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PubMed1976

Myocardial infarction complicated by rheumatic heart disease.

This report describes the case of a 32-year-old woman with the sudden onset of chest pain and an evolving inferior wall infarction proved by the electrocardiogram and enzyme studies. The patient underwent embolectomy 2 months later for a thromboembolus in the right main coronary artery. An autologous patch graft was used to close the arteriotomy. Four years later, the patient is asymptomatic, having no activity limitations. The patch graft to the right coronary artery is patent. This case exemplifies and reaffirms the possibility of emboli being lodged in the coronary arteries in certain types of disease. It may be necessary to operate in order to re-establish proper coronary circulation.

Adult↗
PubMed2001

[Effect of aloe-emodin on c-myc gene expression of cultured vascular smooth muscle cells of injured artery].

OBJECTIVE: To study the molecular mechanism of aloe-emodin (AE) in inhibiting smooth muscle cells' (SMC) proliferation. METHODS: Deendothelialization was performed in abdominal aorta of Japanese white ear rabbits by using 3F Fogarty arterial embolectomy catheter. The media of abdominal aorta was isolated 48 hrs later for performing primary SMC culture. Cells were synchronized with G0/G1 phase by serum starvation, the AE was then added to the culture medium of experimental group, at a concentration of 20 micrograms/ml, and to the control group, equal volume of culture solution was added instead. The c-myc mRNA and protein expressions were examined 3 hrs later by using techniques of Northern blotting, Western blotting and immunocytochemistry respectively. RESULTS: In comparing with the control group, neither the expression of c-myc mRNA nor the expression of c-myc protein was changed after addition of AE. CONCLUSION: The inhibition of AE on SMC might not be due to influencing c-myc expression, but via other pathway.

Animals↗
PubMedDate not supplied

Acute mesenteric ischemia: classification, evaluation and therapy.

Mortality rates of acute mesenteric ischemia still range between 60 and 100%. Unfortunately, retrospective series have not shown any significant improvement in mortality in the past decades. With approximately 50%, superior mesenteric artery (SMA) embolism is the most common form of acute mesenteric ischemia, followed by SMA thrombosis (approximately 25%), nonocclusive mesenteric ischemia (approximately 20%) and mesenteric venous thrombosis (approximately 5%). Clinical presentation may be unspecific, but is often characterised by an initial discrepancy between severe subjective pain and relatively unspectacular findings on physical examination. The key to a better outcome (and the main problem in clinical practice) is early diagnosis. Up to now, helas, there are no simple and noninvasive diagnostic tests of sufficient sensitivity and specificity. Thus, angiography remains the cornerstone of diagnosis and should be performed early in all patients with a risk profile and a clinical presentation suspicious of AMI. The initial therapeutic step in all patients with AMI is resuscitation and a stabilization of circulation. If an advanced stage of ischemia is suspected, broad spectrum antibiotics have to be given. Nonocclusive mesenteric ischemia without signs of peritoneal infarction may be managed by pharmacological vasodilation, and vasodilators are also considered as a valuable supportive treatment option in patients with obstructive mesenteric ischemia. Patients with mesenteric venous thrombosis have to be treated by immediate anticoagulation, followed by laparotomy if peritoneal signs are present. Standard treatment for patients with obstructive mesenteric arterial syndromes is a laparotomy with embolectomy or revascularization and, if indicated, resection of infarcted bowel.--. This review will give an overview on the different forms of mesenteric ischemia and then focus on the diagnosis and on generally recommended forms of treatment.

Acute Disease↗
PubMed2002

Vascular trauma in Penang and Kuala Lumpur Hospitals.

OBJECTIVES: The nature of vascular trauma varies greatly between continents and across time. The aim of this study was to prospectively analyse the demographics, pathology, management and clinical outcomes of vascular injuries in two urban Malaysian hospitals and review of international literature on vascular trauma. From this information, preliminary management and preventive implications will be described. METHODS: Eighty-four consecutive cases of trauma requiring vascular surgery were prospectively analysed over three years at Hospital Kuala Lumpur and Hospital Pulau Pinang, Malaysia. Extensive patient demographic and injury data, including the mechanism of injury, associated injuries, angiographic findings, operative details and post-operative complications, were systematically gathered. RESULTS: Most vascular injuries were incurred by males (76/84), with 37% (28/76) of them aged between 21 and 30 years. Malays were most frequently injured (n = 36) followed by Chinese and Indians. Road traffic accidents (n = 49) substantially outnumbered all other causes of injury. Lower limb injuries (n = 57) occurred more than twice as often as upper limb injuries (n = 27). Complete arterial transections (n = 43) and intimal injuries (n = 27) were more common than arterial lacerations (n = 10) and pseudoaneurysms (n = 4). The most frequently damaged vessels were the popliteal/tibioperoneal trunk (n = 33). All patients received urgent Doppler ultrasound assessment and, where possible, ankle-brachial systolic index measurement. Of all patients, 40 received an angiogram, haemodynamic instability making this investigation impractical in others. Primary arterial repair was the most frequently employed surgical procedure (n = 54) followed by autogenous reverse long saphenous vein (LSV) interposition graft (n = 14), embolectomy (n = 5) and PTFE interposition graft (n = 3). The most common post-operative complication was wound infection (n = 11). Amputation, as a last resort, was required in 13 cases following either primary or autogenous reverse LSV repair complicated by sepsis or critical ischaemia. CONCLUSIONS: Vascular trauma, especially in conjunction with severe soft tissue, nerve or orthopaedic injury carries colossal physical, psychological, financial and social costs. Associated nerve and venous injury portended poor outcome in this study. Whilst orthopaedic trauma was a common association, the concurrence of occult vascular trauma and soft tissue injury without fracture emphasises the crucial importance of thorough and rapid clinical vascular assessment, investigation and surgical intervention. Fasciotomy, especially for the lower limb, is important for the prevention of compartment syndrome and its, limb-threatening sequelae. Primary preventive road safety promotion and interventions, with attention to high-risk groups (young males and motorcyclists), is urgently required.

Adolescent↗
PubMed2003

[Acute massive pulmonary embolism occurring during orthopedic surgery].

We present an emergent surgical case of massive pulmonary embolism (MPE) that happened during orthopedic surgery. A 38-year-old man, who had bone fractures with his lumbar vertebra and ankle, underwent the internal fixation of the tibial bone with tourniquet under general anesthesia in our hospital. During this surgery, the pulse oxymeter showed a drop of arterial oxygen saturation suddenly. Immediately we installed a transesophageal echo (TEE) probe in the patient, and detected enlargement of the right ventricle and right atrial thrombus. Half an hour later, the thrombus disappeared from the right atrium and the patient showed hemodynamic shock. We performed emergent embolectomy immediately under moderate hypothermic complete cardiopulmonary bypass. The postoperative course was uneventful, and one month later, his orthopedic surgery underwent completely. We conclude that TEE was a useful devise for the diagnosis of intraoperative MPE.

Adult↗
PubMed2003

[High-dose external ionizing radiation prevents intimal hyperplasia and limits secretion of growth factors PDGFbb, bFGF, and TGFb1. Experiments and results].

PURPOSE: To evaluate the ionizing radiation for intimal hyperplasia prevention and to assess the production of growth factors. METHODS: An oversized injury using an embolectomy catheter was performed on a rabbit distal aorta (N=23), associated (test group; N=12) or not (control group; N=11) with a post-operative external radiation (25 Gy). At t=45 days, histological studies and morphometric studies were performed on the aorta. Smooth muscular cells and endothelial cells were stained using immuno-histologic revelation. Immuno-histological analysis was performed on arteries for growth factors PDGFbb, bFGF and TGFb1. RESULTS: Twenty-one animals survived the procedure, 11 were in the test group and 10 in the control group. Intimal thickness and ratio intima/media were significantly lower after radiation (respectively p=0.008, p=0.008). There was no difference for the medial thickness (p=0.155). Immuno-histochemical positive staining for PDGF and TGFb1 was lower after radiation (respectively 18.44 +/- 2.963% versus 47.64 +/- 6.86%, p<0.001 and 10.11 +/- 3.18% versus 29.45 +/- 4.156%, p<0.001). There was no difference for the expression of bFGF growth factor. After radiation, the media was found to be reduced and replaced by interstitial fibrosis. CONCLUSION: After external radiation the thickness parameter of the intima and the ratio intima/media decreased significantly in comparison with the control group. PDGF and TGFb1 were also less expressed in the artery irradiated. Fibrosis recasting needs to be confirmed by further investigation.

Animals↗
PubMed1992

[Pulmonary arteriography and bronchial arteriography in pulmonary embolism].

Pulmonary arteriography is the most reliable technique for evaluation of pulmonary embolism and other vascular abnormalities. A definitive diagnosis of pulmonary embolism is made on the basis of direct angiographic signs of emboli of intravascular filling defect and vessel cut-off sign. To obtain these findings, pulmonary arteriography needs to be performed as soon as possible, and in acutely ill patients who are in shock and under consideration for thrombolytic therapy or emergency embolectomy, the study should be performed on an emergency basis. Digital subtraction pulmonary angiography may be an useful technique for massive pulmonary embolism, but it cannot exclude clinically important peripheral pulmonary embolism. Wedged pulmonary arteriography can demonstrate the direct signs of distal emboli, which are difficult to obtain by main pulmonary artery injection angiogram. In the chronic stage of pulmonary embolism, bronchial arteriogram shows collaterals to pulmonary arteries. This study may be useful in patients with chronic pulmonary embolism, especially when thromboembolectomy is planned.

Angiography, Digital Subtraction↗
PubMed1992

[Primary Aspergillus endocarditis. Apropos of a case and review of the international literature].

The authors report a case of primary aspergillus endocarditis with endophthalmitis and vertebral osteomyelitis. No underlying disease and no predisposing factors were found. Valve replacement plus combined antifungal chemotherapy proved to be effective as the patient is asymptomatic 18 months after the first symptoms. 48 cases of aspergillus endocarditis, without prior cardiac surgery have been reported in the literature. Aspergillus endocarditis was valvular or mural. Extracardiac dissemination was common but endophthalmitis and osteomyelitis were infrequent. In 11 cases, the diagnosis was made by histologic examination of embolectomy or ocular, skin biopsy tissue. All patients were febrile. Blood cultures showed no Aspergillus species. Clinical manifestations of endocarditis were described in less than fifty per cent of cases. Echocardiographic visualization of vegetations was obtained in 5 cases. Many patients experienced embolic phenomena. Mortality from Aspergillus endocarditis is extremely high (96%). Surgery is the main treatment, consisting of valve replacement. Antifungal chemotherapy should be combined. The proper duration and dosage and the combination of antifungal drugs have not been clearly defined.

Amphotericin B↗
PubMed1992

Combined cardiac and abdominal aortic aneurysm operations. The dual operation on cardiopulmonary bypass.

Eight patients underwent both cardiac operation and repair of abdominal aortic aneurysm. All had respiratory impairment and significant impairment of left ventricular function, whereas six patients had severe diffuse distal coronary disease. In all patients the cardiac procedure was performed first, and the patients continued to receive cardiopulmonary bypass. Rewarming was not commenced until the abdominal repair was well under way, to protect the vital organs. There were no problems in weaning the patients from bypass, and six of the patients were extubated within 24 hours; one required ventilation for 36 hours. One patient died of colonic infarction complicated by kidney failure without being extubated. Another patient who was initially extubated in 11 hours required reintubation because of poor lung function and eventually died of multisystem organ failure caused by bilateral lower limb ischemia that persisted despite embolectomies. All survivors are well and in New York Heart Association functional class I or II between 3 and 18 months postoperatively. We conclude that for patients considered unfit for abdominal aortic aneurysm operations because of the nature of the cardiac disease, the combined operation with cardiopulmonary bypass is both safe and effective.

Aged↗
PubMed1992

[Peripheral calcific embolism after percutaneous mitral valvuloplasty].

The authors report a case of calcific embolization after percutaneous mitral valvuloplasty. The nature of the embolism was confirmed by anatomopathological examination after popliteal embolectomy. This complication would appear to be extremely rare but represents an additional risk in patients with calcific mitral stenosis.

Adult↗
PubMed1992

[Peripheral embolism of hemostasis collagen (VasoSeal)].

VasoSeal is a purified bovine, absorbable collagen plug currently successfully used to close the femoral arterial puncture site after cardiac catheterization under full anticoagulation. Up to now there has been no experience with potential complications. We observed acute ischemia in the right lower leg of 2/100 patients 36 resp. 24 h after successful closure of the puncture site with VasoSeal. Angiography confirmed acute occlusion of the distal A. poplitea dextra. A 25-mm resp. 50-mm long cylindrical foreign body embolus was removed with a Fogarty-catheter by retrograde indirect embolectomy. Histopathology confirmed a fresh collagen clot with appositional thrombosis.

Aged↗
PubMed1977

Celiac axis, superior mesenteric artery, and inferior mesenteric artery occlusion: surgical considerations.

Occlusion of the celiac, superior mesenteric, and inferior mesenteric artery has been studied in 46 patients treated by operation. The condition was acute and was caused by embolic obstruction of the superior mesenteric artery in four cardiac patients and detachment of the inferior mesenteric artery in two patients during removal of infrarenal abdominal aortic aneurysms. The condition was chronic and involved two or all three of the vessels in 40 patient. Embolic obstruction caused severe abdominal pain but few physical signs early in the process,, but the picture of an acute abdomen indicating bowel gangrene developed in a few hours. Ischemia from inferior mesenteric detachment was observed at operation. Patients with chronic obstruction had abdominal pain, weight loss, and diarrhea. Patients with embolic obstruction were treated successfully by embolectomy, and patients developing intraoperative sigmoid ischemia were treated by reattachment of inferior mesenteric arteries to aortic graft. Various procedures were employed in patients with chronic multiple obstruction. However, graft bypass using Dacron tubing was preferable because of its simplicity and because the frequently (48%) associated occlusive disease and aneurysm of the distal aorta were treated at the same time. Confining operation to the abdomen significantly reduced the magnitude of operation and eliminated risks in this age group. Of the 46 patients, 91% survived and were relieved of their symptoms despite associated disease. The 5-year survival rate in this group of patients was 62%.

Adult↗
PubMed2003

Superior mesenteric arterial embolism: a retrospective study of local thrombolytic treatment with urokinase in West China.

Embolism of the superior mesenteric artery (SMA) is a rare disorder. To explore the selective criteria of local thrombolysis, evaluate its efficacy and discuss the therapeutic protocol of SMA embolism, a retrospective case control study was undertaken. Sixteen cases were divided into two groups: nine cases (group A) from May 1995 to April 1999 were given traditional treatment, while seven cases (group B) from November 1999 to June 2002 received comprehensive therapy including local thrombolysis. The local thrombolytic treatment was performed without procedure-related complications and the embolus was successfully lysed in four patients. The time between admission and diagnosis (or treatment) was shorter in group B than in group A (2.3 +/- 1.2 vs 12.3 +/- 9.2 hr, p = 0.013). Gangrenous bowel segments in group A were much longer than in group B (159.4 +/- 87.7 vs 45.7 +/- 61.6 cm, p = 0.009). However, mortality between the two groups was the same (p = 0.282, OR = 0.32, 95% CI = 0.039, 2.618) perhaps because of the small sample size. Angiography could shorten the duration from the onset of SMA embolism to therapy and certainly lowers the risk of mortality. Local fibrinolytic infusion may be an effective alternative to embolectomy in patients with SMA embolism but without intestinal infarction.

Adult↗
PubMed2003

Diagnosis of pulmonary embolism with helical C.T. scan.

OBJECTIVE: To determine the role of helical C.T. scan in the diagnosis of pulmonary embolism. SETTING: Radiology department, Aga Khan University Hospital. One year prospective study May 2001 to May 2002. METHODS: Sixty patients suspected of having pulmonary embolism were included in this study. Helical C.T. scan chest was performed from aortic arch to lung bases with intravenous contrast medium. Images were acquired in mediastinal and lung windows. Image interpretation was performed on the console and hard copies for main branch and segmental thrombus. RESULTS: Fifteen patients were diagnosed of having pulmonary embolism on C.T. scan. Clinical correlation and follow up with pulmonary angiography and Doppler ultrasound of leg was carried out. Pulmonary angiography was performed in one patient with embolectomy done after confirmation of diagnosis. 8 patients had associated DVT confirmed on Doppler sonography. Sensitivity of helical C.T. is 93.75%, specificity 100% and positive predictive value 95.65%. CONCLUSION: Helical CT scan is a quick, easy and accurate imaging modality for diagnosing pulmonary embolism.

Adult↗
PubMed2003

[Surgical treatment for acute massive pulmonary thromboembolism].

Acute massive pulmonary thromboembolism is a life threatening disorder that must be treated immediately. We performed emergent pulmonary thrombectomy using cardiopulmonary bypass on 15 patients. The patients were 7 men and 8 women aged 28 to 81 years. Early diagnosis was made by body CT scan and echocardiography. When patient had massive pulmonary thromboembolism, when hemodynamics could not be improved by medical treatment, direct embolectomy was performed immediately. 12 patients developed shock and 8 patients underwent cardiac massage. Among 15 patients, 11 were saved by surgical treatment, while the remaining 4 died of multiple organ failure, cardiac failure and mediastinitis. The lives of patients with acute massive pulmonary thromboembolism can be saved by early detection and emergent thrombectomy using cardiopulmonary bypass.

Acute Disease↗
PubMed2002

[Candida parapsilosis endocarditis after prolonged antibiotic therapy].

Infective endocarditis is still a very serious disease whose prognosis has improved in recent years, even though advanced technologies have brought a greater number of cases attributable to increased growth of fungi in more virulent forms. We describe a case of endocarditis caused by Candida parapsilosis on a previously healthy aortic valve in a man who had received prolonged intravenous antibiotic treatment a few months earlier. The initial presentation included acute arterial ischaemia of the lower limbs. The diagnosis of endocarditis was then confirmed by echocardiography and microbiology. Specific antifungal therapy was started, and embolectomy and valve replacement were performed; however, the infection could not be controlled and the patient died a few days later.

Candida↗
PubMed2003

Management of a "saddle" embolus at the popliteal bifurcation by a variation of the "push and park" approach. A case report.

We present a modification of a previously reported endovascular technique where a large embolus was "pushed and parked" into a diseased artery. A saddle embolus at the bifurcation of the popliteal artery, which occurred as a complication after a percutaneous subintimal recanalization, was pushed and parked into the tibio-peroneal trunk. This was achieved using 2 balloon catheters, one to disengage the embolus from the anterior tibial artery, and the other to push the embolus into the tibio-peroneal trunk, thus establishing flow into the anterior tibial artery. Pushing and parking an embolus into a less useful vessel when all attempts at catheter embolectomy have failed is a simple and quick method which should be borne in mind by all vascular interventionalists.

Aged↗