document_id
stringclasses 31
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stringclasses 127
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stringclasses 56
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EN100090
|
Exam: CD45
|
not available
| 4 |
We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
|
EN100090
|
Exam: T3
|
not available
| 4 |
We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
|
EN100090
|
Exam: TSH
|
not available
| 4 |
We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
|
EN106156
|
Exam: height
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: fever
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: FGSI
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: UFGSI
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: LRINEC
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: SOFA
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: APACHE
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: pancytopenia
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: hemoglobin
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: albumin
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: fibrinogen
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: triglycerides
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: ferrintin
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: dehydrogenase
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: neutrophils
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: WBC
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: BCR-ABL
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: pressure
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: lymphoblasts
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: CD45
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: T3
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN106156
|
Exam: TSH
|
not available
| 4 |
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.
Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.
Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.
The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.
After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.
The lesions improved after intraoral incision and drainage, and administration of antibiotics.
|
EN103007
|
Exam: MRI
|
not available
| 5 |
A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets (PLT), 3000-8000/μL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy (D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient's complication of severe and medically refractory ITP.
|
EN103007
|
Exam: electroencephalography
|
not available
| 5 |
A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets (PLT), 3000-8000/μL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy (D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient's complication of severe and medically refractory ITP.
|
EN103007
|
Exam: EEG
|
not available
| 5 |
A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets (PLT), 3000-8000/μL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy (D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient's complication of severe and medically refractory ITP.
|
EN103007
|
Exam: height
|
not available
| 5 |
A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets (PLT), 3000-8000/μL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy (D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient's complication of severe and medically refractory ITP.
|
EN103007
|
Exam: Apgar
|
not available
| 5 |
A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets (PLT), 3000-8000/μL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy (D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient's complication of severe and medically refractory ITP.
|
EN103007
|
Exam: PLT
|
3000-8000/μL.
| 5 |
A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets (PLT), 3000-8000/μL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy (D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient's complication of severe and medically refractory ITP.
|
EN103007
|
Exam: S-100
|
not available
| 5 |
A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets (PLT), 3000-8000/μL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy (D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient's complication of severe and medically refractory ITP.
|
EN103007
|
Exam: CD1a
|
not available
| 5 |
A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets (PLT), 3000-8000/μL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy (D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient's complication of severe and medically refractory ITP.
|
EN103007
|
Exam: CD-68
|
not available
| 5 |
A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets (PLT), 3000-8000/μL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy (D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient's complication of severe and medically refractory ITP.
|
EN103007
|
Exam: CD45RO
|
not available
| 5 |
A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets (PLT), 3000-8000/μL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy (D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient's complication of severe and medically refractory ITP.
|
EN103266
|
Exam: MRI
|
not available
| 5 |
A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus.
|
EN103266
|
Exam: electroencephalography
|
not available
| 5 |
A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus.
|
EN103266
|
Exam: EEG
|
not available
| 5 |
A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus.
|
EN103266
|
Exam: height
|
not available
| 5 |
A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus.
|
EN103266
|
Exam: Apgar
|
not available
| 5 |
A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus.
|
EN103266
|
Exam: PLT
|
not available
| 5 |
A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus.
|
EN103266
|
Exam: S-100
|
not available
| 5 |
A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus.
|
EN103266
|
Exam: CD1a
|
not available
| 5 |
A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus.
|
EN103266
|
Exam: CD-68
|
not available
| 5 |
A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus.
|
EN103266
|
Exam: CD45RO
|
not available
| 5 |
A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus.
|
EN104184
|
Exam: MRI
|
not available
| 5 |
We report a 9-year-old male child who was referred to us with swelling in the posterior aspect of the neck. Anteroposterior and lateral radiographs of the cervical spine show an elongated left spinous process in the neck at the level of C5 vertebrae. There was an associated hemivertebra at the C4 level. Computed tomography examination better depicted this congenital variant and clearly showed the associated schisis of the posterior arch as well as unfused spinous process at the same level on the left side. This is a very rare congenital anomaly and probably among the few such cases reported in literature.
|
EN104184
|
Exam: electroencephalography
|
not available
| 5 |
We report a 9-year-old male child who was referred to us with swelling in the posterior aspect of the neck. Anteroposterior and lateral radiographs of the cervical spine show an elongated left spinous process in the neck at the level of C5 vertebrae. There was an associated hemivertebra at the C4 level. Computed tomography examination better depicted this congenital variant and clearly showed the associated schisis of the posterior arch as well as unfused spinous process at the same level on the left side. This is a very rare congenital anomaly and probably among the few such cases reported in literature.
|
EN104184
|
Exam: EEG
|
not available
| 5 |
We report a 9-year-old male child who was referred to us with swelling in the posterior aspect of the neck. Anteroposterior and lateral radiographs of the cervical spine show an elongated left spinous process in the neck at the level of C5 vertebrae. There was an associated hemivertebra at the C4 level. Computed tomography examination better depicted this congenital variant and clearly showed the associated schisis of the posterior arch as well as unfused spinous process at the same level on the left side. This is a very rare congenital anomaly and probably among the few such cases reported in literature.
|
EN104184
|
Exam: height
|
not available
| 5 |
We report a 9-year-old male child who was referred to us with swelling in the posterior aspect of the neck. Anteroposterior and lateral radiographs of the cervical spine show an elongated left spinous process in the neck at the level of C5 vertebrae. There was an associated hemivertebra at the C4 level. Computed tomography examination better depicted this congenital variant and clearly showed the associated schisis of the posterior arch as well as unfused spinous process at the same level on the left side. This is a very rare congenital anomaly and probably among the few such cases reported in literature.
|
EN104184
|
Exam: Apgar
|
not available
| 5 |
We report a 9-year-old male child who was referred to us with swelling in the posterior aspect of the neck. Anteroposterior and lateral radiographs of the cervical spine show an elongated left spinous process in the neck at the level of C5 vertebrae. There was an associated hemivertebra at the C4 level. Computed tomography examination better depicted this congenital variant and clearly showed the associated schisis of the posterior arch as well as unfused spinous process at the same level on the left side. This is a very rare congenital anomaly and probably among the few such cases reported in literature.
|
EN104184
|
Exam: PLT
|
not available
| 5 |
We report a 9-year-old male child who was referred to us with swelling in the posterior aspect of the neck. Anteroposterior and lateral radiographs of the cervical spine show an elongated left spinous process in the neck at the level of C5 vertebrae. There was an associated hemivertebra at the C4 level. Computed tomography examination better depicted this congenital variant and clearly showed the associated schisis of the posterior arch as well as unfused spinous process at the same level on the left side. This is a very rare congenital anomaly and probably among the few such cases reported in literature.
|
EN104184
|
Exam: S-100
|
not available
| 5 |
We report a 9-year-old male child who was referred to us with swelling in the posterior aspect of the neck. Anteroposterior and lateral radiographs of the cervical spine show an elongated left spinous process in the neck at the level of C5 vertebrae. There was an associated hemivertebra at the C4 level. Computed tomography examination better depicted this congenital variant and clearly showed the associated schisis of the posterior arch as well as unfused spinous process at the same level on the left side. This is a very rare congenital anomaly and probably among the few such cases reported in literature.
|
EN104184
|
Exam: CD1a
|
not available
| 5 |
We report a 9-year-old male child who was referred to us with swelling in the posterior aspect of the neck. Anteroposterior and lateral radiographs of the cervical spine show an elongated left spinous process in the neck at the level of C5 vertebrae. There was an associated hemivertebra at the C4 level. Computed tomography examination better depicted this congenital variant and clearly showed the associated schisis of the posterior arch as well as unfused spinous process at the same level on the left side. This is a very rare congenital anomaly and probably among the few such cases reported in literature.
|
EN104184
|
Exam: CD-68
|
not available
| 5 |
We report a 9-year-old male child who was referred to us with swelling in the posterior aspect of the neck. Anteroposterior and lateral radiographs of the cervical spine show an elongated left spinous process in the neck at the level of C5 vertebrae. There was an associated hemivertebra at the C4 level. Computed tomography examination better depicted this congenital variant and clearly showed the associated schisis of the posterior arch as well as unfused spinous process at the same level on the left side. This is a very rare congenital anomaly and probably among the few such cases reported in literature.
|
EN104184
|
Exam: CD45RO
|
not available
| 5 |
We report a 9-year-old male child who was referred to us with swelling in the posterior aspect of the neck. Anteroposterior and lateral radiographs of the cervical spine show an elongated left spinous process in the neck at the level of C5 vertebrae. There was an associated hemivertebra at the C4 level. Computed tomography examination better depicted this congenital variant and clearly showed the associated schisis of the posterior arch as well as unfused spinous process at the same level on the left side. This is a very rare congenital anomaly and probably among the few such cases reported in literature.
|
EN105223
|
Exam: MRI
|
not available
| 5 |
A 49-year-old white Caucasian woman presented with vaginal bleeding. A pelvic examination revealed a cystic lesion arising from her cervix. Examination of a biopsy specimen revealed a poorly differentiated neoplasm, with sheets of small hyperchromatic cells, staining weakly for neuroendocrine markers. She was diagnosed with small cell carcinoma and started on concurrent chemotherapy and radiation. However, additional positive immunostaining for CD99 was strongly suggestive of Ewing's sarcoma. Fluorescence in situ hybridization revealed ESWR1 gene rearrangement, confirming Ewing's sarcoma. Our patient underwent surgery, which confirmed stage IIB Ewing's sarcoma. She received adjuvant chemotherapy but died from progressive metastatic disease after four cycles.
|
EN105223
|
Exam: electroencephalography
|
not available
| 5 |
A 49-year-old white Caucasian woman presented with vaginal bleeding. A pelvic examination revealed a cystic lesion arising from her cervix. Examination of a biopsy specimen revealed a poorly differentiated neoplasm, with sheets of small hyperchromatic cells, staining weakly for neuroendocrine markers. She was diagnosed with small cell carcinoma and started on concurrent chemotherapy and radiation. However, additional positive immunostaining for CD99 was strongly suggestive of Ewing's sarcoma. Fluorescence in situ hybridization revealed ESWR1 gene rearrangement, confirming Ewing's sarcoma. Our patient underwent surgery, which confirmed stage IIB Ewing's sarcoma. She received adjuvant chemotherapy but died from progressive metastatic disease after four cycles.
|
EN105223
|
Exam: EEG
|
not available
| 5 |
A 49-year-old white Caucasian woman presented with vaginal bleeding. A pelvic examination revealed a cystic lesion arising from her cervix. Examination of a biopsy specimen revealed a poorly differentiated neoplasm, with sheets of small hyperchromatic cells, staining weakly for neuroendocrine markers. She was diagnosed with small cell carcinoma and started on concurrent chemotherapy and radiation. However, additional positive immunostaining for CD99 was strongly suggestive of Ewing's sarcoma. Fluorescence in situ hybridization revealed ESWR1 gene rearrangement, confirming Ewing's sarcoma. Our patient underwent surgery, which confirmed stage IIB Ewing's sarcoma. She received adjuvant chemotherapy but died from progressive metastatic disease after four cycles.
|
EN105223
|
Exam: height
|
not available
| 5 |
A 49-year-old white Caucasian woman presented with vaginal bleeding. A pelvic examination revealed a cystic lesion arising from her cervix. Examination of a biopsy specimen revealed a poorly differentiated neoplasm, with sheets of small hyperchromatic cells, staining weakly for neuroendocrine markers. She was diagnosed with small cell carcinoma and started on concurrent chemotherapy and radiation. However, additional positive immunostaining for CD99 was strongly suggestive of Ewing's sarcoma. Fluorescence in situ hybridization revealed ESWR1 gene rearrangement, confirming Ewing's sarcoma. Our patient underwent surgery, which confirmed stage IIB Ewing's sarcoma. She received adjuvant chemotherapy but died from progressive metastatic disease after four cycles.
|
EN105223
|
Exam: Apgar
|
not available
| 5 |
A 49-year-old white Caucasian woman presented with vaginal bleeding. A pelvic examination revealed a cystic lesion arising from her cervix. Examination of a biopsy specimen revealed a poorly differentiated neoplasm, with sheets of small hyperchromatic cells, staining weakly for neuroendocrine markers. She was diagnosed with small cell carcinoma and started on concurrent chemotherapy and radiation. However, additional positive immunostaining for CD99 was strongly suggestive of Ewing's sarcoma. Fluorescence in situ hybridization revealed ESWR1 gene rearrangement, confirming Ewing's sarcoma. Our patient underwent surgery, which confirmed stage IIB Ewing's sarcoma. She received adjuvant chemotherapy but died from progressive metastatic disease after four cycles.
|
EN105223
|
Exam: PLT
|
not available
| 5 |
A 49-year-old white Caucasian woman presented with vaginal bleeding. A pelvic examination revealed a cystic lesion arising from her cervix. Examination of a biopsy specimen revealed a poorly differentiated neoplasm, with sheets of small hyperchromatic cells, staining weakly for neuroendocrine markers. She was diagnosed with small cell carcinoma and started on concurrent chemotherapy and radiation. However, additional positive immunostaining for CD99 was strongly suggestive of Ewing's sarcoma. Fluorescence in situ hybridization revealed ESWR1 gene rearrangement, confirming Ewing's sarcoma. Our patient underwent surgery, which confirmed stage IIB Ewing's sarcoma. She received adjuvant chemotherapy but died from progressive metastatic disease after four cycles.
|
EN105223
|
Exam: S-100
|
not available
| 5 |
A 49-year-old white Caucasian woman presented with vaginal bleeding. A pelvic examination revealed a cystic lesion arising from her cervix. Examination of a biopsy specimen revealed a poorly differentiated neoplasm, with sheets of small hyperchromatic cells, staining weakly for neuroendocrine markers. She was diagnosed with small cell carcinoma and started on concurrent chemotherapy and radiation. However, additional positive immunostaining for CD99 was strongly suggestive of Ewing's sarcoma. Fluorescence in situ hybridization revealed ESWR1 gene rearrangement, confirming Ewing's sarcoma. Our patient underwent surgery, which confirmed stage IIB Ewing's sarcoma. She received adjuvant chemotherapy but died from progressive metastatic disease after four cycles.
|
EN105223
|
Exam: CD1a
|
not available
| 5 |
A 49-year-old white Caucasian woman presented with vaginal bleeding. A pelvic examination revealed a cystic lesion arising from her cervix. Examination of a biopsy specimen revealed a poorly differentiated neoplasm, with sheets of small hyperchromatic cells, staining weakly for neuroendocrine markers. She was diagnosed with small cell carcinoma and started on concurrent chemotherapy and radiation. However, additional positive immunostaining for CD99 was strongly suggestive of Ewing's sarcoma. Fluorescence in situ hybridization revealed ESWR1 gene rearrangement, confirming Ewing's sarcoma. Our patient underwent surgery, which confirmed stage IIB Ewing's sarcoma. She received adjuvant chemotherapy but died from progressive metastatic disease after four cycles.
|
EN105223
|
Exam: CD-68
|
not available
| 5 |
A 49-year-old white Caucasian woman presented with vaginal bleeding. A pelvic examination revealed a cystic lesion arising from her cervix. Examination of a biopsy specimen revealed a poorly differentiated neoplasm, with sheets of small hyperchromatic cells, staining weakly for neuroendocrine markers. She was diagnosed with small cell carcinoma and started on concurrent chemotherapy and radiation. However, additional positive immunostaining for CD99 was strongly suggestive of Ewing's sarcoma. Fluorescence in situ hybridization revealed ESWR1 gene rearrangement, confirming Ewing's sarcoma. Our patient underwent surgery, which confirmed stage IIB Ewing's sarcoma. She received adjuvant chemotherapy but died from progressive metastatic disease after four cycles.
|
EN105223
|
Exam: CD45RO
|
not available
| 5 |
A 49-year-old white Caucasian woman presented with vaginal bleeding. A pelvic examination revealed a cystic lesion arising from her cervix. Examination of a biopsy specimen revealed a poorly differentiated neoplasm, with sheets of small hyperchromatic cells, staining weakly for neuroendocrine markers. She was diagnosed with small cell carcinoma and started on concurrent chemotherapy and radiation. However, additional positive immunostaining for CD99 was strongly suggestive of Ewing's sarcoma. Fluorescence in situ hybridization revealed ESWR1 gene rearrangement, confirming Ewing's sarcoma. Our patient underwent surgery, which confirmed stage IIB Ewing's sarcoma. She received adjuvant chemotherapy but died from progressive metastatic disease after four cycles.
|
EN100024
|
Exam: radiogram
|
normal.
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: electrocardiogram
|
normal.
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: phosphokinase
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: troponin
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: lymphopenia
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: globulin
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: nitrogen
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: cholesterol
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: Echocardiogram
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: hemoglobin
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: amylase
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: lipase
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: cytokeratin
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: CK7
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: synaptophysin
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: CD56
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: SCAN
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: fever
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: WBC
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: aminotransferase
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: ALT
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: LDH
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: phosphatase
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: Entamoeba
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: echinococcus
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: leismania
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: brucella
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: amikacin
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: cefepime
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: ciprofloxacin
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: gentamycin
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: meropenem
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: chromogranin
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: Synaptophysin
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
EN100024
|
Exam: CD10
|
not available
| 7 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
|
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