Renal angiomyolipoma with inferior vena cava and right atrial embolism: A case report and literature review / 中南大学学报(医学版)

Renal angiomyolipoma (AML) with renal vein, inferior vena cava (IVC), and right atrial embolism is a rare solid tumor, whose etiology and pathogenesis are still unclear. Moreover, it is often misdiagnosed. One patient with renal AML complicated with renal vein, IVC, and right atrial embolism was admitted to the Second Xiangya Hospital of Central South University, who was a 35-year-old female, without any previous medical history, presented with right low back pain for more than 3 years. Computed tomography (CT) scan showed irregular lobulated fatty density mass in the right kidney, renal vein, IVC, and right atrium. The contrast-enhanced scan showed no enhancement of fat components at each phase and mild enhancement of solid components. Radical resection of the right kidney and removal of tumor thrombus were performed, and there was no recurrence 1 year after the operation. It is rare for renal AML to grow along the renal vein, IVC, and extend to the right atrium. Imaging examination is extremely important, and the CT findings of this case are characteristic, but the diagnosis eventually depends on pathological and immunohistochemical examinations.

Deterioro del sensorio de un paciente con endocarditis infecciosa en sala de internados / Impairment of the sensorium in a patient with infective endocarditis in an inpatient ward

El caso expuesto a continuación demuestra que, a pesar del diagnóstico precoz de la endocarditis infecciosa, el buen pronóstico del paciente se da cuando el tratamiento es oportuno. Por lo tanto, es de suma importancia tener presente cuales son las posibles complicaciones para tratarlas a tiempo. Paciente de sexo masculino, de 72 años de edad, consultó por fiebre de ocho días de evolución. Al examen físico se constató soplo diastólico en foco aórtico. Retornaron hemocultivos positivos para streptococcus gallolyticus, se inició tratamiento con antibióticos según antibiograma; en la segunda semana de tratamiento presentó deterioro del sensorio, primero estuvo confuso y luego somnoliento. Se realizó una tomografía de cráneo simple en primera instancia y luego resonancia magnética encefálica donde se observaron lesiones compatibles con posibles complicaciones de la endocarditis infecciosa como el émbolo séptico. Se continuó con el mismo esquema de antibióticos por seis semanas con mejoría del sensorio. El germen aislado en el caso clínico se relaciona en un porcentaje no infrecuente en pacientes con patologías gastrointestinales, el dato positivo que se obtuvo dentro de sus hábitos fisiológicos era la constipación crónica como dato importante ya que se relaciona frecuentemente con pólipos intestinales o neoplasias que se descartaba con estudios complementarios. Además, que los patógenos frecuentemente implicados en complicaciones neurológicas fueron por S. aureus y Streptococcus gallolyticus, coincidiendo el último con el germen aislado en este caso clínico, además que presentaba dos de las muchas complicaciones como ictus isquémico y émbolos sépticos en un mismo paciente

The case presented below goes beyond the early diagnosis of infective endocarditis and the association of the patient's prognosis with timely treatment; It is also important to keep in mind about possible complications despite adequate clinical management. A male patient consulted for a fever of eight days of evolution, the positive finding on physical examination was the auscultation of a diastolic murmur in the aortic focus. Positive blood cultures returned for streptococcus gallolyticus, antibiotic treatment had been started according to the antibiogram, and in the second week of treatment there was deterioration of the sensorium. A simple skull tomography had been performed in the first instance and then brain magnetic resonance imaging showing lesions compatible with possible complications of infective endocarditis. The same antibiotic scheme was continued for six weeks with improvement of the sensorium. The isolated germ in the clinical case is related in a not infrequent percentage in patients with gastrointestinal pathologies, the positive data that was obtained within their physiological habits was chronic constipation as important data since it is frequently related to intestinal polyps or neoplasms that are ruled out with complementary studies. In addition, the pathogens frequently involved in neurological complications were S. aureus and Streptococcus gallolyticus, the latter coinciding with the isolated germ in this clinical case, in addition to presenting two of the many complications such as ischemic stroke and septic embolism in the same patient

Profilaxis farmacológica para la prevención de la enfermedad tromboembólica en paciente con enfermedad cerebrovascular / Pharmacological prophylaxis for the prevention of thromboembolic disease in patients with cerebrovascular disease

INTRODUCCIÓN: La enfermedad cerebrovascular es un conjunto de alteraciones atribuidas a lesiones agudas y focales en el sistema nervioso central, en su mayoría secundaria a aterosclerosis DESARROLLO: En la prevención de la enfermedad cerebrovascular, existen dos grandes grupos farmacológicos, los antitromboticos y los anti plaquetarios, los cuales impactan en la calidad de vida de estos pacientes mejorando el pronóstico de los mismos. CONCLUSIONES: La enfermedad cerebrovascular comparte factores de riesgo de enfermedad tromboembólica, por lo que se recomienda iniciar profilaxis.

INTRODUCTION: Cerebrovascular disease is a group of alterations attributed to acute and focal lesions in the central nervous system, mostly secondary to atherosclerosis. DEVELOPMENT: In the prevention of cerebrovascular disease, there are two major pharmacological groups, antithrombotics and antiplatelet drugs. , which impact the quality of life of these patients, improving their prognosis. CONCLUSIONS: Cerebrovascular disease shares risk factors for thromboembolic disease, so it is recommended to start prophylaxis.

Limb ischemia in patients with COVID-19 / Isquemia de membros em pacientes com COVID-19

Abstract This narrative review covers the life-threatening thromboembolic events associated with SARS-CoV-2 infection/COVID-19. It addresses the physical changes that cause vascular and arterial damage to limbs, laboratory management of coagulation, and management of anticoagulation. COVID-19's relationship with deep venous thrombosis and arterial thrombosis is also emphasized. The main thromboembolic events described in the literature are illustrated with examples from our experience with COVID-19 patients.

Resumo Esta revisão narrativa abrange os eventos tromboembólicos com risco de vida associados a infecção por SARS-CoV-2/COVID-19. Aborda as mudanças físicas que causam danos vasculares e arteriais aos membros, o manejo laboratorial da coagulação e o manejo da anticoagulação. A relação de COVID-19 com trombose venosa profunda e trombose arterial também é enfatizada. Os principais eventos tromboembólicos descritos na literatura são ilustrados a partir de nossa experiência com pacientes COVID-19.

Causes of death in growing-finishing pigs in two technified farms in southern Brazil / Causas de morte em suínos de crescimento e terminação em duas granjas tecnificadas no Sul do Brasil

The aim of this study was to investigate the main causes of death in growing-finishing pigs in southern Brazil. During a one-year period (from 2018 to 2019), two industrial pig herds (18 and 20 thousand pigs each farm) in southern Brazil were monitored along the four seasons of the year (12 days per season on each farm), in order to perform necropsies of all pigs that died in that period. The two farms had an average monthly mortality rate ranging from 0.94 to 3.93% in the evaluated months. At necropsy, tissues were collected, fixed in 10% formalin solution and processed routinely for histopathological examination. When necessary, samples were sent for bacterial culture and PCR to identify etiologic agents. A total of 601 necropsies were performed, with 94.9% of conclusive diagnoses. Infectious diseases corresponded to 64.4% of conclusive diagnosis and non-infectious diseases to 35.6%. The most prevalent causes of death were: pneumonia (33%), gastric ulcers (15.4%), circovirosis (9.9%), systemic bacterial embolism (5.4%), polyserositis (4.4%), dilated cardiomyopathy and torsion of abdominal organs (4.3% each), and bacterial pericarditis (3.4%). Regarding pneumonias (199/601), the main agents identified in these cases were Pasteurella multocida, Influenza A virus and Mycoplasma hyopneumoniae, mainly in associations.(AU)

O objetivo do presente trabalho foi investigar as principais causas de morte de suínos em fase de crescimento e terminação no Sul do Brasil. Durante o período de um ano (entre 2018 e 2019), duas granjas tecnificadas de suínos no Sul do Brasil foram acompanhadas nas quatro estações (12 dias por estação em cada granja), para realização de necropsias dos suínos que morreram nesse período. As duas propriedades apresentavam mortalidade mensal média entre 0,94 e 3,93% nos meses avaliados. Na necropsia, amostras de órgãos foram colhidas, fixadas em formol 10% e processadas rotineiramente para o exame histopatológico. Quando necessário, amostras foram enviadas para o cultivo bacteriano e PCR para identificação de agentes etiológicos. Foram realizadas um total de 601 necropsias, com 94,9% de diagnósticos conclusivos. As doenças infecciosas corresponderam a 64,4% dos diagnósticos conclusivos e as não infecciosas a 35,6%. As principais causas de morte foram: pneumonias (33%), úlcera gástrica (15,4%), circovirose (9,9%), embolia bacteriana sistêmica (5,4%), polisserosite (4,4%), cardiomiopatia dilatada e torção de órgãos abdominais (4,3% cada) e pericardite bacteriana (3,4%). Com relação às pneumonias (199/601), os principais agentes associadas as lesões foram Pasteurella multocida, vírus da Influenza A e Mycoplasma hyopneumoniae, principalmente associados entre si.(AU)

Fenómenos embólicos y ecocardiografía transtorácica (ETT) durante cirugía de artroplastía de cadera (AC) / Embolic phenomena in hip Arthroplasty with intraoperative transthoracic echocardiography (TTE)

Embolic event's exist during hip arthroplasty surgery and specially those who had been caused by hip fracture. Complications depends mainly on the preoperative clinical conditions, and may even be subclinical if the patient was previously healthy. Thus, thanks to the technology progress, especially transesophageal echocardiography (TEE), it has been possible to identify these embolic phenomena at an early stage, allowing to be anticipated and treated an eventual cardiorespiratory compromise. A report was made of 2 patients with hip fracture, who underwent hip arthroplasty surgery (HA), in which through transthoracic echocardiography (TTE), it was possible to visualize embolic events, mainly during the acetabular reaming and the press-fit impact of the Cup. One patient presented hemodynamic impact that was early treated. This emphasizes how critical that period of the surgery is, and that when the anesthesiologist must be especially vigilant. There could be different causes: the energy made by the surgeons to make the acetabular reaming or to insert the cup; or even the destruction of the surrounding tissue during the fracture moment. So, in that way blood thrombus, air, fat or bone can get into the blood vessels and produce eventual complications. Therefore, special attention is required to the hemodynamic changes that may occur in these stages of surgery. Particularly, in these cases, in whom the patient's receive regional anesthesia and were positioned on lateral decubitus, it has to monitored by TTE and not by TEE, which gave more limitations at the moment to get the different echocardiograph Windows, thus it was chosen to use the subxiphoid window to see the inferior vena cava. In both cases, it was visualized embolic's events. But as it's said before, only one presented hemodynamic compromised. Also stands out, the relevance that there is more access to TTE in most of the operating centers of the country, unlike the TEE, which the transducer use for it, is more difficult for the anesthesiologist to get access to it and also requires more training.

Durante las cirugías de prótesis de cadera y especialmente aquellas por fractura de cadera pueden presentar eventos embólicos. Las complicaciones dependen principalmente de la condición clínica preoperatoria, pudiendo incluso ser subclínico si el paciente es sano. Así, gracias al progreso de la tecnología, particularmente la ecocardiografía transesofágica (ETE) y transtoraxica (ETT), se ha logrado identificar precozmente dichos fenómenos embólicos, permitiendo anticipar y tratar oportunamente una eventual descompensación cardiorrespiratoria. Se realizó un reporte de 2 pacientes con fractura de cadera, que se sometieron a una cirugía de artroplastía de cadera (AC), en los cuales mediante la vigilancia de ETT, se logró visualizar estos eventos, principalmente durante la fenestración e impactación del cotilo en el acetábulo, presentando uno de estos pacientes un impacto hemodinámico que se trató precozmente. Las causas de las embolías pueden ser variadas, como la presión ejercida por el cirujano para fenestrar e introducir la prótesis o la destrucción del tejido circundante a la lesión durante el momento de la fractura, entre otros. Así, se pueden producir embolias de trombos, grasa, hueso o incluso aire que pueda entrar al torrente sanguíneo y producir eventualmente complicaciones. Con estos hallazgos, ecográficos y en algunas oportunidades clínicos, se podría demostrar lo crítico que es aquel período de la cirugía, en donde se requiere especial atención a los cambios hemodinámicos que se puedan producir, y en el que el anestesiólogo debe estar especialmente vigilante. Particularmente, en estos casos, en que las pacientes recibieron anestesia regional y se intervino en posición de decúbito lateral, se tuvo que realizar monitoreo mediante ETT y no ETE, lo cual entrego más limitantes a la hora de conseguir buena calidad de ventanas cardiacas y por lo tanto, después de visualizar las distintas ventanas se optó por utilizar la ventana subxifoidea para visualizar la vena Cava inferior y así observar los distintos eventos embólicos circulantes. En ambas pacientes se pudieron apreciar eventos embólicos, pero en sólo una paciente tuvo compromiso cardiorrespiratorio con hipotensión, aumento de la frecuencia cardiaca y desaturación. Junto con la demostración de la posibilidad de visualización de embolías con ETT, se destaca la relevancia de que existe mayor acceso a este tipo de ecografía en gran parte de los pabellones de nuestro país, a diferencia de la ETE, en la que la sonda utilizada es de más difícil acceso por parte de los anestesistas y requiere un mayor entrenamiento.

Primitive Trigeminal Artery: A Route for Emboli and Collateral

@#INTRODUCTION: Persistent carotid-basilar anastomoses are potentially clinically relevant anomalies of the intracranial vasculature. The trigeminal artery is the largest and persists for the longest embryonic period among the anastomoses. The increasing use of arteriographic procedures has augmented its incidence to 0.1-1%. This is a case of a 39-yearold male who presented with acute occipital lobe infarct after sustaining a traumatic right carotid dissection. CASE PRESENTATION: A 39-year-old male was brought in to the emergency room after a 200-kilogram sack fell on his upper back. He landed on his chest with his head rotated to the right and sustained multiple lacerations on his face and chest. There were noted acute bilateral loss of vision, lethargy and unsteady gait. Computed tomography (CT) scan of the brain showed neither infarct nor hemorrhage. However, magnetic resonance imaging (MRI) of the brain revealed an acute occipital lobe infarct. The patient was started on antiplatelet. Further workup revealed a totally occluded right common carotid artery upon carotid duplex. His vision improved to be able to perceive light and hand movement. Further workup was done as an outpatient. A week after hospital discharge, patient’s vision improved to left bilateral hemianopsia. His gait has improved and was able to walk with balance. A cerebral angiogram later revealed a large bilateral persistent primitive trigeminal artery (PPTA). The right PPTA provided collateral flow to the right cerebral hemisphere. This primitive collateral vessel is believed to have served as a route for emboli to be thrown to the posterior circulation in the occipital lobe. CONSLUSION: The consideration of a persistent primitive carotid-basilar anastomoses may elucidate the physician when a gap between patient’s manifestation and imaging studies exist. The presence of persistent carotid-basilar anastomoses may herald other vascular anomalies, it may offer as alternative endovascular access, or may serve as access for emboli passage.

Multiple Extracarciac Complications of Infective Endocarditis: Report of One Case / 中国医学科学院学报

Infective endocarditis is a microbial infection of the endocardium and can easily affect heart valve.Its characteristic lesion is vegetation formation,and the shedding of vegetation results in arterial embolism and ischemic necrosis of corresponding tissues and organs.A case of infective endocarditis with multiple extracardiac complications was described in this article.The characteristic ultrasound finding was the vegetation formation in anterior mitral valve.CT and MRI scans revealed involvements in multiple organs and blood vessels,which were manifested as splenic infarction,renal infarction,cerebral infarction,splenic aneurysm,superior mesenteric artery aneurysms,renal artery aneurysms,and distal segment stenosis and occlusion of right middle cerebral artery.

Malformación arteriovenosa cerebelosa. Caso clínico / Cerebellar arteriovenous malformation. Clinical case

Las malformaciones arteriovenosas representan un grupo extenso y heterogéneo de lesiones. Dichas anomalías se caracterizan por ser congénitas y por representar un verdadero desafío diagnóstico y terapéutico. El presente caso trata de una paciente femenina de 7 años, sin antecedentes de importancia que presentó un cuadro evolutivo de 2 meses, caracterizado por cefalea a nivel fronto-parietal derecha y debilidad de miembro superior izquierdo. Mediante exámenes complementarios de imagen se identifica una malformación arteriovenosa-cerebelosa que compromete diencéfalo y tálamo derecho. Durante su estadía hospitalaria es sometida a embolización, lo que mejoró notablemente el cuadro patológico establecido.

Arteriovenous malformations represent a large and heterogeneous group of lesions. These anomalies are characterized by being congenital and representing a true diagnostic and therapeutic challenge. The present case deals with a 7-year-old female patient without health history of importance. She presented a 2-month evolutionary picture, specified by right frontal-parietal headache and left upper limb weakness. Complementary imaging tests identify an arteriovenous-cerebellar malformation that compromises the diencephalon and right thalamus. An embolization was applied during hospitalization, which markedly improved the established pathological picture

Mielitis isquémica como presentación de aorta shaggy en paciente con síndrome aórtico agudo concomitante / Ischaemic myelitis as a presentation of a shaggy aorta in a patient with concomitant acute aortic syndrome

Resumen La aorta shaggy se define como una degeneración ateromatosa agresiva y extensa de la aorta, cuya friabilidad predispone a ulceración y complicaciones embólicas, cursa con alto riesgo de embolia sistémica y no se conocen prevalencia ni incidencia en poblaciones de riesgo. La mayoría de casos publicados hacen referencia a complicaciones en procedimientos quirúrgicos. En la literatura no se hallaron reportes que asocien ateroembolia aórtica con obstrucción de la arteria de Adamkiewicz, cuyo diagnóstico no siempre es posible visualizando su oclusión por angiotomografía o por angiorresonancia, pues el defecto puede ser evanescente o puede existir compromiso distal con obstrucción microvascular, difícilmente aparente con arteriografía selectiva. Se presenta un caso de mielopatía isquémica embólica asociada a aorta shaggy con probable oclusión de la arteria de Adamkiewicz como responsable del deterioro neurológico agudo de la paciente, confirmado por resonancia magnética nuclear. Para caracterizar mejor esta enfermedad y para tener las estrategias diagnósticas y terapéuticas apropiadas en su abordaje oportuno, consideramos importante el reporte de casos similares aumentando así su sospecha diagnóstica.

Abstract A shaggy aorta is defined as an aggressive and extensive atheromatous degeneration of the aorta. Its friability predisposes to ulceration and embolic complications. It carries a high risk of systemic embolisms, and its prevalence and incidence in risk populations is unknown. The majority of published cases mention complications in surgical procedures. No reports have been found in the literature that associate aortic atheroembolism with obstruction of the artery of Adamkiewicz. Its diagnosis is not always possible by visualising its occlusion by computed tomography angiography or by magnetic resonance angiography, since the defects may be evanescent, or there may be a distal compromise with a microvascular obstruction, hardly apparent with selected angiography. A case is presented of embolic ischaemic myelitis associated with a shaggy aorta, with probable occlusion of the artery of Adamkiewicz being responsible form the acute neurological deterioration of the patient, confirmed by a nuclear magnetic resonance scan. In order to better describe the features of this disease and to have the appropriate diagnostic and therapeutic strategies for its timely approach, it is considered important to report all similar cases, thus increasing its diagnostic suspicion.

Caso Clínico: Rotura y Embolización de Catéter Femoral / Case Report: Rupture and Embolization of a Femoral Catheter

INTRODUCCIÓN:La embolización de cuerpos extraños intravasculares es una complicación poco frecuente; sin embargo, está asociada a alteraciones cardíacas y pulmonares en más del 50% de los casos. Actualmente se prefiere realizar el manejo utilizando técnicas de extracción por cateterismo cardíaco, esto debido a la naturaleza menos invasiva del procedimiento y a las menores tasas de mortalidad y complicaciones asociadas. A continuación se presenta un reporte de caso donde se realizó la extracción un catéter intracardiaco mediante vía percutánea. CASO CLÍNICO: Lactante de sexo masculino, de 51 días de vida, con antecedentes de prematuridad extrema y peso adecuado para edad gestacional, ingresado en el servicio de neonatología; a quien como acceso vascular central se le colocó un catéter percutáneo femoral. Tras el retiro del mismo se apreció rotura y embolización de los dos tercios distales; la evaluación radiológica evidenció catéter a nivel de cavidades cardíacas derechas. EVOLUCIÓN: Se inició antibioticoterapia por el riesgo de infección asociado. De forma exitosa se realizó la extracción del cuerpo extraño por intervencionismo percutáneo; el paciente evolucionó favorablemente, no presentó ninguna complicación. CONCLUSIÓN: La rotura y embolización del catéter es un evento poco frecuente que incrementa la morbimortalidad de los pacientes ingresados en neonatología. La extracción percutánea debe ser la primera opción por la eficacia y seguridad del procedimiento.(au)

BACKGROUND: The embolization of foreign intravascular bodies is a rare complication; however, it is associated with cardiac and pulmonary dysfunction in more than 50% of cases. Currently, it is preferred to perform the management using extraction techniques by cardiac catheterization; this is explained by the less invasive nature of the procedure and the lower mortality and complications rates. The following is a case report where an intracardiac catheter was extracted by a percutaneous procedure. CASE REPORT: Male, 52-day-old infant, with history of extreme prematurity and adequate weight for gestational age; hospitalized in the neonatology service; as central vascular access a percutaneous femoral catheter was placed. After removal, rupture and embolization of the distal two thirds were observed; the radiological evaluation showed a catheter at the level of right heart cavities. EVOLUTION: By the associated infection risk, antibiotic therapy was initiated. The foreign body was extracted successfully by percutaneous intervention; the patient presented a favorable evolution without any complications. CONCLUSIONS: The catheter rupture and embolization is a rare event that increases morbidity and mortality rates of patients admitted to neonatology. Percutaneous extraction should be the first option by the procedure efficacy and safety.(au)

Masas cardiacas: registro de la experiencia en un centro de alta complejidad / Cardiac masses: report of experience in a high complexity centre

Resumen Introducción: Las masas cardiacas son una entidad heterogénea, que incluye lesiones neoplásicas y no neoplásicas y se clasifican en primarias y secundarias o metastásicas. Métodos: Estudio observacional analítico de tipo cohorte retrospectivo. Resultados: Se incluyeron un total de 73 individuos de los cuales se analizaron los datos de 66. Las masas cardiacas se diagnosticaron con mayor frecuencia en mujeres (53%). El síntoma más frecuente fue disnea (35%), seguido por dolor torácico (28%); otras manifestaciones comunes fueron fiebre (22%), pérdida de peso (22%) y focalización neurológica (22%). 44 pacientes fueron llevados a intervención quirúrgica o toma de biopsia de lesiones primarias encontrando como principal diagnóstico mixoma en 18 de ellos (27%); el resto de neoplasias primarias cardiacas fueron raras, fibroelastoma 2 casos (3%), al igual que rabdomioma y rabdomiosarcoma con solo un caso; el compromiso secundario fue frecuente con 18 casos (27%) representados principalmente por linfomas con 5 casos (8%), tumores primarios renales con 4 casos (6%) y cáncer de pulmón con 3 casos (5%). Dentro del seguimiento, el 77% estaban vivos en los siguientes seis meses del diagnóstico; la principal causa de muerte fue la progresión de la enfermedad oncológica (8 pacientes), seguida por ataque cerebrovascular (3 pacientes) y choque postoperatorio (2 pacientes). Conclusiones: Los pacientes con masas cardíacas con frecuencia tienen síntomas inespecíficos incluidos en tres ejes principales: insuficiencia cardíaca, síntomas generales y embolia sistémica. La frecuencia de mixoma auricular y las neoplasias secundarias fue similar.

Abstract Introduction: Cardiac masses are a heterogeneous condition, and include neoplastic and non-neoplastic lesions that can be classified as primary, secondary, or metastatic. Methods: An analytical observational study of a retrospective cohort. Results: A total of 74 subjects were included, of which the data of 66 of them were analysed. Cardiac masses were diagnosed more often in women (53%). The most frequent symptom was dyspnoea (35%), followed by chest pain (28%). Other common signs were fever (22%), weight loss (22%), and a neurological focus (22%). A total of 44 patients had surgery or a biopsy taken of the primary lesions found. The primary diagnosis was a myxoma in 18 (27%). The rest of the primary cardiac tumours were rare, with a fibroelastoma in 2 cases (3%), rhabdomyoma 2 cases (3%), and only one case of rhabdomyosarcoma. There was secondary involvement in 18 cases (27%), mainly as lymphomas in 5 cases (8%), primary renal tumours in 4 cases (6%), and lung cancer in 3 cases. During follow-up, 77% were alive in the six months following the diagnosis. The main cause of death was progression of the oncological disease (8 patients), followed a cerebrovascular attack (3 patients), and post-surgical shock (2 patients). Conclusions: Patients with cardiac masses of have non-specific symptoms included in three main groups: heart failure, general symptoms, and systemic embolisms. The frequency of atrial myxoma and secondary tumours was similar.

Inadvertent Subclavian Artery Catheterization: Juxta-Catheter Thrombosis with Subsequent Stroke

No abstract available.

Multiple Cerebral Infarction after Injection of N-Butyl-2-Cyanoacrylate for Gastric Variceal Bleeding

Endoscopic obliteration with N-butyl-2-cyanoacrylate is the first-line treatment for gastric variceal bleeding. Although N-butyl-2-cyanoacrylate has higher success rate, there is some fatal complications such as systemic embolization. We report a case of 54-year-old male who developed myocardial and multiple cerebral infarction after endoscopic obliteration of gastric variceal bleeding with N-butyl-2-cyanoacrylate.