Sample records for embolia paradojal inminente

  1. [Fibrocartilaginous embolia of the spinal cord - a rare cause of myelomalacia (author's transl)].


    Roitzsch, E


    In a 69 years old female patient a paraplegia originated after a sudden fall on the back. By autopsy a fibrocartilaginous embolia in the arteries of the thoracolumbar cord and an extensive myelomalacia were detected.

  2. Nicolau Syndrome (Embolia Cutis Medicamentosa): A Rare and Poorly Recognized Iatrogenic Cause of Cutaneous Thrombotic Vasculopathy.


    Tabor, Dominic; Bertram, Chandra G; Williams, Andrew J K; Mathers, Marie E; Biswas, Asok


    Nicolau syndrome is a rare form of iatrogenic cutaneous necrosis which affects injection sites. Although classically associated with intramuscular injections, it may develop after subcutaneous or other routes of parenteral drug administration. Clinically, it manifests as necrotic ulcers that often develop in a background of erythematous and livedoid reticular patches. The histopathologic characteristics of Nicolau syndrome are poorly documented in the dermatopathology literature and features only rarely as one of the obscure causes of cutaneous thrombotic vasculopathy. We report a case of Nicolau syndrome developing secondary to subcutaneous injection of cyclizine to familiarize the clinicians and pathologists to this unusual condition. Given that it is potentially avoidable, pathologists should alert the clinicians to the possibility of Nicolau syndrome when a skin biopsy from an injection site shows signs of extensive thrombotic vasculopathy.

  3. Ischaemic neuropathy of the lumbosacral plexus following intragluteal injection.

    PubMed Central

    Stöhr, M; Dichgans, J; Dörstelmann


    A lesion of the lumbo sacral plexus may result from an inadvertent intra-arterial injection of vasotoxic drugs into one of the gluteal arteries. Symptoms and follow-up of three cases are reported. The neuropathy is attributed to a toxic endarteritis with retrograde propagation of spasm and thrombosis. Swelling an bluish discoloration of the buttocks ("embolia cutis medicamentosa") as well as an impaired circulation in the homolateral leg are associated with the neurological syndrome in fully developed cases and makes possible a correct diagnosis. Images PMID:7205289

  4. [Nicolau syndrome induced by intramuscular injection of a hexavalent vaccine in a 6-month-old girl].


    Stefano, Paola C; Garello, Mónica; Nolte, María F; Lamy, Patricia; Giglio, Norberto; Castellano, Vanesa; Gentile, Ángela


    Nicolau syndrome, also known as embolia cutis medicamentosa or livedo-like dermatitis, is a sudden tissue necrosis, a rare complication of intramuscular injection of some drugs. We report a case of a 6-month-old girl who received intramuscularly the third dose of hexavalent vaccine (DTaP- HVB-IPV/HIb), and immediately presented a livedoid lesion around the injection site, progressing to necrosis. We reinforce the importance of early diagnosis to perform a suitable treatment and clinical follow-up to avoid ischemic secondary complications.

  5. [Multiple embolisms by atrial myxoma].


    Contreras, Alejandro E; Cragnolini, Ana C; Brenna, Eduardo J; Parisi, Gustavo R; Chamale, Roberto A; Assante, Maria L; Paladini, Guillermo; Martinez Colombres, Alejandro


    El mixoma es el tumor cardiaco más frecuente, se presenta comúnmente entre la tercera y sexta decada de la vida y es más prevalente en mujeres. Una forma de presentación es la embolia sistémica. Una mujer de 56 años de edad presentó síntomas de isquemia cerebral, infarto agudo de miocardio silente e isquemia en miembro inferior derecho. Se diagnosticó mixoma de aurícula izquierda y fue intervenida quirúrgicamente de urgencia.

  6. [Massive cerebral air embolism following endoscopic retrograde cholangiopancreatography. A case report and review of the literature].


    Fernandez-Fernandez, J; Real-Noval, H; Rodriguez-Rodriguez, E


    Introduccion. La embolia aerea cerebral tras procesos endoscopicos es una complicacion infrecuente, pero que puede tener consecuencias catastroficas. Caso clinico. Varon de 85 años, diagnosticado de colangiocarcinoma distal con criterios de irresecabilidad, al cual se coloca una protesis biliar de drenaje. Se realiza una colangiopancreatografia retrograda endoscopica para el cambio de protesis. Tras el procedimiento, el paciente sufre un deterioro de las constantes vitales y del nivel de consciencia, y requiere intubacion orotraqueal. En la tomografia axial computarizada craneal se evidencia una embolia aerea masiva con focos de isquemia hiperaguda en ambos hemisferios. El paciente fallece posteriormente. Conclusiones. El embolismo aereo cerebral tras una colangiopancreatografia retrograda endoscopica es infrecuente, pero potencialmente letal. La manipulacion de la pared biliointestinal en las exploraciones endoscopicas podria originar comunicaciones entre la luz y el sistema venoso. Esto, unido a la alta presion de insuflacion para la realizacion de la prueba, condicionaria el paso de aire al sistema venoso portal y, de ahi, al sistema circulatorio. En el sistema nervioso central, las burbujas de aire provocarian una obstruccion vascular, con la consiguiente isquemia y necrosis del tejido. Es fundamental un diagnostico precoz y una terapia de soporte vital. Su rapido manejo puede contribuir a un mejor pronostico, que en principio es sombrio.

  7. Successful selective arterial thrombolysis in patient with acute abdominal thromboembolism.


    Tsekov, Christo; Loukova, Anelia; Gelev, Valeri


    The paper reports successful thrombolysis conducted in 64 years old woman admitted to the clinic with clinical and angiographic data for acute surgical abdomen caused by acute tromboembolia of arteria mesenterica superior (AMS). The therapeutic approach required to undertake lifesaving decision on i.e. surgical vs. invasive treatment in conditions of emergency. Finally, it was decided to undertake invasive treatment with successful restoration of blood flow in the related artery. The patient was discharged from the clinic with considerable clinical improvement on the fifth day of her stay. The case report includes discussion on issues relating the consequence of the diagnostic and interventional procedures in such patients, opportunities for conducting emergency thrombolysis in acute embolia of AMS and preventive measures in patients with high tromboembolic risk.

  8. [Fatal amnioinfusion with previous choriocarcinoma in a parturient woman].


    Hrgović, Z; Bukovic, D; Mrcela, M; Hrgović, I; Siebzehnrübl, E; Karelovic, D


    The case of 36-year-old tercipare is described who developed choriocharcinoma in a previous pregnancy. During the first term labour the patient developed cardiac arrest, so reanimation and sectio cesarea was performed. A male new-born was delivered in good condition, but even after intensive therapy and reanimation occurred death of parturient woman with picture of disseminate intravascular coagulopathia (DIK). On autopsy and on histology there was no sign of malignant disease, so it was not possible to connect previous choricarcinoma with amniotic fluid embolism. Maybe was place of choriocarcinoma "locus minoris resistentiae" which later resulted with failure in placentation what was hard to prove. On autopsy we found embolia of lung with a microthrombosis of terminal circulation with punctiformis bleeding in mucous, what stands for DIK.

  9. [Postoperative thromboembolic complications and preventive measures].


    Vegar-Brozović, Vesna; Prajdić-Predrijevac, D


    Modern surgical procedures become very extensive and aggressive in every surgical branch. Due to expressive development of anesthesia techniques with large monitoring systems support is provided to patients for broad spectrum of disorders. Therefore, we need to protect patients from imminent complications, as development of deep venous thrombosis and embolic pulmonary incidents. The main target in prophylaxis is to divide patients by risk and the type of surgical procedures during the time of "bed recovery". Today, current farmacological treatment is prone to control and prevent such events and to decrease mortality. Patients are divided in three groups: low risk (small operations with early mobilization); medium risk (surgery with risk in patients history); high risk (severe patients and long surgery, prolonged recovery). The best solutions in current medicine is to prevent most of complications, by administration of low molecular heparin (LMWH). Advantages of that treatment are: no need of intensive monitoring, long-time treatment, safe usage in "day case surgery" Beside LMWH, we still use heparin, although we tend to trial newer treatments and supports for prevention of complications. For special groups of patients recent trials examine heparinoid like drug-hyrudin, provided by chemical engeneering. That drug is metabolised in liver. Current therapy and prevention of DVT and pulmonary embolia is LMWH. It entered in every alghorythm of surgical and anaesthetic procedures and become CONDITIO SINE QUA NON.

  10. [Medical emergencies following dermatological injections and infusions].


    Dill-Müller, D


    Emergency situations following appropriately administered injections and infusions are an uncommon dermatologic problem. Embolia cutis medicamentosa is an uncommon complication following intramuscular injection which leads to infarct-like cutaneous necrosis. It may develop after gluteal injection of corticosteroids, anti-inflammatory agents and antibiotics and has rarely been described following venous sclerotherapy with polidocanol. Hoigné syndrome is a pseudoanaphylactic or pseudoallergic reaction following intramuscular injection of procaine penicillin, with neuropsychiatric problems developing immediately after the injection. Subacute forms following intramuscular or oral administration of structurally-related antibiotics. The intraoperative use of patent blue dye has a 1-2% risk of allergic reactions. The patient must be monitored carefully following injection for the onset the life-threatening immediate reaction. Extravasation of cytostatic agents is a critical iatrogenic problem in oncology with an incidence of up to 6.5%. Every oncologic department should have an understanding of necrotic risk of the various agents and an emergency kit with instructions for immediate steps, also including agent-specific antidotes as available.


    PubMed Central

    Cheng, Jianguo; Abdi, Salahadin


    Prevention of complications is one of the most important aspects of patient care in pain management. The objective of this study is to review documented complications in medical literature that are associated with interventional pain management, specifically those associated with joint, tendon, and muscle injections. We conducted Medline research from 1966 to November 2006 using keywords complication, injection, radiofrequency, closed claim, facet, zygophyseal joint, sacroiliac joint, shoulder, hip, knee, carpel tunnel, bursa, and trigger point. We found over 35 relevant papers in forms of original articles, case reports, and reviews. The most common complications appear to be infections that have been associated with virtually all of these injections. These infections include spondylodiscitis, septic arthritis, epidural abscess, necrotizing fasciitis, osteomyelitis, gas gangrene, and albicans arthritis. Other complications include spinal cord injury and peripheral nerve injuries, pneumothorax, air embolism, pain or swelling at the site of injection, chemical meningism, granulomatous inflammation of the synovium, aseptic acute arthritis, embolia cutis medicamentosa, skeletal muscle toxicity, and tendon and fascial ruptures. We suggest that many of the infectious complications may be preventable by strict adherence to aseptic techniques and that some of the other complications may be minimized by refining the procedural techniques with a clear understanding of the relevant anatomies. PMID:18591992

  12. [The etiology of neurological complications after cardiopulmonary bypass surgery].


    Carrascal, Y; Guerrero-Peral, A L; Maroto, L C; López-Gude, M J; Rodríguez-Hernández, J E; Rufilanchas, J J


    Cardiopulmonary bypass (CEC) in the surgical treatment of cardiac diseases may cause the appearance of neurological damage of an intensity which varies between minor neuropsychological disorders and global cerebral anoxia. There are two mechanisms for the production of these lesions: ischaemic and embolic. The mortality associated with this type of complication is low, but morbidity may be considerable. The neurological disorders derived from CEC may be classified according to the aetiology and clinical findings. In the first group are included: severe cerebral anoxia, embolic cerebro-vascular accidents, microvascular embolias, lesions of spinal vascularization and lesions of the peripheral nerves. In the second group are: encephalic focal lesions, convulsive crises, lesions of the extra-pyramidal system, alterations in the level of consciousness and neuropsychological disorders. Quantification of neuronal damage has been attempted by: monitoring cerebral blood flow and neurone metabolism, EEG and study of intra-operative evoked potentials, echography of the carotid, cardiac and ascending aorta, transcranial doppler, fluorescein-angiography and the study of biochemical markers of neuronal and glial damage. Different studies have identified a series of factors which potentiate the risk of neurological lesions following CEC. These are: age, severe carotid disease, aortic atherosclerosis and previous cerebro-vascular haemorrhage, amongst others. An attempt is made to reduce the incidence of neurological complications by: pre-operative evaluation of carotid bruits, hypothermia, careful surgical technique and the use of drugs with a neuroglial protector effect. None of these methods gives sufficiently effective protection to the central nervous system subjected to the changes involved in the use of CEC. There are still many unknown aspects of neurone pathology in these circumstances, leaving a door open to investigation.

  13. [Comparison of the cost-utility of direct oral anticoagulants for the prevention of stroke in patients with atrial fibrillation in Spain].


    Monreal-Bosch, M; Soulard, S; Crespo, C; Brand, S; Kansal, A


    Introduccion. El apixaban, el dabigatran y el rivaroxaban son tres anticoagulantes orales de accion directa (ACOD) indicados para la prevencion del ictus y la embolia sistemica en pacientes con fibrilacion auricular no valvular (FANV) en España. Objetivo. Comparar el coste-utilidad de los tres ACOD frente a los antivitamina K. Pacientes y metodos. Se utilizo un modelo Markov con ciclos trimestrales para simular pacientes con FANV desde que inician su tratamiento hasta el resto de su vida desde la perspectiva del Sistema Nacional de Salud. El modelo incorporo 36 estados de salud, incluyendo combinaciones de tratamientos, discapacidad y antecedentes de eventos, y considero una cohorte hipotetica de 10.000 pacientes con FANV. La eficacia relativa se calculo a partir de una comparacion indirecta formal de los tratamientos segun los datos de los ensayos pivotales de cada ACOD. Resultados. El dabigatran se asocio al valor maximo de años de vida ajustados por calidad (AVAC) (8,40 AVAC), seguido del apixaban (8,33 AVAC), el rivaroxaban (8,15 AVAC) y el acenocumarol (8,03 AVAC). Los costes totales fueron menores con el acenocumarol (22.230 €), seguido del dabigatran (24.564 €), el apixaban (24.655 €) y el rivaroxaban (25.900 €). La ratio coste-utilidad incremental frente a los antivitamina K fue de 6.397, 8.039 y 29.957 €/AVAC para el dabigatran, el apixaban y el rivaroxaban, respectivamente. Comparados entre ellos, el dabigatran domino al apixaban y al rivaroxaban. Los analisis de sensibilidad confirmaron la robustez del caso base. Conclusiones. Los tres ACOD son coste-efectivos frente al acenocumarol. El dabigatran es economicamente dominante frente al rivaroxaban y al apixaban en España, al ser mas efectivo y menos costoso.

  14. [Deep Vein Thrombosis Prophylaxis in Patients with Traumatic Brain Injury].


    Silva, Vinícius Trindade Gomes da; Iglesio, Ricardo; Paiva, Wellingson Silva; Siqueira, Mario Gilberto; Teixeira, Manoel Jacobsen


    Introdução: O risco de trombose venosa profunda encontra-se aumentado em doentes vítimas de traumatismo cranioencefálico, mas a profilaxia da trombose venosa profunda se confronta com o possível risco de piora de lesões hemorrágicas relacionados ao traumatismo cranioencefálico. Neste artigo apresentamos uma revisão crítica do tema e propomos um protocolo de profilaxia para estes doentes.Material e Métodos: Foi realizada uma pesquisa na base de dados Medline/PubMed, Cochrane, e Scielo de janeiro de 1998 a janeiro de 2014 com a expressão de busca âÄúdeep venous thrombosis and prophylaxis and traumatic brain injuryâÄù. Foram encontrados 44 artigos usando os termos MeSH definidos. Destes foram selecionados 23 artigos, usando como critérios: publicação em inglês ou português, fase aguda do traumatismo cranioencefálico moderado e grave, profilaxia mecânica não invasiva ou química.Resultados: O traumatismo cranioencefálico é um fator de risco para trombose venosa profunda e tromboembolismo pulmonar. A chance de trombose venosa profunda é 2,59 vezes maior em doentes com traumatismo cranioencefálico. A prevalência de trombose venosa profunda e embolia pulmonar em doentes que sofreram traumatismo cranioencefálico é de 20%, podendo atingir 30% dos doentes em alguns estudos.Discussão e Conclusão: As diversas formas de traumatismo de forma isolada constituem fator de risco para trombose venosa profunda e tromboembolismo pulmonar. Ensaios clínicos são necessários para estabelecer a eficácia da profilaxia e o melhor momento de iniciar medicação para trombose venosa profunda em doentes com traumatismo craniencefálico.

  15. [Assessment of pulmonary complications in renal transplantation through the use of radiography].


    Ramírez-García, Laura Elena; Juárez-Hernández, Fortunato; Tanus-Hajj, Janet; Avelar-Garnica, Francisco José


    Introducción: las infecciones del tracto respiratorio inferior son la complicación más frecuente en pacientes trasplantados de riñón en los primeros seis meses y están asociadas a alta mortalidad. Otras complicaciones pulmonares incluyen edema, embolia y hemorragia pulmonar. Se buscó evaluar las complicaciones pulmonares en los pacientes trasplantados de riñón utilizando la radiografía de tórax. Métodos: se analizaron 516 radiografías de tórax de 150 pacientes que recibieron trasplante renal en el 2014. Las radiografías se tomaron en la valoración preoperatoria, postoperatoria dentro de las 48 horas posteriores, 3 a 7, 8 a 15, 16 a 30, 31 a 90, 91 a 180 y más de 180 días. Para el estudio del parénquima pulmonar se dividió el tórax en cuatro cuadrantes asignando un valor de 1 a cada patrón radiográfico que se encontrara: reticulonodular o de ocupación alveolar, lobar o segmentario, atelectasia y vidrio deslustrado; el parénquima pulmonar obtuvo un valor mínimo de 0 y un mayor de 16 puntos. También se evaluó género, edad, comorbilidad asociada y tipo de trasplante renal. Resultados: se obtuvo la información de un total de 150 pacientes; 19 presentaron complicaciones pulmonares en las primeras 24-48 horas y 15 entre los 90 y los 180 días posteriores al trasplante renal. Las complicaciones más frecuentes fueron edema agudo pulmonar en la etapa temprana e infecciones en la etapa tardía. Conclusión: la prevalencia de complicaciones diagnosticadas por radiografía de tórax fue baja y se observó más en la etapa temprana y tardía.

  16. Thromboembolism and bleeding risk scores and predictors of cardiac death in a population with atrial fibrillation.


    Silva, Rose Mary Ferreira Lisboa da; Silva, Pollyana Ardavicius E; Lima, Marcos Correia; Sant'Anna, Lívia Tanure; Silva, Túlio Corrêa; Moreira, Pedro Henrique Vilela; Gandra, Robert Moreira; Cavalcanti, Túlio Ramos; Mourão, Plínio Henrique Vaz


    Atrial fibrillation (AF) is a common arrhythmia, with risk of systemic embolism and death. It presents rheumatic etiology in up to 32% of developing countries, whose anticoagulation and evolution data are scarce. to determine the predictors of cardiac death considering the clinical profile, thromboembolism and bleeding scores of patients with AF of a single center, with high prevalence of rheumatic heart disease. 302 patients with AF were studied, mean age 58.1 years; 161 women; 96 pts with rheumatic etiology. Patients underwent clinical and laboratory evaluation, measurement of risk scores and the mean follow-up of 12.8 months. 174 were using warfarin. The averages of the HAS-BLED and ATRIA scores were 1.4 and 1.2, respectively. Percent time in therapeutic range of international normalized ratio was 45.8%. Thirty patients (9.9%) had cardiac death and 41 had some type of bleeding due to warfarin. By univariate analysis, there was statistical significance between cardiac death and permanent AF, blood pressure, systolic dysfunction, R2CHADS2, CCS, EHRA and HAS-BLED. There was no association with valvular AF. By multivariate analysis, systemic arterial and pulmonary artery pressures, classification CCS and systolic dysfunction showed statistical significance. There was no association between cardiac death and valvular AF. Independent predictors of cardiac death were low measures of blood pressure, higher score CCS classification and the presence of systolic ventricular dysfunction. A fibrilação atrial (FA) é uma arritmia comum, com risco de embolia sistêmica e morte. Apresenta etiologia reumática em até 32% dos países em desenvolvimento, cujos dados de anticoagulação e evolução são escassos. Verificar as variáveis preditoras de morte cardíaca (MC) conforme o perfil clínico, os escores de tromboembolismo e de sangramento dos pacientes com FA de uma única instituição universitária, com alta prevalência de cardiopatia reumática. Foram estudados 302