Behcet's disease is a chronic multisystemic disorder involving many organs and characterized by recurrent oral and genital ulcers and relapsing iritis. A case of BD with large vein thrombosis involving superior and inferior vena cava is presented. Large vein thrombosis in BD is not commonly developed and most commonly observed in the inferior or superior vena cava. A review of the literature emphasizes the rarity of the combined superior and inferior vena caval occlusion. Existence of extensive large vein occlusion in BD is associated with limited therapy and poor prognosis.
Adult ; Behcet's Syndrome/diagnosis ; Behcet's Syndrome/complications* ; Disease Progression ; Fatal Outcome ; Female ; Fibrinolytic Agents/therapeutic use ; Human ; Phlebography ; Thrombosis/etiology* ; Thrombosis/drug therapy ; Thrombosis/diagnosis ; Vena Cava, Inferior/radiography* ; Vena Cava, Superior/radiography* ; Substances: Fibrinolytic Agents

Intra-carotid urokinase (UK) infusion in 20 patients with acute internal carotid artery (ICA) territorial ischemic stroke achieved immediate recanalization in 45% and the clinical outcome in patients with recanalization was superior to that of patients without recanalization. The procedure was most effective in patients with smaller arterial occlusions: 7 of 10 patients with MCA branch occlusions (M2 to M4) achieved recanalization compared to only 2 of 10 with distal ICA or M1 occlusions, which should be an important issue for the critical evaluation of the efficacy of thrombolytic therapy (TT). Hemorrhagic transformation was observed in 9 patients on CT scan; petechial hemorrhage in 5 and intraparenchymal hematoma formation in 4. Among 4 patients with hematoma formation, clinical deterioration was seen in 3 cases and the angiography at the immediate end of the UK infusion showed recanalization in only one patient. The average dose of UK in patients with parenchymal hematoma formation was higher than that of patients without hemorrhagic transformation (123.3 x 10(4) units vs 101 x 10(4) units). The administration of a large dose of UK, probably more than 100 x 10(4) units, and the absence of immediate recanalization seemed to increase the risk of parenchymal hematoma formation. Despite the effort of investigators, the in-hospital time delay for the TT was significant which was mainly related to the time consuming preparation for angiography especially during night. A more effective system for the earlier intervention of acute ischemic stroke needs to be developed.
Adult ; Aged ; Angiography ; Brain Ischemia/*drug therapy/radiography ; Carotid Artery Thrombosis/*drug therapy/radiography ; Female ; Human ; Male ; Middle Age ; Support, Non-U.S. Gov't ; Thrombolytic Therapy/*methods ; Tomography, X-Ray Computed ; Urinary Plasminogen Activator/*administration & dosage

Trousseau's syndrome comsists of migratory thrombophlebitis and thromboembolic disorders of the venous and arterial systems in a malignancy or occult cancer. The overall incidence has been reported to vary from 1 to 11%. Pancreatic, lung, prostate, and stomach cancer is associated with the greatest risk of thromboembolic events. We encountered a 49-year-old man who presented with painful swelling of his lower legs. The chest radiograph showed increased opacity of the Left middle lung fields and Doppler sonography showed a thrombus in the left superficial femoral vein. Chest Computed Tomography showed a 5cm sized left hilar mass invading the pericardium with lymphadenopathy. The bronchoscope biopsy demonstrated an adenocarcinoma of the lung. Platinum based chemotherapy and anticoagulant therapy with warfarin was carried out. The patient was later discharged with an improvement in the painful swelling of his lower legs.
Adenocarcinoma ; Biopsy ; Bronchoscopes ; Drug Therapy ; Femoral Vein ; Humans ; Incidence ; Leg* ; Lung Neoplasms* ; Lung* ; Lymphatic Diseases ; Middle Aged ; Pericardium ; Platinum ; Prostate ; Radiography, Thoracic ; Stomach Neoplasms ; Thorax ; Thrombophlebitis ; Thrombosis ; Warfarin

INTRODUCTIONGas is rarely found within the viscera outside the lumen of the gastrointestinal tract. Emphysematous gastritis is a rare form of infection of the stomach wall by gas producing organisms.

CLINICAL PICTUREA 45-year-old Chinese lady underwent hepatectomy for hepatocellular carcinoma. Postoperatively, she turned septic and encephalopathic with worsening liver function. Computed tomography scan revealed a thickened, oedematous stomach wall with air pockets within.

TREATMENTThe patient was started on a course of broad spectrum antibiotics.

OUTCOMEShe responded and was discharged well.

CONCLUSIONEmphysematous gastritis is a rare condition with high mortality. There is however, still no preferable approach of treatment despite therapeutic advances.

Anti-Bacterial Agents ; therapeutic use ; Emphysema ; diagnostic imaging ; Female ; Gastritis ; drug therapy ; pathology ; Humans ; Middle Aged ; Portal Vein ; Radiography ; Thienamycins ; therapeutic use ; Ultrasonography ; Venous Thrombosis ; diagnostic imaging

Very late stent thrombosis (VLST) after implantation of drug-eluting stent is rare, but very fatal complication after percutaneous coronary intervention. We report a case of VLST of a sirolimus-eluting Cypher(TM) stent (Cordis, Johnson and Johnson) presenting as acute ST elevation myocardial infarction at 26 months after deployment with continued combined dual antiplatelet medication of aspirin and clopidogrel. The patient did not show anti-platelet resistance.
Aged ; Angina Pectoris/*therapy ; Aspirin/*therapeutic use ; Coronary Angiography ; Coronary Thrombosis/drug therapy/*etiology/radiography ; Drug Resistance ; Drug-Eluting Stents/*adverse effects ; Electrocardiography ; Female ; Humans ; Platelet Aggregation Inhibitors/*therapeutic use ; Ticlopidine/*analogs & derivatives/therapeutic use ; Time Factors

We report a case of delayed cerebral infarction due to stent longitudinal folding deformation following carotid artery stenting using a self-expandable stent with an open-cell design. The stented segment of the left common carotid artery was divided into two different lumens by this folding deformation, and the separated lumens became restricted with in-stent thrombosis. Although no established method of managing this rare complication exists, a conservative approach was taken with administration of anticoagulant and dual antiplatelet therapy. No neurological symptoms were observed during several months of clinical follow-up after discharge.
Aged ; Anticoagulants/therapeutic use ; Carotid Arteries/radiography ; Cerebral Infarction/*diagnosis/therapy ; Humans ; Male ; Platelet Aggregation Inhibitors/therapeutic use ; Stents/*adverse effects ; Thrombosis/drug therapy/*etiology ; Ticlopidine/analogs & derivatives/therapeutic use ; Tomography, X-Ray Computed

Thrombophlebitis of the portal venous system (PVS) with superimposed bacterial infection (septic pylephlebitis) is an extremely rare complication of Crohn's disease (CD), and therefore diagnosis of septic pylephlebitis is difficult without high clinical suspicion. A 16-year old male patient who was diagnosed with CD 3 months earlier was admitted with recurrent fever and abdominal pain. CD activity had been well controlled with conventional medical treatment during a follow-up period. Abdominal contrast-enhanced computed tomography showed massive thrombosis in the PVS without evidence of intra-abdominal infection, and blood cultures were positive for Streptococcus viridians. There was no evidence of deep vein thrombosis or pulmonary thromboembolism, and all laboratory tests for thrombophilia were normal. Based on these findings, the patient was diagnosed with septic pylephlebitis complicated with CD, and was successfully treated with intravenous antibiotic therapy combined with anticoagulation. This case suggests that early comprehensive evaluation is crucial for immediate diagnosis and proper treatment of septic pylephlebitis in patients with CD who present with fever and abdominal pain of unknown origin, even with stable disease activity and absence of other intra-abdominal infections.
Adolescent ; Anti-Bacterial Agents/therapeutic use ; Anticoagulants/therapeutic use ; Colonoscopy ; Crohn Disease/complications/*diagnosis ; Humans ; Male ; Phlebitis/complications/*diagnosis ; Portal Vein/radiography ; Sepsis/*diagnosis/microbiology ; Streptococcal Infections/diagnosis/drug therapy ; Thrombosis/drug therapy/radiography ; Tomography, X-Ray Computed ; Viridans Streptococci/isolation & purification

Totally implanted central venous access devices for chemotherapy (chemoport) are being used increasingly in lung cancer patients. Vascular catheters are associated with various complications including infection, thrombosis as well as spontaneous fractures and embolization of the catheter, which is known as 'pinch-off syndrome'. 'Pinch-off syndrome' refers to the compression of a subclavian central venous catheter between the clavicle and first rib resulting in an intermittent or permanent obstruction, which can lead to tears, transection, or embolization. We report two cases of fractured and embolized implanted subclavian venous catheters in which the fragments were removed percutaneously. A 62-year-old man presented with back pain with a duration of a few weeks. The chest radiograph revealed complete transsection and embolization of the catheter into the right atrium. In addition, a 47-year-old woman with a chemoport had a grade 3 pinch-off sign in a chest radiograph demonstrating complete transsection and embolization of the catheter into the pulmonary artery. Both cases were managed by retrieving the embolized distal fragment percutaneously and removing the proximal section of the catheter.
Back Pain ; Catheters ; Central Venous Catheters ; Clavicle ; Drug Therapy ; Female ; Fractures, Spontaneous ; Heart Atria ; Humans ; Lung Neoplasms* ; Lung* ; Middle Aged ; Pulmonary Artery ; Radiography, Thoracic ; Ribs ; Thrombosis ; Vascular Access Devices

Adult ; Aged ; Aged, 80 and over ; Fractures, Bone ; complications ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Male ; Middle Aged ; Pelvic Bones ; blood supply ; diagnostic imaging ; injuries ; Radiography ; Venous Thrombosis ; diagnostic imaging ; drug therapy ; prevention & control ; Young Adult

Protein S (PS), a vitamin K-dependent glycoprotein, performs an important role in the anticoagulation cascade as a cofactor of protein C. Because of the presence of a pseudogene and two different forms of PS in the plasma, protein S deficiency (PSD) is one of the most difficult thrombophilias to study and a rare blood disorder associated with an increased risk of thrombosis. We describe a unusual case of previously healthy 37-year-old man diagnosed with portal-splenic-mesenteric vein thrombosis secondary to PSD. The patient was admitted to the hospital due to continuous nonspecific abdominal pain and nausea. Abdominal computed tomography revealed acute venous thrombosis from inferior mesenteric vein to left portal vein via splenic vein, and laboratory test revealed decreased PS antigen level and PS functional activity. Conventional polymerase chain reaction and direct DNA sequencing analysis of the PROS1 gene demonstrated duplication of the 166th base in exon 2 resulting in frame-shift mutation (p.Arg56Lysfs*10) which is the first description of the new PROS1 gene mutation to our knowledge. Results from other studies suggest that the inherited PSD due to a PROS1 gene mutation may cause venous thrombosis in a healthy young man without any known predisposing factor.
Adult ; Anticoagulants/therapeutic use ; Base Sequence ; Blood Proteins/*genetics ; Codon, Terminator ; Exons ; Humans ; Male ; Mesenteric Veins/radiography ; Polymorphism, Restriction Fragment Length ; Portal Vein/radiography ; Protein S Deficiency/complications/*diagnosis ; Sequence Analysis, DNA ; Splenic Vein/radiography ; Tomography, X-Ray Computed ; Venous Thrombosis/*diagnosis/drug therapy/etiology