613 Microsurgical Salvage of Neonatal Upper Limb Ischaemia Subsequent to Intrauterine Brachial Vessel Constriction

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Clements ◽  
M McBride ◽  
B Fogarty ◽  
H Lewis
Keyword(s):  
Brachial Artery ◽  
Clinical Presentation ◽  
Great Saphenous Vein ◽  
Early Recognition ◽  
Saphenous Vein Graft ◽  
Elective Caesarean Section ◽  
Tissue Loss ◽  
Treatment Modalities ◽  
Limb Ischaemia ◽  
Appropriate Treatment

Abstract Introduction We report a case of limb salvage due to intra uterine brachial artery thrombosis. Treatment modalities include medical, endovascular, and surgical. Early recognition, prompt institution of appropriate treatment and monitoring is vital to achieve successful revascularisation and prevention of lifelong morbidity. Description A male baby at (36 + 6week) gestation was born to a nulliparous mother with gestational diabetes via uncomplicated elective caesarean section. The child was noted to have a ‘flail’ ischeamic limb post-delivery. There were no palpable pulses in the limb and ultrasonography confirmed thrombosis of the proximal brachial artery. Aetiology was due to dense fibrotic circumferential constriction of the brachial vessels and plexus. Successful revascularisation was achieved with a contralateral interposition reversed great saphenous vein graft. Discussion Neonatal limb ischaemia is a rare disease entity with devastating morbidity- including compartment syndrome, tissue loss, limb loss, reduced limb growth, irreparable neuropathies and Volkmann’s syndrome. The initial diagnosis is based on the characteristic sequelae of ischaemia. Therapy should be individualised based on the clinical presentation. Early recognition, prompt institution of appropriate treatment and monitoring is vital to achieve successful revascularisation and prevention of lifelong morbidity.

Lower extremity artery disease

ESC CardioMed ◽  
2018 ◽  
pp. 2720-2733
Author(s):  
Marianne Brodmann
Keyword(s):  
Early Recognition ◽  
Ankle Brachial Index ◽  
Clinical Signs ◽  
Treatment Decision ◽  
Tissue Loss ◽  
Limb Ischaemia ◽  
First Line ◽  
Atypical Symptoms ◽  
Asymptomatic Patients ◽  
Artery Disease

Most patients with LEAD are asymptomatic. Walking capacity must be assessed to detect clinically masked LEAD. The clinical signs vary broadly. Atypical symptoms are frequent. Even asymptomatic patients with LEAD are at high risk of CV events and must benefit from most CV preventive strategies, especially strict control of risk factors. Antithrombotic therapies are indicated in patients with symptomatic LEAD. There is no proven benefit for their use in asymptomatic patients. Ankle-brachial index is indicated as first-line test for screening and diagnosis of LEAD. DUS is the first imaging method. Data from anatomical imaging tests should always be analysed in conjunction with symptoms and haemodynamic tests prior to treatment decision. In patients with intermittent claudication, CV prevention and exercise training are the cornerstones of management. If daily life activity is severely compromised, first-line revascularization can be proposed, along with exercise therapy. Chronic limb-threatening ischaemia specifies clinical patterns with a vulnerable limb viability related to several factors. The risk is stratified according to the severity of ischaemia, wounds, and infection. Early recognition of tissue loss and/or infection and referral to the vascular specialist is mandatory for limb salvage by a multidisciplinary approach. Revascularization is indicated whenever feasible. Acute limb ischaemia with neurological deficit mandates urgent revascularization.

Break Dancing: A New Risk Factor for Scarring Hair Loss

2011 ◽  
Vol 15 (3) ◽  
pp. 177-179 ◽  
Author(s):  
Assaf Monselise ◽  
Lisa J.Y. Chan ◽  
Jerry Shapiro
Keyword(s):  
Risk Factor ◽  
Hair Loss ◽  
Early Recognition ◽  
Androgenetic Alopecia ◽  
Treatment Modalities ◽  
Lichen Planopilaris ◽  
First Case ◽  
Appropriate Treatment ◽  
Scalp Biopsy

Background: We report on a first case of lichen planopilaris (LPP) mimicking androgenetic alopecia (AGA) in an individual who has been break-dancing on his head for many years. LPP is an autoimmune inflammatory scalp condition that when left untreated can result in scarring and irreversible hair loss. The etiology of LPP is unknown. Different treatment modalities are used for LPP and AGA. Objective: To increase the awareness of physicians to the possibility of scarring hair loss (LPP) presenting like AGA. Results: Scalp examination showed scarring patches of hair loss. A scalp biopsy confirmed the diagnosis of LPP. Conclusion: Chronic scalp trauma due to break dancing may be a trigger for LPP. A meticulous scalp examination should be performed before making a diagnosis of nonscarring conditions of hair loss such as AGA. Early recognition of LPP and appropriate treatment are important before scarring and irreversible hair loss ensue.

scholarly journals Diabetic muscle infarction: rare complication with a distinct clinical manifestation

2019 ◽  
Vol 12 (4) ◽  
pp. e228480
Author(s):  
Poranee Ganokroj ◽  
Patchaya Boonchaya-anant
Keyword(s):  
Clinical Presentation ◽  
Early Recognition ◽  
Rare Complication ◽  
Imaging Study ◽  
Clinical Findings ◽  
Muscular Pain ◽  
Muscle Infarction ◽  
Appropriate Treatment ◽  
Uncontrolled Diabetes

Diabetic muscle infarction is an unusual condition with distinctive clinical characteristics seen in patients with prolonged and uncontrolled diabetes. Clinical findings and imaging study are unique and challenging. Patients usually present with acute unilateral severe muscular pain and swelling, particularly in the lower extremities. The presentation is difficult to distinguish from other common conditions such as deep venous thrombosis and infectious myositis. However, early recognition of the clinical presentation and appropriate imaging selection can lead to the diagnosis and avoid unnecessary muscle biopsy. Here, we report a case of diabetic muscle infarction in a patient with poorly controlled type 1 diabetes who had a good clinical response after an early detection and appropriate treatment.

scholarly journals Saphenous Vein Graft between Brachial Artery and Cephalic Vein in Antebrachial Arteriovenous Anastomosis – Simulation of the Procedure

2020 ◽  
Author(s):  
Lilija Banceviča ◽  
Dzintra Kažoka ◽  
Aleksandrs Maļcevs ◽  
Māra Pilmane
Keyword(s):  
Brachial Artery ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Great Saphenous Vein ◽  
Saphenous Vein Graft ◽  
Graft Infection ◽  
Cephalic Vein ◽  
Successful Outcome ◽  
Arteriovenous Anastomosis ◽  
Cubital Fossa

Patients with chronic renal failure and vascular diseases require the vascular access for hemodialysis procedure to be performed with the most possible comfort for the patient. Native vein graft has a longer-lasting term in the patients’ limb, lower risk of graft infection and lower price. Native vein graft is constructed from the great saphenous vein, if the diameter of the vessel is smaller than the diameters of vessels (brachial artery, cephalic vein) it is connected to in the cubital fossa region due to the risk of graft folding, that might occur, if the graft diameter is bigger than the diameter of one or both vessels, on which anastomosis is made. The most important sizes, that were taken before graft placement, are the length of the forearm compartment, the distance between the brachial artery and cephalic vein in the cubital fossa region, distance from an expected incision in the brachial artery to the middle of the forearm compartment, the distance between incision in cephalic vein to the middle of the forearm compartment, length of the great saphenous vein (the graft) and diameters of blood vessels, used in the procedure. Finally, the right position of the graft should be determined for the successful outcome of anastomosis creating procedure.

Overview of Treatment Options for Critical Limb Ischaemia Patients

2011 ◽  
Vol 7 (1) ◽  
pp. 51 ◽  
Author(s):  
Frederic Baumann ◽  
Nicolas Diehm ◽  
◽  
Keyword(s):  
Treatment Options ◽  
Critical Limb Ischaemia ◽  
Treatment Modalities ◽  
High Morbidity ◽  
Limb Ischaemia ◽  
Arterial Revascularisation ◽  
Planning Treatment ◽  
Treatment Concepts ◽  
Peripheral Arterial ◽  
Renal Origin

Patients with critical limb ischaemia (CLI) constitute a subgroup of patients with particularly severe peripheral arterial occlusive disease (PAD). Treatment modalities for these patients that often exhibit multilevel lesions and severe vascular calcifications are complicated due to multiple comorbidities, i.e. of cardiac and vascular but also of renal origin. These need to be taken into consideration while planning treatment options. Although CLI is associated with considerably high morbidity and mortality rates, the clinical outcome of patients being subjected to revascularisation has improved substantially in recent years. This is mainly due to improved secondary prevention strategies as well as dedicated endovascular innovations for this most challenging patient cohort. The aim of this article is to provide a discussion of the contemporary treatment concepts for CLI patients with a focus on arterial revascularisation.

scholarly journals Clinical presentation of strokes confined to the insula: a systematic review of literature

2021 ◽  
Author(s):  
Vincenzo Di Stefano ◽  
Maria Vittoria De Angelis ◽  
Chiara Montemitro ◽  
Mirella Russo ◽  
Claudia Carrarini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Presentation ◽  
Insular Cortex ◽  
Affective Processing ◽  
Appropriate Treatment ◽  
Insula Cortex ◽  
Atypical Presentations ◽  
High Level ◽  
To Receive ◽  
Insular Region

Abstract Background and purpose The insular cortex serves a wide variety of functions in humans, ranging from sensory and affective processing to high-level cognition. Hence, insular dysfunction may result in several different presentations. Ischemic strokes limited to the insular territory are rare and deserve a better characterization, to be quickly recognized and to receive the appropriate treatment (e.g. thrombolysis). Methods We reviewed studies on patients with a first-ever acute stroke restricted to the insula. We searched in the Medline database the keywords “insular stroke” and “insular infarction”, to identify previously published cases. Afterwards, the results were divided depending on the specific insular region affected by the stroke: anterior insular cortex (AIC), posterior insular cortex (PIC) or total insula cortex (TIC). Finally, a review of the clinical correlates associated with each region was performed. Results We identified 25 reports including a total of 49 patients (59.7 ± 15.5 years, 48% male) from systematic review of the literature. The most common clinical phenotypes were motor and somatosensory deficits, dysarthria, aphasia and a vestibular-like syndrome. Atypical presentations were also common and included dysphagia, awareness deficits, gustatory disturbances, dysautonomia, neuropsychiatric or auditory disturbances and headache. Conclusions The clinical presentation of insular strokes is heterogeneous; however, an insular stroke should be suspected when vestibular-like, somatosensory, speech or language disturbances are combined in the same patient. Further studies are needed to improve our understanding of more atypical presentations.

scholarly journals Toll-Like Receptors in Ischaemia and Its Potential Role in the Pathophysiology of Muscle Damage in Critical Limb Ischaemia

2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
Hemanshu Patel ◽  
Sidney G. Shaw ◽  
Xu Shi-Wen ◽  
David Abraham ◽  
Daryll M. Baker ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Muscle Damage ◽  
Potential Role ◽  
Arterial Disease ◽  
Severe Form ◽  
Tissue Loss ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Toll Like Receptors ◽  
Skeletal Muscle Damage

Toll-like receptors (TLRs) are key receptors of the innate immune system which are expressed on immune and nonimmune cells. They are activated by both pathogen-associated molecular patterns and endogenous ligands. Activation of TLRs culminates in the release of proinflammatory cytokines, chemokines, and apoptosis. Ischaemia and ischaemia/reperfusion (I/R) injury are associated with significant inflammation and tissue damage. There is emerging evidence to suggest that TLRs are involved in mediating ischaemia-induced damage in several organs. Critical limb ischaemia (CLI) is the most severe form of peripheral arterial disease (PAD) and is associated with skeletal muscle damage and tissue loss; however its pathophysiology is poorly understood. This paper will underline the evidence implicating TLRs in the pathophysiology of cerebral, renal, hepatic, myocardial, and skeletal muscle ischaemia and I/R injury and discuss preliminary data that alludes to the potential role of TLRs in the pathophysiology of skeletal muscle damage in CLI.

A True Distal Brachial Artery Aneurysm Treated with a Bifurcated Saphenous Vein Graft

2016 ◽  
Vol 31 ◽  
pp. 207.e9-207.e11 ◽  
Author(s):  
Melek Ben Mrad ◽  
Chaouki Neifer ◽  
Faker Ghedira ◽  
Nesrine Ghorbel ◽  
Raouf Denguir ◽  
...  
Keyword(s):  
Brachial Artery ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Artery Aneurysm

Placental Mesenchymal Dysplasia

2007 ◽  
Vol 131 (1) ◽  
pp. 131-137 ◽  
Author(s):  
Zahida Parveen ◽  
Jane Elaine Tongson-Ignacio ◽  
Cory R. Fraser ◽  
Jeffery L. Killeen ◽  
Karen S. Thompson
Keyword(s):  
Differential Diagnosis ◽  
Clinical Presentation ◽  
Early Recognition ◽  
Data Sources ◽  
Molar Pregnancy ◽  
Close Attention ◽  
Normal Fetus ◽  
Fetal Complications ◽  
Microscopic Features ◽  
Placental Mesenchymal Dysplasia

Abstract Context.—Placental mesenchymal dysplasia is characterized by placentomegaly and may be mistaken for molar pregnancy both clinically and macroscopically because of the presence of “grapelike vesicles.” It may be associated with a completely normal fetus, a fetus with growth restriction, or a fetus with features of Beckwith-Wiedemann syndrome. Objective.—To review the etiology, molecular pathology, gross and microscopic features, clinical presentation, complications, and differential diagnosis of placental mesenchymal dysplasia. Data Sources.—The PubMed and the Medline databases were systematically searched for articles between 1970 and 2006. The following keywords were used: placental mesenchymal dysplasia, mesenchymal hyperplasia, molar pregnancy, pseudomolar pregnancy, Beckwith-Wiedemann syndrome, and placentomegaly. Relevant references from review articles were also searched. Conclusions.—Placental mesenchymal dysplasia should be considered in the differential diagnosis when the ultrasonographic findings show a cystic placenta. Close attention should be paid to fetal morphology for early recognition of fetal complications and to prevent unnecessary termination of pregnancy in cases associated with a normal fetus.

Immune Reconstitution Inflammatory Syndrome

2011 ◽  
Vol 23 (1) ◽  
pp. 90-96 ◽  
Author(s):  
A.R. Tappuni
Keyword(s):  
Antiretroviral Therapy ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
T Regulatory Cells ◽  
Clinical Presentation ◽  
Early Recognition ◽  
Clinical Intervention ◽  
Suppressor Cell ◽  
Life Threatening ◽  
Inflammatory Syndrome

Immune reconstitution inflammatory syndrome (IRIS) is a phenomenon observed in patients recovering from immunodeficiency. The clinical presentation of IRIS involves the unmasking of covert infections or the worsening of overt conditions. Several causes and pathways have been suggested, most recognizing an inflammatory flare component occurring in the context of rapid immune reconstitution. In HIV-infected patients, IRIS inadvertently occurs as the consequence of successful antiretroviral therapy, and it is affiliated with improvement of the immune function, complicating the course of the disease and presenting treatment challenges to clinicians. The pathogenesis of IRIS is poorly understood, but in recovering HIV patients, its initiation and progression seem to be primarily linked to an increase in CD4+ T-helper and CD8+ T-suppressor cell count and a reduction in T-regulatory cells, all endorsed by exaggerated cytokine release and activity. The clinical presentation of IRIS is usually atypical. The manifestations depend on the trigger antigen, which can be an infective agent (viable or nonviable), a host antigen, or a tumor antigen. Most IRIS cases are self-limiting, but a few cases can be overwhelming and life-threatening; hence, early recognition is important. In most cases, there is no need to discontinue the antiretroviral therapy, although in the more severe cases, other clinical intervention may be necessary.

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