Onychodystrophy as the Presenting Sign of Steal Syndrome

2021 ◽  
pp. 1-4
Author(s):  
Colleen M. Morken ◽  
Sarah Mortimer ◽  
Richard Denney ◽  
Molly A. Hinshaw
Keyword(s):  
Emergency Department ◽  
Physical Examination ◽  
Vascular Surgery ◽  
Arteriovenous Fistula ◽  
Clinical Features ◽  
Radial Pulse ◽  
Critical Importance ◽  
Nail Changes ◽  
History Of ◽  
Steal Syndrome

A man in his 70s presented to the dermatology nail clinic with a 1-month history of worsening onychodystrophy, leukonychia, and pain in his left fifth finger. Physical examination revealed a cool hand and absent radial pulse. Ischemia was suspected, and the patient was sent to the emergency department where the diagnosis of steal syndrome was made and his previously required arteriovenous fistula was ligated. This case highlights the clinical features of steal syndrome, that nail changes should be recognized as clinical features, and that urgent triage of these patients to vascular surgery is of critical importance.

Rozycki-Feliciano Lecture Rudolph Matas, the Father of Vascular Surgery

2022 ◽  
pp. 000313482110697
Author(s):  
Richard J. Field ◽  
Don K. Nakayama
Keyword(s):  
Vascular Surgery ◽  
Arteriovenous Fistula ◽  
New Orleans ◽  
Artery Aneurysm ◽  
Peripheral Artery ◽  
Medical Degree ◽  
History Of Vascular Surgery ◽  
Continuous Service ◽  
American College Of Surgeons ◽  
History Of

Rudolph Matas (1860-1957) was one of the foremost figures in the history of vascular surgery. He is considered the father of vascular surgery for his operations for arteriovenous fistula and peripheral artery aneurysm, all devised before the isolation of heparin and the wide adoption of techniques for vascular anastomosis. A medical and surgical prodigy, Matas received his medical degree from Tulane University at age 19 (1880) and was named its chair of surgery at 35 (1895), a position he would hold until 1927. A contemporary and friend of Halsted, Matas throughout his career he was known as a leader in the field, holding the presidencies of the American College of Surgeons (1925-1926) and the American Surgical Association (1909). He maintained loyal relationships to those who trained in surgery with him at Touro Hospital in New Orleans, including the author’s grandfather, the first Richard J. Field. Matas was an honored guest at the dedication of the Centreville Clinic in 1928, the facility where three generations of Field surgeons have provided continuous service to its rural Mississippi community for nearly a century.

Abstract TP174: Identifying Predictors for Final Diagnosis of Ischemic Events in an Emergency Department Observation Unit

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Arooshi Kumar ◽  
Koto Ishida ◽  
Ava Liberman ◽  
Cen Zhang ◽  
Shadi Yaghi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Features ◽  
Univariate Analysis ◽  
Final Diagnosis ◽  
Minor Stroke ◽  
Symptom Duration ◽  
Facial Weakness ◽  
Presenting Symptoms ◽  
History Of ◽  
Ischemic Events

Introduction: Transient neurologic events have high rates of diagnostic uncertainty. Emergency department observation units (ED-OU) allow an accelerated diagnostic work up for suspected transient ischemic attacks (TIAs). However, clinical decision support regarding which patients to admit to these units is lacking. This study aimed to identify clinical features that differentiate true ischemic events from nonischemic transient neurological attacks (NI-TNA) among patients admitted to an ED-OU for suspected TIA. Methods: A retrospective analysis was performed on consecutive patients admitted to the ED-OU at a single academic center for suspected TIA. Demographics, vascular risk factors, presenting symptoms, and details of the clinical presentation were abstracted from chart review. Final discharge diagnosis was dichotomized to either ischemic event (TIA or minor stroke, TIAMS) or NI-TNA based on the treating vascular neurologist’s final diagnosis. Standard statistical tests were used for comparison testing between the two groups. Significantly different factors with p<0.2 on univariate analysis were carried forward in a multivariable logistic regression model. Results: Of 186 consecutive patients, 101 (54%) had a final diagnosis of NI-TNA and 85 (46%) of TIAMS. The median population ABCD2 score was 4 [IQR 3-4]. On univariate analysis, older age (63 vs. 70, p<0.01), history of atrial fibrillation (AF) (12% vs. 26%, p=0.01), and facial weakness (5% vs. 14% p=0.03) were associated with TIAMS. Headache (24% vs. 12%, p=0.04) and symptom duration>60min (57% vs. 40%, p=0.02) were associated with NI-TNA. On multivariable analysis, only symptom duration>60 minutes predicted NI-TNA (OR 0.39, p=0.04) and only history of AF (OR 2.53, p=0.03) predicted TIAMS. Facial weakness was strongly predictive of TIAMS (OR 3.22, p=0.05), but not significant. Conclusion: We identified two clinical features that distinguished TIAMS from NI-TNA among patients admitted to an ED-OU for suspected TIA.These may be helpful in emergency room triage of TIAMS. Data from ED-OU can be used to identify factors associated with cerebral ischemia and improve current care pathways for patients with suspected TIA, so diagnostic evaluation is received in the most appropriate setting.

scholarly journals Perichondritis: inspect the lobule

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Eli Bress ◽  
Jason E. Cohn
Keyword(s):  
Emergency Department ◽  
Physical Examination ◽  
Marked Improvement ◽  
Otitis Externa ◽  
Left Auricle ◽  
Case Presentation ◽  
Physical Examination Finding ◽  
Examination Finding ◽  
History Of ◽  
Caucasian Female

Abstract Case presentation This is a brief report of a 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea which progressed to helical erythema, prompting a visit to the emergency department. She was noted to have erythema of the left auricle and swelling of the left auditory meatus. Our otolaryngology service observed erythema of the auricle with sparing of the lobule. Diagnosis The diagnosis to be otitis externa with perichondritis was established, and we recommended otic ciprofloxacin-hydrocortisone, IV vancomycin, and ciprofloxacin. The patient had marked improvement and was discharged on an oral and otic fluoroquinolone. In this case, the diagnosis of perichondritis was made by a classic physical examination finding: erythema and edema with sparing of the fatty lobule. This key finding helps to distinguish perichondritis from otitis externa.

scholarly journals Clavicle Pseudarthrosis: A Rare Cause of Thoracic Outlet Syndrome

2010 ◽  
Vol 37 (6) ◽  
pp. 863-865 ◽  
Author(s):  
Kathleen Joy Khu ◽  
Rajiv Midha
Keyword(s):  
Physical Examination ◽  
Shoulder Pain ◽  
Thoracic Outlet Syndrome ◽  
Clinical Findings ◽  
Radial Pulse ◽  
History Of ◽  
Arm Elevation ◽  
One Year ◽  
The Right ◽  
Intrinsic Muscles

A 22-year-old man presented with a one year history of rightsided shoulder pain, hand weakness and tingling, and purplish discoloration of the upper extremity upon abduction. He had congenital pseudarthrosis of the right clavicle since childhood. Aside from an obvious deformity characterized by asymmetry of the shoulders and a palpable bony depression over the right clavicle, the patient had been previously asymptomatic. Physical examination revealed the musculoskeletal deformities as described, as well as prominent veins over his right shoulder, arm, and chest. With arm elevation, his right arm became dusky and his radial pulse diminished. Neurologically, the patient had no deficits except for mild weakness (Grade 4+/5) of the ulnarinnervated intrinsic muscles of the right hand. The clinical findings were consistent with a combined neurogenic and vascular form of thoracic outlet syndrome.

A case of Fournier’s gangrene diagnosed with POCUS

POCUS Journal ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 3
Author(s):  
Marco Badinella Martini, MD ◽  
Antonello Iacobucci, MD
Keyword(s):  
Type 2 Diabetes ◽  
Emergency Department ◽  
Alzheimer Disease ◽  
Physical Examination ◽  
Subcutaneous Emphysema ◽  
Vital Signs ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
History Of

An 87-year-old man with a history of type 2 diabetes and severe Alzheimer disease was admitted to the emergency department with a lesion of the perineum for two days. The patient appeared agitated and not collaborating on the visit. His vital signs were normal. Physical examination revealed an edematous, suppurative, and foul-smelling perineal-scrotal lesion, with possible subcutaneous emphysema.

scholarly journals Arthritis in Idiopathic Inflammatory Myopathy: Clinical Features and Autoantibody Associations

2014 ◽  
Vol 41 (6) ◽  
pp. 1133-1139 ◽  
Author(s):  
Martin Klein ◽  
Heřman Mann ◽  
Lenka Pleštilová ◽  
Zoe Betteridge ◽  
Neil McHugh ◽  
...  
Keyword(s):  
Physical Examination ◽  
Clinical Features ◽  
Strong Association ◽  
Inflammatory Myopathy ◽  
Clinical Manifestations ◽  
Idiopathic Inflammatory Myopathy ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
History Of ◽  
Autoantibody Status

Objective.To determine the prevalence, distribution, and clinical manifestations of arthritis in a cohort of patients with idiopathic inflammatory myopathies (IIM). Associations with autoantibody status and HLA genetic background were also explored.Methods.Consecutive patients with IIM treated in a single center were included in this cross-sectional study (n = 106). History of arthritis, 68-joint and 66-joint tender and swollen joint index, clinical features of IIM, and autoantibody profiles were obtained by clinical examination, personal interview, and review of patient records. High-resolution genotyping in HLA-DRB1 and HLA-DQB1 loci was performed in 71 and 73 patients, respectively.Results.A combination of patients’ medical history and cross-sectional physical examination revealed that arthritis at any time during the disease course had occurred in 56 patients (53%). It was present at the beginning of the disease in 39 patients (37%) including 23 cases (22%) with arthritis preceding the onset of muscle weakness. On physical examination, 29% of patients had at least 1 swollen joint. The most frequently affected areas were wrists, and metacarpophalangeal and proximal interphalangeal joints. Twenty-seven out of the 29 anti-Jo1-positive patients had arthritis at any time during the course of their illness; this prevalence was significantly higher compared to patients without the anti-Jo1 autoantibody (p < 0.0001). No association of arthritis with individual HLA alleles was found.Conclusion.Our data suggest that arthritis is a common feature of myositis. It is frequently present at the onset of disease and it may even precede muscular manifestations of IIM. The most common presentation is a symmetrical, nonerosive polyarthritis affecting particularly the wrists, shoulders, and small joints of the hands. We have confirmed a strong association of arthritis with the presence of the anti-Jo1 antibody.

scholarly journals Routine pre admission laboratory screening investigations in aggressive patients who require sedation in the emergency department – necessary or unnecessary

2009 ◽  
Vol 15 (3) ◽  
pp. 5
Author(s):  
Shamima Saloojee
Keyword(s):  
Emergency Department ◽  
Mental Illness ◽  
Physical Examination ◽  
Psychiatric Illness ◽  
Past History ◽  
Behavioural Control ◽  
Full Blood Count ◽  
Laboratory Screening ◽  
History Of ◽  
Laboratory Investigations

<p><strong>Background</strong>: The triage of aggressive patients who require sedation for behavioural control in the emergency department (ED) at our hospitals is delayed because the results of mandatory screening laboratory investigations to exclude a general medical condition (GMC) must be available prior to a psychiatric referral. The monitoring of these sedated patients in the ED is the problem.</p><p><strong>Objective</strong>: The primary objective of this study was to determine the value of the results of routine pre-admission laboratory screening investigations in the differentiation of a medical from a psychiatric cause of aggression in consecutive aggressive patients who required sedation in the EDs at King Edward V111 and Addington Hospitals. Specific objectives were to determine if there was an association between a history of past psychiatric illness, the physical examination, the results of laboratory screening investigations and the cause of the aggression.</p><p><strong>Methods</strong>: a retrospective chart review of 339 consecutive aggressive patients who required intravenous or intramuscular sedation for behavioural control in the EDs of Addington and King Edward V111 Hospitals in Kwa Zulu Natal (KZN) was conducted from 01 January 2006 to 31 December 2006. Patients who required oral or no sedation were excluded from the study. <strong></strong></p><p><strong>Results:</strong> 82 (24.2%) of the 339 patients in the study had a medical cause for the aggression .40 (11.7%) of these had no previous medical history. Overall the yield of clinically significant results from laboratory investigations was 9.6%. No past history of psychiatric illness, physical examination, the Full Blood Count (FBC), Urea and Electroloyte estimation (U&amp;E) and Random Blood Glucose (RBG) had sensitivities of 28%, 63%, 57%, 40% and 21% respectively for the identification of a GMC causing the aggression. The variables that remained significantly associated with a causal GMC were an abnormal physical examination only (OR 42.151), an abnormal FBC (OR 2.363),an abnormal U &amp; E (OR 3.531) and no past history of mental illness combined with an abnormal physical examination (OR 277.442). A previous history of a mental illness only was not significantly associated with the cause of aggression. These are adjusted odds ratios, ie they are independent of the effects of the other variables.</p><p><strong> Conclusion:</strong> The high rate of a medical cause for the aggressive behaviour and the overall yield from screening laboratory investigations emphasize the need for mandatory screening to exclude a GMC in the EDs of our hospitals. Aggressive patients with a documented past psychiatric history and a normal physical examination can be referred for a psychiatric assessment prior to the results of routine laboratory investigations becoming available.</p>

Preoperative Ultrasound Assessment for Dialysis Access Placement

2005 ◽  
Vol 29 (3) ◽  
pp. 131-136
Author(s):  
M. Ann Needham
Keyword(s):  
Renal Failure ◽  
Arteriovenous Fistula ◽  
Flow Diagram ◽  
Dialysis Access ◽  
Venous Outflow ◽  
The Status ◽  
Arterial Inflow ◽  
History Of ◽  
Ultrasound Assessment ◽  
Steal Syndrome

Vascular access includes any form of cannulation of arteries or veins. For the treatment of chronic renal failure, this term refers to the ability to access both the arterial inflow and the venous outflow for the purpose of replacing the function of the kidney. This work provides a brief review of the history of hemodialysis and presents the method we use currently to map the arterial and venous system prior to placement of an arteriovenous fistula. The purpose is to present the process we use to determine the status of the arteries and the venous patency, as well as the flow diagram we use to determine the steps taken for each patient referred for preoperative vein mapping, including the worksheet used to collect the information for the surgeon. This work presents the minimum prerequisites that are thought to be necessary to create a viable arteriovenous fistula. A brief discussion of the criteria and protocol is presented that is used to diagnose steal syndrome from the hand. Billing codes are included when this procedure is used.

scholarly journals A Case of Superficial Femoral Arteriovenous Fistula and Severe Venous Stasis Ulceration, Managed with an Iliac Extender Prosthesis

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Nicole Ilonzo ◽  
Selena Goss ◽  
Chun Yang ◽  
Michael Dudkiewicz
Keyword(s):  
Heart Failure ◽  
Arteriovenous Fistula ◽  
Endovascular Repair ◽  
Gunshot Wound ◽  
Venous Insufficiency ◽  
Venous Stasis ◽  
Arteriovenous Fistulas ◽  
History Of ◽  
Surgical Options ◽  
Steal Syndrome

Most femoral artery arteriovenous fistulas occur as a result of percutaneous interventions. However, arteriovenous fistulas can occur in the setting of trauma, with resultant consequences such as heart failure, steal syndrome, or venous insufficiency. Indications for endovascular repair in this setting are limited to patients who are at too high risk for anesthesia, have a hostile groin, or would not survive significant bleeding. We report the case of a traumatic femoral arteriovenous fistula, causing severe venous insufficiency and arteriomegaly, in a 58-year-old male, with history of traumatic gunshot wound complicated by popliteal DVT. Surgical options for arteriovenous fistula include open and endovascular repair but this patient’s fistula was more suitable for endovascular repair for reasons that will be discussed.

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