Successful Management of Post-Tumor Resection Middle Cerebral Artery Thrombosis With Stent-Assisted Angioplasty and Thrombolytic Therapy: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 55 (3) ◽  
pp. E732-E737 ◽  
Author(s):  
Elad Levy ◽  
Michael Horowitz ◽  
Tudor Jovin ◽  
Amin Kassam
Keyword(s):  
Intracranial Hemorrhage ◽  
Low Dose ◽  
Clinical Presentation ◽  
Tumor Resection ◽  
Antiplatelet Agents ◽  
Cerebral Peduncle ◽  
Artery Thrombosis ◽  
Acute Complications ◽  
History Of ◽  
Postoperative Setting

Abstract OBJECTIVE AND IMPORTANCE: To describe successful endoluminal revascularization of an acute M1 occlusion 4 days after craniotomy and tumor resection. CLINICAL PRESENTATION: A 16-year-old right-handed girl presented with a 1-month history of daily headaches. The neurological examination was normal. Magnetic resonance imaging and computed tomography demonstrated a mass consistent with an epidermoid tumor compressing the left upper pons, left cerebral peduncle, and mesial left temporal lobe. INTERVENTION: A combination of low-dose antiplatelet agents administered intra-arterially and stent-assisted angioplasty was used. Successful endoluminal revascularization was achieved. Acute complications such as intracranial stent-thrombosis and/or intracranial hemorrhage were successfully avoided. CONCLUSION: In the acute postoperative period, most current chemical thrombolytic protocols are contraindicated because of the prohibitive risk of iatrogenic intracranial hemorrhage. With an understanding of the pharmacokinetics of the currently available antiplatelet drugs, combined chemical and mechanical thrombolysis may be used in the acute postoperative setting for endoluminal recanalization.

scholarly journals An Undiagnosed Paraganglioma in a 58-Year-Old Female Who Underwent Tumor Resection

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
William C. Fox ◽  
Matthew Read ◽  
Richard E. Moon ◽  
Eugene W. Moretti ◽  
Brian J. Colin
Keyword(s):  
Blood Pressure ◽  
Perioperative Management ◽  
Clinical Presentation ◽  
Tumor Resection ◽  
Healthcare Providers ◽  
Surgical Intensive Care Unit ◽  
High Morbidity ◽  
Tumor Removal ◽  
Surgical Intensive Care ◽  
Acute Complications

Paragangliomas and pheochromocytomas are rare neuroendocrine tumors that can have high morbidity and mortality if undiagnosed. Here we report a case of an undiagnosed paraganglioma in a 58-year-old female who underwent tumor resection. The patient became severely hypertensive intraoperatively with paroxysmal swings in blood pressure and then later became acutely hypotensive after tumor removal. She was managed in the surgical intensive care unit (SICU) postoperatively and discharged from the hospital without acute complications. We briefly discuss the epidemiology, clinical presentation, perioperative management, and possible complications of these tumors to assist healthcare providers if one were to encounter them.

scholarly journals Intracranial hemorrhage in infants after massaged by a traditional birth attendant

2007 ◽  
Vol 47 (3) ◽  
pp. 130
Author(s):  
Elisabeth S. Herini ◽  
Sunartini Hapsara ◽  
S. Yudha Patria
Keyword(s):  
Intracranial Hemorrhage ◽  
Bleeding Time ◽  
Clinical Presentation ◽  
Traditional Birth Attendant ◽  
Activated Partial Thromboplastin Time ◽  
Hemoglobin Level ◽  
Clotting Time ◽  
History Of ◽  
Parental Refusal ◽  
Epidural Hemorrhage

Background The overall incidence of birth related injuries declineswith the improvement in obstetrics. However, the incidence ofhead trauma in infants after massaged by a traditional birthattendant (TBA) is still unknown.Objective To study the characteristics of intracranial hemorrhagein infants after massaged by a TBA.Methods A retrospective study was conducted in Sardjito Hospital,Yogyakarta, Indonesia between October 2001 and May 2005.Infants with intracranial hemorrhage after massaged by a TBAwere included. Data on patients’ demography, history of massagingby TBA, clinical presentation, and injury characteristics such asanemia, clotting time (CT), bleeding time (BT), prothrombin time(PT) and activated partial thromboplastin time (APTT) werenoted. Computed cranial tomography (CT) scans were performed.Results A total of seven infants were diagnosed with intracranialhemorrhage after massaged by a TBA. There were four malesand three females (mean age 46 days; range 27-60 days). Allinfants were referred to Sardjito Hospital, Yogyakarta, Indonesiawith bad condition and anemia; mean hemoglobin level was 5.5g/dl (range 3.7-8.3 g/dl). All infants presented with seizures.Coagulation screening showed normal results in five patients. Theremaining patients had a prolonged CT and PT. CT scan showedsubdural hemorrhage in four patients, intracerebral hemorrhagein four, epidural hemorrhage in two, and subarachnoid hemorrhagein one. Two patients had chronic hemorrhage, while the rest hadacute hemorrhage. Four of them underwent craniotomy, twopatients were under an observation only, and one patient was nottreated due to parental refusal. Six patients survived and the onewho refused to be treated died.Conclusions The parents, midwives, and doctors have to be awareof head massaging since it may harm infants.

Covered Carotid Stents as an Adjunct in the Surgical Treatment of Carotid Body Tumors

2012 ◽  
Vol 71 (suppl_1) ◽  
pp. onsE182-onsE185 ◽  
Author(s):  
Cameron M. McDougall ◽  
Richard Liu ◽  
Michael Chow
Keyword(s):  
Acetylsalicylic Acid ◽  
Carotid Body ◽  
Internal Carotid ◽  
Clinical Presentation ◽  
Tumor Resection ◽  
Case Series ◽  
Dual Therapy ◽  
Antiplatelet Agents ◽  
Intravenous Heparin ◽  
Carotid Body Tumors

Abstract BACKGROUND AND IMPORTANCE: Carotid body tumors are a technically challenging surgical problem. One of the primary goals of surgery and often one of the most difficult aspects of management involves preservation of the ipsilateral internal carotid artery (ICA). We report a small case series with challenging aspects to ICA preservation that were successfully treated with covered stenting and review the literature to date on this topic. CLINICAL PRESENTATION: Two patients with carotid body tumors were selected for covered ICA stenting, the first because of bilateral disease and the second because of failure of test occlusion. The patients were initially loaded with antiplatelet agents, and the stents were deployed transfemorally. The patients were kept on dual therapy (acetylsalicylic acid and Plavix) for 6 weeks, followed by acetylsalicylic acid alone, which was discontinued 1 week before surgery. The patients were admitted 3 days before surgery, and intravenous heparin was started and then stopped 6 hours preoperatively. Both tumors were completely resected with minimal blood loss, and the ipsilateral ICA was successfully preserved in both cases. CONCLUSION: The covered ICA stent offers a significant adjunct for preserving the ICA in carotid body tumor resection.

Incidence of Intracranial Hemorrhage and Outcomes after Ground-level Falls in Geriatric Trauma Patients Taking Preinjury Anticoagulants and Antiplatelet Agents

2014 ◽  
Vol 80 (10) ◽  
pp. 975-978 ◽  
Author(s):  
Subhash Reddy ◽  
Rohit Sharma ◽  
Jonathan Grotts ◽  
Lisa Ferrigno ◽  
Stephen Kaminski
Keyword(s):  
Intracranial Hemorrhage ◽  
Antiplatelet Agent ◽  
Ground Level ◽  
Antiplatelet Agents ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
History Of ◽  
Anticoagulant Medication

Antiplatelet and anticoagulant medication increases the risk of intracranial hemorrhage (ICH) after a fall in geriatric patients. We sought to determine whether there were differences in ICH rates and outcomes based on type of anticoagulant or antiplatelet agent after a ground-level fall (GLF). Our institutional trauma registry was used to identify patients 65 years old or older after a GLF while taking warfarin, clopidogrel, or aspirin over a 2-year period. Rates and types of ICH and patient outcomes were evaluated. Of 562 patients who met inclusion and exclusion criteria, 218 (38.8%) were on warfarin, 95 (16.9%) were on clopidogrel, and 249 (44.3%) were on aspirin. Overall ICH frequency was 15 per cent with no difference in ICH rate, type of ICH, need for craniotomy, mortality, or intensive care unit or hospital length of stay between groups. Patients with ICH were more likely to present with abnormal Glasgow Coma Score, history of hypertension, and/or loss of consciousness.

Popliteal artery thrombosis secondary to a tibial osteochondroma

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 251-255 ◽  
Author(s):  
Gruber-Szydlo ◽  
Poreba ◽  
Belowska-Bien ◽  
Derkacz ◽  
Badowski ◽  
...  
Keyword(s):  
Case Report ◽  
Magnetic Resonance Angiography ◽  
Popliteal Artery ◽  
Doppler Ultrasonography ◽  
Histopathological Examination ◽  
Previous History ◽  
Plain Radiography ◽  
Artery Thrombosis ◽  
History Of ◽  
The Right

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

LUNGRADS AND UPDATE OF LUNG NODULES SCREENING BY LOW DOSE COMPUTED TOMOGRAPHY

2015 ◽  
pp. 12-19
Author(s):  
Thi Ngoc Ha Hoang ◽  
Trong Khoan Le
Keyword(s):  
Lung Cancer ◽  
Low Dose ◽  
False Negative ◽  
Lung Nodule ◽  
Lung Cancer Mortality ◽  
Smoking History ◽  
Low Dose Ct ◽  
History Of ◽  
Chest X Ray ◽  
Low Dose Computed Tomography

Background: A pulmonary nodule is defined as a rounded or irregular opacity, well or poorly defined, measuring up to 3 cm in diameter. Early detection the malignancy of nodules has a significant role in decreasing the mortality, increasing the survival time and consider as early diagnosis lung cancer. The main risk factors are those of current or former smokers, aged 55 to 74 years with a smoking history of at least 1 pack-day. Low dose CT: screening individuals with high risk of lung cancer by low dose CT scans could reduce lung cancer mortality by 20 percent compared to chest X-ray. Radiation dose has to maximum reduced but respect the rule of ALARA (As Low as Resonably Archivable). LungRADS 2014: Classification of American College of Radiology, LungRADS, is a newly application but showed many advantages in comparison with others classification such as increasing positive predict value (PPV), no result of false negative and cost effectiveness. Key words: LungRADS, screening lung nodule, low dose CT, lung cancer

Surgical management of choke through oesophagotomy in a buffalo: A case report

2017 ◽  
Vol 12 (3) ◽  
Author(s):  
Devasee Borakhatariya ◽  
A. B. Gadara
Keyword(s):  
Case Report ◽  
Surgical Management ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Thoracic Inlet ◽  
Cervical Oesophagus ◽  
Foreign Objects ◽  
History Of ◽  
Oesophageal Obstruction ◽  
Large Animals

Oesophageal disorders are relatively uncommon in large animals. Oesophageal obstruction is the most frequently encountered clinical presentation in bovine and it may be intraluminal or extra luminal (Haven, 1990). Intraluminal obstruction or “choke” is the most common abnormality that usually occurs when foreign objects, large feedstuff, medicated boluses, trichobezoars, or oesophageal granuloma lodge in the lumen of the oesophagus. Oesophageal obstructions in bovine commonly occur at the pharynx, the cranial aspect of the cervical oesophagus, the thoracic inlet, or the base of the heart (Choudhary et al., 2010). Diagnosis of such problem depends on the history of eating particular foodstuff and clinical signs as bloat, tenesmus, retching, and salivation

scholarly journals Ectopic pregnancy in a tertiary care centre of Jharkhand, India

2019 ◽  
Vol 8 (8) ◽  
pp. 2969
Author(s):  
Meetali Parashar ◽  
Meena Mehta
Keyword(s):  
Ectopic Pregnancy ◽  
Clinical Presentation ◽  
Previous History ◽  
First Trimester ◽  
Near Miss ◽  
Obstetrics And Gynaecology ◽  
Maternal Morbidity And Mortality ◽  
History Of ◽  
Β Hcg ◽  
A Prospective Study

Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions:Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions: Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.

scholarly journals When less is more: a daring conservative approach to postpneumonectomy oesophago-pleural fistula

2019 ◽  
Vol 30 (1) ◽  
pp. 146-148
Author(s):  
Lara Girelli ◽  
Elena Prisciandaro ◽  
Niccolò Filippi ◽  
Lorenzo Spaggiari
Keyword(s):  
Clinical Presentation ◽  
Clinical Status ◽  
High Morbidity ◽  
Conservative Approach ◽  
Chronic Fistula ◽  
Less Is More ◽  
Primary Surgery ◽  
History Of ◽  
Uncommon Complication

Abstract Oesophago-pleural fistula is an uncommon complication after pneumonectomy, usually related to high morbidity and mortality. Due to its rarity and heterogeneous clinical presentation, its diagnosis and management are challenging issues. Here, we report the case of a patient with a history of pneumonectomy for a tracheal tumour, who developed an asymptomatic oesophago-pleural fistula 7 years after primary surgery. In consideration of the patient’s good clinical status and after verifying the preservation of respiratory and digestive functions, a bold conservative approach was adopted. Five-year follow-up computed tomography did not disclose any sign of recurrence of disease and showed a stable, chronic fistula.

scholarly journals 651. Comparative Analysis Between Bacterial And Fungal Malignant Otitis Externa

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S383-S384
Author(s):  
Fatma Hammami ◽  
Makram Koubaa ◽  
Amal Chakroun ◽  
Fatma Smaoui ◽  
Khaoula Rekik ◽  
...  
Keyword(s):  
Otitis Externa ◽  
Clinical Presentation ◽  
The Elderly ◽  
Causative Organism ◽  
Diabetic Patients ◽  
Duration Of Treatment ◽  
Evolutionary Features ◽  
Significant Difference ◽  
Malignant Otitis Externa ◽  
History Of

Abstract Background Malignant otitis externa is a fatal infection of the external ear and temporal bone. Pseudomonas aeruginosa is the most common causative organism, while fungi are a rare cause of malignant otitis externa. We aimed to compare the clinical, therapeutic and evolutionary features between bacterial and fungal malignant otitis externa. Methods We conducted a retrospective study including all patients hospitalized for malignant otitis externa in the infectious diseases department between 2000 and 2018. Results Overall, we encountered 82 cases of malignant otitis externa, among which there were 54 cases (65.9%) of bacterial malignant otitis externa (BMO) and 28 cases (34.1%) of fungal malignant otitis externa (FMO). The males were predominant among BMO cases (57.4% vs 50%; p=0.5). Patients with FMO were significantly older (70±9 years vs 61±10 years; p< 0.001) and had medical history of diabetes mellitus more frequently (96.4% vs 77.8%; p=0.03). The use of topical corticosteroids was significantly more reported among FMO cases (28.6% vs 5.6%; p=0.006). Otalgia (96.4% vs 81.5%), otorrhea (75% vs 66.7%) and cephalalgia (46.4% vs 42.6%) were the revealing symptoms among FMO and BMO, respectively, with no significant difference. Tenderness to palpation of the mastoid bone (64.3% vs 38.9%; p=0.02) and stenosis of the external auditory canal (92.9% vs 72.2%; p=0.02) were significantly more frequent among FMO cases. Complications were significantly more frequent among FMO cases (42.9% vs 9.3%; p< 0.001). Treatment duration was significantly longer among FMO cases (70[40-90] days vs 45[34-75] days; p=0.03). Conclusion Our study showed that FMO affected more frequently the elderly and diabetic patients, when compared with BMO. Regardless of the causative agent, the clinical presentation was similar. However, the outcome was poor among FMO cases with the occurrence of complications, requiring a longer duration of treatment. Disclosures All Authors: No reported disclosures

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