1/15. diagnosis of hemophilia made after intraoperative bleeding during attempted penetrating keratoplasty in an elderly patient.PURPOSE: To report an unusual case where the diagnosis of hemophilia was made after attempted penetrating keratoplasty in an elderly patient. methods: A 75 year old white male with a full-thickness corneal scar in the visual axis and a visually significant cataract OD was to undergo penetrating keratoplasty and cataract extraction with lens implantation for visual rehabilitation. There was no history of bleeding diathesis given. RESULTS: During placement of the Flieringa ring, a progressively enlarging 360 degrees subconjunctival hemorrhage was observed. Given the unusual bleeding,the procedure was aborted and the patientwas referred to the hematology service for further evaluation. Laboratory studies revealed a diagnosis of atypical hemophilia of mild severity. CONCLUSIONS: The initial diagnosis of hemophilia in any elderly patient is unusual. This case is even more unusual asthe diagnosis of a bleeding disorder was first considered after excessive subconjunctival hemorrhage developed during attempted penetrating keratoplasty.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/15. Successful use of recombinant factor viia in a haemophiliac with inhibitor undergoing cataract surgery.A 40-year-old patient with severe haemophilia A and an inhibitor against factor viii underwent a cataract extraction under local anaesthesia. Recombinant activated factor VII was use to achieve haemostasis. The procedure was successful. Neither bleeding complications nor side effects occurred.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/15. Successful use of recombinant factor viia in a patient with inhibitor secondary to severe factor xi deficiency.Factor XI (FXI) inhibitors are a rare complication of inherited FXI deficiency. We report the successful use of recombinant factor viia (FVIIa) in a patient with a high-responding inhibitor undergoing cataract extraction. At the time of surgery there were limited available data on the optimal management of patients with FXI deficiency. A 62-year-old Ashkenazi Jewish woman had a lifelong history of excessive bleeding secondary to severe FXI deficiency (2 U dL-1), and received FXI concentrate (FXI:C) when she underwent a colposuspension procedure. She was subsequently diagnosed with a FXI inhibitor of 16 Bethesda units (BU) when she developed a poor response to FXI:C at the time of total hip replacement. Two months later she was admitted for cataract extraction. The FXI level was < 1 U dL-1 with an inhibitor titre of 48 BU. She received 90 microg kg-1 of FVIIa immediately preoperatively followed by continuous infusion at a rate of 20 microg kg-1 h-1 for 24 h. The cataract extraction was successful and there was no excess bleeding during surgery or in the postoperative period. mutation analysis of the FXI gene showed that the patient was homozygous for the type II genotype [exon 5, Glu117-->Ter]. The reason for the low prevalence of inhibitor formation in patients with FXI deficiency is unclear but may reflect a number of factors including reporting bias, the rarity of absent circulating FXI:C activity, and the infrequent use of FXI replacement therapy.- - - - - - - - - - ranking = 3keywords = extraction (Clic here for more details about this article) |
4/15. Vascular and bowel complications during retroperitoneal laparoscopic surgery.PURPOSE: We report on vascular and bowel complications during major retroperitoneal laparoscopic renal and adrenal surgery. MATERIALS AND methods: A total of 404 patients underwent retroperitoneoscopy for various renal and adrenal pathology between July 1997 and February 2001. The occurrence of intraoperative vascular and bowel injuries, specific intraoperative circumstances, management techniques and outcomes were evaluated. RESULTS: There were 7 vascular injuries (1.7%) and 1 bowel injury (0.25%), which involved the right adrenal vein (2), left renal vein (2), right renal vein (1), right renal artery (1), inferior vena cava (1) and a superficial, small serosal injury to the duodenum (1). Of these 8 cases 5 (63%) had been treated prior with major open intra-abdominal surgery. Average blood loss for patients with vascular injuries was 1,186 cc (range 300 to 3,000). Of the 8 cases 1 was converted to open surgery and in another 2 cases the vascular injury was controlled through the extraction incision, which had already been created. Retroperitoneoscopic control and repair without open conversion were possible in each of the most recent 5 cases. Of the 404 cases open conversion has not been necessary for control of vascular or bowel complications in the most recent 200 cases, demonstrating the impact of the learning curve. CONCLUSIONS: During major renal and adrenal retroperitoneoscopic surgery our incidence of vascular and bowel injuries was 1.7% and 0.25%, respectively. With experience inadvertent vascular and bowel injuries can be efficaciously controlled retroperitoneoscopically despite the somewhat small operative field available.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/15. Recombinant activated factor VII combined with local measures in preventing bleeding from invasive dental procedures in patients with Glanzmann thrombasthenia.Recombinant activated factor VII (rFVIIa), combined with local measures of fibrin glue and a celluloid splint, preventing bleeding from four invasive dental procedures is reported. A single dose of 180-200 micro g/kg was successfully used in three surgical removals of impacted teeth. Four doses of rFVIIa were required in another full mouth treatment of extraction, pulpotomy, filling and the stainless steel crowning of 13 teeth. The repeated dose of rFVIIa was given whenever the bleeding complication was visualized. It is cost-effective for preventing external bleeding. Additionally, an oral rinsing solution of tranexamic acid (25 mg/kg) was given three times a day for 7 days. In conclusion, rFVIIa has been shown to be an effective alternative to platelet concentrate in patients with Glanzmann thrombasthenia.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/15. Sublingual hematoma formation during immediate placement of mandibular endosseous implants.BACKGROUND: Sublingual hematoma during placement of mandibular endosseous dental implants is a rare, but potentially life-threatening, complication. The development of a sublingual hematoma during a dental procedure may result in the need for acute airway management, including intubation or even emergent tracheostomy. dental implants are becoming a well-accepted treatment, and thousands of implants are placed every year by general practitioners and specialists, with few adverse sequelae. Clinicians rarely discuss this complication with patients before surgery, and no reports of death secondary to sublingual hematoma formation have been published. The incidence of this event is difficult to ascertain, and only, a few cases have been reported. CASE DESCRIPTION: A 56-year-old man with severe caries underwent multiple mandibular tooth extractions and alveoloplasty and received endosseous implants. During the surgical procedure, the patient developed a large sublingual hematoma that required hospitalization. CLINICAL IMPLICATIONS: Practitioners who perform implant surgery in the anterior mandible should notify patients of the potential risk of sublingual hematoma formation, and be able to manage acute airway issues that may result from this complication.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
7/15. Occult hemophilia: prolonged bleeding follows extraction.A 51-year-old man had delayed and recurrent bleeding after tooth extractions. Occult hemophilia b was discovered. This case emphasizes the importance of evaluating patients for an underlying coagulopathy when bleeding greater than expected occurs. In this case, the patient had no personal or family history of bleeding.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
8/15. Recombinant activated factor VII combined with desmopressin in preventing bleeding from dental extraction in a patient with Glanzmann's thrombasthenia.The case of a 41-year-old woman with Glanzmann's thrombasthenia who underwent double dental extraction is presented. In the past, treatments with desmopressin (DDAVP) and tranexamic acid had often unsuccessful efficacy to stop or decrease bleeding. After ineffective DDAVP administration, the removal was performed successfully with recombinant activated factor VII (rFVIIa) infusion. rFVIIa infusion after DDAVP administration could be useful in patients with Glanzmann's thrombasthenia in which DDAVP and tranexamic acid weren't always effective.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
9/15. Successful use of recombinant factor viii devoid of von willebrand factor during multiple teeth extractions in a patient with type 3 von Willebrand disease.We report a 55-year-old patient with type 3 von Willebrand disease who underwent multiple tooth extractions with successful hemostatic management using recombinant factor viii. The patient was previously misdiagnosed and treated incorrectly then at 53 years old, he was diagnosed with type 3 von Willebrand disease. As he had avoided dental treatments for two decades due to severe bleeding after dental extraction, multiple severe caries and marginal periodontitis were revealed. The patient refused the use of blood products in hemostatic management because he was afraid of blood-borne diseases and development of anti-von willebrand factor alloantibodies. After close consultation, we therefore decided to use recombinant factor viii. Four teeth extraction procedures were executed twice. Before extraction, bolus recombinant factor viii (50 IU/kg) was administered intravenously followed by continuous infusion (5-10 IU/kg per h) for approximately 48 h. The factor viii:C level increased from about 1 to 20-32% 30 min after bolus infusion. During continuous infusion (10 IU/kg/h), factor viii:C was maintained at more than 10%. Little bleeding occurred during and after the multiple teeth extractions and during suture removal. On frequent examinations during a 1-year follow-up, neither von willebrand factor nor factor viii inhibitors were detected.- - - - - - - - - - ranking = 9keywords = extraction (Clic here for more details about this article) |
10/15. Anesthetic management of a patient with sturge-weber syndrome undergoing oral surgery.This case involves a possible complication of excessive bleeding or rupture of hemangiomas. Problems and anesthetic management of the patient are discussed. A 35-year-old man with sturge-weber syndrome was to undergo teeth extraction and gingivectomy. Hemangiomas covered his face and the inside of the oral cavity. We used intravenous conscious sedation with propofol and N2O-O2 to reduce the patient's emotional stress. It was previously determined that stress caused marked expansion of this patient's hemangiomas. periodontal ligament injection was chosen as the local anesthesia technique. Teeth were extracted without excessive bleeding or rupture of hemangiomas, but the planned gingivectomies were cancelled. deep sedation requiring airway manipulation should be avoided because there are possible difficulties in airway maintenance. Because this was an outpatient procedure, propofol was selected as the sedative agent primarily because of its rapid onset and equally rapid recovery. periodontal ligament injection with 2% lidocaine containing 1: 80,000 epinephrine was chosen for local anesthesia. gingivectomy was cancelled because hemostasis was challenging. As part of preoperative preparation, equipment for prompt intubation was available in case of rupture of the hemangiomas. The typically seen elevation of blood pressure was suppressed under propofol sedation so that expansion of the hemangiomas and significant intraoperative bleeding was prevented. periodontal ligament injection as a local anesthetic also prevented bleeding from the injection site.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
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