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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A very rare case of a myxosarcoma with metastases to the brain is reported. A 33-year-old female was admitted to our hospital because of lassitude, fever, slight left hemiparesis, headache and other signs of intracranial hypertension and cardiac symptoms such as dyspnea and palpitation. She had the cardiac symptoms once 14 years before, which reappeared and rapidly aggravated two months before the admission. Cerebral angiography revealed a mass in the right temporal lobe and physical and laboratory examinations revealed mitral value failure and hyperthyroidism. On the next day, March 19, 1976, a grossly cystic 60 gm tumor was totally removed which was largely imbedded in the subcortex of the right temporal lobe. The symptoms except for the cardiac symptoms and disseminated intravascular coagulopathy rapidly improved, but headache and left hemiparesis returned 13 days postoperatively. She died suddenly 18 days after the operation due to acute cardiac failure. Autopsy revealed two separate hard and solid tumors both attached to the mitral valve and occupied the whole left atrium and another metastasis to the frontal lobe which had not been diagnosed before the death. Microscopic examinations including electronmicroscopic study established the diagnosis of myxosarcoma in all the four tumors.
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PMID:[Brain metastases from primary cardiac myxosarcoma--report of a case (author's transl)]. 71 43

The general features and problems of renal vein thrombosis in children are first discussed. The records of 11 children with this condition, 7 ill neonates and 4 older children with burns, are then reviewed, indicating the clinical course of the disease, how they were treated, the results, and pathological findings. From this study, the natural history is assembled and a protocol for treatment is proposed. Supportive therapy is necessary in all cases to correct dehydration and sepsis. Many children will develop a consumptive coagulopathy. Others will develop pulmonary emboli associated with thrombosis of the inferior vena cava. Anticoagulation should be achieved for these two conditions. Nonvisualization of affected renal units upon initial urographic examination virtually assures an atrophic, functionless kidney later. Nephrectomy will be required because of hypertension, persistent infection, and scarring. Thrombectomy may be attempted when bilateral nonvisualization on urography is associated with a positive venacavogram.
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PMID:Natural history and treatment of renal vein thrombosis in children. 91 51

Twelve patients who had no evidence of arteriosclerotic cerebral vascular disease, lacked hypertension or coagulation defect, and had not been receiving contraceptive therapy had recurrent transient cerebral ischemic attacks (TIAs) and partial nonprogressive strokes. All had prolapsing mitral valve proved by angiocardiography. The average age was 38 years, compared with 62 years in a larger series of patients with TIA associated with arteriosclerosis. We propose that the ischemic events are related to emboli emanating from the abnormal mitral valve with or without an associated paroxysmal cardiac arrhythmia.
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PMID:Cerebral ischemic events associated with prolapsing mitral valve. 98 56

The HELLP syndrome (haemolysis, elevated liver enzymes, low platelet count) was first referred to by Weinstein in 1982 as an extremely progressive form of gestosis. In addition to the more common gestotic symptoms, such as oedema, proteinuria and hypertension, the clinical picture is characterized by microangiopathic haemolysis, thrombocytopenia and, especially, impaired hepatic function. Within this clinical picture severe complications can occur, such as eclamptic attacks, renal dysfunction, intracranial haemorrhage, intrahepatic haemorrhage and coagulopathy. An imbalance in prostanoid metabolism has been implicated in the pathogenesis. A decrease in synthesis of the vasodilator and thrombocyte aggregation inhibitor prostacyclin leads to a preponderance of the vasoconstrictor thromboxane A2, which promotes thrombocyte aggregation. This results in local vascular spasms and endothelial lesions, which in the case of hypercoagulopathy are accompanied by the formation of fibrin deposits with resultant vascular constriction. Intravascular fibrin deposits indicate that the coagulation system has been compromised and can lead to consumption coagulopathy in approximately 10% of cases. In the majority of cases, however, one finds low-grade disseminated intravascular coagulation (DIC), i.e. mild hypercoagulopathy with thrombocytopenia, a tendency to thrombocyte aggregation and fibrinogen deficiency in the presence of usually normal plasmatic coagulation. These vascular changes occur particularly in organs that have high blood flow, such as liver, kidneys and placenta. In the liver, sinusoidal obstruction causes vascular congestion, leading to an increase in intrahepatic pressure, dilatation of Glisson's capsule, development of subcapsular hepatic haematomas and hepatic rupture. Hepatic haematoma virtually always requires surgical treatment, and otherwise the patient has hardly any chance of survival. Nevertheless, mortality is around 35%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Spontaneous liver rupture as a rare complication of the HELLP syndrome]. 149 26

In their severest forms, pre-eclampsia and eclampsia may be life-threatening complications of pregnancy. We describe a patient with severe post-partum eclampsia characterized by seizures, deep coma, hypertension, renal insufficiency, coagulopathy, and microangiopathic hemolysis. The patient responded to treatment that included intensive plasma exchange, and she achieved full recovery. Our case supports the use of plasma exchange in patients with severe pre-eclampsia and eclampsia.
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PMID:Severe post-partum eclampsia: response to plasma exchange. 159 49

The course of preeclamptic/eclamptic patients may be complicated by HELLP syndrome, a syndrome of intravascular hemolysis (H), elevated liver enzymes (EL) and low platelet count (LP). These patients typically present at early third trimester with epigastric or right upper quadrant pain, nausea and vomiting. They may present without the clinical signs of preeclampsia (hypertension and proteinuria or edema), thus an initial wrong nonobstetric diagnosis is not uncommon. The most frequent maternal complication is intravascular coagulopathy (30%). Placental abruption and acute renal failure are also common. Ten cases of maternal deaths were reported among 295 cases reviewed in the English language literature, while the perinatal mortality rate was 226/1000. The grave prognosis for mother and fetus warrants physician awareness in order to accomplish early diagnosis and proper management. This paper is a review of the literature in English.
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PMID:HELLP syndrome--a syndrome of hemolysis, elevated liver enzymes and low platelet count--complicating preeclampsia-eclampsia. 168 23

The causes of postoperative haematomas after operations for intracranial meningiomas are analysed. The percentage of this complication in this material was 5.2%. The most frequent concomitant disease in this series was arterial hypertension. The majority of postoperative haematomas was observed after longer lasting operations with totally excised large tumour. Perhaps, one of a large number of causes, is slight coagulopathy.
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PMID:[Intracranial hematoma as a complication after surgical treatment of meningiomas]. 180 19

Of 3632 consecutive admissions to the Wilmer Ophthalmological Institute between July 1, 1987 and June 30, 1989, 27 patients required transfer to a medical or surgical service (0.74%). The major reasons for transfer included acute or decompensated cardiac disease (26%), poorly controlled diabetes mellitus (19%), acute renal failure (11%), coagulopathy, stroke, and hypertension (7% each). Only one transfer was a direct result of an anesthesia complication. The highest rates of transfers were associated with orbital (4.3%), enucleation/evisceration (3.1%), and glaucoma (2.3%) surgeries, while vitreoretinal surgery had the lowest rate of transfer (0.3%). Most of the transfers of patients with orbital disease were for management of related problems such as sinusitis or increased intracranial pressure.
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PMID:Transfer from ophthalmology to another service is a marker of high risk medical events. 190 39

Ten women with severe pre-eclampsia, i.e. a blood pressure greater than or equal to 150/110 mmHg or 140/90 mmHg and proteinuria greater than 3 g/24 h were, after initial antihypertensive treatment, centrally monitored with a pulmonary artery catheter (Swan-Ganz). All had been normotensive in early pregnancy. Mean age was 29 years (range 23-37). Mean gestational age upon admission was 29 weeks (range 23-36) and 7 of the women were nulliparous. Nine of the 10 patients had subjective symptoms, e.g. headache and/or epigastric pain. All were considered in need of intensive care. Two patients were found to have an abnormal coagulation and liver function. All patients had normal serum creatinine values despite proteinuria. Hypertension was treated with dihydralazine and/or labetalol. Volume substitution was carried out with plasma and albumin. The women could be divided into two groups: 5 patients where progress of the disease despite therapy led to delivery within 24 h, and 5 patients whose diastolic blood pressure could be stabilized around 100 mmHg after treatment and pregnancy could be prolonged by 5-13 days. Common for all patients was a hyperkinetic circulation with an increased cardiac output despite a variety of central pressures. Invasive monitoring of central pressures with a Swan-Ganz catheter demonstrated that the clinical status could be stabilized and the pregnancy prolonged in 5 of the 10 women with severe pre-eclampsia. The variety of the central hemodynamic values illustrates clearly that treatment has to be individualized regarding antihypertensive medication, fluids and diuretics.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hemodynamic measurements with Swan-Ganz catheter in women with severe proteinuric gestational hypertension (pre-eclampsia). 192 95

Acute angle-closure glaucoma from a spontaneous massive hemorrhagic retinal or choroidal detachment occurred in five eyes. The source of the hemorrhagic detachment was a disciform macular lesion in all instances. The mechanism for the angle closure is the abrupt forward displacement of the lens-iris diaphragm resulting from the massively detached choroid and retina. Four of the five patients had either systemic hypertension or a primary or anticoagulant-induced clotting disorder. All patients underwent ultrasonographic studies, and one patient had magnetic resonance imaging (MRI) to rule out melanoma. Only one eye required enucleation for pain relief. Glaucoma medication, cyclophotocoagulation, or retrobulbar alcohol controlled the other four eyes. The clinical, ultrasonographic, MRI, and histopathologic features of this rare condition are described, and an updated therapeutic approach is discussed.
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PMID:Acute angle-closure glaucoma from spontaneous massive hemorrhagic retinal or choroidal detachment. An updated diagnostic and therapeutic approach. 217 99


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