Vasovasorum and subsequent intramural hemorrhage. viagra price canada The patient remained stable during her hospital course, without evidence of recurrent bleeding. In summary, neurofibromatosis is associated with vascular abnormalities that can either directly (smooth muscle proliferation) or indirectly (tumor in vessel) result in hemorrhagic events. Intramural hematoma of the aorta should be considered among such patients in whom the presenting signs and symptoms elicit an index of suspicion. The natural history of aortic intramural hematoma has not been fully elucidated. viagra why two bathtubs Though it is a pathologically distinct entity, there exists some clinical overlap with aortic dissection and penetrating ulcer. generic viagra Currently, the management of aortic intramural hematoma is indistinct from that of aortic dissection. Involvement of the descending aorta requires blood pressure control and monitoring. A nonsurgical approach is warranted unless complications develop. Patients with hematoma involving the ascending aorta (type a) have a higher morbidity and mortality rate than those with hematoma involving the descending aorta (type b), and they should be treated surgically [6, 7]. Several series have demonstrated a substantial reduction in mortality in those patients with hematoma of the ascending aorta whose cases were managed surgically . In our patient, a decision was made not to proceed with surgical intervention, given the unclear site of initial hemorrhage and lack of involvement of the proximal aorta. viagra without prescription The patient has remained active and free of events now 24 months from her initial hospitalization. references top abstract introduction comment references leier c. , dewan c. , anatasia l. Fatal hemorrhage as a complication of neurofibromatosis. Vasc surg 1972;6:98-101. viagra why two bathtubs [medline] brasfield r. how to get a prescription for viagra , gupta t. Von recklinghausens disease: a clinicopathological study. Ann surg 1972;175:86-104. [medline] knight j. , cancilla p. Neurofibroma involving the superior vena cava with formation of aneurysm. Arch pathol 1968;86:427-430. Ahlgren j. leadmedic online pharmacy generic viagra viagra , maggio w. , chen f. , kent a. Neurofibromatosis mrna expression in blood vessels. Biochem biophys res commun 1993;197:1019-1024. cheap viagra online [medline] fuyano g. , kobayashi r. , horio h. , kodera k. , moringa s. viagra fast shipping A case of von recklinghausens disease associated with a hemothorax due to a rapidly growing malignant schwannoma. online viagra pills Jpn j thorac dis 1995;33:682-685. Muluk s. , kaufman j. , torchinan d. , gertler j. , cambria r. Diagnosis and treatment of thoracic aortic intramural hematoma. J vasc surg 1996;24:1022-1029. [medline] harris k. , brav.