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

A case of acute aortic dissection (AAD) presenting as sudden, transient paraplegia and severe back pain is reported. The patient was a 66-year-old male with a 10-year-history of hypertension. The pain characteristically migrated from the back to the neck and then returned to the back. He showed complete transverse myelopathy at the level of the 9th thoracic cord. Computed tomography disclosed internal displacement of aortic intimal calcifications, without abnormalities in the spinal canal, and myelography showed no spinal canal block or stenosis. Electrocardiography and chest x-ray indicated nonspecific changes of high amplitudes and mild cardiomegaly, respectively. Together, these findings suggested acute aortic dissection with spinal cord ischemia. The initial systolic blood pressure of 220 mmHg was lowered with medication, and the pain was controlled with morphine. He recovered fully and was discharged 80 days after the onset of symptoms, with no neurological deficits. AAD carries a very poor prognosis unless treated immediately. Therefore, it is very important to promptly differentiate this disorder from spinal vascular conditions that also produce back pain and paraparesis.
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PMID:Transient paraplegia caused by acute aortic dissection--case report. 169 75

This is a case report of 63-year-old man suffering from DeBakey III B acute dissection in association with thoracic aortic aneurysm. He had been following up for hypertension and thoracic aortic aneurysm. He was brought to the hospital by city ambulance complaining of sudden onset of severe back pain. Emergency operation was carried out. It revealed aneurysm of 90 mm in diameter located just distal to the aortic arch and an intimal tear or entry of the dissection located distal to the left subclavian artery. A low porosity Dacron graft was interposed between the distal aortic arch and middle portion of the thoracic descending aorta using inclusion technique. Systemic circulation was bypassing external iliac vein to artery using pump-oxygenator during aortic clamping. His postoperative course was uneventful. In review of the literature, association of the atherosclerotic aneurysm and acute dissection occurred approximately 5% in the cases of aortic dissection with increasing risk of aneurysmal rupture.
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PMID:[A case report of surgical treatment of acute aortic dissection (DeBakey III B) in association with thoracic aortic aneurysm]. 175 13

Between 1985 and 1988, a two-phase epidemiological study was conducted at the "Ruta 100" company in Mexico City to examine the harmful effects of the working conditions on drivers of urban transport vehicles. In the first phase, five groups of nine drivers each were interviewed regarding their opinions about their working conditions and possible work-related disorders. On the basis of this information, an epidemiological survey was developed and applied using a polytypic sampling design to some 200 drivers plus two other groups of approximately the same size, one consisting of maintenance workers and the other of office workers, which served as controls. The driver group showed a high prevalence of respiratory and neuropsychiatric disorders, diarrhea, myopia, arterial hypertension, urinary disorders, hemorrhoids, hearing loss, back pain, varicose veins, peptic ulcers, diabetes, cardiopathies, abdominal hernias, and appendicitis. For arterial hypertension, hemorrhoids, nervous disorders, and psychiatric disorders the prevalence ratios of drivers/maintenance workers and drivers/administrative workers were statistically significant.
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PMID:[Health status of urban passenger transportation conductors in Mexico City]. 183 60

Severe back pain in the pediatric patient is an infrequent complaint. The following case report illustrates the disastrous outcome for this patient with back pain secondary to aortic dissection. The most common predisposing disease process is hypertension, which exposes the aortic wall to high pressures and flows. Just as in the adult patient, the possibility of aortic dissection should be included in the differential diagnosis of acute onset of severe back pain with preexisting hypertension in the pediatric patient. A high index of suspicion is warranted.
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PMID:Back pain with cardiovascular collapse in a pediatric emergency department patient. 213 33

Autosomal dominant polycystic kidney disease (ADPKD) is the commonest hereditary nephropathy. We collected 92 cases in VGH. Diagnosis was confirmed by intravenous pyelogram, renal sonogram, or renal CAT scan. The incidence of having positive family history was just only 28.3%. Patients were diagnosed at the mean age of 54 +/- 11 years (26-74 years). The common clinical findings were hypertension (73.9%), abdominal mass, proteinuria, anemia, azotemia, abdominal or back pain and pyuria in orders. Hypertension might present in the early stage with normal renal function (near 40%). Polycystic liver was the major extrarenal lesion (57.6%), but the incidence of abnormal liver function was only 10.1%. Enlarged kidneys were not always palpable, even at end stage of renal function (mean age 56 +/- 9 years, 89.4% kidney palpable). Patient's urine amount was usually nonoliguric, even in uremic stage (82.9%). Sepsis was the first cause of death. Cardiovascular disease and uremia were followed in sequence. Their expired mean age was 61 +/- 7 years (53-74 years).
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PMID:[Autosomal dominant polycystic kidney disease clinical analysis in VGH--Taipei]. 217 45

Physicians who participate in preferred provider organizations (PPOs) usually agree to various types of utilization review and sometimes discount their charges or agree to accept lower fees. This study was performed to determine whether they provided more or fewer services to their PPO patients than to their indemnity patients and whether the discounting resulted in lower expenditures for each episode of illness. In 1984, Metropolitan Life offered PPO coverage to Dade County (Florida) school board employees and dependents but only a standard indemnity plan to Dade County government employees and dependents. Episodes of care were examined for patients with chest pain, hypertension, joint pain, gastrointestinal or liver disorders, and lower back pain cared for by physicians who treated patients in both the PPO and indemnity employee groups. For PPO patients, charges per physician service were the same or lower, but total physician charges during an episode were higher. For services such as laboratory tests, diagnostic x-rays, and room and board, PPO and indemnity patients' charges were not significantly different.
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PMID:Services and charges by PPO physicians for PPO and indemnity patients. An episode of care comparison. 223 20

Appropriate diagnostic procedure for spinal epidural hematomas has not been established yet. The authors reported a case of spontaneous epidural hematomas at the thoracic level, in which correct diagnosis was made with MRI and good results were obtained by surgery. A 63-year-old female experienced a severe back pain which appeared suddenly during a walk and was followed by motor weakness in both legs deteriorating quickly to paraplegia. The patient had no history of hypertension, trauma or bleeding tendency. The laboratory data were normal. On admission, neurological examination revealed flaccid paraplegia, total sensory loss below the level of Th 6 and urinary and fecal incontinence. Myelograms showed incomplete block at the Th 6 level and postmyelographic CT scan showed an isodense mass, which was suspected to be an epidural tumor located behind the spinal cord. Emergent MRI confirmed an epidural hematoma as a high intensity area extending from Th 3 through Th 11. Sixty-five hours after onset, laminectomy of Th 4 through Th 11 and the evacuation of epidural hematoma were performed without identification of the origin of the bleeding. Neither vascular malformation nor tumor was recognized during operation. Neither was it noticed on histological examination. The patient made favorable progress after the surgery. During the first two weeks in the postoperative period, she regained muscle strength enough to do standing exercise, and satisfactory improvement was made in sensory function including urination and defecation. We emphasize that MRI is indispensable to make a differential diagnosis of thoracic lesions. In the reported case, a correct diagnosis was made with MRI, and an extremely good result was obtained by an emergency operation.
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PMID:[Spontaneous spinal epidural hematoma diagnosed by MRI: a case report]. 259 57

A 62-year-old man with a 2-year history of hypertension was referred for evaluation of severe back pain, but his blood pressure was normal during his hospital stay. Plain radiography and excretory urography demonstrated central and eggshell-like calcification in the left suprarenal area. Computed tomographic scan confirmed similar shapes for the left adrenal calcifications. Laboratory examination revealed that the urinary normetanephrine was elevated. Left adrenal venography showed that the mass was in the middle to lower portion of the left adrenal gland. The most likely diagnosis was, calcified pheochromocytoma. The left adrenal tumor was removed surgically through a thoracolumbar incision on September 19, 1985. The blood pressure rose to 186/102 mmHg at the time of tumor manipulation. The tumor was a markedly hard mass, which was 3.5 x 3.5 x 3.0 cm and weighed 20 g. The histopathologic diagnosis was calcified pheochromocytoma. The patient remained symptomless after the operation.
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PMID:[Uncommon calcification of a pheochromocytoma: a case report]. 268 60

The patient has been receiving hemodialysis (H.D.) for chronic renal failure due to polycystic kidney since last February. He suddenly had back pain and short of breath February 8, 1988. He was pointed out to have hypertension and cardiomegaly on chest roentgenogram. He was transferred to our hospital, and suspected dissecting aneurysm. Magnetic resonance imaging was useful for the diagnosis of the dissecting aneurysm and may have a potential advantage in following up the residual false lumen. The patient underwent graft inclusion technique for dissecting aneurysm of the thoracic aorta of type IIIb with an aid of partial femoro-femoral bypass. The water and electrolytes balances were controlled by GI therapy and hemoconcentrator during operation. Since serum potassium level was gradually increasing up to 7.8 mEq/l inducing arrhythmias with coronary arterial spasm postoperatively, H.D. was instituted. The induction of H.D. was easily performed with satisfactory results. Heparin was not used while blood coagulation profiles tended to be low in early postoperative period. He returned to his work this August.
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PMID:[A case report of surgical treatment of dissecting aneurysm of the thoracic aorta (DeBakey IIIb) with chronic renal failure]. 268 33

The records of 22 patients, aged 61 to 85 years, with histologically proven cholesterol embolism (CE) were reviewed. All had one or more risk factors. Twenty-one patients had preexisting symptomatic or recognized atherosclerotic disease. Twenty patients had one or more identifiable precipitating factors, including warfarin administration (4), angiography (15), angioplasty (2), intra-aortic balloon pump placement (2), vascular surgery (11), aortitis (2), and cardiopulmonary resuscitation (1). These preceded the onset of symptoms by as many as 3 months, but usually by less than 3 weeks. Eight patients had peripheral CE alone. Fourteen patients had visceral CE. All 14 had renal CE that was characterized by abrupt deterioration of renal function after a precipitating event (13), evidence of concurrent CE to the lower extremities or other organs (10), accelerated hypertension (9), gross hematuria (6), or flank and back pain (3). Unusual presentations included one case each of spinal cord infarction, penile gangrene, adrenal insufficiency, and symptomatic splenic infarct. If patients with visceral CE survived after initial hospitalization, they often required dialysis and later hospitalizations because of complications. Premortem diagnoses were made in 18 patients: nine from surgical specimens and nine from biopsies (one kidney, eight muscle and skin). Attempts at definitive vascular surgery were possible in only two patients and successful in one. The challenges encountered in managing these patients' conditions are reviewed.
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PMID:Cholesterol embolism: experience with 22 histologically proven cases. 272 1


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