Internal medicine
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Case Reports
Spontaneous dissection of the superior mesenteric artery in four cases treated with anticoagulation therapy.
Reports of spontaneous dissection of the superior mesenteric artery are rare. Diagnosis in the acute stage has been considered difficult, but we encountered four cases from November 1998 to November 2001. ⋯ The mean period of continuous abdominal pain was 10.2 days, the mean period of fasting was 27.2 days, and the mean number of in-hospital days was 44.5. There is no established opinion on treatment, but conservative treatment is considered possible if there are no symptoms or if it has not been aggravated.
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A 19-year-old man with severe active ulcerative colitis was admitted to our hospital where he was prescribed 80 mg prednisolone and underwent leukocytapheresis (LCAP). Two weeks after initiating therapy, his symptoms had not recovered. We administered cyclosporin via continuous intravenous infusion for 12 days. ⋯ Immediate plain computed tomography (CT) and magnetic resonance imaging angiography (MRA) revealed extensive thrombosis in the superior sagittal sinus and right transverse sinus. We treated this condition with the anticoagulant agent, heparin, which prevents and can treat venous thrombosis. We report an occurrence of cerebral sinus thrombosis accompanying ulcerative colitis, where active anticoagulant therapy was useful.
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We describe a patient wih subacute cor pulmonale caused by tumor emboli in the lungs. A 64-year-old female suffering from a subacute progressive cough and shortness of breathing died of severe pulmonary hypertension seven days after admission. ⋯ Microscopic examination after an autopsy revealed diffuse intravascular tumor emboli occluding not only the small pulmonary arteries and arterioles, but also the lymphatic vessels, which were suggested to be metastases of a breast carcinoma resected five years previously. Thus, pulmonary tumor embolism should be considered in the differential diagnosis of primary pulmonary hypertension, particularly in patients with a past history of cancers.
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A 19-year-old man visited our hospital complaining of cough, sputum and low-grade fever. Chest radiograph and computed tomography findings suggested that he was suffering from pulmonary Langerhans' cell histiocytosis (PLCH). Bronchoscopy revealed a whitish elevated lesion at the bifurcation of the right upper lobe bronchus, and a specimen of this lesion showed the same pathological findings as pulmonary parenchymal lesions. Although there have been only a few reports of endobronchial LCH without pulmonary parenchymal lesions, this is, to our knowledge, the first case of PLCH with an endobronchial lesion, which was confirmed by bronchoscopy, and disappeared several months later.