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Thứ Ba, 9 tháng 7, 2013

NHÂN CA Pseudoaneurysms (False Aneurysms) TẠI MEDIC

A pseudoaneurysm, or false aneurysm, is a collection of blood that results from a leaking hole in an artery. This life-threatening condition is described below.

Posted by | Last updated: Mar 25, 2013
 
A pseudoaneurysm (false aneurysm) results from a leakage of blood from an artery after trauma or after "dehiscence," or separation, of a surgical anastomosis. The causes are discussed in greater detail below. Blood leaks from the artery into the surrounding tissue to form the pseudoaneurysm. Since blood from the artery continues to fill the pseudoaneurysm, it is under relatively high pressure and can expand and compress the surrounding structures (nerves, veins, etc.).
This article is part of a three-part series. The causes, differential diagnosis, and diagnosis of pseudoaneurysms is described below. In Part 2, the Treatment of Pseudoaneurysms is discussed. Finally, Part 3 provides a Summary of Pseudoaneurysms and a listing of references.
 
Causes of Pseudoaneurysms
  • Penetrating trauma: A gunshot wound, stabbing, or bomb blast can disrupt the arterial wall and allow blood to leak into the surrounding tissue, forming a pseudoaneurysm.
  • Blunt trauma: A kick to the shin or even a bad ankle sprain can damage the wall of an artery enough to create a pseudoaneurysm.
  • Endovascular procedure: During certain medical (endovascular) procedures, doctors will introduce thin wires and instruments into the body, usually through the femoral blood vessels in the groin. One example of such a procedure is "arteriography," in which doctors insert a thin instrument through the femoral artery into the aorta in the abdomen. They then inject a contrast dye, which flows into the arteries in the legs. They then take images with an X-ray machine (fluoroscopy) to observe how the contrast and blood flow through the arteries in the legs, looking for any stenoses (narrowings) or other damages. Since this procedure involves injection into the high-pressure arteries, this minor damage to the arterial wall can allow leakage of blood and formation of a pseudoaneurysm.
Differential Diagnosis of Pseudoaneurysms
When deciding if a patient has a pseudoaneurysm, other diagnoses to consider are the following:
  • Hematoma
  • Abscess
  • Arteriovenous fistula (AVF)
  • Lymphadenopathy: Enlargement of lymph nodes that occurs with infections, lymphoma, and other cancers.
  • Lymphocele
  • Deep venous thrombosis: Blood clots in the leg veins.
  • Compartment syndrome
How to Diagnosis a Pseudoaneurysm (False Aneurysm)
A patient with a pseudoaneurysm will typically have had some type of traumatic event that could have damaged the patient's blood vessels. This could be a recent blunt or penetrating trauma, or an endovascular procedure (as described above). A pseudoaneurysm occurs when blood leaks from the artery days to even years after this traumatic event. The patient will complain of a mass near the site of the trauma that is pulsating, painful, and warm. It may be possible to feel the vibration or movement of blood within the mass (called a "thrill"). If the pseudoaneurysm is large enough to compress a nearby nerve, the patient may experience numbness or tingling (called "paresthesias") or pain.
Imaging Techniques:
  • Doppler ultrasound: Can detect the size and shape of the mass (pseudoaneurysm) and determine if there is bloodflow into it from a nearby artery.
  • Arteriography, CT angiography, and MR angiography: These three imaging techniques are very good at showing the anatomy of the arterial system. A dye (contrast agent) is injected into the bloodstream proximal to (before) the area of the pseudoaneurysm. Then an X-ray, CT scan, or MRI is obtained as the contrast dye flows through the arteries. As seen in the images below, contrast flowing into a pseudoaneurysm can easily be seen with these images.
Other Diagnostic Techniques:
  • Needle aspirate: If the doctor is unsure if a warm, painful mass is a hematoma, pseudoaneurysm, abscess (infection), cyst, or enlarged lymph node, the doctor can insert a needle into the mass and attempt to withdraw fluid. If the needle withdraws blood, then the mass could be a hematoma or a pseudoaneurysm.
The Treatment of Pseudoaneurysms is discussed next, followed by a summary of pseudoaneurysms.
References
  1. Aiyer S et al. Pseudoaneurysm of the posterior tibial artery following a closed fracture of the calcaneus. A case report. J Bone Joint Surg 2005. 87(10):2308-12.
  2. Aydin A, Lee CC, Schultz E, and Ackerman J. Traumatic inferior gluteal artery pseudoaneurysm: Case report and review of the literature. Am J Emer Med 2007. 25:488.e1-e3.
  3. Baynosa RC et al. Iatrogenic pseudoaneurysm following reverse radial forearm free tissue transfer. J Reconstructive Microsurgery 2007. 23(6):335-8.
  4. Corso R et al. Large iatrogenic pseudoaneurysm of the posterior tibial artery treated with sonographically guided thrombin injection. Am J Radiology 2003. 180:1479-80.
  5. Wikipedia: Pseudoaneurysm
From Suite 101

Thứ Sáu, 5 tháng 7, 2013

NHÂN CA POLYP LỚN DẠ DÀY tại MEDIC




Gastric polyps,Vallot T. Presse Med. 2007 Oct;36(10 Pt 2):1412-7. Epub 2007 May 7.

Source

Service d' hépato-gastroentérolgie, CHU Bichat Claude Bernard, Paris. thierry.vallot@bch.ap-hop-paris.fr

Abstract





Gastric polyps exist in a wide variety of types, most often benign. Endoscopic discovery of gastric polyps necessitates biopsies - not only of the lesion but also of the antral and fundic mucosa to determine the therapeutic strategy and subsequent surveillance. Fundic gland polyps are the most frequent type; they are asymptomatic with no malignant potential. They require neither treatment nor surveillance. Hyperplastic polyps, adenomas and tumors must be totally resected. Biopsies alone are insufficient to assess the extent of malignancy of adenomas and of hyperplastic polyps more than 5 mm in diameter. These polyps are associated with an elevated frequency of precancerous alterations of the gastric mucosa and consequently by an elevated risk of synchronous or metachronous cancer. Eradication of Helicobacter pylorus may reduce the risk of metachronous gastric cancer and recurrence after resection. Carcinoid tumors of the fundus most often occur in patients with hypergastrinemia during atrophic gastritis of autoimmune origin; they are not serious. The advantages and procedures for endoscopic surveillance of patients with a precancerous condition of the gastric mucosa have not yet been clearly established in populations with a low incidence of cancer.

Giant gastric hyperplastic polyp: not always a benign lesion, Dang S, McElreath DP, Kumar S, Kakati B, Atiq M, Morton WJ, Aduli F. J Ark Med Soc. 2010 Oct;107(5):89-92.

Abstract

Giant gastric hyperplastic polyps constitute of around 76% of all gastric polyps found. They are often found incidentally on upper GI endoscopy. They often present with occult GI bleeding causing iron deficiency anemia or partial gastric outlet obstruction. Although mostly benign, they do have potential for malignant transformation and hence must be excised endoscopically or surgically, whichever may be feasible

Clinical consequences of the endoscopic diagnosis of gastric polyps. Stolte M.,  1995 Jan;27(1):32-7; discussion 59-60.

Source

Institute of Pathology, Klinikum Bayreuth, Germany.

Abstract

The procedure following endoscopic detection of a gastric polyp depends on the findings on histological examination of the lesion, for which forceps biopsy material usually suffices. If Elster's polyps are present, the recommendation is merely a search for epithelial tumors in the colorectum, which occur statistically more frequently in these patients. In the case of hyperplastic polyps, the recommended procedure is endoscopic polypectomy, typing of gastritis and regular follow-up examinations. Carcinoid tumors, which usually arise in type A gastritis, require only follow-up, while sporadic carcinoid tumors should be treated surgically. Irrespective of the type and grade of dysplasia, adenomas of the gastric mucosa should always be removed in toto. Polypoid type I or type IIa early carcinomas of the stomach initially only need to be removed endoscopically. If histological examination then reveals well or moderately differentiated adenocarcinoma limited to the mucosa, surgery is not necessary, but regular follow-up is essential.