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

The incidence of and mortality from ruptured infrarenal abdominal aortic aneurysm (AAA) are increasing. Therefore, it is important to identify groups at high risk. Tobacco use, hypertension, a family history of AAA, and male sex are clinical risk factors for the development of an aneurysm. Chronic inflammation and enzymatic degradation of elastin and collagen constitute the prominent pathogenetic mechanism of infrarenal AAA. Intervals for surveillance depend on the aneurysm diameter, taking into account that AAA >5.5 cm should be referred to a vascular surgeon. Asymptomatic patients with an infrarenal AAA should be medically optimized before repair. Symptomatic aneurysms present with back, abdominal, or leg pain and require urgent surgical attention. Rupture of an AAA involves complete loss of aortic wall integrity and is a surgical emergency requiring immediate repair.
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PMID:[Infrarenal abdominal aortic aneurysms]. 1797 23

Blood pressure at the ankle level is a reliable indicator of peripheral arterial disease (PAD) and the ankle brachial index (ABI) is a useful non-invasive screening tool for the early detection of atherosclerosis. In the first part of the study, systolic blood pressures obtained by oscillometry and plethysmography were compared in 80 subjects referred for possible vascular disease. In the second part of the study, 31 general practitioners enrolled 1258 consecutive patients aged more than 60 years. ABI was estimated by oscillometry. Patients with an ABI lower than 0.9 were referred to the local hospital for standardized measurements. In the first part, oscillometry showed a sensitivity of 97% and a specificity of 62% with a positive and negative predictive value of 71% and 96%, respectively. In the second part, significant PAD was found in 111 cases corresponding to a prevalence of 12.2%. In this population, the oscillometry showed a positive predictive value of 47%. The presence of PAD was significantly correlated to exercise related leg pain, a diagnosis of hypertension and smoking, whereas no correlation could be found with a diagnosis of heart disease, stroke, or with the presence of diabetes. The prevalence of PAD was sufficiently high in subjects over the age of 60 years to warrant screening. The ankle brachial index based on measurements with an oscillometric device was shown reliable in the exclusion of PAD, thereby fulfilling an important criterion for the use in screening.
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PMID:Oscillometric blood pressure measurement: a simple method in screening for peripheral arterial disease. 1880 41

Acute aortic dissection is a life-threatening disease. To increase the awareness of this diagnosis as a cause of feto-maternal mortality during pregnancy, we have analyzed risk factors using information from five pregnant women admitted for acute aortic dissection to the Karolinska University Hospital over an eight-year period (1999-2007). Four of the women died and only one survived. One fetus was stillborn and all newborn infants showed signs of asphyxia at birth. Of the women, who were on average five years above the mean age for delivery in Sweden, three had hypertension, two had first-degree relatives with aortic dissection which had occurred during the second half of pregnancy (gestational age at diagnosis 26-41 weeks). The most common presenting symptoms were severe back, abdominal and leg pain, and confusion. If a rapid diagnosis is not made, the risk of mortality for both mother and fetus is high. The incidence of aortic rupture during pregnancy in Sweden appears to be 14.5/1,000,000 and the case maternal fatality ratio 4.4/1,000,000.
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PMID:Aortic dissection in pregnancy: a life-threatening disease and a diagnosis of worth considering. 1970 97

Diabetic mellitus (DM) has many well-known complications. However, there is one rare complication, diabetic muscle infarction (DMI), which is usually under diagnosed. Hereby, we present a 53-year-old Chinese man with a history of DM, hypertension and atrial fibrillation. He had acute onset of severe left lower leg pain and swelling with difficulty in walking 4 days before admission. Physical examination revealed non-pitting and non-erythematous swelling with cold sensation of the left medial calf muscles. Magnetic resonance image (MRI) showed homogenous high signal changes in the calf muscles on T2 images, which indicated DMI. After anticoagulation treatment, the patient had a fair recovery within 4 weeks and he could walk by himself thereafter. DMI is a rare complication of poorly controlled DM. It does have a characteristic clinical presentation and MRI findings. Increased clinical awareness is important for early recognition and correct treatment.
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PMID:Diabetic muscle infarction in a patient with acute embolic stroke. 1992 2

A 52-year-old physically active man with a medical history of coronary artery disease, hypertension, and hyperlipidemia presented with numbness and tingling in the legs. His symptoms were intermittent initially, triggered by running or playing soccer and relieved by rest. Symptoms progressed during 1 year. The numbness became more constant, and he developed leg pain radiating from the popliteal fossa to the heel bilaterally (pain was more severe in the left leg compared with the right leg). Recently, he had noted some constipation as well as difficulty in initiating urination.
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PMID:Exercise-associated numbness and tingling in the legs. 2215 60

Neurologic complications after anesthesia are relatively uncommon but occasionally severe. Intraoperative intracranial hypertension in patients with brain masses, delayed arousal, and postoperative delirium and cognitive dysfunction are among the main complications of general anesthesia. Neuropathy and transient gluteal and leg pain are the most frequent complications of regional blockade. Seizures are infrequent with both anesthesia modalities. Patients with primary neurologic disorders, such as neurodegenerative or neuromuscular conditions, can be at risk for specific complications, and the anesthesia plan must be cautiously adjusted in these patients. In the neurointensive care unit, the complications from large doses of anesthetic agents used for suppression of seizures or control of intracranial pressure are different from those seen perioperatively. Propofol infusion syndrome can be life-threatening when administered for those indications.
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PMID:Neurologic complications of anesthesia. 2281 Jul 92

Spinal arteriovenous malformations are rare in children, although perimedullary arteriovenous fistulas (PMAVFs) may account for up to 24% of spinal arteriovenous malformations in this age group. Reported presentations of PMAVFs have included progressive or acute myelopathic symptoms, pain, hematomyelia, and subarachnoid hemorrhage. No known reports of an unruptured PMAVF causing communicating hydrocephalus have been previously published. A 17-month-old girl presented to the authors' clinic with a 6-month history of back and leg pain, gait regression, constipation, and marked lumbar hyperlordosis due to a PMAVF. A brain MRI study also demonstrated advanced hydrocephalus. The patient underwent embolization with Onyx of 2 feeding arteries from the right L-1 and 1 feeding artery from the left L-1 lumbar arteries. Postembolization follow-up imaging demonstrated a reduction in size of the L-1 pedicles and no residual supply of the fistula. Three-year clinical follow-up showed normal bowel and bladder function with significant improvements in the patient's back pain, gait, and hyperlordosis. The patient's ventricular enlargement improved without direct management of her hydrocephalus. To the authors' knowledge, this is the first reported case of communicating hydrocephalus caused by an unruptured PMAVF. The authors postulate that the origin of hydrocephalus was either central venous hypertension caused by the high-flow fistula or a change in fluid dynamics reducing CSF resorption through arachnoid granulations in the lumbar region of the spinal cord. The exact role that spinal arachnoid granulations play in CSF resorption is not currently known. Regardless of pathogenesis, initial treatment should focus on management of the fistula with additional hydrocephalus management only when necessary.
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PMID:Communicating hydrocephalus caused by an unruptured perimedullary arteriovenous fistula in the lumbar region of an infant. 2324 Aug 50

Disseminated intravascular coagulation (DIC) is an extremely rare complication of acute thrombosis in popliteal aneurysms and makes it difficult to restore the blood flow with thrombolytic therapy or surgical repair. A 75-year-old man with a history of hypertension presented to the emergency department with complaints of right leg pain and bleeding tendency over a 5-day period. The laboratory findings and multislice computed tomography were suggestive of overt DIC caused by acute thrombosis in the right popliteal aneurysm. Successfully treated with medication, he could discharge without surgical or thrombolytic recanalization of the aneurysm.
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PMID:Disseminated intravascular coagulation with acutely-thrombosed popliteal aneurysm. 2355 3

The authors identified patients with an increase in their Oswestry Disability Index (ODI) score after lumbar spine fusion to evaluate whether this is a plausible definition of deterioration and to determine whether any common patient characteristics exist.A total of 1054 patients who underwent lumbar spinal fusion and had 2-year follow-up data, including the Short Form 36, the ODI, and numeric rating scales for back and leg pain, were identified. Patients with worsening ODI were compared with the remaining cohort. Twenty-eight patients had an absolute increase (worse) in ODI at 1 year postoperatively. Participants with worsening ODI scores included 13 men and 15 women with an average age of 43.3 years; 15 (54%) were smokers. Common medical comorbidities included obesity and hypertension. Complications occurred in 5 (18%) patients and included wound infection, dural tear, and nerve root injury. Pseudarthrosis was common (n=8; 28%). Twenty-one patients required an additional intervention, including epidural injections, fusion revision, and cervical spine surgery.It is important to have a clear definition of deterioration to better provide informed consent or choice of treatment. Only 28 (2.6%) patients were identified as having an increase in ODI score at 2-year follow-up.
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PMID:Predictors of Oswestry Disability Index worsening after lumbar fusion. 2359 Jul 89

Peripheral arterial disease (PAD) is an atherosclerotic condition that can provoke symptoms of leg pain ("intermittent claudication") during exercise. Because PAD is often observed with comorbid conditions such hypertension, dyslipidemia, diabetes, cigarette smoking, and/or physical inactivity, the pathophysiology of PAD is certainly complex and involves multiple organ systems. Patients with PAD are at high risk for myocardial infarction, stroke, and all-cause mortality. For this reason, a better physiological understanding of the pathogenesis and treatment options for PAD patients is necessary and forms the basis of this Physiology in Medicine review.
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PMID:Physiology in medicine: peripheral arterial disease. 2397 May 34


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