ABSTRACT
Arsha's is one among the Astamahagada, and a commonest ano-rectal disease with a wide range of symptoms. It affects all economic groups of the population. In Ayurveda, Arsha's is a growth of Mamsa with obstructs the anal opening. Anatomically anal canal is 51/2 Angula's length. A faulty lifestyle and dietary habits along with occupational and physical stress triggers the pathology of Arsha's. Doshic involvement includes Rakta along with Mamsa dhatu at Rakthavaha Dahmanis of Guda, which forms as Mamsa Ankura. Acharya Susrutha mentioned 4 curative measures for the treatment, they are Bhesaja, Kshara karma, Agni karma, Shastra karma. Hemorrhoids are dilated rectal veins. Thrombosed piles occur where there is high venous pressure, which is associated with severe pain, which hampers their daily routine, thereby they avoid defecation which leads to hardening of stool, constipation and rectal bleeding. The treatment includes the surgical excision of the thrombosed pile mass. A case study of thrombosed pile treated with Jaloukavacharana (leech therapy) has been recorded which has reduced the mass, pain, bleeding per rectum
ABSTRACT
Introducción: Los aneurismas de la arteria comunicante anterior (AComA) se presentan frecuentemente como causa de hemorragia subaracnoidea espontánea (HSAE), en casos raros se asocian a síntomas visuales por compresión mecánica o ruptura y su tratamiento quirúrgico a menudo representa un desafío. Descripción del caso: Se presenta el caso clínico de una paciente adulta con disminución de la agudeza visual del ojo derecho a predominio temporal, y hallazgos en RMN cerebral y angiografía compatibles con un aneurisma grande de AcomA, asociado a trombosis parcial; se realizó clipaje y trombectomía del aneurisma, la panangiografia de control evidenció exclusión completa de la lesión con posterior resolución del déficit visual. Discusión: El déficit visual por un aneurisma de la AcoA se puede generar por varios mecanismos, uno de ellos es la ruptura del aneurisma hacia el nervio óptico, con la subsecuente formación de un hematoma, adherencias y fibrosis; el otro mecanismo es la compresión mecánica de un aneurisma gigante no roto. El manejo quirúrgico a menudo implica técnicas complejas microquirúrgicas para intentar resolver el efecto de masa y excluir el aneurisma. La terapia endovascular es otra alternativa de tratamiento, pero tiene desventajas respecto a la cirugía. Conclusión: Los aneurismas de la AComA en raros casos se pueden asociar a síntomas visuales, debido a que por lo general se romepen cuando son pequeños, y no alcanzan a tener el tamaño suficiente para generar compresión de la vía óptica. Las técnicas microquirúrgicas ofrecen un método efectivo para disminuir el efecto de masa y mejorar los síntomas visuales
Introduction: Aneurysms of the anterior communicating artery (AComA) frequently present as a cause of spontaneous subarachnoid hemorrhage (HSAE), in rare cases they are associated with visual symptoms due to mechanical compression or rupture and their surgical treatment often represents a challenge. Description of the case: We present the clinical case of an adult patient with a decrease in visual acuity due to the right eye with a temporal predominance and findings on brain MRI and angiography compatible with a large AcomA aneurysm associated with partial thrombosis; clipping and thrombectomy of the aneurysm were performed, the control panangiography showed complete exclusion of the lesion. With subsequent resolution of the visual deficit. Discussion: The visual deficit due to an AcoA aneurysm can be generated by several mechanisms, one of them is the rupture of the aneurysm towards the optic nerve, with the subsequent formation of a hematoma, adhesions and fibrosis; The other mechanism is mechanical compression of a giant, unruptured aneurysm. Surgical management often involves complex microsurgical techniques to try to resolve the mass effect and exclude the aneurysm. Endovascular therapy is another treatment alternative, but it has disadvantages compared to surgery. Conclusion: AComA aneurysms in rare cases can be associated with visual symptoms, because they generally rupture when they are small, and are not large enough to generate compression of the optic pathway. Microsurgical techniques offer an effective method to alleviate the mass effect and improve visual symptoms
Subject(s)
Female , Aneurysm , Optic Nerve , Visual Acuity , Thrombectomy , EyeABSTRACT
Among all the diseases of gastrointestinal disordershaemorrhoidis the commonest and troublesome disease. Haemorrhoids are dilated veins within the anal canal. The condition becomes worse after thrombosis and strangulation of the pile mass. Urgent surgical intervention is required in all the cases. Patient strucks in serious woe and seeks urgent surgical attention. Leeches can be used as a successful tool in this situation for the purpose of bloodletting as accumulation of morbid humor is the main cause of haemorrhoid in Unani system of medicine. In present case study,a patient of thrombosed pile mass was cured by Irsale Alaq(leech therapy)
ABSTRACT
Carpal tunnel syndrome can be produced by abnormal mass effect due to trauma, ganglion cysts, various soft tissue tumors, musculotendinous variants, and aberrant vascular structures. Persistent median artery is one of the causes of the carpal tunnel syndrome. Thrombosed persistent median artery usually accompanies the anomaly of the median nerve and causes a sudden onset of severe pain and paresthesia. In contrast to previous literature, we report the rare case of gradual onset and mild symptom of a 53-year-old man with a thrombosed persistent median artery but without anomaly of the median nerve and abnormal finding of electrophysiologic study.
Subject(s)
Humans , Middle Aged , Arteries , Carpal Tunnel Syndrome , Dilatation , Ganglion Cysts , Median Nerve , Paresthesia , UltrasonographyABSTRACT
A 76-year-old man who suffered from consistent back pain was admitted for anti-hypertensive therapy to strictly manage the early thrombosed acute type A aortic dissection (AAAD). On admission, his blood pressure could not be controlled well ; soon he complained of recurrent severe back pain. The second thoracoabdominal enhanced computed tomography revealed the progression of AAAD from DeBakey type II to type I with thrombosed pseudolumen at the descending thoracic aorta ; therefore, emergent surgical intervention by primary central repair was conducted. Paraplegia was diagnosed eight hours after surgery, then cerebrospinal fluid drainage and intravenous administration of Naloxone were started immediately followed by keeping the systemic blood pressure more than 120 mmHg. However, paraplegia had never improved and been persistent with neurological deficit of the lower extremities. We herein report a complicated surgical case of an AAAD patient with paraplegia and review the complex clinical settings.
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Introducción: La trombosis constituye la principal causa de disfunción y pérdida de las fístulas arterio-venosas para hemodiálisis. Objetivo: actualizar los aspectos relacionados con los principales tratamientos de las fístulas arterio-venosas trombosadas. Fuente de los datos: Se realizó la búsqueda de artículos sobre el tema en la base de dato Medline, artículos publicados en páginas web y revistas líderes en la publicación de estudios sobre fístulas arterio-venosas para hemodiálisis. Síntesis de los datos: La trombosis es la complicación más frecuente de las fístulas arterio-venosas, su principal causa lo constituyen los errores técnicos en la trombosis precoz y las estenosis en las tardías. Conclusiones: La repermeabilización precoz de las fístulas arterio-venosas y tratar las estenosis en el mismo acto quirúrgico, es lo que se recomienda. Para tales fines se cuenta con las técnicas quirúrgicas identificadas como el gold standard y las endovasculares, con resultados alentadores(AU)
Introduction: Thrombosis is the most frequent cause of dysfunction and loss of hemodyalisis arteriovenous fistula. Objective: To update knowledge on the epidemiology, the characteristics and the main treatments of the thrombosed hemodyalisis arteriovenous fistulae. Data source: A literature research about the topic was made in Medline, in articles published in different web pages and in leading journals in the publication of studies about hemodialysis arteriovenous fistula. Data synthesis: Thrombosis is the most frequent complication of the arteriovenous fistula, being the technical errors the main cause of premature thrombosis and the stenosis in the late thrombosis. Conclusions: It is recommended to use early repermeabilization of the arteriovenuos fistulae and to treat stenosis in the same surgical act; for that purpose the surgical treatment identified as the "standard gold" and the endovascular technique achieve encouraging results(AU)
Subject(s)
Humans , Arteriovenous Fistula/surgery , Arteriovenous Fistula/complications , Arteriovenous Fistula/diagnosis , Renal Dialysis/methodsABSTRACT
The number of surgical treatments for acute aortic dissection in octogenarians is increasing. They should return to their daily life as soon as possible after the operation without any complications. Some literature reported that minimally invasive cardiac surgery (MICS) helps quick recovery for the patients. We report a case of minimally invasive ascending aorta replacement for Stanford type A chronic thrombosed aortic dissection in an octogenarian to help quick recovery. An 81-year-old man was admitted in our hospital suffering from chest and back pain. Enhanced CT scan showed Stanford type A acute thrombosed aortic dissection. The diameter of ascending aorta was 45 mm and the diameter of false lumen was 7 mm. Therefore we decided on medical treatment for this patient according to the guideline. After four weeks medical treatment, ascending aorta was dilated to 49 mm and the false lumen also expanded to 9 mm. He underwent minimally invasive ascending aorta replacement to help quick recovery considering his age. He was discharged 11 days postoperatively without any complications. MICS offers a better cosmetic result, less blood loss, less pain, better respiratory function and quick recovery. Thus, minimally invasive operation for the elderly is also very satisfactory.
ABSTRACT
Distal thrombosed aneurysm of the superior cerebellar artery (SCA) is extremely rare and is often associated with cerebellar infarction or subarachnoid hemorrhage. We report herein on a case involving a patient with a ruptured thrombosed distal SCA aneurysm which was treated successfully through the endovascular approach.
Subject(s)
Humans , Aneurysm , Arteries , Infarction , Subarachnoid HemorrhageABSTRACT
Despite the remarkable developments in neurosurgical and neuro-interventional procedures, the optimal treatment for large or giant partially thrombosed aneurysms with a mass effect remains controversial. The authors report a case of a partially thrombosed aneurysm with a mass effect, which was successfully treated by stent-assisted coil embolization. A 41-year-old man presented with headache. Brain computed tomography depicted an 18x18 mm sized thrombosed aneurysm in the interpeducular cistern. More than 80% of the aneurysm volume was filled with thrombus and the canalized portion beyond its neck measured 6.8x5.6 mm by diagnostic cerebral angiography. Stent-assisted endovascular coiling was performed on the canalized sac and the aneurysm was completely obliterated. Furthermore, most of the thrombosed aneurysm disappeared in the interpeduncular cistern was clearly visualized follow-up brain magnetic resonance imaging conducted at 21 months. The authors report a case of selective coiling of a large, partially thrombosed basilar tip aneurysm.
Subject(s)
Adult , Humans , Aneurysm , Brain , Cerebral Angiography , Follow-Up Studies , Headache , Magnetic Resonance Imaging , Neck , ThrombosisABSTRACT
Type B intramural hematoma (IMH) is not considered to be a life-threatening condition, and medical treatment is the first treatment choice. We report 2 cases of ruptured type B intramural hematoma. Total arch replacement was performed via median sternotomy, which is not a common surgical strategy for type B dissection. Case 1 : a 77-year-old woman was transferred to our hospital with chest and back pain. CT revealed type B IMH with a large hematoma in the anterior mediastinum. She underwent total arch replacement, but she died of respiratory failure on the 167th postoperative day. Case 2 : a 60-year-old man was transferred to our hospital with chest and back pain. CT revealed a type B IMH with a large hematoma on the anterior side of the arch. He underwent total arch replacement, but died of sepsis on the 13th postoperative day. We had 2 rare cases of ruptured type B IMH. In both cases, postoperative courses were problematic. However, median sternotomy could be an approach for ruptured type B dissection in some cases.
ABSTRACT
A 64-year-old woman was referred to our hospital with a one-month history of progressive headache. Magnetic resonance imaging (MRI) showed a hemorrhagic mass adjacent to the left inferior cerebellar hemisphere associated with a peripheral rim of signal void. Angiography demonstrated an avascular mass and the provisional diagnosis was a large cavernous angioma in the cerebellum. Intraoperative findings revealed a thrombosed giant aneurysm of the left distal posterior inferior cerebellar artery (PICA). We report an unusual case of a completely thrombosed giant aneurysm simulating a large cavernous angioma in the cerebellum. The cerebellar cisternal location of the mass may be a clue for the pre-operative diagnosis of an aneurysm.
Subject(s)
Female , Humans , Middle Aged , Aneurysm , Angiography , Arteries , Caves , Cerebellum , Headache , Hemangioma, Cavernous , Magnetic Resonance Imaging , PicaABSTRACT
Capillary aneurysm is classically described as a suddenly growing dark papule, and is also known as thrombosed capillary or vein. It is clinically significant that the clinical features of capillary aneurysm are closely similar to those of malignant melanoma or dysplastic nevus. The histopathological finding of capillary aneurysm reveals dilated thin-walled venule(s) just beneath the hyperplastic epidermis, lined by a single layer of endothelium and a thrombus in the lumen. This abstract focuses on four patients who presented with a dark black-colored dome-shaped nodule and clinical impression included malignant melanoma, dysplastic nevus, angiokeratoma and lymphangioma circumscriptum. We herein report four cases histologically diagnosed as capillary aneurysm, which should be considered for differential diagnosis.
Subject(s)
Humans , Aneurysm , Angiokeratoma , Capillaries , Diagnosis, Differential , Dysplastic Nevus Syndrome , Endothelium , Epidermis , Lymphangioma , Melanoma , Thrombosis , VeinsABSTRACT
Fournier's gangrene is a life-threatening disorder characterized by necrotizing fasciitis of the perineal region. Because delay in diagnosis and treatment of this condition can be fatal, it is important not to overlook the symptoms. We present an unusual case of Fournier's gangrene after excision of a thrombosed hemorrhoid. A previously healthy 74-year-old female patient developed Fournier's gangrene after a hemorrhoidectomy. In spite of aggressive treatment, she eventually died. Here, we emphasize early recognition and prompt treatment of this condition, reporting an unexpected disastrous complication of a hemorrhoidectomy.
Subject(s)
Aged , Female , Humans , Diagnosis , Fasciitis, Necrotizing , Fournier Gangrene , Hemorrhoidectomy , HemorrhoidsABSTRACT
Giant intracranial aneurysm, approximately 5-7% of all intracranial aneurysm, is defined as aneurysm with a maximal sac diameter reaching or exceeding 25 mm. Its high incidence of thrombus formation causes difficulty in diagnosis through imaging studies. Recently, we have experienced a giant contralateral internal carotid artery aneurysm that was completely thrombosed and negative in imaging studies. It was only verified during surgery for clipping of an anterior communicating artery aneurysm. On initial cerebral angiography, authors had not found any other aneurysm except a small-sized anterior communicating artery aneurysm. There was no evidence of aneurysm or mass on right internal carotid artery even though in postoperative computed tomographic angiography (CTA). We emphasize the fact that another completely thrombosed aneurysm may be present as a hidden lesion during initially planned aneurysmal surgery.
Subject(s)
Aneurysm , Angiography , Carotid Artery, Internal , Cerebral Angiography , Diagnosis , Incidence , Intracranial Aneurysm , ThrombosisABSTRACT
Spontaneously thrombosed cerebral arteriovenous malformations (AVM) are infrequently reported. Its pathophysiology, and natural course, however, are still not clarified yet. Authors report a case of symptomatic, spontaneously thrombosed cerebral AVM in a 34-year-old male with a follow-up of 16-year duration, which was surgically extirpated due to repeated bleeding and intractable seizure disorder, and histopathologically confirmed. Relevant literatures are reviewed and discussed.
Subject(s)
Adult , Humans , Male , Epilepsy , Follow-Up Studies , Hemorrhage , Intracranial Arteriovenous Malformations , SeizuresABSTRACT
A 24-year-old female patient presented with a midline extra-axial posterior fossa lesion. We failed to suspect this lesion could be a giant thrombosed aneurysm of PICA(posteior inferior cerebellar artery) preoperatively, and didn't perform preoperative angiogram even after rather typical finding of thrombosed giant aneurysm on MRI. We suggest a giant thrombosed aneurysm should be included in the differantial diagnosis of any round extra-axial mass lesion in the skull base.
Subject(s)
Female , Humans , Young Adult , Aneurysm , Arteries , Diagnosis , Infratentorial Neoplasms , Magnetic Resonance Imaging , Pica , Skull BaseABSTRACT
Thrombosed capillary or vein is a dome-shaped or slightly lobulated moderately firm, blue black nodule arising either abruptly or gradually. There may be a rim of erythema or brownish pigmentation around it. Its clinical features are similar to a malignant melanoma. We report a case of thrombosed capillary or vein associated with angiokeratoma in 44-year old male patient who has a bean sized, dome-shaped, blue-black nodule and multiple hyperkeratotic pinhead sized dark red papules un scrotum.