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Hemobilia Due to an Iatrogenic Arteriobiliary Fistula Complicating Laparoscopic Cholecystectomy: A Case Report  [PDF]
Hicham El Bouhaddouti, Khalid Mazine, Abdesslam Bouassria, Ouadii Mouaqit, Elbachir Benjelloun, Abdelmalek Ousadden, Khalid Ait Taleb
Open Journal of Gastroenterology (OJGas) , 2014, DOI: 10.4236/ojgas.2014.46040
Abstract: Hemobilia is the result of a pathological communication between bile duct and intra or extrahepatic vessel. 40% to 60% of the haemobilia cases are Iatrogenic, and the other causes are either vascular malformations or hepatic blunt trauma. We describe the case history of a patient in which laparoscopic cholecystectomy was complicated 3 months later by massive hemobilia. The cause of haemorrhage was a fistula between the principal bil duct and the right hepatic artery. This complication was successfully managed by surgery and angiographic embolization with full recovery of the patient.
Internal carotid artery occlusion or subocclusion: Contemporary diagnostic challenges: Case report
Popov Petar,Radak Sandra,Ilijevski Nenad,Nenezi? Dragoslav
Srpski Arhiv za Celokupno Lekarstvo , 2009, DOI: 10.2298/sarh0906271p
Abstract: Introduction. Measurement of vessel stenosis using ultrasonography or magnetic resonance is still the principal method for determining the severity of carotid atherosclerosis and need for endarterectomy. Case Outline. A 56-year-old male was admitted to the Cardiovascular Institute 'Dedinje' due to a clinically asymptomatic restenosis of the operated left internal carotid artery (ICA). Angiography and magnetic resonance angiography (MRA) in previous hospitalization had revealed occluded right ICA. However, routine duplex ultrasonography revealed a highgrade restenosis (85%) of the left ICA and subocclusion of the right ICA by an ulcerated plaque (confirmed on repeated MRA). Conclusion. Selective arteriography examination could misrepresent the degree of stenosis especially in patents with the ICA that seems to be occluded. MRA is considered the method of choice for identifying pseudo-occlusions of ICA.
"The Study Of X Syndrome, Afshar Hospital – Yazd "
Rafiei M,Sadr S M,Mirjalili M R,Nayeb Zadeh M
Tehran University Medical Journal , 2004,
Abstract: Background: All the patients with Angina pectoris have not stenotic coronary artery. Syndrome x consists of patients with Angina pectoris and positive Exercise test along with normal coronary angiography. Syndrome x includes 25-30 percent of those who undergo diagnostic coronary arteriography at the different centers. In our study it was attempted to know the prevalence and characteristics of this special group in Afshar cath-lab. Materials and Methods: In a prospective cross sectional descriptive study 200 patients who were admitted for coronary angiography evaluated in terms of Risk factors: HTN, Family history Hyperlipidemia, DM, Cigarette smoking , clinical symptoms , response to TNG, different symptoms, ECG and Exercise test. data in two subgroups with normal and abnormal Coronary angioghraphy were compared. Six patients were excluded because of ambiguous Coronary angiography. Results: Among 194 patients 51 patients (26.3% )had normal coronary artery. 38.9% of female and 21.4% of males showed normal coronary angioghraphy (P = 0.013). The prevalence of risk factors among those with syndrome x and abnormal coronary Artery were as follow. HTN 37% vs 42% , Hyperlipidemia 50% vs 51% , smoking 25% vs 37% , DM 12% vs 28% , obesity 45% vs 47% Positive family history for CAD = 21.5% vs 47% respectively. Angina relieved suitably with TNG in 24% of those with syndrome x compared to 76% suitable response in those with abnormal coronary arteries.(P Value = 0.49 ). Regarding to functional class , 87% of patients with normal coronary artery belonged to class I and II. also 26% had atypical pain 50% had normal rest ECG and 51% achieved stage III or IV of Bruce protocol during Exercise test. Conclusion: Syndrome x was more prevalent among women ,also angina was less typical and less responsive to TNG. Most patients had not positive familial history for CAD. normal ECG was more prevalent among those with syndrome x .
Post Traumatic Hemobilia: Three Case Reports  [PDF]
Hicham Jalal, Hana Elmansouri, Sofia El Fakir, Leila Berghalout, I. Zouita, Najat Cherif Idrissi El Ganouni, Youssef Narjiss, Khalid Rabbani
Open Access Library Journal (OALib Journal) , 2019, DOI: 10.4236/oalib.1105102
The authors report three cases of post-traumatic hemobilia. Hemobilia complicates about 0.5% to 2% of liver injuries. The diagnosis can be difficult because of its possible delay of appearance. The ultrasound and CT scan performed urgently are of great help in both positive diagnosis and monitoring of this pathology. Once the diagnosis is made—immediatly or a while after the trauma—a diagnostic and therapeutic arteriography must be carried out quickly.
Embolización arterial para el tratamiento del traumatismo del ri?ón en herradura
Esquena Fernández,Salvador; Trilla Herrera,Enrique; Abascal Junquera,José María; Pérez,Mercedes; Morote Robles,Juan;
Archivos Espa?oles de Urología (Ed. impresa) , 2005, DOI: 10.4321/S0004-06142005001000015
Abstract: objectives: to report one case of renal trauma in a patient with horseshoe kidney treated conservatively by superselective embolization. methods: we report the case of a 19 year old male presenting at the emergency room with macroscopic hematuria and severe abdominal pain after a motor vehicular accident. results: iv contrast ct scan showed a horseshoe kidney with a fracture in the area between the lower pole of the left kidney and the isthmus, with active bleeding and a big retroperitoneal hematoma extended to pelvis. retarded exams showed contrast extravasation compatible with significant urinoma. renal arteriography was performed, showing a double renal pedicle on each kidney and a common caudal lumbar-renal trunk giving accessory branches to both kidneys? lower poles and contrast extravasation compatible with active bleeding. the lumbar-renal trunk was selectively catheterized reaching the left kidney and isthmus branches which were embolized. retrograde catheterization of the urinary tract with a straight ureteral catheter was performed to facilitate drainage of the urinoma. this catheter was subsequently removed after control ct scan showing complete resolution of the urinoma and no bleeding. control ct scan three months after embolization demonstrated complete resolution of the hematoma. no late complications appeared. renal function and blood pressure have been completely normal after 12 months of follow-up. conclusions: horseshoe kidney is a rare congenital malformation. this clinical case demonstrates that conservative treatment is a still the gold standard treatment for renal trauma, even in kidneys with congenital anomalies.
Ferritina sérica e coronariopatia obstrutiva: correla??o angiográfica
Godoy, Moacir Fernandes de;Takakura, Isabela Thomaz;Machado, Rafael Dinardi;Grassi, Luciano Vaccari;Nogueira, Paulo Roberto;
Arquivos Brasileiros de Cardiologia , 2007, DOI: 10.1590/S0066-782X2007000400011
Abstract: objective: to verify the possible association between the levels of serum ferritin and the degree of obstructive coronary artery disease. methods: 115 patients with coronary arteriography and concomitant evaluation of serum ferritin were studied. the adopted cut-off values were 80 ng/ml for women and 120 ng/ml for men. results: the mean ferritin levels for males and females were 133.9±133.8 ng/ml and 214.6±217.2 ng/ml, respectively (p=0.047). it was observed that 44.1% of the women had normal serum ferritin levels in comparison to 30.9% of the men (p=0.254). in the patients without obstructive coronary artery disease or with less severe obstructions (group a) the serum ferritin level was 222.3±325 ng/ml. on the other hand, for those with moderate (group b) and severe obstructions (group c) the levels were 145.6+-83.7 ng/ml and 188.9±150.6 ng/ml, respectively. there was no correlation between the degree of coronary artery disease and the mean level of serum ferritin. regarding the cut-off value, the number of women with serum ferritin level > 80 ng/ml in groups b+c or only c was significantly higher than the number of women in group a (odds ratio 9.71 with 95%ci from 1.63 to 57.72). for males there was no significant difference between the number of cases above or below the cut-off values (odds ratio 0.92 with 95%ci from 0.28 to 2.95). conclusion: it was verified that women with serum ferritin levels > 80 ng/ml presented more severe obstructive coronary artery disease than women with lower levels. in men, the serum ferritin level was not a predictor element of the degree of obstruction.
Correlation between syndrome factor combination and cardiac function as well as blood-lipid in coronary heart disease
Jie WANG,Qing-yong HE
Zhong Xi Yi Jie He Xue Bao , 2008,
Abstract: Objective: To discuss the distribution laws of traditional Chinese medicine (TCM) syndrome factor and their combination in coronary heart disease (CHD), and to study the correlation between the TCM syndrome factor combination and cardiac function as well as blood-lipid.Methods: The parameters of the cardiac function of 300 patients with a final diagnosis of CHD by coronary angiography were measured by echocardiography, and the levels of blood lipids in the CHD patients were detected. An analysis of the correlation was done between the TCM syndrome factor combination and cardiac function as well as blood-lipid in CHD.Results: The TCM syndrome factor combinations of CHD were blood stasis due to qi deficiency, qi and yin deficiency, intermingled phlegm and blood stasis, and yang deficiency and blood stasis. The ejection fraction of CHD patients with yang deficiency and blood stasis was markedly decreased. The levels of triglyceride and low-density lipoprotein cholesterol in CHD patients with intermingled phlegm and blood stasis were markedly increased, and the level of triglyceride in CHD patients with qi and yin deficiency was markedly increased too.Conclusion: The treatment of CHD should aim directly at the symptoms and causes. It is also proved that some compound traditional Chinese herbal medicines for supplementing qi and activating blood circulation, nourishing yin and resolving phlegm, and activating yang should be used in treatment of CHD. In cases of CHD with low cardiac function, particular emphasis should be laid on activating yang and blood circulation, while in cases of CHD with blood-lipid disturbance, particular emphasis should be laid on resolving phlegm and activating blood circulation, replenishing qi and nourishing yin.
Fístula arteriovenosa renal congénita
Ramírez Zambrana,Antonio; Lallave Martín,Fátima; Zapata Blanco,Juan; Mateos Blanco,Jesús; Toledo Serrano,Ma José; Molina Suárez,Juan L.;
Actas Urológicas Espa?olas , 2009, DOI: 10.4321/S0210-48062009000600014
Abstract: we present the case of a young woman who went to the emergency departent with macroscopic and anaemic haematuria. we also confirm that, when faced with the possibility of finding an arteriovenous fistula, arteriography is the best choice for diagnosis, and the best option for treatment is selective embolization.
Can patients with left main coronary artery disease wait for myocardial revascularization surgery?
Rocha, Ant?nio Sérgio Cordeiro da;Silva, Paulo Roberto Dutra da;
Arquivos Brasileiros de Cardiologia , 2003, DOI: 10.1590/S0066-782X2003000200007
Abstract: objective: to assess the occurrence of cardiac events in patients diagnosed with left main coronary artery disease on diagnostic cardiac catheterization and waiting for myocardial revascularization surgery. methods: all patients diagnosed with left main coronary artery disease (stenosis 350%) consecutively identified on diagnostic cardiac catheterization during an 8-month period were selected for the study. the group comprised 56 patients (40 males and 16 females) with a mean age of 61±10 years. the cardiac events included death, nonfatal acute myocardial infarction, acute left ventricular failure, unstable angina, and emergency surgery. results: while waiting for surgery, patients experienced the following cardiac events: 7 acute myocardial infarctions and 1 death. all events occurred within the first 60 days after the diagnostic cardiac catheterization. more patients, whose indication for diagnostic cardiac catheterization was unstable angina, experienced events as compared with those with other indications [p=0.03, relative risk (rr) = 5.25, 95% confidence interval = 1.47 - 18.7]. in the multivariate analysis of logistic regression, unstable angina was also the only factor that independently contributed to a greater number of events (p = 0.02, or = 8.43, 95% ci =1.37 - 51.7). conclusion: unstable angina in patients with left main coronary artery disease acts as a high risk factor for cardiac events, emergency surgery being recommended in these cases.
Lack of a relationship between serum ferritin levels and coronary atherosclerosis evaluated by coronary arteriography
Manfroi, W.C.;Zago, A.J.;Cruz, R.;Oliveira, J.;Kirschnick, L.S.;Ordovás, K.;Candiago, R.H.;Souza, J.;Ribeiro, L.W.;Leit?o, C.;Brizolara, M.L.;
Brazilian Journal of Medical and Biological Research , 1999, DOI: 10.1590/S0100-879X1999000300009
Abstract: many clinical and epidemiological studies have demonstrated the relationship between serum ferritin and ischemic heart disease. in the present study we evaluated the relationship between coronary heart disease (chd) and serum ferritin levels in patients submitted to coronary arteriography. we evaluated 307 patients (210 (68.7%) males; median age: 60 years) who were submitted to coronary angiography, measurement of serum ferritin and identification of clinical events of ischemic heart disease. serum ferritin is reported as quartiles. ninety-six patients (31.27%) had normal coronary angiography (group 1) and 211 (68.73%) had coronary heart disease (group 2). of the patients with chd, 61 (28.9%) had serum ferritin levels higher than 194 ng/ml (4th quartile), as opposed to only 14 (14.58%) of those without chd (p = 0.0067). in the 2nd quartile, 39 patients (18.48%) had chd, while 35 patients (36.46%) had normal coronary arteries (p = 0.00064). multivariate analysis of the data showed that the difference between groups was not statistically significant (p = 0.33). we conclude that there is no independent relationship between coronary heart disease and increased levels of serum ferritin.
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