Home About us Contact
|
Home About us Contact | ||
|
|
||
Uncommon Complication (uncommon + complication)
Selected AbstractsAcute myeloid leukaemia arising from a patient with untreated essential thrombocythaemiaEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 6 2002Javier Bolańos-Meade Abstract:, Acute myeloid leukaemia (AML) is an uncommon complication of patients with essential thrombocythaemia (ET). We report a patient with ET which progressed into AML and who had only received a few days of therapy with hydroxyurea (HU) when diagnosed with ET. This is extremely rare, as in large series no patients who were left untreated for their ET developed this complication. This case supports the theory that AML transformation can be part of the natural history of ET in some cases. [source] Minimally invasive management of bile leak after laparoscopic cholecystectomyHPB, Issue 2 2001G Tzovaras Background Bile leakage is an uncommon complication of cholecystectomy. The bile may originate from the gallbladder bed, the cystic duct or rarely from injury to a major bile duct. This study aims to evaluate the efficacy of minimal access endoscopic and percutaneous techniques in treating symptomatic bile leak. Patients and methods Twenty-one patients with symptomatic bile leak following laparoscopic cholecystectomy underwent assessment of the extent of the bile leak via ultrasound/CT and ERCP. Following diagnosis, the patients were treated by sphincterotomy and biliary drainage and, if necessary, percutaneous drainage of the bile collection. Results Only one patient required primary surgical treatment following diagnosis of a major duct injury. The other 20 were treated by a combination of sphincterotomy (including a stent in most) plus percutaneous drainage in six. In 19 of 20, this minimal access approach stopped the leak. Discussion Most patients who present with bile leakage after cholecystectomy can be managed successfully by means of ERCP with percutaneous drainage of any large bile collection. [source] Sarcoidosis presenting with granulomatous uveitis induced by pegylated interferon and ribavirin therapy for hepatitis CINTERNAL MEDICINE JOURNAL, Issue 3 2008K. K. L. Yan Abstract Sarcoidosis is a systemic granulomatous disease that is triggered by an autoimmune process, and is now a well recognized but uncommon complication of antiviral therapy for Hepatitis C virus (HCV) infection, likely related to its immunomodulatory effects. The clinical presentation of HCV related sarcoidosis is as varied as systemic sarcoidosis, but ocular presentation alone has not been reported previously. We present a 23 year-old female who developed visual disturbances due to ocular sarcoidosis during the course of antiviral therapy for chronic HCV infection. Our case presentation is then followed by a review of the literature on the topic. We aim to stress the importance of screening for eye problems in following HCV patients undergoing antiviral therapy, and raise clinicians' awareness of sarcoidosis as a possible cause for eye problems even in the absence of respiratory complaints. [source] Laparoscopic treatment of colovesical fistulas: technique and review of the literatureINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2006ALEXANDER TSIVIAN Abstract, Colovesical fistula is an uncommon complication of diverticulitis. We present our technique of a laparoscopic approach for treatment of vesicosigmoid fistulas and review the available published literature. We believe that a laparoscopic approach is a feasible and advantageous alternative for the treatment of colovesical fistulas, with low morbidity and short hospital stay. [source] Xanthogranulomatous pyelonephritis with a renocolic fistula caused by a parapelvic cystINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2006YOH MATSUOKA Abstract, Fistula formation between the upper urinary tract and bowel is an uncommon complication in urogenital diseases. We present a rare case of focal xanthogranulomatous pyelonephritis with a renocolic fistula. This is the first case where a parapelvic cyst obstructs the caliceal outflow and leads to the formation of a renocolic fistula in renal inflammatory disease. It is difficult to make a preoperative diagnosis of focal xanthogranulomatous pyelonephritis with widespread involvement that is caused by non-calculous urinary tract obstruction. [source] Risk Factors for Requirement of Permanent Pacemaker Implantation After Aortic Valve ReplacementJOURNAL OF CARDIAC SURGERY, Issue 3 2006Hasan Basri Erdogan M.D. Methods: Among 465 patients operated between 1994 and 2004, 19(4.1%) patients with a mean age 49.9 ± 17.2 years required the implantation of a permanent pacemaker. Eleven of them were female (57.9%). The main indication was aortic stenosis (89.5%). Severe annular calcification was documented in 78.9% of them, and the aortic valve was bicuspid in 57.9%. Results: Risk factors for permanent pacing after aortic valve replacement (AVR) identified by univariate analysis were female sex, hypertension, preoperative ejection fraction, aortic stenosis, annular calcification, bicuspid aorta, presence of right bundle branch block (RBBB) or left bundle branch block (LBBB), prolonged aortic cross-clamp and perfusion times, and preoperative use of calcium channel blockers. Multivariate analysis showed that female sex (p = 0.01, OR; 5.21, 95% CI: 1.48-18.34), annular calcification (p < 0.001, OR; 0.05, 95% CI: 0.01-0.24), bicuspid aortic valve (p = 0.02, OR; 0.24, 95% CI: 0.07-0.84), presence of RBBB (p = 0.009, OR; 0.03, 95% CI: 0.003-0.44) or LBBB (p = 0.01, OR; 0.13, 95% CI: 0.02-0.69), hypertension (p = 0.03, OR; 0.22, 95%CI: 0.05-0.89), and total perfusion time (p = 0.002, OR; 1.05, 95% CI: 1.01-1.08) were associated risk factors. Conclusion: Irreversible atrioventricular block requiring a permanent pacemaker implantation is an uncommon complication after AVR. Risk factors are annular calcification, bicuspid aorta, female sex, presence of RBBB or LBBB, prolonged total perfusion time, and hypertension. [source] Questionable efficacy of plasma exchange for thrombotic thrombocytopenic purpura after bone marrow transplantation,JOURNAL OF CLINICAL APHERESIS, Issue 4 2001J. Teruya Abstract Thrombotic thrombocytopenic purpura (TTP) after bone marrow transplantation (BMT) is an uncommon complication presumably associated with extensive endothelial cell damage due to Cyclosporine, total body irradiation, or other drugs. While the majority of patients with primary TTP, which is considered to be an autoimmune process, respond to plasma exchange, TTP after BMT has a very poor prognosis. A total of 7 patients out of 307 patients who underwent BMT were diagnosed with TTP during 1989,1999. The diagnosis of TTP was made based on thrombocytopenia and microhemangiopathic hemolytic anemia characterized by an elevated LDH and the presence of schistocytes on the peripheral blood smear. Five patients were treated with plasma exchange (PE) using fresh frozen plasma and/or cryoprecipitate poor plasma as replacement fluid. One patient was treated using a protein A column. One patient did not receive plasma exchange because the 125 patient was clinically stable and was discharged. It was hard to assess the efficacy of PE due to the multiplicity of the patients' clinical condition and laboratory data. At least 4 patients did not respond to PE and 2 patients were not able to be evaluated due to multi organ failure. However, all patients died. It is not clear at this moment if PE for patients with TTP after BMT is truly beneficial. J. Clin. Apheresis 16:169,174, 2001. © 2001 Wiley-Liss, Inc. [source] Magnetic resonance imaging of cauda equina syndrome in long-standing ankylosing spondylitisJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2007A Arslanoglu Summary The cauda equina syndrome is an uncommon complication of long-standing ankylosing spondylitis and its aetiology is controversial. We report a case of the cauda equina syndrome, erosion of the posterior elements of the lumbar spine and traction of the lumbar nerve roots because of multiple dural diverticula in a patient with long-standing ankylosing spondylitis. Magnetic resonance imaging is valuable in excluding other spinal lesions. Extensive dural diverticula formation is characteristic of ankylosing spondylitis and has the potential to provide an early diagnosis. [source] Mucinous adenocarcinoma and strumal carcinoid tumor arising in one mature cystic teratoma of the ovary with synchronous cervical cancerJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2003Seok Mo Kim Abstract Malignant transformation of mature cystic teratoma is an uncommon complication. While any of the constituent tissues of a teratoma has the potential to undergo malignant transformation, squamous cell carcinoma is the most commonly associated cancer. We present an unusual case of a postmenopausal woman with synchronous mucinous adenocarcinoma and strumal carcinoid tumor from one of two ovarian mature cystic teratomas (one in each ovary) with synchronous cervical cancer. We suggest that malignant transformation of mature cystic teratoma and synchronous cervical cancer be treated by hysterectomy, chemotherapy, and radiotherapy. [source] Successful treatment of pulmonary zygomycosis in two transplant recipients with liposomal amphotericin B and partial surgical resection followed by posaconazoleMYCOSES, Issue 2 2010David T. Cooke Summary Pulmonary zygomycosis is a relatively uncommon complication of solid organ or peripheral blood stem cell transplantation and has a high associated mortality. Optimal therapy consists of complete resection of infected tissue and treatment with amphotericin B (AmB). We describe two patients, one of whom underwent orthotopic heart transplantation and the other who received a peripheral blood stem cell transplant, who were diagnosed with invasive pulmonary zygomycosis. Both patients were treated with a liposomal preparation of AmB and early partial resection of the infected structures followed by prolonged posaconazole maintenance therapy. Despite incomplete resection, this treatment regimen resulted in a favourable outcome in both patients, including survival of more than 17 months in one patient at last follow up. For patients in whom complete resection of pulmonary zygomycosis is not possible, subtotal resection and treatment with liposomal AmB followed by therapy with posaconazole may be an effective treatment option. [source] Bilateral re-expansion pulmonary edema in a child: a reminderACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2000O. Özlü Re-expansion pulmonary edema (RPE) is an uncommon complication of sudden reinflation of a lung collapsed by pneumothorax or pleural effusion. We present a case of bilateral pulmonary edema following unilateral drainage of a pleural effusion in a young child with non-Hodgkin's lymphoma. [source] Delayed Complications Following Pacemaker ImplantationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2002KENNETH A. ELLENBOGEN ELLENBOGEN, K.A., et al.: Delayed Complications Following Pacemaker Implantation. Acute complications resulting from permanent pacemaker implantation are well known and include perforation of the right atrium or right ventricle. Recently, several reports have described the occurrence of perforation and pericarditis as late complications following pacemaker implantation. These complications may occur days to weeks following uncomplicated pacemaker implantation and may lead to death if they are not recognized early. Five patients with late complications caused by active-fixation leads are reported and the clinical features of their presentation and management are reviewed. Late perforation of the right atrium or right ventricle is an uncommon complication after pacemaker implantation but should be suspected by the general cardiologist in a patient who has a device implanted within a week to several months prior to the development of chest pain. [source] Kawasaki Disease with Facial Nerve ParalysisPEDIATRIC DERMATOLOGY, Issue 6 2003Margarita Larralde M.D., Ph.D. We describe an instance of facial nerve paralysis in a patient with KD. A 5-month-old boy developed fever, irritability, and diarrhea, treated 8 days later with cefaclor and ibuprofen. Three days later a confluent, erythematous and papular rash appeared, his lips were reddened and swollen, and his white blood count and platelet count were 20,900/mm3 and 558,000/mm3, respectively. He was admitted to the hospital with a diagnosis of KD, and an echocardiogram showed a right coronary aneurysm. The patient then developed an acute, right-sided, facial nerve peripheral paralysis that resolved over the next 6 weeks. He was treated with intravenous immune globulin (IVIG) 2 g/kg and aspirin 100 mg/kg/day with improvement of signs and symptoms. This report documents facial nerve paralysis as an uncommon complication of KD and points out that it may be a marker of increased risk of cardiovascular disease in this disorder. [source] Acute biphenotypic leukemia arising in a patient with essential thrombocythemiaAMERICAN JOURNAL OF HEMATOLOGY, Issue 8 2006Gee Chuan Wong Abstract Acute leukemia is an uncommon complication of patients with essential thrombocythemia (ET). We describe a patient with ET, who transformed to acute biphenotypic leukemia 4 and 1/2 years after initial ET diagnosis. She had received hydroxyurea, anagrelide, and interferon, in different combinations and varying doses, before leukemic transformation. Acute biphenotypic leukemia was confirmed on bone marrow studies and immunophenotyping. Complete remission (CR) was achieved with induction chemotherapy for acute leukemia. This was followed with consolidation chemotherapy and the patient has remained in CR 9 months after initial induction chemotherapy. To our knowledge, this is a rare event of acute biphenotypic leukemic transformation of a patient with ET. Am. J. Hematol. 81:624,626, 2006. © 2006 Wiley-Liss, Inc. [source] Near-fatal uterine hemorrhage during induction chemotherapy for acute myeloid leukemia: A case report of bilateral uterine artery embolizationAMERICAN JOURNAL OF HEMATOLOGY, Issue 2 2004John T. Phelan II Abstract Severe transfusion-dependent uterine hemorrhage is a relatively uncommon complication of induction chemotherapy for acute myeloid leukemia (AML). Even less common is the failure of systemic conjugated estrogens in this setting. We report a case of life-threatening uterine hemorrhage in a 38-year-old woman in the setting of transfusion-refractory thrombocytopenia after completing induction chemotherapy for AML. She experienced dramatic breakthrough uterine hemorrhage despite multiple platelet transfusions, conjugated estrogens, recombinant factor VIIa, ,-aminocaproic acid, and intracavitary thrombin-soaked gauze tamponade. At the point of near-exsanguination in the setting of hypotension, hematocrit of 14%, and a platelet count of 3,000/,L, she underwent bilateral uterine artery embolization which proved immediately successful. We review the literature and indications for this procedure in the oncologic patient care setting. Am. J. Hematol. 77:151,155, 2004. © 2004 Wiley-Liss Inc. © 2004 Wiley-Liss, Inc. [source] Postobstructive Pulmonary Edema After Laryngospasm in the Otolaryngology PatientTHE LARYNGOSCOPE, Issue 9 2006Vishvesh M. Mehta MD Abstract Context: Post-obstructive pulmonary edema (PPE) is an uncommon complication which develops immediately after the onset of acute airway obstruction such as laryngospasm or epiglottitis (type I) or after the relief of chronic upper airway obstruction such as adenotonsillar hypertrophy (type II). Objective: To describe the development of type I PPE following laryngospasm in pediatric and adult patients undergoing otolaryngologic surgical procedures other than those for treatment of obstructive sleep apnea. Design: Retrospective case series of 13 otolaryngology patients from 1996 to 2003. Setting: Tertiary care teaching hospital and its affiliates. Patients: 13 patients (4 children, 9 adults, 5 males, 8 females) ranging in age from 9 months to 48 years. Results: Operative procedures included adenoidectomy, tonsillectomy, removal of an esophageal foreign body, microlaryngoscopy with papilloma excision, endoscopic sinus surgery, septorhinoplasty, and thyroidectomy. Six patients required reintubation. Treatment included positive pressure ventilation, oxygen therapy, and diuretics. Seven patients were discharged within 24 hours and the others were discharged between 2 and 8 days postoperatively. There were no mortalities. Conclusion: Laryngospasm resulting in PPE may occur in both children and adults after various otolaryngologic procedures. Among the subgroup of children, our study is the first to report its occurrence in healthy children without sleep apnea undergoing elective surgery. [source] Death from Metastatic Donor-Derived Ovarian Cancer in a Male Kidney Transplant RecipientAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2009G. S. Lipshutz Posttransplant malignancy developing in an allograft is an uncommon complication of organ transplantation. The tumor may represent malignant transformation of donor or recipient cells that were previously normal, metastatic malignancy of recipient origin or malignancy transmitted from organ donor to recipient. Establishing the origin of the malignancy is critical to treatment algorithms. It is generally believed allograft removal and immunosuppression withdrawal will lead to resolution of transmitted malignancies in cases where the renal allograft is the origin. We report a male patient who developed metastatic ovarian malignancy secondary to donor transmission. [source] Clinical practice guidelines for the management of acute limb compartment syndrome following traumaANZ JOURNAL OF SURGERY, Issue 3 2010Christopher J. Wall Abstract Background:, Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency, and is associated with significant morbidity if not managed appropriately. There is variation in management of acute limb compartment syndrome in Australia. Methods:, Clinical practice guidelines for the management of acute limb compartment syndrome following trauma were developed in accordance with Australian National Health and Medical Research Council recommendations. The guidelines were based on critically appraised literature evidence and the consensus opinion of a multidisciplinary team involved in trauma management who met in a nominal panel process. Results:, Recommendations were developed for key decision nodes in the patient care pathway, including methods of diagnosis in alert and unconscious patients, appropriate assessment of compartment pressure, timing and technique of fasciotomy, fasciotomy wound management, and prevention of compartment syndrome in patients with limb injuries. The recommendations were largely consensus based in the absence of well-designed clinical trial evidence. Conclusions:, Clinical practice guidelines for the management of acute limb compartment syndrome following trauma have been developed that will support consistency in management and optimize patient health outcomes. [source] SURVEY OF MANAGEMENT OF ACUTE, TRAUMATIC COMPARTMENT SYNDROME OF THE LEG IN AUSTRALIAANZ JOURNAL OF SURGERY, Issue 9 2007Christopher J. Wall Background: Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency and is associated with significant morbidity if not diagnosed promptly and treated effectively. Despite the urgency of effective management to minimize the risk of adverse outcomes, there is currently little consensus in the published reports as to what constitutes best practice in the management of acute limb compartment syndrome. Methods: A structured survey was sent to all currently practising orthopaedic surgeons and accredited orthopaedic registrars in Australia to assess their current practice in the management of acute, traumatic compartment syndrome of the leg. Questions were related to key decision nodes in the management process, as identified in a literature review. These included identification of patients at high risk, diagnosis of the condition in alert and unconscious patients, optimal timeframe and technique for carrying out a fasciotomy and management of fasciotomy wounds. Results: A total of 264 valid responses were received, a response rate of 29% of all eligible respondents. The results indicated considerable variation in management of acute compartment syndrome of the leg, in particular in the utilization of compartment pressure measurement and the appropriate pressure threshold for fasciotomy. Of the 78% of respondents who regularly measured compartment pressure, 33% used an absolute pressure threshold, 28% used a differential pressure threshold and 39% took both into consideration. Conclusions: There is variation in the management of acute, traumatic compartment syndrome of the leg in Australia. The development of evidence-based clinical practice guidelines may be beneficial. [source] Dramatic efficacy of infliximab in cauda equina syndrome complicating ankylosing spondylitisARTHRITIS & RHEUMATISM, Issue 6 2009Divi Cornec Cauda equina syndrome is an uncommon complication of ankylosing spondylitis (AS) characterized by the slow and insidious development of severe neurologic impairment. Imaging studies usually show a wide lumbar canal with dural ectasia. No medical or surgical treatment has been proven effective. We managed the care of a 66-year-old man who had longstanding AS and clinical features of cauda equina syndrome, including anal incontinence and buttock hypoesthesia. Magnetic resonance imaging demonstrated no cause for these symptoms other than AS. The patient was treated with infliximab, a monoclonal antibody to tumor necrosis factor , that is used for the treatment of active AS. After 3 infliximab infusions, sphincter control and sensation were normal. The treatment was continued, and he was still doing well 1 year later. This is the first report of an effective treatment for cauda equina syndrome complicating AS. Our case report strongly supports an inflammatory mechanism to this condition. [source] Graft-vs.-host disease in lung and other solid organ transplant recipientsCLINICAL TRANSPLANTATION, Issue 1 2007Maha A Assi Abstract:, Graft-vs.-host disease (GVHD) is an uncommon complication of solid organ transplantation. Herein, we report a case of GVHD occurring in a lung transplant recipient and review 29 reported cases of GVHD that complicated thoracic organ, and non-hepatic intra-abdominal organ transplantation. The major presenting clinical symptom of GVHD was skin rash. Less frequent clinical manifestations were cytopenia (16%), diarrhea (11%), and fever (5%). The mainstay of treatment was high-dose corticosteroids. The mortality rate was high (30%). The cause of death was mainly due to infection, suggesting that antimicrobial prophylaxis may improve the outcome of this potentially fatal complication. [source] | |||||||||||||||||||||||||