Ergotamine-induced acute vascular insufficiency of the lower limb--a case report

Ergotamine-containing drugs are widely used in the treatment of acute migraine attacks. Spastic vasoconstriction is one of the possible side effects usually affecting the lower extremities and sometimes leading to gangrene. A 28-year-old woman was hospitalized for severe acute arterial insufficiency of the limbs. The initial surgical approach was not successful since the diagnosis was missed. Overuse of ergotamine derivative was acknowledged by the patient, who had a long history of migraine headaches. Therefore, the patient was treated conservatively with intravenous heparin and prostaglandin infusion and sympatheticolysis via epidural catheter. The vascular complications, angiographic findings, and different modalities of treatment of ergotamine-induced peripheral vascular insufficiency of the lower limb are reviewed.     

Mitomycin C-induced renal insufficiency: a case report

A 58-year-old normotensive male with normal renal function and gastric cancer underwent total gastrectomy and received adjuvant chemotherapy with mitomycin C (MMC) for 10 months. He developed anemia, hypertension, and renal function impairment 9 months after initiation of chemotherapy. Kidney biopsy showed thrombotic microangiopathy with marked mesangiolysis and expansion of the subendothelial space resulting in cystic dilation of the glomerular capillaries, and cellular atypia in the tubular cells. His renal function deteriorated gradually then stabilized after treatment with plasma exchange, antihypertensive agents, and antiplatelet agents. He had no sign of tumor recurrence after 3 years of follow-up. We suggest that patients receiving MMC should have their blood pressure and renal function closely monitored for the possibility of development of drug-induced renal insufficiency.     

Cytomegalovirus-associated protein losing gastropathy in an immunocompetent adult: a case report

Cytomegalovirus infection of the gastro-intestinal tract is frequent and may be serious in the immunocompromised patient. We report a case of cytomegalovirus infection in an immunocompetent young man who presented total food intolerance, pleural effusion and oedema as the result of severe protein losing hypertrophic gastropathy. Hypertrophic gastropathy with severe mucosal protein loss has been described in Menetrier's disease, a condition of unknown cause which involves foveolar hyperplasia of the gastric mucosa. Related hypoalbuminemia is responsible for a clinical picture of diffuse edema. In adults, the natural course of the disease is marked by a chronic course and carries a bad prognosis. In our case, the disease ran a protracted disabling course, likely shortened by ganciclovir therapy, followed by slow clinical, endoscopic and biochemical resolution after several' months course.     

Lethal hypercytokinemia following hepatic resection under pringle maneuver: a case report

Clinical implications of acute reactant cytokines remain to be clarified in ischemia/reperfusion injury of humans. We report a lethal case of hypercytokinemia following continuous Pringle maneuver. A 36-year-old man with intrahepatic duct stones underwent left lobectomy under continuous hepatic inflow occlusion for 70 minutes. The postoperative course was stormy with rapid deterioration of liver functions, resulting in death due to multiorgan dysfunction on the 4th postoperative day. Analysis of cytokines demonstrated marked elevation of plasma acute inflammatory cytokines level (Interleukin-6 and -8) during surgery and immediate postoperative day. Our experience suggests that excessive production of inflammatory cytokines was detrimentally associated with multiorgan dysfunction including liver. The strategies against such hypercytokinemia should be considered when performing liver resection particularly under continuous Pringle maneuver.     

A case of chronic ischemic erosive gastropathy healed after surgical revascularization

A case of chronic ischemic erosive gastropathy secondary to chronic abdominal vascular insufficiency is reported. This gastropathy healed after revascularization procedure but then recurred after stenosis of the aortomesenteric graft. The clinical picture was characterized by post-prandial abdominal pain, weight loss and an abdominal bruit. The upper gastrointestinal endoscopy showed multiple non hemorrhagic antral erosions with irregular outlines and a pseudomembranous floor. Reduction of the resistance of the gastric mucosal barrier by a chronic decrease of mucosal blood flow probably accounted for the gastric erosions. Although the prevalence is unknown, ischemic injury to the stomach is unexpected, because of the rich collateral circulation of this organ. Increased awareness of the disease and its prognostic implications should lead to suggest abdominal vascular insufficiency based on their clinical and gastroscopic aspects, thus leading to operation before acute mesenteric infarction occurs.     

Traumatic tricuspid valve insufficiency: case report

A 30-year old man underwent a head-on motor accident and was admitted to hospital, where he was successfully treated for several injuries. He was discharged home with slight tricuspid regurgitation, without signs of hemodynamic decompensation, and required no further treatment. Five years later he was admitted to the National Institute of Cardiology due to overt right ventricular failure secondary to tricuspid valve regurgitation. After several unsuccessful attempts at papillary muscle and chordal repair, a 33-mm SJM Biocor valve was implanted. This case history underlines the value of echocardiography, even after blunt chest trauma without cardiac symptoms. A good functional result can be achieved years after onset of traumatic valve insufficiency, but early diagnosis and surgical treatment increases the feasibility of tricuspid valve repair rather than replacement, and also prevents progressive deterioration of right ventricular function.     

Fulminant ischemic gastropathy: the final stage of a difficult-to-diagnose disease

Ischemic gastropathy is highly infrequent in daily medical practice. In the last few years, the number of reported cases has increased. Although the guiding symptom is usually abdominal pain, the clinical spectrum of the disease is highly variable. Early diagnosis and treatment are essential to change the natural history of the disease. We present the case of a 75-year-old man with chronic abdominal pain who developed a fulminant form of necrotizing gastric ischemia and died within less than 24h.     

Combined surgery for ischemic cardiomyopathy: report of a case

A 65-year-old female with catecholamine-dependent ischemic cardiomyopathy was admitted to our hospital. Preoperative examination revealed severe triple vessel coronary artery disease, severe mitral valve regurgitation and left ventricular (LV) dilatation associated with low ejection fraction. Coronary artery bypass grafting with four distal anastomoses, mitral valve plasty using original papillary muscle application method, LV volume reduction using overlapping method and biventricular pacing were performed. Postoperative course was uneventful and quality of life at 2 years after surgery was good. Active combined surgery has the possibility of improving the outcome of patients with severe ischemic cardiomyopathy.     

Hyperplastic gastropathy with acid hypersecretion. A case report

The case of a 60-year-old male patient with hyperplastic hypersecretory gastropathy. The diagnosis was reached by means of the histologic study of a sample obtained by endoscopic macrobiopsy. Examination of the gastric secretions showed stimulate and basal hypersecretion; gastrinemia was normal and albumin levels were at the lower limit. Several observations are made concerning the acid secretion clinical aspects and treatment of this rare disorder.     

慢性乙型肝炎患者应用阿德福韦酯出现肾损害1例分析

1 病例资料患者男性,33岁,主因发现肌酐升高3月余,尿检异常1周入院.自觉间断乏力、腰酸,1周前尿蛋白(++),尿蛋白定量3.6 g/d.无脱发、光过敏、颜面及下肢水肿;无游走性关节痛、关节畸形;无发热、盗汗、心悸、畏寒;无恶心呕吐、腹痛腹泻、尿频、尿急、尿痛.自觉尿泡沫增多,尿量、尿色未见明显变化,饮食睡眠良好,体重无明显变化.     

Small intestinal obstruction resulting from ischemic enteritis: a case report

A 69-year-old male was admitted to our institution because of a sudden onset of vomiting and abdominal distention. His past history of illness included femoral head fracture, congestive heart failure and ischaemic colitis. Plain abdominal computed tomography revealed extensively dilated small intestinal loops with a calibre change around the end of the ileum. Small intestinal obstruction was diagnosed and a transnasal ileus tube was placed. The ileus tube was constantly moved towards small intestine until it reached the distal ileum. Contrast medium from the ileus tube revealed a distal ileal stricture. Subsequently, transanal single balloon enteroscopy was performed to inspect the stricture, revealing a circumferential and afferent tubular ulcer in the distal ileum, 5 cm from the ileocecal valve; gastrofluorography confirmed the stricture. Although the stricture was dilated on several occasions using balloon catheters, the stricture could not be improved. However, during the treatment, his general condition worsened over time; thus, surgical treatment was decided. Operative findings revealed several circumferential ulcers with a clear margin 5–28 cm from the ileocecal valve: all lesions were successfully resected. Pathological findings were consistent with ischaemic enteritis. We report a case of small intestinal obstruction resulting from stenotic ischaemic enteritis.     

Acute ischemic colitis during scuba diving： Report of a unique case

The presentation of clinical symptoms due to decompression during diving, varies significantly, as mainly minor disturbances for the gastrointestinal tract in particular have been reported. The following case debates whether diving can cause severe symptoms from the gastrointestinal system. We describe a clinical case of ischemic colitis presented in a 27-year-old male, who manifested abdominal pain while in the process of scuba diving 20 meters undersea, followed by bloody diarrhoea as soon as he ascended to sea level. Taking into account his past medical history, the thorough, impeccable clinical and laboratory examinations and presence of no other factors predisposing to ischemia of the colon, we assume that a possible relationship between diving conditions and the pathogenesis of ischemic colitis may exist. This unusual case might represent a hematologic manifestation of decompression sickness, due to increased coagulability and/or transient air emboli, occurring during a routine scuba diving ascent to sea level.     

Management of ischemic proctitis with severe rectal haemorrhage： A case report

Acute ischemic proctitis is a rare pathological condition. We report here a patient presented with massive rectal haemorrhage from a bleeding vessel superimposed on an underlying pathology of ischemic proctitis. This case report illustrates the difficulties in making the clinical distinction between ischemic proctitis and other pathological entities. We also discussed the beneficial role of arteriogram with embolotherapy as an effective therapeutic measure in the management of lower gastrointestinal bleeding. The literature on the subject is reviewed.     

A case of severe acute pancreatitis and ischemic gastropathy caused by acute aortic dissection

A 49-year-old man presented with chest pain and was given a diagnosis of aortic dissection based on computed tomography (CT) findings. Two days later the dissection reached the origin of the celiac artery and there was poor blood flow from the body to the tail of the pancreas and fundus of the stomach wall. Severe acute pancreatitis developed. Endoscopy showed a near-circumferential gastric ulcer in the gastric cardia and we diagnosed ischemic gastropathy. A fistula between the area of infected pancreatic necrosis and the stomach had formed spontaneously and the necrotic tissue was draining into the stomach. His recovery was uneventful.