to different brands of hyaluronic acid fillers. As there is currently no standardization of treatment options of adverse effects, these cases accentuate the debate regarding the approach to the individual patient and the possible need for pre-testing in patients with an atopic tendency.

  10. Acquired hemophilia as the cause of life-threatening hemorrhage in a 94-year-old man: a case report

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    Blanchard Elizabeth

    2010-07-01

    Full Text Available Abstract Introduction Acquired factor VIII deficiency is a rare entity that can lead to severe and life-threatening bleeding. We describe a case of severe bleeding from the tongue secondary to acquired hemophilia and discuss treatment options, including aminocaproic acid and recombinant factor VIII, which have not been widely reported in the literature for the management of such patients. Case presentation A 94-year-old Caucasian man presented to our institution with diffuse bruising and extensive bleeding from the tongue secondary to mechanical trauma. He had no prior history of bleeding and his medical history was unremarkable except for dementia and hypertension. Coagulation studies revealed a prolonged activated partial thromboplastin time and a mixing study was consistent with the presence of an inhibitor. Quantitative assays revealed a reduced level of factor VIII activity (1% and the presence of a factor VIII inhibitor, measured at seven Bethesda units, in the serum. Oral prednisone therapy (60mg/day was given. He also received intravenous aminocaproic acid and human concentrate of factor VIII (Humate-P and topical anti-thrombolytic agents (100 units of topical thrombin cream. His hospital course was prolonged because of persistent bleeding and the development of profuse melena. He required eight units of packed red blood cells for transfusion. Hospitalization was also complicated by bradycardia of unclear etiology, which started after infusion of aminocaproic acid. His activated partial thromboplastin time gradually normalized. He was discharged to a rehabilitation facility three weeks later with improving symptoms, stable hematocrit and resolving bruises. Conclusions Clinicians should suspect a diagnosis of acquired hemophilia in older patients with unexplained persistent and profound bleeding from uncommon soft tissues, including the tongue. Use of factor VIII (Humate-P and aminocaproic acid can be useful in this coagulopathy but

  11. Case of “Slow” Stroke from Carotid Artery Occlusion Treated by Delayed but Cautious Endovascular Intervention

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    Kachi Illoh

    2011-01-01

    Full Text Available In a challenging case of carotid occlusion with slowly evolving stroke, we used brain imaging to facilitate endovascular revascularization resulting in the relief of the patient's symptoms. Patients with carotid occlusion and continued neurological worsening or fluctuations present enormous treatment challenges. These patients may present “slow” strokes with subacute infarcts that present significant challenges and risks during attempts at revascularization of the occluded artery. We present such a case in which we used multimodal imaging techniques, including MR-perfusion, to facilitate endovascular revascularization. Our approach of delayed but cautious intra-arterial thrombolytic therapy, guided by brain imaging, and followed by stent placement across the residual stenosis, enabled revascularization of the occluded artery without overt in-hospital complications.

  12. Case Report: Delayed Perforation after Definitive Treatment of Focal Intestinal Perforation with a Peritoneal Drain

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    Brian G. A. Dalton

    2012-01-01

    Full Text Available Focal intestinal perforation (FIP has long been described in the pediatric literature. Peritoneal drainage (PD is widely used as treatment for focal intestinal perforation. Here we report a premature infant that underwent PD on day of life 9 for a FIP. The infant recovered well from this episode and was discharged home without known sequelae. Subsequently, the same patient presented 16 months later with peritonitis. A perforation was discovered at laparotomy without evidence of surrounding necrosis. Given this finding, we believe this second episode of perforation was at the same site as the initial episode of FIP. The finding of FIP has been described without findings of surrounding necrosis. However, we believe this to be the first report of delayed perforation greater than 1 year from initial presentation after FIP treated definitively with peritoneal drain.

  13. The concept of delayed nucleation in nanocrystal growthdemonstrated for the case of iron oxide nanodisks

    Energy Technology Data Exchange (ETDEWEB)

    Casula, Maria F.; Jun, Young-wook; Zaziski, David J.; Chan, EmoryM.; Corrias, Anna; Alivisatos, Paul A.

    2005-09-09

    A comprehensive study of iron oxide nanocrystal growth through non-hydrolitic, surfactant-mediated thermal reaction of iron pentacarbonyl and an oxidizer has been conducted, which includes size control, anisotropic shape evolution, and crystallographic phase transition of monodisperse iron oxide colloidal nanocrystals. The reaction was monitored by in situ UV-Vis spectroscopy taking advantage of the color change accompanying the iron oxide colloid formation allowing measurement of the induction time for nucleation. Features of the synthesis such as the size control and reproducibility are related to the occurrence of the observed delayed nucleation process. As a separate source of iron and oxygen is adopted, phase control could also be achieved by sequential injections of oxidizer.

  14. Delayed post-hypoxic leukoencephalopathy: case report with a review of disease pathophysiology

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    Michael Andrew Meyer

    2013-07-01

    Full Text Available Delayed post-hypoxic leukoencephalopathy is a rare clinical phenomenon usually observed in a small number of carbon monoxide poisoning survivors. A similar phenomenon is reported here in a patient who successfully recovered from a large overdose of diazepam and methadone, but then abruptly declined 3 weeks after the initial event. Magnetic resnance revealed confluent white matter hyperintensity on fluid-attenuated inversion recovery and T2 weighted sequences, and spectroscopy revealed elevated peaks in choline, creatinine, and lactate. Analysis and review of the literature suggests this phenomenon occurs on average about 19 days after the initial event. Although the pathophysiology remains obscure, it is noted here that the mean lucid interval coincides approximately with the replacement half-life for myelin related lipids and proteins.

  15. Adenosine kinase deficiency with neurodevelopemental delay and recurrent hepatic dysfunction: A case report

    Science.gov (United States)

    Shakiba, Marjan; Mahjoub, Fatemeh; Fazilaty, Hassan; Rezagholizadeh, Fereshteh; Shakiba, Arghavan; Ziadlou, Maryam; Gahl, William A.; Behnam, Babak

    2016-01-01

    Hypermethioninemia may be benign, present as a nonspecific sign of nongenetic conditions such as liver failure and prematurity, or a severe, progressive inborn error of metabolism. Genetic causes of hypermethioninemia include mitochondrial depletion syndromes caused by mutations in the MPV17 and DGUOK genes and deficiencies of cystathionine β-synthase, methionine adenosyltransferase types I and III, glycine N-methyltransferase, S-adenosylhomocysteine hydrolase, citrin, fumarylacetoacetate hydrolase, and adenosine kinase. Here we present a 3-year old girl with a history of poor feeding, irritability, respiratory infections, cholestasis, congenital heart disease, neurodevelopmental delay, hypotonia, sparse hair, facial dysmorphisms, liver dysfunction, severe hypermethioninemia and mild homocystinemia. Genetic analysis of the adenosine kinase (ADK) gene revealed a previously unreported variant (c.479–480 GA>TG) resulting in a stop codon (p.E160X) in ADK. A methionine-restricted diet normalized the liver function test results and improved her hypotonia. PMID:27500280

  16. Unnecessary multiple epidural steroid injections delay surgery for massive lumbar disc: Case discussion and review

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    Nancy E Epstein

    2015-01-01

    Full Text Available Background: Epidural steroid injections (ESI in the lumbar spine are not effective over the long-term for resolving "surgical" lesions. Here, we present a patient with a massive L2-L3 lumbar disk herniation whose surgery was delayed for 4 months by multiple unnecessary ESI, resulting in a cauda equina syndrome. Methods: A 54-year-old male acutely developed increased low back and radiating left leg pain in October of 2014. In December of 2014, a magnetic resonance imaging (MRI scan showed a massive central/left sided disk herniation at the L2-L3 level resulting in marked thecal sac and left L2 foraminal and L3 lateral recess root compression. Despite the marked degree of neural compression, pain management treated him with 3 ESI over the next 3 months. Results: At the end of April of 2015, he presented to spine surgeon with a cauda equina syndrome. When the new MRI scan confirmed the previously documented massive central-left sided L2-L3 disk herniation, the patient emergently underwent an L1-L3 laminectomy with central-left sided L2-L3 lateral/foraminal diskectomy. Postoperatively, the patient was neurologically intact. Conclusions: Pain specialists performed multiple unnecessary lumbar ESI critically delaying spinal surgery for 4 months in this patient with a massive lumbar disk herniation who ultimately developed a cauda equina syndrome. Unfortunately, pain specialists (e.g., radiologists, anesthesiologists, and physiatrists, not specifically trained to perform neurological examinations or spinal surgery, are increasingly mismanaging spinal disease with ESI/variants. It is time for spine surgeons to speak out against this, and "take back" the care of patients with spinal surgical disease.

  17. Clinical analysis of 189 cases of nasal hemorrhage%189例鼻出血临床分析

    Institute of Scientific and Technical Information of China (English)

    仇宝琴

    2015-01-01

    目的:探讨鼻出血的病因以及相应的治疗方法。方法对该院2012年6月—2014年6月期间收治的189例鼻出血患者的临床资料进行回顾性的总结分析。结果189例患者131例患者通过保守治疗治愈:其中114例患者通过前鼻孔填塞后鼻出血治愈,56例患者通过手术的方法治愈。37例难治性鼻出血在前鼻镜下未见确切病变、经前鼻孔填塞后鼻出血仍反复发作的患者采取全麻鼻内镜下鼻腔等离子止血术,术后鼻出血治愈。2例因血液系统疾病致鼻出血患者1例为血友病,1例为再生障碍性贫血,转入上一级医院,无严重不良反应和并发症的发生。结论鼻出血在临床上是比较多见的一种临床症状,可以由多种原因导致,在经过积极有效的治疗之后大部分可以得到有效的治愈,而其中安全、严谨的临床诊断和有效的治疗方法是提高患者治愈率的关键所在。%Objective To investigate the etiology of nasal bleeding and the corresponding treatments. Methods in my hospital from 2012 June to 2014 June 189 cases of epistaxis patients clinical data were retrospectively analyzed to summarize. Results 189 patients, 131 patients were cured with conservative treatment, of which 114 patients were cured with former nostril nose bleeds after stuffing, 56 cases were cured by surgery. 37 cases of refractory nasal bleeding under nasal mirror before did not see the exact lesion, premenstrual nostril nose bleeds after stuffing is still repeated attacks to take general anesthesia in patients with nasal endoscopic plasma bleeding, postoperative nasal. Conclusion nose bleeding in clinic is a clinical symptom sees more quite, can be caused by a variety of reasons, after the most active and effective treatment can effectively cure, of which clinical diagnosis of safety, strict and effective treatment is the key to improve the cure rate of the patients with.

  18. Clinical analysis of 27 cases with fetomaternal hemorrhage%胎母输血综合征27例临床分析

    Institute of Scientific and Technical Information of China (English)

    蒋红清; 宜小如; 张建梅

    2013-01-01

    目的 探讨胎母输血综合征(fetomaternal hemorrhage,FMH)的病因、临床特征、诊断及治疗,以降低其引起的围生儿并发症的发生率及死亡率.方法 收集2007年1月至2012年6月北京海淀区妇幼保健院诊治的27例大量胎母输血综合征病例,采用红细胞酸洗脱试验法(Kleihauer-Betke test,KB试验)检测母血中胎儿红细胞并计算胎儿出血量,并对胎母输血综合征孕妇及新生儿的临床资料进行分析.结果 胎母输血综合征的发生率为0.39‰ (27/69 497),多数(74.07%,20/27)病因不明确,产前确诊率(14.81%,4/27)低;胎母输血综合征最常见的临床表现为胎动减少或消失(70.37%,19/27),其次为胎心监护异常(62.96%,17/27)、胎儿窘迫(55.56%,15/27)、胎儿生长受限(7.41%,2/27)、胎儿水肿(3.70%,1/27);新生儿均表现为不同程度的贫血(100%),其中新生儿轻度贫血2例,中度贫血5例,重度贫血14例,极重度贫血6例,最低者血红蛋白仅20 g/L;根据公式计算胎儿失血量为80~313ml,占胎儿循环血量的(50.54±19.67)%.在27例患者中,17例(62.96%)母血甲胎蛋白增高;17例(62.96%)新生儿接受小量多次输血治疗;25例(92.59%)好转出院,2例(7.41%)死亡.结论 胎母输血综合征是一种少见的产科并发症,大部分病例原因不明;临床表现有胎动减少、正弦曲线样胎心监护及胎儿水肿“三联征”;母体血循环检测到有核红细胞可以诊断胎母输血综合征,早期诊断,尽早处理,可降低围生儿死亡率和发病率.%Objective To study the etiology,clinical characteristics,diagnosis and treatment of fetomaternal hemorrhage (FMH),thus to improve the understanding of the disease and to reduce perinatal infants complications and mortality rate.Methods 27 cases of FMH who delivered in Beijing Haidian Madam and Children Health Hospital from January 2007 to June 2012 were recruited in this study.Fetal red blood cells in

  19. Two cases of cervical disc disease with intramedullary pathological changes, which are responsible for their neurological syndromes, on delayed CT myelography

    Energy Technology Data Exchange (ETDEWEB)

    Isu, Toyohiko; Iwasaki, Yoshinobu; Abe, Hiroshi; Tashiro, Kunio; Murai, Hiroshi; Miyasaka, Kazuo

    1987-08-01

    We report two cases of cervical disc disease with myelopathy classified as of motor system syndrome type showing small contrast accumulation within the spinal cord on delayed CT myelography. In our two cases, high density spots on delayed CT myelography were bilaterally localized within the spinal cord, and believed represent pathological changes of the spinal cord, such as collection of microcavities or cystic necrosis. In case 1, the high density areas seemed to be localized in the anterior horn and corticospinal tract, and in case 2, they seemed to be localized in the corticospinal tract. The patient in case 1 produced signs and symptoms resembling motor neurone disease and lesion could not be differentiated from the latter. Delayed CT myelography showed that the cause of the upper limb amyotrophy was attributed to an anterior horn disorder and that of pyramidal tract sign to a corticospinal tract disorder. Therefore, we could differentiate the lesion from motor neurone disease on delayed CT myelography in case 1. In conclusion, we emphasize that delayed CT myelography can demonstrate the intramedullary pathological changes in the cervical disc disease and is useful in distinguishing between cervical disc disease simulating motor neurone disease and the latter.

  20. Pulmonary Hemorrhage in Cryoglobulinemia

    Directory of Open Access Journals (Sweden)

    G Kirkpatrick

    2015-01-01

    Full Text Available Pulmonary manifestations of cryoglobulinemia are uncommon and their clinical behaviour is unpredictable, ranging from mild dyspnea to life-threatening presentations. A patient with cryoglobulinemia who presented with hypoxic respiratory failure attributed to pulmonary hemorrhage is reported.

  1. Hemorrhagic fever with renal syndrome and coexisting hantavirus pulmonary syndrome

    Directory of Open Access Journals (Sweden)

    Young Min Hong

    2012-06-01

    Full Text Available Hemorrhagic fever with renal syndrome (HFRS is an acute viral disease with fever, hemorrhage and renal failure caused by hantavirus infection. Hantavirus induces HFRS or hantavirus pulmonary syndrome (HPS. HPS progression to a life-threatening pulmonary disease is found primarily in the USA and very rarely in South Korea. Here, we report a case of HFRS and coexisting HPS.

  2. Recovery from a Subarachnoid Hemorrhage: Patient and Spouse Perspectives

    Science.gov (United States)

    Brice, Roanne G.; Brice, Alejandro

    2017-01-01

    This second article of a two-part case study focuses on the experiences of a patient and his spouse (caregiver) when a neurological trauma occurs. It is the personal account when A.B. survived a vertebral artery aneurysm and hemorrhage resulting in a subarachnoid hemorrhage. It is also an in-depth post-trauma account from two speech-language…

  3. Intracerebral hemorrhage caused by varicella-induced thrombocytopenia.

    Science.gov (United States)

    Lizarazo, Jairo; Castellanos, María Fernanda; Omaña, Claudia Rosa; Chaín, Miguel; Villamizar, Sergio

    2016-02-16

    We present the case of a previously healthy 44-years-old man with chickenpox, severe thrombocytopenia, mucosal hemorrhage, and intracerebral hemorrhage in the right hemisphere. The patient was treated with platelets and high doses of steroids. He recovered although with persistent left homonymous hemianopsia and epilepsy, which were controlled with medication.

  4. Ebola hemorrhagic Fever.

    Science.gov (United States)

    Burnett, Mark W

    2014-01-01

    Ebola hemorrhagic fever is an often-fatal disease caused by a virus of the Filoviridae family, genus Ebolavirus. Initial signs and symptoms of the disease are nonspecific, often progressing on to a severe hemorrhagic illness. Special Operations Forces Medical Providers should be aware of this disease, which occurs in sporadic outbreaks throughout Africa. Treatment at the present time is mainly supportive. Special care should be taken to prevent contact with bodily fluids of those infected, which can transmit the virus to caregivers.

  5. Delayed drug interactions in psychiatry: armodafinil and risperidone as a potential case in point.

    Science.gov (United States)

    Andrade, Chittaranjan

    2015-12-01

    Modafinil or armodafinil (ar/mod) augmentation of antipsychotic medication in schizophrenia patients may be considered with a view to reduce negative symptoms associated with the illness or excessive daytime drowsiness due to any cause. The available data suggest that there is no role for ar/mod in reducing negative symptom burden. A recent pharmacokinetic (PK) study suggested that armodafinil (250 mg/d) reduces key PK parameters of risperidone by about 50%, and key PK parameters of 9-hydroxyrisperidone (paliperidone) by about 20%-30%, probably through induction of CYP3A4. Ar/mod augmentation is therefore best avoided in patients receiving risperidone or paliperidone (and most other atypical antipsychotic drugs, as well, because most atypical antipsychotics are metabolized by enzymes that ar/mod induce). If the ar/mod-antipsychotic drug combination is necessary, for whatever reason, then the dose of the atypical antipsychotic drug may need to be appropriately raised. If this is not done, relapse may occur; because the relapse may postdate the introduction of ar/mod by many months, the causal role of a metabolic drug interaction may not be suspected, and physicians may attribute the relapse to the natural course of the illness. Physicians need to be aware that any agent that induces the metabolism of psychotropic drugs that are used in maintenance therapy may, through lowered psychotropic drug levels, result in a delayed drug interaction that is characterized by illness relapse.

  6. Recurrent intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Shen jinsong; Lu jianhong

    2000-01-01

    Objective: In order to study the clinical manifestation and risk factor of recurrent intracerebral hemorrhage(ICH).Methods:The 256 patients were analysed who admitted to our hospital for intracerebral hemorrhage between 1995 and 1997.The 15(5 .86%)patients had a recurrent ICH.There were 9 men and 6 women and the mean age of the patients was 63.5 ± 6.4years at the first bleeding episode and 67.8± 8. 5 years at the second. The mean interval between the two bleeding episodes was 44.6 ± 12.5 months. The 73.3%patients were hypertensive .′The site of the first hemorrhage was ganglionic in 8 patients , ]ohar in six paients and brainstem in one .The recurrent hemorrhage occurred at a different location from the previous ICH.The most common pattern of recurrence was “ganglionic -ganglionic” (7 patients), lobar - ganglionic (3 patients), lobar-lobar(three patients), which was always observed in hypertensive patients. The outcome after the recurrent hemorrhage was usually poor. By comparison with 24 patients followed up to average 47.5± 18.7 months with isolated ICH without recurrence .Only lobar hematoma and a younger age were risk factors for recurrences whereas sex and previous hypertension were not. The mechanism of recurrence of ICH were multiple(hypertension, cerebral amyloid angiopathy).Contral of blood pressure and good living habit after the first hemorrhage may prevent ICH recurrences.

  7. Delayed diagnosis of hemoptysis in the case of prior aortic coarctation repair: A case report of aortobronchial fistula

    Directory of Open Access Journals (Sweden)

    Vinay Kansal

    2015-01-01

    Full Text Available We report a case of a 46-year old man who presented with spontaneous bright red blood per mouth for several months. The patient had history of aortic coarctation repair at age 17. Endoscopy and nasopharyngeoscopy revealed no source of bleeding. Computed tomography scan revealed the presence of thoracic aortic pseudoaneurysm with the formation of an aortobronchial fistula (ABF. This case illustrates the high index of suspicion for ABF in the case of hemoptysis or hematemesis with prior history of coarctation repair. Furthermore, we discuss the role of thoracic endovascular aneurysm repair (TEVAR as the standard of repair over open surgery.

  8. Gorlin syndrome: Importance of clinical signs and danger of delayed diagnosis - A case report with eight years follow-up

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    Erica Dorigatti de-Avila

    2015-02-01

    Full Text Available Nevoid basal cell carcinoma (NBCCS or Gorlin-Goltz syndrome (GS is a multidisciplinary problem, the early diagnosis of which allows secondary prophylaxis that follows an appropriate regimen to delay progression of the syndrome. The aim of this study was to present a case of delayed diagnosis of GS in a young patient who received multidisciplinary treatment 5 years after onset. The patient presented for evaluation with painless swelling of the left maxilla. Histological examination confirmed the diagnosis of a keratocyst odontogenic tumor (KOT that was enucleated. On presentation, the patient's symptoms and clinical signs were not related to complications of GS, and the possibility of GS was initially rejected, as he did not have a family history of the syndrome. Four years after the first surgery to remove the lesion, the patient came to our clinic with a brown, pigmented lesion. Computed tomography revealed ectopic lamellar calcification of the falx cerebri, which was the conclusive factor for the diagnosis of GS. It is important that clinicians recognize the clinical signs of GS, which mainly manifests itself as multiple basal cell carcinomas in the skin. [Arch Clin Exp Surg 2015; 4(1.000: 49-53

  9. Research of CT Angiography Combined with CT Perfusion on Prognosis of Delayed Cerebral Ischemia After Onset of Subarachnoid Hemorrhage%CT血管造影联合CT灌注成像对蛛网膜下腔出血与迟发性脑缺血的相关性探讨

    Institute of Scientific and Technical Information of China (English)

    赵一平; 李松柏; 张贺; 徐克

    2013-01-01

    Objective To investigate the clinical value of CT angiography (CTA) combined with CT perfusion (CTP) on prognosis with delayed cerebral ischemia after onset of subarachnoid hemorrhage ( SAH). Methods CTP and CTA were performed in 71 patients with SAH. CTP data were analyzed using Philips Extended Brilliance Workspace Postprocessing workstation and the volume rendering (VR) images of cerebral arteries were reconstructed using advanced vessel analysis (AVA) software. Whole brain CTP maps were created using Brain Perfusion Software. CTP measurements were made on the CTP maps. CTA and CTP images were reconstructed to detect aneurysm and vasospasm. The change of CTP values on vasospasm and the relationship between perfusion characteristics and the prognosis of patients were evaluated. Results Among 71 patients, 67 cases had aneurysms which included 12 cases of two or more aneurysms; 33 cases showed severe vasospasm in CTA performance in which 14 cases occurred in the anterior cerebral artery and 19 cases occurred in the middle cerebral artery; 25 patients with the emergence of delayed cerebral ischemia (DCI) which were located in the anterior cerebral artery dominated area, accounting for 35.2% of the total number of patients with SAH. The CTP Rainbow Color Scheme had high sensitivity and specificity (78. 6% , 78% ) on diagnosis of DCI; patients with DCI whose anterior circulation cerebral blood flow in the brain had obvious hypoperfusion; these changes of cerebral blood flow and circulation time were relatively less in posterior cerebral artery circulation; the CBF which in four parameters of CTP had the highest sensi-tivity and specificity on diagnosis of DCI (72. 4% , 85. 7% ). The bad prognosis of patients had relationship with vaso-spasm, degree of vasospasm and CBF value. Conclusion CTA combined with CTP can detect the cause and vasospasm of the SAH, it can also judge the prognosis of patients on SAH.%目的 探讨CT血管造影(CTA)联合CT脑血流灌注(CTP)

  10. A report of two cases: post flood autopsy findings in urban patients with an unusual presentation of leptospirosis with hemorrhagic pneumonia in government medical college, Surat

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    Mandakini M Patel, Bhavna Gamit, R D Patel, Rahul Modi

    2011-01-01

    Full Text Available South Gujarat is endemic zone for leptospirosis in paddy workers but recently we have post flood plenty of urban patients who were presented with high grade fever, dyspnea & haemoptysis with rapid deterioration. Clinicians were suspecting an outbreak of Hantavirus or leptospirosis. Both our patients were serologically negative for leptospirosis ante mortem, but alveolar hemorrhage & raised urea was the only finding. Both our patient rapidly deteriorated. We performed autopsy & took post mortem samples for serologically & HP Examination of tissue. Serological finding showed one patient positive for PCR and second was positive for Leptocheck and IgM ELISA. On HP examination we observed massive intra-alveolar hemorrhage, interstitial nephritis, vasculitis in spleen and kidney, myocarditis & hemorrhage in various organs like heart, suprarenal gland, and subarachnoid space in both our patient. Levaditi’s stain was also performed but results were not conclusive. IHC for kidney tissue was not possible due to lack of facility. Extensive hemorrhage in lung was the cause of death in both patients. Follow up autopsy studies of 30 patients were showing same histopathological findings.

  11. Retrospective analysis of 32 cases undergoing hysterectomy due to postpartum hemorrhage%32例产后出血致子宫切除的原因及处置方式分析

    Institute of Scientific and Technical Information of China (English)

    李玲玲; 谯小勇; 谢兰; 杨业洲

    2013-01-01

    Objective To study the cause, opportunity, surgical approach and clinical treatment of hysterectomy due to postpartum hemorrhage. Methods Thirty-two cases of hysterectomy due to postpartum hemorrhage from January 2005 to December 2012 in our hospital were retrospectively analyzed. Results The placenta factor was the most common reason ( n = 18 ). In these cases, 11 cases had placenta implantation,7 cases had pernicious placenta previa (3 cases were complicated with placenta accrete) ,3 cases had placenta previa (2 cases were complicated with placenta accrete) , and 2 cases had placental abruption. The uterine factors were the second common reason (n = 12) . One case was suffered from amniotic fluid embolism and one patient from coagulation dysfunction. There were 22 cases with uterine scar in hysterectomy. Hysterectomy was performed in 21 cases,and subtotal hysterectomy in 11 cases. Conclusions Placental abnormalities followed by uterine factors are the major reasons for hysterectomy due to postpartum hemorrhage.%目的 探讨产后出血致子宫切除的原因、时机、方式及临床处理.方法 回顾性分析2005年1月至2012年12月在我院因产后出血致子宫切除的32例患者的病历资料.结果 产后出血致子宫切除胎盘因素是最多见的原因(18例),其中胎盘植入11例,凶险性前置胎盘7例(3例合并胎盘植入),前置胎盘3例(2例合并胎盘植入),胎盘早剥2例;其次为子宫因素(12例);羊水栓塞和凝血功能障碍各1例.22例为瘢痕子宫;全子宫切除术21例,次全子宫切除术11例.结论 胎盘因素是产后出血致子宫切除术的主要原因,其次为子宫因素.

  12. Dramatic resolution of vitreous hemorrhage after an intravitreal injection of dobesilate.

    Science.gov (United States)

    Cuevas, Pedro; Outeiriño, Luis Antonio; Azanza, Carlos; Angulo, Javier; Giménez-Gallego, Guillermo

    2015-01-01

    Vitreous hemorrhages are important clinical manifestations of proliferative diabetic retinopathy. Non-cleared vitreous hemorrhages could lead to hemosiderosis bulbi and glaucoma. Here, we describe the case of a type 2 diabetic patient presenting anterior segment and vitreous hemorrhages that resolved three days after treatment with a single intravitreal injection of dobesilate.

  13. Dramatic resolution of vitreous hemorrhage after an intravitreal injection of dobesilate

    Institute of Scientific and Technical Information of China (English)

    Pedro Cuevas; Luis Antonio Outeirio; Carlos Azanza; Javier Angulo; Guillermo Gimnez-Gallego

    2015-01-01

    Vitreous hemorrhages are important clinical manifestations of proliferative diabetic retinopathy. Non-cleared vitreous hemorrhages could lead to hemosiderosis bulbi and glaucoma. Here, we describe the case of a type 2 diabetic patient presenting anterior segment and vitreous hemorrhages that resolved three days after treatment with a single intravitreal injection of dobesilate.

  14. 68 cases of cesarean section hemorrhage in clinical analysis and prevention measures%68例剖宫产术中出血的临床分析与预防措施

    Institute of Scientific and Technical Information of China (English)

    杨坤

    2016-01-01

    Objective To investigate the causes and preventive measures of hemorrhage during cesarean section.Methods 68 cases of postpartum hemorrhage during cesarean section were selected from January 2015 to November 2015. The clinical data were retrospectively analyzed. The causes of bleeding during cesarean section were analyzed, and the effective measures were given.Results 68 cases of cesarean section surgery bleeding women due to placental factors produce maternal bleeding in 22 cases(32.4%); because of blood coagulation disorders produce maternal hemorrhage in 14 cases(21.9%), due to incision and produce abnormal maternal hemorrhage 12 cases(17.6%); uterine inertia due to produce maternal hemorrhage in 16 cases(23.5%); due to uterine fibroids have maternal bleeding in 4 cases(5.9%).Conclusion Cesarean section caused by placental factors, coagulation dysfunction, abnormal incision and uterine atony, are the main factors of hemorrhage during cesarean section should be in the perinatal period to take corresponding preventive measures according to the specific situation of the maternal and maternal formulation scientific and reasonable treatment method, ensure the cesarean section operation smoothly.%目的:探讨剖宫产术中出血原因以及预防措施。方法选取2015年1月~2015年11月收治的剖宫产术中出血产妇68例,对其临床资料进行回顾性分析,分析剖宫产术中出血原因,并给出切实有效的预防措施。结果68例剖宫产术中出血产妇中因胎盘因素产生出血的产妇22例(32.4%);因凝血障碍产生出血的产妇14例(21.9%);因切口异常产生出血的产妇12例(17.6%);因宫缩乏力产生出血的产妇16例(23.5%);因子宫肌瘤产生出血的产妇4例(5.9%)。结论剖宫产手术中引发产妇术中出血的因素主要有胎盘因素、凝血功能障碍、切口异常以及宫缩乏力等,应该在围产期根据产妇具体情况采取相对应的预防措

  15. Pulmonary hemorrhage resulting from leptospirosis

    Directory of Open Access Journals (Sweden)

    Mauro Razuk Filho

    2016-07-01

    Full Text Available Leptospirosis is one of the most widespread zoonoses in the world, although the mechanisms responsible for the pathogenesis of spirochetes of the genus Leptospira are largely unknown. Human infection occurs either by direct contact with infected animals or indirectly, through contact with water or soil contaminated with urine, as the spirochetes easily penetrate human skin. The present report exposes the case of a female patient, diagnosed with leptospirosis after having had contact with a dog infected by Leptospira sp. that developed pulmonary hemorrhage, acute respiratory distress syndrome and acute renal failure.

  16. Increased Intensity of Physical Therapy for a Child with Gross Motor Developmental Delay: A Case Report

    Science.gov (United States)

    Schreiber, Joe

    2004-01-01

    Background and Purpose: The intensity of physical therapy provided for children in early intervention (EI) programs may be influenced by a number of factors. In an individualized program, however, some children and families may benefit from an increased frequency of services. The purpose of this case report was to systematically document and…

  17. Delayed-onset of multiple cutaneous infantile hemangiomas due to propranolol: a case report.

    Science.gov (United States)

    Porcel Chacón, Rocío; del Boz González, Javier; Navarro Morón, Juan

    2015-04-01

    Infantile hemangiomas are the most common vascular tumors in childhood. In view of its proven effectiveness in such cases, propranolol is the drug of choice. We present the case of a male infant who started treatment with propranolol shortly after birth due to heart disease. After 7 months, when the patient had suffered various respiratory exacerbations, this treatment was suspended. One week later, multiple skin lesions (ie, multifocal infantile hemangiomas) began to appear, with no extracutaneous involvement. It was decided to resume treatment with propranolol, although at lower doses than before, and the skin lesions improved rapidly, with some disappearing completely. Treatment was definitively withdrawn at age 16 months, with only slight recurrence of the lesions. The case described is of multifocal infantile hemangiomas without extracutaneous involvement appearing beyond the neonatal period after treatment with propranolol beginning in the first days of life. The details of the case support the hypothesis that this drug is not only therapeutic but also plays a prophylactic role against infantile hemangiomas. In turn, this supports the recent proposal that this drug may be useful in preventing the growth and spread of tumors with high angiogenic potential. It is postulated that the inhibition of β-adrenergic receptors is associated with multiple intracellular processes related to the progression and metastasis of different tumors.

  18. Delayed duodenal obstruction after intramural hematoma in a patient with paroxysmal nocturnal hemoglobinuria: A case report

    Directory of Open Access Journals (Sweden)

    Tugan Tezcaner

    2014-01-01

    CONCLUSION: We report a rare intestinal obstruction case caused by stricture at the level of ligamentum Treitz with PNH. The possibility simply has to be borne in mind that strictures can be occurring at hematoma, ischemia or inflammation site of gastrointestinal tract.

  19. Achromobacter xylosoxidans mesh related infection: a case of delayed diagnosis and management.

    Science.gov (United States)

    Gupta, Vishal; Nirkhiwale, Suhas; Gupta, Parul; Phatak, Satish

    2012-03-01

    We present the first case of mesh related infection caused by Achromobacter xylosoxidans after ventral hernia repair. After repair of a small paraumbilical hernia, the postoperative course was complicated by persistent discharging sinuses despite the removal of underlying polypropylene mesh. Removal of an intrabdominal omental inflammatory mass containing pus that showed growth of A. xylosoxidans led to the resolution of all the symptoms.

  20. Delayed Diagnosis of Osteonecrosis of the Jaw (ONJ Associated with Bevacizumab Therapy in Colorectal Cancer Patients: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Francesco Erovigni

    2016-10-01

    Full Text Available Medication-induced Osteonecrosis of the Jaw (MRONJ has been reported not only after use of antiresorptive agents (bisphosphonates and denosumab, but also in cancer patients receiving antiangiogenic agents, alone or combined with antiresorptive drugs. We report two cases of MRONJ observed in colorectal cancer patients after bevacizumab therapy only. MRONJ was diagnosed, respectively, two and seven months after a tooth extraction; both the patients had received two courses of bevacizumab infusions (for a total of 29 and 10 administrations, respectively. We discuss if tooth extraction during or after antiangiogenic therapy could be a potential trigger of MRONJ, but also if an underlying bone disease not evident before oral surgery might be a possible cause. A careful drug history has to be registered by dental specialists in cancer patients before oral surgery and adequate imaging might be obtained to avoid a delayed diagnosis.

  1. The effect of steroids for the treatment of delayed urological involvement arising from radiation therapy; A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kawano, Shinichi; Tasaki, Yoshihisa; Fukunaga, Yoshikazu (Oita National Hospital (Japan))

    1992-07-01

    A 55-year-old woman visited our hospital with the chief complaint of high fever. She had received whole pelvic radiation therapy following radical hysterectomy 22 years earlier. Excretory urography revealed bilateral severe hydrone phrosis. Urological examinations were carried out. Urethral stricture and marked small bladder were found. This case was diagnosed as delayed urological involvement arising from radiation therapy complicated with neurogenic bladder. Prednisolone at a total dose of 1,060 mg was administered over 51 days under indwelling catheters to the urethra and to both ureters. The function of the urinary bladder has been maintained at an improved level over a period of 2 months following the removal of the ureteral and urethral catheters. (author).

  2. Evaluation of multi-professional obstetric skills training for postpartum hemorrhage

    DEFF Research Database (Denmark)

    Markova, Veronika; Sørensen, Jette Led; Holm, Charlotte

    2012-01-01

    To evaluate the effect of multi-professional obstetric skills training on the incidence of postpartum hemorrhage (PPH) indicated by red blood cell (RBC) transfusion and time delay in surgical interventions before, during, and after implementation of the training.......To evaluate the effect of multi-professional obstetric skills training on the incidence of postpartum hemorrhage (PPH) indicated by red blood cell (RBC) transfusion and time delay in surgical interventions before, during, and after implementation of the training....

  3. Superficial siderosis is a warning sign for future intracranial hemorrhage.

    Science.gov (United States)

    Linn, Jennifer; Wollenweber, Frank A; Lummel, Nina; Bochmann, Katja; Pfefferkorn, Thomas; Gschwendtner, Andreas; Bruckmann, Hartmut; Dichgans, Martin; Opherk, Christian

    2013-01-01

    Supratentorial superficial siderosis (SS) is a frequent imaging marker of cerebral amyloid angiopathy (CAA). It is most probably caused by focal subarachnoid hemorrhages (fSAHs). Based on single-case observations, it has been proposed that such fSAHs might be a predisposing factor for future intracranial hemorrhage. Here we tested the hypothesis if a SS as a residue of fSAHs must be regarded as a warning sign for future intracranial hemorrhage. Fifty-one consecutive patients with SS and no apparent cause other than possible or probable CAA were identified through a database search and followed-up for a median interval of 35.3 months (range 6-120 months). Main outcome measures were rate and location of new intracranial hemorrhages. Twenty-four patients (47.1 %) had experienced any new intracranial hemorrhage, 18 patients (35.3 %) had an intracerebral hemorrhage (ICH), and in 13 of them (25.5 %), the hemorrhage was located at the site of pre-existing siderosis. Six patients (11.7 %) had developed a new subarachnoid hemorrhage (SAH), four of them at the site of siderosis. Patients with SS are at substantial risk for subsequent intracranial hemorrhage. SS can be considered a warning sign of future ICH or SAH, which frequently occur adjacent to pre-existing SS. Prospective studies are needed to confirm these findings.

  4. 青年脑出血128例的病因、危险因素及预后分析%Analysis of the etiology,risk factors and prognosis of youth cerebral hemorrhage in 128 cases

    Institute of Scientific and Technical Information of China (English)

    徐新良

    2015-01-01

    Objective:To explore the etiology,risk factors and prognosis of youth cerebral hemorrhage.Methods:The clinical data of 128 patients with youth cerebral hemorrhage were retrospectively analyzed.Results:99 cases(77.34% ) had definite etiology, including 43 cases(33.59% ) of hypertension,36 cases(28.13% ) of arteriovenous malformation,12 cases(9.38% ) of internal medicine diseases,6 cases(4.69%) of hematological system diseases,2 cases(1.56%) of pregnancy status.29 cases(22.67%) were unknown cause.The main risk factors were smoking,drinking.32 cases(25% ) were cured,50 cases(39.06% ) were improved,22 cases(17.19%) were unrecovered,24 cases(18.75%) were death.Conclusion:Hypertension,cerebral vascular malformation are the main causes of youth cerebral hemorrhage,its clinical symptoms are heavier,most patients have good prognosis.%目的:探讨青年脑出血的病因、危险因素及预后。方法:对128例青年脑出血患者的临床资料进行回顾性分析。结果:有明确病因99例(77.34%),其中高血压43例(33.59%),动静脉畸形36例(28.13%),内科疾病12例(9.38%),血液系统疾病6例(4.69%),妊娠状态2例(1.56%);原因不明29例(22.67%)。主要危险因素有吸烟、饮酒。痊愈32例(25%),好转50例(39.06%),未愈22例(17.19%),死亡24例(18.75%)。结论:高血压病、脑血管畸形是青年脑出血的主要病因,临床症状表现较重,大多数患者预后良好。

  5. Delay in Clamping Umbilical Cord Benefits Babies, Doctors Say

    Science.gov (United States)

    ... doctors' group said. Although delayed clamping increases the newborn's risk of jaundice that will require treatment, ACOG said there's no evidence that waiting increases the mother's risk of hemorrhage. The guidelines are to be published in the ...

  6. Subarachnoid Hemorrhage Presenting with Seizure due to Cerebrospinal Fluid Leakage after Spinal Surgery.

    Science.gov (United States)

    Bozkurt, Gokhan; Yaman, Mesut Emre

    2016-01-01

    Cerebrospinal fluid leakage may commonly occur during spinal surgeries and it may cause dural tears. These tears may result in hemorrhage in the entire compartments of the brain. Most common site of such hemorrhages are the veins in the cerebellar region. We report a case of hemorrhage, mimicking aneurysmal subarachnoid hemorrhage due to a cerebrospinal fluid leakage following lumbar spinal surgery and discuss the possible mechanisms of action.

  7. Subtotal tongue necrosis in delayed diagnosed giant-cell arteritis: a case report.

    Science.gov (United States)

    Biebl, Matthias Oliver; Hugl, Beate; Posch, Lydia; Tzankov, Alexandar; Weber, Florian; Perkmann, Reinhold; Fraedrich, Gustav

    2004-01-01

    Giant-cell arteritis (GCA) is a chronic systemic vasculitis of large- and medium-sized vessels, mainly affecting elderly patients. Headache, vision impairment, jaw claudication, and scalp tenderness are common symptoms. However, diagnosis can be difficult because GCA can affect almost every vascular pathway and lead to a variety of possible manifestations. We report the case of a belated diagnosed GCA, resulting in nearly complete necrosis of the mobile part of the tongue, visual impairment, and neurologic as well as intestinal ischemic symptoms. Aggressive immunosuppressive treatment resolved the symptoms, but the patient remained severely morbid because of bilateral necrosis of the mobile part of the tongue. In any case of unclear ischemic symptoms in an elderly patient, one must keep GCA in mind as the possible culprit disease.

  8. A case of extreme prematurity and delayed diagnosis of pyridoxine-dependent epilepsy.

    Science.gov (United States)

    Al-Saman, Abdulaziz S; Rizk, Tamer M

    2012-10-01

    Pyridoxine-dependent epilepsy presents early in life, even in utero. It is usually refractory to conventional antiepileptic medications and responds only to lifelong pyridoxine supplementation. Seizures are usually generalized tonic clonic. We report a 3-year-old child that was born prematurely at 25 weeks of gestation. He presented with abnormal movements in the second month of life. At 10 months of age he presented with status epilepticus, which was refractory to multiple antiepileptic medications and was controlled with intravenous pyridoxine. An elevated level of a-aminoadipic semialdehyde excretion in the urine supported the diagnosis of pyridoxine-dependent epilepsy. Subsequently, a c.1195G>C homozygous mutation in the 5q31 aldehyde dehydrogenase 7A1 gene was confirmed. This case calls for considering pyridoxine-dependent epilepsy and its early management in cases with resistant seizures; even in the presence of extreme prematurity with its neurological consequences.

  9. Delayed diagnosis of isolated alar ligament rupture:A case report

    Institute of Scientific and Technical Information of China (English)

    Robin; A; Kaufmann; Ingo; Marzi; Thomas; J; Vogl

    2015-01-01

    Ligament disruptions at the craniovertebral junction are typically associated with atlantoaxial rotatory dislocation during upper cervical spine injuries and require external orthoses or surgical stabilization. Only in few patients isolated ruptures of the alar ligament have been reported. Here we present a further case, in which the diagnosis was initially obscured by a misleading clinical symptomatology but finally established six month following the trauma, demonstrating the value of contrast-enhanced high resolution 3 Tesla magnetic resonance imaging in identifying this particular lesion.

  10. Unilateral delayed opercularization in a case of Sotos' syndrome (cerebral gigantism)

    Energy Technology Data Exchange (ETDEWEB)

    Barth, P.G.; Vlasveld, L.; Valk, J.

    1980-08-01

    A case of Sotos' syndrome (cerebral gigantism) is described. Pneumencephalography, performed at the age of 15 days, revealed abnormal separation of the opercula on the right. By comparing the contours with developmental anatomical features of this area it agreed with a foetal development of 24 weeks gestational age. Bilateral carotid angiography was normal. CT showed normal development of the Sylvian area at the age of 27 months.

  11. 283 例中央性前置胎盘产后出血高危因素分析%Analysis of 283 case of central placenta previa in patients with high-risk factors of postpartum hemorrhage

    Institute of Scientific and Technical Information of China (English)

    贾红梅; 胡贵平; 徐华东; 张永明; 陈斌; 马遥

    2015-01-01

    目的:观察中央性前置胎盘的临床表现及结局,探讨其产后出血的高危因素. 方法:回顾性分析我院2006年9月至2015年6月283例中央性前置胎盘患者的临床资料,根据是否并发产后出血而分为2组. 结果:产后出血组114例,产后未出血组169例;产后出血组的产前出血率、人工流产史发生率以及并发胎盘粘连、胎盘植入率均显著高于产后未出血组(P <0.05);Logistic 回归分析表明,双胎(OR =10.94,95%CI:1.120~106.871)、妊娠期合并胎盘粘连(OR=4.11, 95%CI:0.946~17.852)、产前出血(OR=2.60,95%CI:1.328~5.089)、产检次数(OR =1.13,95%CI: 1.026 ~1.243)以及并发贫血(OR =2.37,95%CI:1.078~5.206 )均是孕产妇发生产后出血的高危险因素,而高龄初产( OR=0.35 ,95%CI:0.117~1.057 )、妊娠期合并瘢痕子宫( OR=0.285 ,95%CI:0.057~1.441 )为中央性前置胎盘并发产后出血的保护因素. 结论:中央性前置胎盘常并发多种不良妊娠结局;双胎、妊娠期合并胎盘粘连、产前出血、并发贫血等可能为其并发产后出血的高危因素,高龄初产、妊娠期合并瘢痕子宫可能是中央性前置胎盘并发产后出血的保护因素.%Objective:To observe the clinical manifestation and outcome of central placenta previa and further explore the risk factors of postpartum hemorrhage with central placenta previa .Methods:283 patients with central placenta previa in our hospital between September ,2006 to June,2015 were retrospectively analyzed .According to the circumstance of postpartum hemorrhage , they were divided into two groups , postpartum hemorrhage group and no postpartum hemorrhage .Results: There were 114 cases in postpartum hemorrhage group and 169 cases in no postpartum hemorrhage group . Compared with no postpartum hemorrhage group , the rate of antepartum haemorrhage, abortion, placenta conglutination and placenta implantation were significantly higher in postpartum hemorrhage group ( P<0.05) .Logistic

  12. Fatal case of hemolytic-uremic syndrome in an adult due to a rare serogroup O91 Entero hemorrhagic Escherichia coli associated with a Clostridium difficile infection. More than meets the eye.

    Science.gov (United States)

    Guillard, Thomas; Limelette, Anne; Le Magrex-Debar, Elisabeth; Wynckel, Alain; Gouali, Malika; Mariani-Kurkdjian, Patricia; Guyot-Colosio, Charlotte; de Champs, Christophe

    2015-08-01

    Hemolytic-uremic syndrome due to enterohemorrhagic Escherichia coli, belonging to serogroup O91 has rarely been described. We report here a case of post-diarrheal HUS due to EHEC O91 in an elderly patient for whom diagnosis was delayed given a previously diagnosed C. difficile infection. This case highlights the usefulness of Shiga-toxin detection.

  13. Fatal case of hemolytic-uremic syndrome in an adult due to a rare serogroup O91 Entero hemorrhagic Escherichia coli associated with a Clostridium difficile infection. More than meets the eye

    Directory of Open Access Journals (Sweden)

    Thomas Guillard

    2015-08-01

    Full Text Available Hemolytic-uremic syndrome due to enterohemorrhagic Escherichia coli, belonging to serogroup O91 has rarely been described. We report here a case of post-diarrheal HUS due to EHEC O91 in an elderly patient for whom diagnosis was delayed given a previously diagnosed C. difficile infection. This case highlights the usefulness of Shiga-toxin detection.

  14. Diabetes with hypertension as risk factors for adult dengue hemorrhagic fever in a predominantly dengue serotype 2 epidemic: a case control study.

    Directory of Open Access Journals (Sweden)

    Junxiong Pang

    Full Text Available BACKGROUND: Dengue hemorrhagic fever (DHF is a severe form of dengue, characterized by bleeding and plasma leakage. A number of DHF risk factors had been suggested. However, these risk factors may not be generalized to all populations and epidemics for screening and clinical management of patients at risk of developing DHF. This study explored demographic and comorbidity risk factors for DHF in adult dengue epidemics in Singapore in year 2006 (predominantly serotype 1 and in year 2007-2008 (predominantly serotype 2. METHODS: A retrospective case-control study was conducted with 149 DHF and 326 dengue fever (DF patients from year 2006, and 669 DHF and 1,141 DF patients from year 2007-2008. Demographic and reported comorbidity data were collected from patients previously. We performed multivariate logistic regression to assess the association between DHF and demographic and co-morbidities for year 2006 and year 2007-2008, respectively. RESULTS: Only Chinese (adjusted odds ratio [AOR] = 1.90; 95% confidence interval [CI]: 1.01-3.56 was independently associated with DHF in year 2006. In contrast, age groups of 30-39 years (AOR = 1.41; 95% CI:1.09-1.81, 40-49 years (AOR = 1.34; 95% CI:1.09-1.81, female (AOR = 1.57; 95% CI:1.28-1.94, Chinese (AOR = 1.67; 95% CI:1.24-2.24, diabetes (AOR = 1.78; 95% CI:1.06-2.97, and diabetes with hypertension (AOR = 2.16; 95%CI:1.18-3.96 were independently associated with DHF in year 2007-2008. Hypertension was proposed to have effect modification on the risk of DHF outcome in dengue patients with diabetes. Chinese who had diabetes with hypertension had 2.1 (95% CI:1.07-4.12 times higher risk of DHF compared with Chinese who had no diabetes and no hypertension. CONCLUSIONS: Adult dengue patients in Singapore who were 30-49 years, Chinese, female, had diabetes or diabetes with hypertension were at greater risk of developing DHF during epidemic of predominantly serotype 2. These risk factors

  15. 原发性蛛网膜下腔出血502例临床分析%Clinical analysis of 502 cases of subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    陈兴泳; 唐荣华; 陈云; 张旭; 雷惠新; 汪银洲

    2009-01-01

    Objective To summarize the clinical and imaging features of subarachnoid hemorrhage(SAH) and its complications and prognosis. Methods The clinical data of 502 cases of SAH were retrospectively analyzed and summarized. Results There were 84.3 % (423/496) patients sufferring from intense headache, dizziness or vertigo (13. 1%, 66/496 ), disturbance of consciousness ( 27. 5%, 138/496 ), partial neurologic impairment (58.2% ,292/496) ,meningeal irritation sign(72.5% ,364/496). The positive rate of digital subtraction angiogra-phy was 54.1% (93/172). Aneurysm was the common reason of SAH (20. 1%, 101/496). Prognosis in most pa-tients was better,but the old patients suffered from high mortality. Conclusions The cause and clinical manifesta-tion of SAH varies,cerebral angiography often could help find the cause of SAH. Most SAH patients recover well.%目的 总结原发性蛛网膜下腔出血(SAH)的临床特点、影像学特征、并发症和预后.方法 回顾性分析总结502例SAH患者的临床资料.结果 84.3%(423/496)患者以剧烈头痛为主要症状,13.1%(66/496)出现头晕或眩晕,意识障碍占27.5%(138/496),局灶性神经功能缺损体征58.2%(292/496),脑膜刺激征阳性72.5%(364/496),数字减影血管造影术检查阳性率54.1%(93/172),病因以动脉瘤最常见占20.1%(101/496).绝大部分预后好,老年人病死率高.结论 SAH病因复杂,临床表现多样化,脑血管造影常可明确病因,多数患者恢复良好.

  16. [Gastrontestinal hemorrhage following thoracic surgery].

    Science.gov (United States)

    Durić, O; Tvrtković, R; Budalica, M

    1976-01-01

    The authors discuss eight cases who suffered hemorrhaging stress ulcers out of 200 cases on whom Thoracotomies were performed. Presented is the common factor of the onset of this complication, it's diagnosis, and therapy. Listed below are the diagnoses and operative procedures used on these eight patients. Cysta Aerea Permagna Lobi Inf. Pulm. Dexter/operation: Mytomis Longitudinalis Ooesophagi. Caverna Bronchiectatica Permagna Lobi Inferior Pulmo Dexter/operation: Lobestomia Typica. Echinococcus Heaptis Complicatus, Empyema Pleurae Dexter/opetation: Decorticatio. Haemathorax Spontaneous Lobus Sinister/operation: Decorticatio Pleurae Sinister. Echi Comp. Cupolae Hepatis Permagnus/operation: Thoracotomia Phrenotomia, evacuatio, Triplex Drainage. Bronchiectasiae Lobi Medius et Inferior Pulmo Dexter/operation: Biblobectomia Typica. Carcinoma Bronchi Lobi Inferior Pulmo Dexter/operation: Lobectomia Typica. Gastric problems had troubled four of these eight patients in their past history. Bleeding in three patients occurred three days postoperatively, and in the remaining five, thirty days following their operation. Six patients had to be treated conservatively because of serious contraindications to reoperation. Four of them expired. Autopsy revealed: Pyothorax, Dehiscention Bronchi, Empyema, and Gastritis Errosiva with multiulcerations, hemoragia, and dilatation of the right heart. Two patients with recent stress ulcers were reoperated on, and were cured. The authors estimate that the occurrence of hemorrhaging stress ulcer following thoracic surgery are basically due to Hypoxia. The chain of events whic brought about the stress ulcer, however, began even before the operation, continued throughout the operation, and appeared postoperatively due to postoperative complications. The authors point out that these complications can be foreseen (early and late), but firstly, an attempt should be made to treat the patient with conservative therapy. Inasmuch as the hemorrhaging

  17. Analysis of 65 cases of emergency internal medicine therapeutic effect in the treatment of sudden cerebral hemorrhage%急诊内科治疗65例突发性脑出血的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    陈杰

    2014-01-01

    ObjectiveTo investigate the clinical efifcacy of the treatment and analysis emergency internal medicine sudden cerebral hemorrhage.Methods 65 cases of sudden cerebral hemorrhage patients were selected and retrospectively analyzed in our hospital from 2012 december to 2013 december. they were treated with the emergency internal medicine.Results after the emergency internal medicine treatment, 33 cases of 65 patients with sudden cerebral hemorrhage were cured (50.77%), effective in 19 cases (29.23%), the total effective rate was 80%; 5 cases (7.69%) with sequelae of different degree of limb movement disorder and epilepsy. Because the special bleeding position 8 cases (12.31%) showed re-bleeding, following by the complications such as oppression and life central cerebral edema, pulmonary infection, alimentary tract hemorrhage and even death.Conclusioncorrect understanding and mastering the clinical manifestations in patients with symptoms in sudden cerebral hemorrhage and given treatment measures of the emergency internal medicine can reduce the morbidity and mortality of patients with sudden cerebral hemorrhage and improve the survival rate and the quality of life in cured patients.%目的:探讨和分析急诊内科治疗突发性脑出血的临床疗效。方法随机抽取我院2012年12月至2013年12月急诊内科收治的65例突发性脑出血患者的资料,进行回顾性分析。结果通过急诊内科的治疗,65例突发性脑出血患者,治愈33例(50.77%),有效19例(29.23%),总有效率为80%;5例(7.69%)患者留下肢体运动障碍、癫痫等不同程度的后遗症;8例(12.31%)患者因出血位置比较特殊,再次出血压迫生命中枢并出现脑水肿、肺部感染、消化道出血等并发症而死亡。结论正确的了解和掌握突发性脑出血患者的症状、临床表现以及急诊内科的诊疗措施,才能降低突发性脑出血患者的致残率和致死率,提高治愈率及患者的生存质量。

  18. Use of CO2 as an angiographic contrast material in the diagnosis of acute hepatic hemorrhage a case report; Uso del CO2 como medio de contraste angiografico en el diagnostico de hemorragia hepatica aguda: a proposito de un caso

    Energy Technology Data Exchange (ETDEWEB)

    Gallardo, L.; Gorriz, E.; Pardo, M. D.; Reyes, R. [Hospital General de Gran Canaria. Dr. Negrin. Canarias (Spain)

    2001-07-01

    Selective abdominal arteriography with an iodinated contrast material is the method of choice for detecting the site of bleeding in patients with acute gastrointestinal hemorrhage in whom the results of endoscopic examination were negative CO{sub 2}, has been used successfully as a contrast material for arteriography of abdomen and lower limbs. We present the case of a patient in whom suspected gastrointestinal bleeding was detected more rapidly and reliably with co{sub 2} than with an iodinated contrast material. (Author) 18 Refs.

  19. Hemorrhagic intra splenic pseudocyst as a complication of chronic pancreatitis in acute phase - a case report; Pseudocisto intra-esplenico hemorragico como complicacao de pancreatite cronica agudizada - relato de um caso

    Energy Technology Data Exchange (ETDEWEB)

    Almeida, Fabiola Assuncao de; Marchiori, Edson; Mello, Walter de Assis; Nogueira, Aline Silva; Sales, Anderson Ribeiro; Martins, Renata Romano; Santos, Tereza Cristina C.R.S. dos [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia

    1999-03-01

    The authors report a case of hemorrhagic intra splenic pseudocyst as a complication of chronic pancreatitis in acute phase. A 43-year-old woman, chronic alcoholic, who had pancreatitis 5 years ago, with symptoms of strong abdominal pain in the epigastrium, nausea and fever. Abdominal sonography showed a lesion contiguous to the spleen and computed tomography demonstrated an heterogeneous lesion of not well defined limits, in the lateral and posterior parts of the spleen. The patient was submitted to Roux-Y cystojejunostomy, he does not present any symptoms at the moment, and is undergoing clinical control. (author)

  20. Dengue hemorrhagic fever complicated by pancreatitis

    Directory of Open Access Journals (Sweden)

    Guido Ricardo Gonzalez Fontal

    2011-10-01

    Full Text Available Acute pancreatitis is an atypical complication of dengue fever and is rarely described. We are reporting a case of dengue hemorrhagic fever complicated by acute pancreatitis in a patient with history of diabetes mellitus type 1 and end stage renal disease on hemodialysis.

  1. Unilateral adrenal hemorrhagic infarction in essential thrombocythemia.

    Science.gov (United States)

    Burnet, G; Lambert, M; Annet, L; Lefebvre, C

    2015-12-01

    Adrenal hemorrhage is a rare disease associated with various conditions. We report a case of a 68-year-old woman with abdominal and back pain. The diagnostic work-up showed a left adrenal gland infarction associated with essential thrombocythemia. Treatment consisted in painkillers and treating the underlying condition in order to prevent further thrombotic events.

  2. Delayed gait recovery in a stroke patient

    Institute of Scientific and Technical Information of China (English)

    Jeong Pyo Seo; Mi Young Lee; Yong Hyun Kwon; Sung Ho Jang

    2013-01-01

    We report on a stroke patient who showed delayed gait recovery between 8 and 11 months after the onset of intracerebral hemorrhage. This 32-year-old female patient underwent craniotomy and drainage for right intracerebral hemorrhage due to rupture of an arteriovenous malformation. Brain MR images revealed a large leukomalactic lesion in the right fronto-parietal cortex. Diffusion tensor tractography at 8 months after onset revealed that the right corticospinal tract was severely injured. At this time, the patient could not stand or walk despite undergoing rehabilitation from 2 months after onset. It was believed that severe spasticity of the left leg and right ankle was largely responsible, and thus, antispastic drugs, antispastic procedures (alcohol neurolysis of the motor branch of the tibial nerve and an intramuscular alcohol wash of both tibialis posterior muscles) and physical therapy were tried to control the spasticity. These measures relieved the severe spasticity, with the result that the patient was able to stand at 3 months. In addition, the improvements in sensorimotor function, visuospatial function, and cognition also seemed to contribute to gait recovery. As a result, she gained the ability to walk independently on even floor with a left ankle foot orthosis at 11 months after onset. This case illustrates that clinicians should attempt to find the months after onset.

  3. ROLE OF INTERNAL ILIAC ARTERY LIGATION IN CONTROL OF PELVIC HEMORRHAGE.

    Directory of Open Access Journals (Sweden)

    Vidyadhar Bangal

    2009-06-01

    Full Text Available Hemorrhage in pregnancy is the leading cause of maternal mortality in developing countries. Internaliliac artery ligation is one of the life saving procedures in intractable pelvic hemorrhage. Althougheffective, the procedure is not commonly performed by obstetricians and gynecologists. Present paper aims at sharing author’s experience about usefulness of this surgical procedure in arrest of pelvic hemorrhage and to remove the inhibition among practicing gynecologists regarding this procedure.Fifty four cases of pelvic hemorrhage were managed by internal iliac artery ligation over 15 year period at tertiary care center. Hemorrhage could be arrested in all cases.

  4. Seat belt syndrome: Delayed or missed intestinal injuries, a case report and review of literature

    Science.gov (United States)

    Al-Ozaibi, Labib; Adnan, Judy; Hassan, Batool; Al-Mazroui, Alya; Al-Badri, Faisal

    2016-01-01

    Introduction Seat belt injuries are not uncommon. The use of seat belts is associated with a unique injury profile collectively termed “the seat belt syndrome”. The aim is to aid in the early diagnosis of seat belt injuries. Case presentation Two different patients presented to the emergency after sustaining a motor vehicle accident. Both were the drivers, restrained and had a frontal impact. On presentation they were hemodynamically stable with mild tenderness on the abdomen and the abdominal computed tomography (CT) did not show any signs of bowel or mesenteric injuries. The signs of peritonitis became obvious after 24 h in one case and after 3 days in the other. Discussion Early diagnosis provides better outcomes for patients with seat belt injuries, but this remains a challenge to trauma surgeons. The typical findings of peritonitis might not be present initially. The presence of abdominal wall ecchymosis (seat belt sign) increases the chance of intraabdominal injuries by eight folds. Conclusion Clinical signs of intestinal injuries might not be obvious on presentation. In the presence of seat belt sign the possibility of bowl injury must be suspected. Admit the patient for observation even if no clinical or radiological findings are present at presentation. PMID:26826929

  5. Delayed orthodontic extrusion of a traumatically intruded immature upper permanent incisor - a case report.

    Science.gov (United States)

    Umesan, Uday Kumar; Chua, Kui Lay; Kok, Ei Chuen

    2014-10-01

    Dental injuries are probably the most common orofacial injuries sustained during sports and play. Intrusion or intrusive luxations occur when the teeth are driven into the alveolus by an axially directed impact. This article describes the clinical case of an 8-year-old patient who suffered complete intrusive luxation of an immature permanent central incisor following an accident. An attempt at spontaneous re-eruption failed to facilitate re-emergence of the tooth beyond 2 mm. The recommended wait-and-see strategy in anticipation of spontaneous re-eruption should cease to be an option when no further elongation can be observed. Orthodontic extrusion or surgical re-positioning is a valid treatment alternative when the former fails. In this case, although the recommended time period for effecting orthodontic extrusion had elapsed, this procedure was undertaken successfully presumably owing to the application of controlled, biologically optimal forces. A review of the extruded tooth a year later revealed no clinical or radiographic signs of loss of vitality. This was confirmed radiographically by the completion of root development, an intact lamina dura and no evident signs of resorption.

  6. Primary pleural malignant mesothelioma with delayed metastasis to the piriform sinus: report of a case.

    Science.gov (United States)

    Taskin, Umit; Yigit, Ozgur; Aricigil, Mithat; Huq, Gulben

    2013-06-01

    Piriform sinus tumors are uncommon and silent lesions. Their prognosis is poor because these tumors are usually not detected until they have reached an advanced stage. Almost all piriform sinus cancers are primary squamous cell carcinomas; other primary and metastatic tumors of the hypopharynx are exceedingly rare. One of the rare tumors in the laryngopharyngeal area is sarcomatoid carcinoma, which is an unusual type of squamous cell carcinoma. Another uncommon malignant tumor that is histologically similar to sarcomatoid carcinoma is malignant mesothelioma, which is a rare form of lung carcinoma. The macroscopic appearance and histologic characteristics of sarcomatoid carcinoma and malignant mesothelioma are so similar that differentiation is usually achieved by immunohistochemical examination. To the best of our knowledge, no case of primary or metastatic laryngohypopharyngeal malignant mesothelioma has been previously reported in the literature. In this article, we describe a case of isolated malignant mesothelioma of the piriform sinus that resembled a sarcomatoid carcinoma in a 50-year-old man with a history of lung mesothelioma.

  7. Complications of hemorrhagic and ischemic stroke : a CT perfusion evaluation

    NARCIS (Netherlands)

    Dankbaar, J.W.

    2010-01-01

    In this thesis the use of CT-perfusion (CTP) imaging in the evaluation of the most severe complications of subarachnoid hemorrhage (SAH)) and ischemic stroke was explored. These complications are delayed cerebral ischemia (DCI) after SAH and damage to the blood-brain barrier (BBB) after ischemic str

  8. Cardiac dysfunction after aneurysmal subarachnoid hemorrhage : Relationship with outcome

    NARCIS (Netherlands)

    van der Bilt, Ivo; Hasan, Djo; van den Brink, Renee; Cramer, Maarten-Jan; van der Jagt, Mathieu; van Kooten, Fop; Meertens, John; van den Berg, Maarten; Groen, Rob; ten Cate, Folkert; Kamp, Otto; Goette, Marco; Horn, Janneke; Groeneveld, Johan; Vandertop, Peter; Algra, Ale; Visser, Frans; Wilde, Arthur; Rinkel, Gabriel

    2014-01-01

    OBJECTIVE: To assess whether cardiac abnormalities after aneurysmal subarachnoid hemorrhage (aSAH) are associated with delayed cerebral ischemia (DCI) and clinical outcome, independent from known clinical risk factors for these outcomes. METHODS: In a prospective, multicenter cohort study, we perfor

  9. Computed tomography in hypertensive cerebellar hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Nose, T.; Maki, Y.; Ono, Y.; Yoshizawa, T.; Tsuboi, K. (Tsukuba Univ., Sakura, Ibaraki (Japan))

    1981-11-01

    Fourteen cases of cerebellar hemorrhage were analysed from the point of CT-scan, and the following results were obtained. 1. The number of cases of cerebellar hemorrhage forms 4.4% of that of total intracranial hemorrhage. 2. Most of the cerebellar hematomas extend upward. Downward extension is rare. 3. In acute dead cases hematomas are 5 cm or more in diameter and lie over bilateral hemispheres with the extension to third or fourth ventricles in CT-scans. 4. Slowly progressive cases are detriorated by the secondary hydrocephalus. 5. In mild cases hematomas are 3cm or less in diameter on CT-scans and the hematoma evacuation is not indicated for these cases. 6. The shunt operation alone is sufficient for the life saving of the slowly progressive cases, but the hematoma evacuation is indicated in these cases if the functional prognosis is taken into consideration. 7. Immediate hematoma evacuation together with the ventricular drainage is considered to be effective for the life saving of the acute fulminant cases.

  10. Mediastinal hemorrhage: An evaluation of radiographic manifestations

    Energy Technology Data Exchange (ETDEWEB)

    Woodring, J.H.; Loh, F.K.; Kryscio, R.J.

    1984-04-01

    Eleven common radiographic signs of mediastinal hemorrhage were evaluated by two observers for the following three patient groups: normal subjects, patients with mediastinal hemorrhage and no arterial injury, and patients with major thoracic arterial injury. Supine chest radiographs were studied in all cases. Four major conclusions can be made based upon these finding. M/C ratio (mediastinal width to chest width), tracheal deviation, left hemothorax, paraspinal line widening, and aorto-pulmonary window opacification do not reliably separate these three groups of patients. The diagnosis of mediastinal hemorrhage may be made if the aortic contour is abnormal or if one of the following signs is positive: abnormal mediastinal width, apical cap, widening of the right paratracheal stripe, or deviation of the nasogastric tube. Due to interobserver variation, there is good agreement between observers for the following four signs only: transverse mediastinal width, tracheal deviation, nasogastric tube deviation, nasogastric tube deviation, and right paratracheal stripe widening.

  11. Delayed acute spinal cord injury following intracranial gunshot trauma: case report.

    Science.gov (United States)

    Cheng, Jason S; Richardson, R Mark; Gean, Alisa D; Stiver, Shirley I

    2012-04-01

    The authors report the case of a patient who presented with a hoarse voice and left hemiparesis following a gunshot injury with trajectory entering the left scapula, traversing the suboccipital bone, and coming to rest in the right lateral medullary cistern. Following recovery from the hemiparesis, abrupt quadriparesis occurred coincident with fall of the bullet into the anterior spinal canal. The bullet was retrieved following a C-2 and C-3 laminectomy, and postoperative MR imaging confirmed signal change in the cord at the level where the bullet had lodged. The patient then made a good neurological recovery. Bullets can fall from the posterior fossa with sufficient momentum to cause an acute spinal cord injury. Consideration for craniotomy and bullet retrieval should be given to large bullets lying in the CSF spaces of the posterior fossa as they pose risk for acute spinal cord injury.

  12. Delayed contact sensitivity on the lips and oral mucosa due to propolis-case report.

    Science.gov (United States)

    Brailo, V; Boras, Vanja Vucicevic; Alajbeg, I; Juras, Vidovic

    2006-07-01

    We report a rare case of a patient who was referred to the Department of Oral medicine in Zagreb, Croatia. The patient was 20 years old, otherwise healthy and not taking any medication. She presented with irregular erosions partially covered with pseudomembranes that involved both lips and retrocomissural mucosa. Discrete erosion was also noticed on her lower lingual gingiva in the area 42. She reported a propolis solution self-medication for treatment of recurrent aphthous ulcers. After ten days of propolis application, lip and oral lesions developed. Patch test to propolis was proven. We highlight the fact that some folk medicine medications, such as propolis, although being known for many decades to be helpful in various conditions, in some individuals might lead to unwanted side-effects due to its antigenic potential. Additionally, every colleague, during the differential diagnosis of the oral lesions must bear in mind unwanted reactions to folk medicine products.

  13. Male lupus: a diagnosis often delayed--a case series and review of the literature.

    LENUS (Irish Health Repository)

    Ambrose, N L

    2012-02-01

    INTRODUCTION: Systemic lupus erythematosus (SLE) is an auto-immune disease that is characterised by autoantibody production. Male lupus is rare, apart from at either end of the age spectrum. AIM: In this series, we review the histories of six male lupus patients attending our service. RESULTS: Our patients presented in middle age and tended to develop haematological abnormalities, renal involvement and neurological manifestations which preceded the onset of their skin and joint complaints. Our patients accrued damage rapidly and overall did badly. They tended to respond sub-optimally to standard treatments. These cases highlight the need an increased awareness that male SLE patients present with a wide variety of symptoms, and that they accrue damage quickly. There is a need for timely diagnosis and appropriate initiation of treatment. This may help avoid preventable organ damage and increase the survival of men with SLE.

  14. Marburg Hemorrhagic Fever (Marburg HF)

    Science.gov (United States)

    ... CDC Cancel Submit Search The CDC Marburg hemorrhagic fever (Marburg HF) Note: Javascript is disabled or is ... first recognized in 1967, when outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt, ...

  15. [A Case of Aplastic or Twig-Like Middle Cerebral Artery Presenting with an Intracranial Hemorrhage Two Years after a Transient Ischemic Attack].

    Science.gov (United States)

    Uchiyama, Taku; Okamoto, Hiroaki; Koguchi, Motofumi; Tajima, Yutaka; Suzuyama, Kenji

    2016-02-01

    Aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a rare anatomical anomaly, which can be associated with intracranial hemorrhage and cerebral ischemia. A 52-year-old woman who presented with sudden headache was admitted to our hospital. Computed tomography (CT) and magnetic resonance imaging showed no abnormality; however, magnetic resonance angiogram revealed an occlusion or severe stenosis in the left middle cerebral artery. Three-dimensional CT angiography demonstrated severe stenosis in the left middle cerebral artery. The patient was discharged without any neurological deficit; however, she subsequently complained of temporary weakness in the right hand. It was possibly due to a transient ischemic attack; therefore, cilostazol 200 mg/day was administered for prevention of cerebral ischemia. Single photon emission computed tomography(with or without administration of acetazolamide)showed neither significant decrease in the cerebral blood flow nor cerebrovascular reactivity; hence, surgical revascularization was not performed. However, two years after the initial admission, she was urgently admitted to our hospital with sudden headache and nausea followed by aphasia and weakness of the right extremities. CT images showed diffuse subarachnoid hemorrhage and intracerebral hemorrhage in the left temporo-parietal lobe. Cerebral angiography revealed that the left middle cerebral artery was Ap/T-MCA without cerebral aneurysms. The patient was treated conservatively, and she eventually recovered without any neurological deficit except mild aphasia. Since Ap/T-MCA is associated with both hemorrhagic and ischemic stroke, antiplatelet therapy should be administered carefully. Moreover, it is necessary to consider extracranial-intracranial bypass to reduce hemodynamic stress on the abnormal vessels.

  16. Timing of traumatic lumbar hernia repair: is delayed repair safe? Report of two cases and review of the literature.

    Science.gov (United States)

    Bathla, L; Davies, E; Fitzgibbons, R J; Cemaj, S

    2011-04-01

    Fewer than 100 cases of traumatic lumbar hernias are described in the English literature. The herniation has been described as a consequence of a combination of local tangential shearing forces combined with an acute increase in intra-abdominal pressure secondary to sudden deceleration sustained during blunt abdominal trauma. Delayed diagnosis is not uncommon, as nearly a quarter of these are missed at initial presentation. These hernias are best managed by operative intervention; however, there is no well-defined treatment strategy regarding either the timing or the type of repair. Several approaches, including laparoscopy, have been described to repair these defects. Various techniques, including primary repair, musculoaponeurotic reconstruction, and prosthetic mesh repair, have been described. These repairs are usually complicated because of the lack of musculoaponeurotic tissue inferiorly near the iliac crest. We describe here two cases of traumatic lumbar hernia managed by initial watchful waiting and subsequent elective repair using a combined laparoscopic and open technique and one with and one without bone anchor fixation.

  17. Intracerebral hemorrhage associated with Sneddon's syndrome: is ischemia-related angiogenesis the cause? Case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Aquino Gondim, F. de A.; Leacock, R.O.; Subrammanian, T.A. [Department of Neurology, Saint Louis University Hospital, 3635 Vista Avenue at Grand Blvd, MO 63110, Saint Louis, MO (United States); Cruz-Flores, S. [Department of Neurology, Saint Louis University Hospital, 3635 Vista Avenue at Grand Blvd, MO 63110, Saint Louis, MO (United States); Neurology Service, John Cochran Veterans Administration Hospital, St. Louis, MO (United States)

    2003-06-01

    Sneddon's syndrome is characterized by livedo reticularis and multiple ischemic infarcts often associated with antiphospholipid antibodies. Intracerebral hemorrhage (ICH) is unusual in Sneddon's syndrome and has not been reported as the presenting complaint. We report a 38-year-old woman with a history of two miscarriages, Raynaud's phenomenon and livedo reticularis who presented acutely with ICH. Angiography showed prominent leptomeningeal and transdural anastomoses (pseudoangiomatosis). Anticardiolipin antibodies were positive. A right frontal brain biopsy failed to reveal vasculitis and a skin biopsy was nonspecific. MRI showed residual intracerebral hemorrhage (ICH), diffuse atrophy, multiple small white matter infarcts and leptomeningeal enhancement. This is the first report of Sneddon's syndrome presenting with an ICH. It shares features with the Divry-van Bogaert syndrome. We discuss the cause of the pseudoangiomatosis pattern and its role in the genesis of the hemorrhage and suggest that cerebral angiography should be done in every patient with Sneddon's syndrome, as it could impact therapy. (orig.)

  18. Contractors' Perception of factors Contributing to Project Delay: Case Studies of Commercial Projects in Klang Valley, Malaysia

    Directory of Open Access Journals (Sweden)

    Azlan Shah Ali

    2010-12-01

    Full Text Available Delay in construction projects is a situation where the project cannot be completed under the planned time. It is a common issue faced in the construction industry all over the world especially in developing countries. In the Malaysian construction industry, 17.3% of construction projects experience more than 3 months delay and some of them are abandoned. Hence, the study of factors contributing to delay is very important in order to reduce the number of projects that experience delay in project delivery. Three objectives of the research have been formulated, namely (1 to identify factors that contribute to delay in construction projects; (2 to analyse and rank the causes of delay rated by contractors; and (3 to study the effects of delay in construction projects. One hundred questionnaires were distributed during data collection stage and only 36 responses received. The respondents only consist of contractors and sub-contractors because the scope of the research focuses on contractors' perception. The data collected was analysed using SPSS software. Seven factors that contribute to delay were identified through literature review, namely contractors' financial difficulties, construction mistakes and defective work, labour shortage, coordination problems, shortage of tools and equipment, material shortage and poor site management. Of those factors, the three most important factors were found to be labour shortage, contractors' financial difficulties and construction mistakes and defective works. Besides project delay, the research shows that cost overrun and extension of time (EOT are the most common effects of delay in construction projects.

  19. Marburg hemorrhagic fever associated with multiple genetic lineages of virus

    DEFF Research Database (Denmark)

    Bausch, D G; Nichol, S T; Muyembe-Tamfum, J J

    2006-01-01

    Background An outbreak of Marburg hemorrhagic fever was first observed in a gold-mining village in northeastern Democratic Republic of the Congo in October 1998. Methods We investigated the outbreak of Marburg hemorrhagic fever most intensively in May and October 1999. Sporadic cases and short...... genetically distinct lineages of virus in circulation during the outbreak. Conclusions Marburg hemorrhagic fever can have a very high case fatality rate. Since multiple genetic variants of virus were identified, ongoing introduction of virus into the population helped perpetuate this outbreak. The findings...

  20. Spontaneous perinephric hemorrhage associated with urolithiasis in pregnancy.

    Science.gov (United States)

    McMann, Leah P; Peterson, Andrew C; Ahuja, Sunil A

    2004-06-07

    Spontaneous perinephric hematoma in the absence of anticoagulation, arteritis, or trauma is uncommon. We report the case of a postpartum patient with nephrolithiasis who initially presented to the obstetric service with a spontaneous perinephric hemorrhage.

  1. Spontaneous Perinephric Hemorrhage Associated with Urolithiasis in Pregnancy

    OpenAIRE

    2004-01-01

    Spontaneous perinephric hematoma in the absence of anticoagulation, arteritis, or trauma is uncommon. We report the case of a postpartum patient with nephrolithiasis who initially presented to the obstetric service with a spontaneous perinephric hemorrhage.

  2. Spontaneous Perinephric Hemorrhage Associated with Urolithiasis in Pregnancy

    Directory of Open Access Journals (Sweden)

    Leah P. McMann

    2004-01-01

    Full Text Available Spontaneous perinephric hematoma in the absence of anticoagulation, arteritis, or trauma is uncommon. We report the case of a postpartum patient with nephrolithiasis who initially presented to the obstetric service with a spontaneous perinephric hemorrhage.

  3. Peripheral Exudative Hemorrhagic Chorioretinopathy: A Variant of Polypoidal Choroidal Vasculopathy?

    Directory of Open Access Journals (Sweden)

    Arman Mashayekhi

    2013-01-01

    Full Text Available Purpose: To report a case of peripheral exudative hemorrhagic chorioretinopathy (PEHCR in an elderly patient. Case Report: A 74-year-old Caucasian woman, with a 20-year history of a stable choroidal nevus in her right eye, was referred for evaluation of two small hemorrhagic pigment epithelial detachments (PEDs affecting the temporal peripheral fundus of the same eye. Nine months later, the lesions became larger and indocyanine green angiography revealed polypoidal choroidal vascular changes corresponding to the location of the ophthalmoscopically visible PEDs. Despite one session of verteporfin photodynamic therapy, the lesions continued to enlarge eventually resulting in the development of a large hemorrhagic PED, which failed to respond to two subsequent injections of intravitreal bevacizumab. The final ophthalmoscopic appearance of the large hemorrhagic PED was typical of PEHCR. Conclusion: This case suggests that polypoidal choroidal vascular changes similar to that seen in our patient may underlie the development of PEHCR in some cases.

  4. Acute brain hemorrhage in dengue

    Institute of Scientific and Technical Information of China (English)

    Somsri Wiwanitkit; Viroj Wiwanitkit

    2014-01-01

    Dengue is a tropical arboviral infection that can have severe hemorrhagic complication.Acute brain hemorrhage in dengue is rare and is a big challenge in neurosurgery.To perform surgery for management of acute brain hemorrhage in dengue is a controversial issue.Here, the authors try to summarize the previous reports on this topic and compare neurosurgery versus conservative management.

  5. DIAGNOSIS AND TREATMENT OF INSIDIOUS RECURRENT SMALL INTESTINAL HEMORRHAGE

    Institute of Scientific and Technical Information of China (English)

    何小东; 陶蔚; 郑朝纪; 张振寰

    2000-01-01

    Objective. To improve the localized diagn osis of insidious recurrent small intestinal hemorrhage. Methods. This retrospective analysis include 64 cases of such diseases, which were admitted from 1988 to 1998 to our hospital. Result. Ultrasonography, CT, small bowel pneumobariumgraphy, diluted barium enema, isotopic examination, DSA and intraoperative small-bowel endoscopy were used for diagnosis of hemorrhagic site, and 37 cases got a definite location before operation, while 10 cases were confirmed the diagnosis during the operation. Forty-seven cases were treated surgically, while the other 17 cases had non-surgical treatment. Of the 47 cases,39 cases underwent partual en terectomy, 5 cases had suture and ligature of vascular deformity, 2 cases had Whipple' s operation, and one patient had ectomy of the end of ileum and right colon. Conclusion. DSA, Isotopic examination and intraoperative enteroscopy are of considerable importance for the lo cation judgement of recurrent small intestinal hemorrhage.

  6. Pericentric inversion of chromosome 11 (p14.3q21) associated with developmental delays, hypopigmented skin lesions and abnormal brain MRI findings - a new case report

    Energy Technology Data Exchange (ETDEWEB)

    Zachor, D.A.; Lofton, M. [Univ. of Alabama, Birmingham (United States)

    1994-09-01

    We report 3 year old male, referred for evaluation of developmental delays. Pregnancy was complicated by oligohydramnios, proteinuria and prematurity. Medical history revealed: bilateral inguinal hernia, small scrotal sac, undescended testes, developmental delays and behavioral problems. The child had: microcephaly, facial dysmorphic features, single palmar creases, hypopigmented skin lesions of variable size, intermittent exotropia and small retracted testes. Neurological examination was normal. Cognitive level was at the average range with mild delay in his adaptive behavior. Expressive language delays and severe articulation disorder were noted, as well as clumsiness, poor control and precision of gross and fine motor skills. Chromosomal analysis of peripheral leukocytes indicated that one of the number 11 chromosomes had undergone a pericentric inversion with breakpoints on the short (p) arm at band p14.3 and the long (q) arm at band q21. An MRI of the brain showed mild delay in myelinization pattern of white matter. Chromosome 11 inversion in other sites was associated with Beckwith-Wiedemann syndrome and several malignancies. To our knowledge this is the first description of inv(11)(p14.3q21) that is associated with microcephaly, dysmorphic features, hypopigmented skin lesions and speech delay. This inversion may disrupt the expression of the involved genes. However, additional cases with the same cytogenetic anomaly are needed to explore the phenotypic significance of this disorder.

  7. Correlative research between homocysteine,cystatin C and patients with essential hypertension and hypertensive intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    孙屿

    2014-01-01

    Objective To investigate the correlation between homocysteine(Hcy),cystatin C(Cys C)and patients with essential hypertension and hypertensive intracerebral hemorrhage.Methods Subjects were divided into hypertensive intracerebral hemorrhage group(108 cases),essential hypertension group(100 cases)and control group(100 cases),and their cystatin C,homocysteine and total cholesterol(TC)and triglycerides(TG)were surveyed.Results The patients with hypertensive intracerebral hemorrhage and essential hypertension had higher

  8. Crimean-Congo hemorrhagic fever in Iran and neighboring countries

    DEFF Research Database (Denmark)

    Chinikar, S; Ghiasi, Seyed Mojtaba; Hewson, R

    2010-01-01

    Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease that is asymptomatic in infected livestock, but a serious threat to humans. Human infections begin with nonspecific febrile symptoms, but progress to a serious hemorrhagic syndrome with a case fatality rate of 2-50%. Although the ...... in Iran and neighboring countries and provide evidence of over 5000 confirmed cases of CCHF in a single period/season....

  9. Treatment for delayed brain injury after pituitary irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Fujii, Takashi; Misumi, Shuzoh; Shibasaki, Takashi; Tamura, Masaru; Kunimine, Hideo; Hayakawa, Kazushige; Niibe, Hideo; Miyazaki, Mizuho; Miyagi, Osamu.

    1988-03-01

    Treatment for delayed brain injury after pituitary irradiation is discussed. Six cases with delayed brain injury were treated with a combination of dexamethasone or betamethasone, with heparin, glycerol, dextran 40 and some vasodilators. Two cases with temporal lobe syndrome were treated in the early stages of brain injury for a period of over 12 months were almost completely cured, another two cases with chiasma syndrome were treated in the relatively late stages, showed a partial improvement. One case which was irradiated 120 GY during 13 years did not improve. The final case treated with steroids for a short period also resulted in failure and the patient underwent an operation for the removal of the necrotic mass three years after the radiotherapy. Steroid therapy started in the early stages of brain injury after irradiation for over the 12 months is thought to be effective. Heparin therapy was also effective in one out of three cases, but in one of the cases subarachnoid hemorrhage from a traumatic aneurysm occurred during the therapy. In an acute phase, showing edematous change of the injured brain, the administration of glycerol is also thought to be useful. But the effectiveness of the other medicines containing some vasodilators was obscure or doubtful. We propose the following : (1) A meticulous observation is essential for the patients who received high doses of irradiation to diagnose brain injury in the early reversible stage. (2) Steroids should be given immediately in this reversible stage of brain injury before the irreversible ''necrosis'' occurs. (3) Steroids should be maintained for a long period over 12 months. (4) Heparin therapy is also thought to be effective, but careful precautions to avoid hemorrhagic complications before the therapy should be scheduled. This recommended plan may also be used for the treatment of brain injuries after cranial irradiation for other intracranial tumors.

  10. Delayed pan-hypopituitarism as a complication following endovascular treatment of bilateral internal carotid artery aneurysms. A case report and review.

    Science.gov (United States)

    Hall, Jonathan; Caputo, Carmela; Chung, Carlos; Holt, Michael; Wang, Yi Yuen

    2015-04-01

    Pan-hypopituitarism has been reported in patients who are subsequently found to have a cerebral aneurysm and there have been reports of pituitary dysfunction immediately following both surgical and endovascular treatment. The authors report a rare case of delayed pan-hypopituitarism following endovascular treatment of bilateral internal carotid artery aneurysms with coil embolisation and flow-diverting stents.

  11. Glibenclamide for the Treatment of Ischemic and Hemorrhagic Stroke

    Directory of Open Access Journals (Sweden)

    Nicholas Caffes

    2015-03-01

    Full Text Available Ischemic and hemorrhagic strokes are associated with severe functional disability and high mortality. Except for recombinant tissue plasminogen activator, therapies targeting the underlying pathophysiology of central nervous system (CNS ischemia and hemorrhage are strikingly lacking. Sur1-regulated channels play essential roles in necrotic cell death and cerebral edema following ischemic insults, and in neuroinflammation after hemorrhagic injuries. Inhibiting endothelial, neuronal, astrocytic and oligodendroglial sulfonylurea receptor 1–transient receptor potential melastatin 4 (Sur1–Trpm4 channels and, in some cases, microglial KATP (Sur1–Kir6.2 channels, with glibenclamide is protective in a variety of contexts. Robust preclinical studies have shown that glibenclamide and other sulfonylurea agents reduce infarct volumes, edema and hemorrhagic conversion, and improve outcomes in rodent models of ischemic stroke. Retrospective studies suggest that diabetic patients on sulfonylurea drugs at stroke presentation fare better if they continue on drug. Additional laboratory investigations have implicated Sur1 in the pathophysiology of hemorrhagic CNS insults. In clinically relevant models of subarachnoid hemorrhage, glibenclamide reduces adverse neuroinflammatory and behavioral outcomes. Here, we provide an overview of the preclinical studies of glibenclamide therapy for CNS ischemia and hemorrhage, discuss the available data from clinical investigations, and conclude with promising preclinical results that suggest glibenclamide may be an effective therapeutic option for ischemic and hemorrhagic stroke.

  12. Umbilical Cord Segmental Hemorrhage and Fetal Distress

    Science.gov (United States)

    Larciprete, Giovanni; Romanini, Maria Elisabetta; Arduini, Domenico; Cirese, Elio; Slowikowska-Hilczer, Jolanta; Kula, Krzysztof

    2006-01-01

    We describe an unexplained case of umbilical cord segmental hemorrhage linked with meconium-stained amniotic fluid. A severely asphyxiated infant was delivered at term by Caesarean section. There were poor prognostic signs on fetal cardiotocography with rupture of membranes with meconium-stained amniotic fluid. The pathophysiologic mechanism in this case is still unknown, even if we argued a possible role of the umbilical cord shortness. PMID:23674981

  13. The Frequency of Recurrence in Primary Hypertensive Intracerebral Hemorrhage

    Directory of Open Access Journals (Sweden)

    SA Mousavi

    2006-01-01

    Full Text Available Background: Primary intracerebral Hemorrhage (PICH is a devasting illness with high early mortality which causes 10 -12 percent of stroke cases. Survivors of PICH are at risk for recurrence of hemorrhage. We wanted to determine the frequency of recurrence of ICH in patients with PICH at Alzahra and Noor hospital Isfahan, Iran. Methods: A descriptive retrospective study was did on the hospital records of patients with a discharge diagnosis of intracerebral hemorrhage to identify the cases. Data were gathered by means of a check list and were analysed by using SPSS statistical software. Results: A total number of 660 cases were identified by computer search. After abstraction, 400 patients with primary hypertensive intracerebral hemorrhage were identified. Widespread distribution of recurrence of ICH were 65 cases which 33 cases of them were men and 32 cases were women. Conclusion: Totally, 16 .25 percent of patients had recurrence which is greater risk of recurrence in comparison to other studies. Key Words: Intracerebral Hemorrhage, hypertension, recurrence of Intracerebral Hemorrhage

  14. The Accordion Maneuver: A Noninvasive Strategy for Absent or Delayed Callus Formation in Cases of Limb Lengthening

    Directory of Open Access Journals (Sweden)

    Asim M. Makhdom

    2015-01-01

    Full Text Available The distraction osteogenesis (DO technique has been used worldwide to treat many orthopaedic conditions. Although successful, absent or delayed callus formation in the distraction gap can lead to significant morbidities. An alternate cycle of distraction-compression (accordion maneuver is one approach to accelerate bone regeneration. The primary aim of our study is to report our experience with the accordion maneuver during DO and to provide a detailed description of this technique, as performed in our center. The secondary aim is to present a review of the literature regarding the use of accordion maneuver. We reviewed the database of all patients undergoing limb lengthening from the year of 1997 to 2012. Four patients (6.15% out of 65 showed poor bone regenerate in their tibiae and therefore accordion maneuver was applied for a mean of 6.75 weeks. Of these, three patients have had successful outcome with this technique. The literature showed that this technique is successful approach to trigger bone healing. However, details of how and when to apply this combination of distraction-compression forces were lacking. In conclusion, the accordion technique is safe noninvasive approach to promote bone formation, thus avoiding more invasive surgical procedures in cases of poor callus formation in limb lengthening.

  15. Delayed colonic perforation following stent placement for colorectal obstruction: a description of two cases with stent palliation.

    Directory of Open Access Journals (Sweden)

    Jalal Vahedian Ardakani

    2013-10-01

    Full Text Available Bowel stent insertion has a variety of complications one major of which is colonic perforation. The purpose of this article is to reveal two cases with delayed colonic perforation after stent placement to relieve bowel obstruction caused by rectal cancer. The first patient was a 55 year-old man who was a candidate for stent placement to avoid palliative surgery and relieve his bowel obstruction. Although the procedure resulted in complete relief of patient symptoms, but he returned with signs of peritonitis 10 days after the stent placement. A perforation was found at rectosigmoid junction on laparotomy. The second patient was a 60 year-old man who underwent a successful stent placement and returned 3 months later with a complaint of abdominal pain that showed up to be due to a rectal perforation on investigations. In conclusion, bowel perforation following stent placement can be a major complication, so close follow-up is necessary to detect it as soon as possible and prevent it from becoming an irreparable complication.

  16. Matrix Metalloproteinases in Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Vivek Mehta

    2013-01-01

    Full Text Available Delayed cerebral vasospasm is a significant cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH. While the cellular mechanisms underlying vasospasm remain unclear, it is believed that inflammation may play a critical role in vasospasm. Matrix metalloproteinasees (MMPs are a family of extracellular and membrane-bound proteases capable of degrading the blood-rain barrier (BBB. As such, MMP upregulation following SAH may result in a proinflammatory extravascular environment capable of inciting delayed cerebral vasospasm. This paper presents an overview of MMPs and describes existing data pertinent to delayed cerebral vasospasm.

  17. Unexplained postoperative retinal hemorrhage after 23-gauge sutureless vitrectomy

    Directory of Open Access Journals (Sweden)

    Ohno H

    2011-07-01

    Full Text Available Hisato Ohno, Kenji InoueInouye Eye Hospital, Tokyo, JapanAbstract: We report five cases of unexplained retinal hemorrhage after 23-gauge sutureless vitrectomy. A 23-gauge sutureless vitrectomy was performed for four cases of macular holes (MH and one case of macular hole retinal detachment (MHRD. Retinal hemorrhages were observed on the first day after surgery and disappeared within several months without leaving any recognizable damage. We speculate that the retinal hemorrhages might have resulted from repeated collapse of the globe through a cannula under air perfusion, but other causes such as retinal vein congestion by face-down positioning are also possible.Keywords: retinal hemorrhage, vitrectomy, postoperative, macular hole, sutureless surgery

  18. Recovery of cognitive dysfunction in a case of delayed encephalopathy of carbon monoxide poisoning after treatment with donepezil hydrochloride

    Directory of Open Access Journals (Sweden)

    Wang Pin

    2009-01-01

    Full Text Available Delayed encephalopathy following carbon monoxide poisoning is a serious complication. Here, we report a patient with delayed encephalopathy who suffered from cognitive disorders and urinary incontinence after a temporal normal period of 15 days after acute intoxication, and his cognitive function recovered gradually following donepezil hydrochloride treatment. Now, he can undertake slight farming work.

  19. Femoral nerve dysfunction after retroperitoneal hemorrhage: pathophysiology revealed by computed tomography.

    Science.gov (United States)

    Reinstein, L; Alevizatos, A C; Twardzik, F G; DeMarco, S J

    1984-01-01

    In three patients receiving anticoagulation therapy who developed retroperitoneal hemorrhage computed tomography (CT) clearly localized the resulting hematoma in each case. Three distinct syndromes are described. A hemorrhage within the iliacus muscle resulted in femoral nerve dysfunction. A large hemorrhage within the iliacus muscle which extended into the psoas muscle produced both femoral and obturator nerve dysfunction. A retroperitoneal hemorrhage extrinsic to both the iliacus and psoas muscles did not produce peripheral nerve dysfunction. The pathophysiology of peripheral nerve dysfunction in retroperitoneal hemorrhage is reviewed in detail.

  20. Analysis of 8 cases of the performance of pseudo subarachnoid hemorrhage of acute cerebral infarction%表现为假性蛛网膜下腔出血的急性脑梗死8例分析

    Institute of Scientific and Technical Information of China (English)

    张梅芳; 易婷玉; 吴燕敏; 陈文伙

    2015-01-01

    目的:探讨表现为假性蛛网膜下腔出血的急性脑梗死的原因.方法:收治急性脑梗死患者8例,分析临床表现及影像学表现.结果:右侧偏瘫及失语3例,左侧偏瘫3例,视野异常2例.头颅MRI显示急性脑梗死8例,左侧额叶3例,其中2例合并皮层下分水岭梗死,右侧额叶3例,均合并皮层下分水岭梗死,右侧枕叶2例, MRA提示脑血管狭窄、闭塞5例,左侧大脑中动脉重度狭窄2例,右侧大脑中动脉闭塞2例,右侧大脑中动脉重度狭窄1例.结论:急性大脑皮层梗死早期因代偿脑膜支血流缓慢,易在CT表现为假性蛛网膜下腔出血.%Objective:To explore the manifestations of acute cerebral pseudo subarachnoid hemorrhage causes.Methods:8 patients with acute cerebral infarction were selected,analysis of clinical manifestation and imaging performance.Results:On the right side of 3 cases of hemiplegia and aphasia,3 cases of left hemiplegia,2 cases of abnormal visual field.Brain MRI showed acute cerebral infarction in 8 cases,left frontal lobe in 3 cases,2 cases with cerebral watershed infarction,right frontal lobe in 3 cases,2 cases of right occipital lobe,5 cases of cerebral artery stenosis,2 cases of left middle cerebral artery stenosis,2 cases of right middle cerebral artery occlusion,right middle cerebral artery stenosis in 1 cases.Conclusion:Acute cortical infarction due to compensatory meningeal branch blood flow is slow,easy to show in CT as a pseudo subarachnoid hemorrhage.