- The Laparoscopic Management of Median Arcuate Ligament Syndrome and Its Long-Term Outcomes. [Journal Article]
- JLJ Laparoendosc Adv Surg Tech A 2018 May 21
- CONCLUSIONS: MALS is a rare condition. Laparoscopic decompression of the median arcuate ligament is safe and offers long-term resolution of symptoms, and improvement in patient quality of life.
- Contralateral extensive cerebral hemorrhagic venous infarction caused by retrograde venous reflux into the opposite basal vein of Rosenthal in posttraumatic carotid-cavernous fistula: A case report and literature review. [Journal Article]
- INInterv Neuroradiol 2018 Jan 01; :1591019918776615
- We describe a patient with traumatic carotid-cavernous fistula (CCF), subsequently developing contralateral extensive hemorrhagic venous infarction from retrograde venous reflux into the opposite bas...
We describe a patient with traumatic carotid-cavernous fistula (CCF), subsequently developing contralateral extensive hemorrhagic venous infarction from retrograde venous reflux into the opposite basal vein of Rosenthal. A 54-year-old woman was involved in a motor vehicle accident and sustained severe traumatic brain injury. Two months later, she developed bilateral proptosis and audible bruit. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain demonstrated the right direct CCF. Fluid-attenuated inversion recovery (FLAIR) images showed a small hyperintense area at the left basal ganglia. Ten days later, she developed right-sided grade 2/5 hemiparesis, facial upper motor neuron weakness, and cognitive impairment. Follow-up MRI showed significant progression of hyperintensities involving the left-sided centrum semiovale, basal ganglia, thalamus, midbrain, pons, cerebellum, basal frontal, temporal lobes, especially subcortical white matter on FLAIR images, and multiple hypointense foci of hemorrhagic component on T2*-weighted gradient-echo images, representing hemorrhagic venous infarction. While waiting for embolization, she rapidly developed right hemiplegia and aphasia, and became somnolent. Under general anesthesia, emergency endovascular treatment was performed successfully to obliterate the fistula without surgical intervention. Five months after endovascular treatment, MRI and MRA confirmed no residual fistula and revealed nearly complete resolution of abnormal increased signal intensity. In the present case, the factors related to the presence of this rare condition were absence of the ipsilateral basal vein of Rosenthal (BVR), occlusion of posterior segment of the contralateral superior petrosal sinus, and a developed uncal vein with hypoplastic second and third segments of the contralateral BVR.
- Surgical treatment of a high-flow femoro-femoral arteriovenous fistula in an intravenous drug abuser. [Journal Article]
- AVAnn Vasc Surg 2018 May 14
- CONCLUSIONS: Surgical repair of femoro-femoral AVF in drug abusers by biologic patch interposition is a challenging, but feasible and effective technique with encouraging mid-term results in terms of patency and resistance to infections.
- Celiac Plexus Block as a Predictor of Surgical Outcome for Sympathetically Mediated Abdominal Pain in a Case of Suspected Median Arcuate Ligament Syndrome: A Case Report. [Case Reports]
- PA A Pract 2018 Feb 14
- Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is an uncommon condition classically characterized by chronic abdominal pain, weight loss, and abdominal bru...
Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is an uncommon condition classically characterized by chronic abdominal pain, weight loss, and abdominal bruit. Chronic mesenteric ischemia caused by intermittent compression of the celiac artery by the MAL provokes upper abdominal pain that is sympathetically mediated via the celiac plexus. Because it is a diagnosis of exclusion, diagnosis of MALS in the clinical setting is typically challenging. We present an atypical case which highlights the utility of celiac plexus block as both an assistant diagnostic tool and a predictor of surgical outcomes for suspected MALS.
- The Incidence of Cranial Arteriovenous Shunts in Patients With Pulsatile Tinnitus: A Prospective Observational Study. [Journal Article]
- ONOtol Neurotol 2018; 39(5):648-653
- CONCLUSIONS: In a tertiary care setting, the prevalence of dAVFs in patients with pulsatile tinnitus is not negligible. Thus, patients with unilateral pulsatile tinnitus should be offered dynamic vascular imaging to rule out a dAVF. Especially, since some of these patients are at risk of intracranial hemorrhage and treatment options exist.
- Orbital Meningoencephalocele and Pulsatile Proptosis: A Rare Entity. [Journal Article]
- CCureus 2018 Jan 15; 10(1):e2064
- Orbital roof defects are rare congenital osseous abnormalities that cause protrusion of intracranial contents into the orbit, resulting in a condition known as the orbital meningoencephalocele, a rar...
Orbital roof defects are rare congenital osseous abnormalities that cause protrusion of intracranial contents into the orbit, resulting in a condition known as the orbital meningoencephalocele, a rare cause of pulsatile proptosis. We present a case of a 25-year-old lady, presented to us with complaints of left frontal headache, left eye protrusion and double vision from the left eye for the past three months. Her higher mental functions were intact. Local examination revealed non-axial pulsatile proptosis and an outward depression of the left eyeball along with diplopia. Extraocular movements and pupillary light response were normal with no bruit or orbital tenderness. Computed tomography (CT) scan of the brain and orbit with contrast showed deficient bone on the left orbital roof and floor with left frontal gliotic brain compressing the eyeball. Magnetic resonance imaging (MRI) of the brain and orbit with contrast showed an asymmetrical deformity of the skull and left cerebral hemisphere which was bulging towards the left orbit. We planned a two-staged surgical reconstruction. The orbital roof was first reconstructed using a titanium mesh. Within two weeks of surgery her pulsatile proptosis, diplopia, and headache had considerably improved and the proptosis had resolved with no visible pulsations. She is scheduled for second stage surgery after three months for reconstruction of the orbital floor.
- Severe Hyperthyroidism Complicated by Agranulocytosis Treated with Therapeutic Plasma Exchange: Case Report and Review of the Literature. [Journal Article]
- CRCase Rep Endocrinol 2018; 2018:4135940
- CONCLUSIONS: Plasmapheresis may be useful in the treatment of hyperthyroidism. It works by removing protein bound hormones and also possibly inflammatory cytokines. Further studies are needed to clarify the role of various modalities of TPE in the treatment of hyperthyroidism.
- Surgical management of a cat with hepatic arterioportal fistula. [Case Reports]
- JSJ Small Anim Pract 2018 Mar 14
- A 9-month-old domestic short-haired cat presented with stunted growth and chronic gastrointestinal signs. Tachypnoea, a heart murmur and cranial abdominal bruit were detected on physical examination....
A 9-month-old domestic short-haired cat presented with stunted growth and chronic gastrointestinal signs. Tachypnoea, a heart murmur and cranial abdominal bruit were detected on physical examination. Echocardiography revealed volume overload in all heart chambers. CT angiography identified an abnormal communication between the hepatic arterial circulation and the portal vein, along with multiple acquired shunts. The abnormal vascular communication was surgically ligated. Echocardiography documented improvement in cardiac parameters following surgery and the cat continues to have no clinical signs 39 months after surgery. This report describes successful surgical management of feline hepatic arterioportal fistula for the first time.
- Pancytopenia: a rare complication of Graves' disease. [Journal Article]
- BCBMJ Case Rep 2018 Mar 09; 2018
- A 27-year-old male patient who presented to the emergency room with complaints of sweating, palpitations, heat intolerance, insomnia and weight loss for the last 3 months. His medical history was sig...
A 27-year-old male patient who presented to the emergency room with complaints of sweating, palpitations, heat intolerance, insomnia and weight loss for the last 3 months. His medical history was significant for hypertension. On examination, he was tachycardic, hypertensive, had tremors of the upper extremities and a smooth goitre with a thyroid bruit. Laboratory assessment revealed a suppressed thyroid-stimulating hormone, high free thyroxine and positive thyroid receptor antibodies. Complete blood count showed pancytopenia. As part of the work-up for pancytopenia, haptoglobin, ferritin, Coombs test, reticulocyte count hepatitis B and C antibodies were done, all of which were normal. Patient was started on methimazole, propranolol and hydrocortisone. His symptoms improved through the hospital course and he was subsequently discharged. Thyroidectomy was done once the patient's hyperthyroidism was controlled. Levothyroxine was started for the control of postsurgical hypothyroidism. Six months after thyroidectomy, the patient was euthyroid and the pancytopenia resolved.
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- Case Image: Bovine-type aortic arch and compression of the kissing carotid arteries by a retrosternal goiter: An uncommon cause of carotid bruit. [Journal Article]
- TKTurk Kardiyol Dern Ars 2018; 46(2):165