RESUMEN
Intercostal herniation is an abnormal protrusion of lung tissue through the boundaries of the thoracic cavity. It is commonly seen after chest trauma or thoracic surgery but rarely occurs spontaneously. We report a male patient who presented with an intercostal herniation after vigorous coughing for over 2 weeks. Treatment of post-coughing intercostal hernias is either conservative management or surgical intervention, which is dictated by the signs, symptoms, site, and presence of strangulation.
RESUMEN
Progressive left ventricular remodeling is characterized by dilation of the left ventricle with a change in the heart from an elliptical shape to a more spherical shape. This change is part of the unfavorable natural history in patients with heart failure. The CorCap Cardiac Support Device (Acorn Cardiovascular, St. Paul, MN) is a mesh device that is implanted around the heart to reduce wall stress and the first therapy specifically designed to address left ventricular remodeling. The CorCap was studied in a large, prospective, randomized, multicentered trial. This study demonstrated safety and effectiveness of the CorCap in patients with advanced heart failure and remodeled ventricles. Moreover, it provided interesting insights into mitral valve surgery in patients with heart failure. These insights and a review of the ACORN (Assessment of a Cardiac Support Device [CSD] in Patients With Heart Failure) trial are discussed in this article.
Asunto(s)
Insuficiencia Cardíaca/complicaciones , Implantación de Prótesis de Válvulas Cardíacas , Corazón Auxiliar/efectos adversos , Válvula Mitral/cirugía , Remodelación Ventricular , Gasto Cardíaco , Insuficiencia Cardíaca/patología , Humanos , Válvula Mitral/patologíaRESUMEN
Blunt peripheral extremity vascular injuries are much less frequent than those of penetrating injuries, especially in the absence of significant musculoskeletal trauma. We present an unusual case of complete femoral artery and vein avulsion that resulted from a forced hip hyperextension and thigh abduction after slipping when a patient's foot became entrapped in a ladder. The patient presented with an acutely ischemic right lower extremity 8 hr postinjury, which necessitated immediate surgical exploration, temporary intravascular shunting, interposition grafting, and prophylactic fasciotomy. To our knowledge, this is the first such mechanism to be reported resulting in complete transection of both femoral artery and vein. We review the mechanism of injury and management.
Asunto(s)
Arteria Femoral/lesiones , Vena Femoral/lesiones , Isquemia/etiología , Enfermedades Musculoesqueléticas/complicaciones , Heridas no Penetrantes/etiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Fasciotomía , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/cirugía , Vena Femoral/diagnóstico por imagen , Vena Femoral/cirugía , Humanos , Isquemia/diagnóstico por imagen , Isquemia/cirugía , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/cirugía , Adulto JovenRESUMEN
BACKGROUND: Gastrointestinal stromal tumors (GISTs) constitute the largest category of nonepithelial neoplasms of the gastrointestinal tract. Histologically, they have a spindle cell appearance but stain by immunohistochemistry for the proto-oncogene, c-kit (CD117). There is some evidence that phosphorylation of these receptors leads to a cascade that may activate the ras/mitogen-activated protein kinase pathway, which may, in turn, allow other oncogenes to become active. HYPOTHESIS: Immunohistochemical staining pattern of GISTs will aid in their differentiation from other spindle cell tumors and predict clinical outcome in patients. DESIGN AND SETTING: Retrospective review of patient records and paraffin block specimens of spindle cell tumors. PATIENTS: We have identified 65 patients with spindle cell tumors of the gastrointestinal tract at our institution in the past 10 years. Tumors were diagnosed by their morphology as leiomyomas, leiomyoblastomas, or leiomyosarcomas. MAIN OUTCOME MEASURES: CD117 and ras p21 were stained by immunohistochemistry on formalin-fixed, paraffin-embedded sections of normal and tumor tissues. RESULTS: Of the 65 patients, there were 23 patients diagnosed as having GIST confirmed by CD117 expression and 42 patients without GIST. Gastrointestinal stromal tumor samples of 17 (77%) of 22 patients stained positive for ras protein compared with 0 of 27 patients with leiomyomas (P<.001). CONCLUSIONS: To our knowledge, this study is the first to demonstrate that GISTs stain positive for ras p21. This molecular trait may be a useful diagnostic tool in addition to the c-kit (CD117) to separate GISTs from leiomyomas and leiomyosarcomas. In the future, ras inhibitors may potentially be a therapeutic to treat GISTs.