1/9. Treatment of iatrogenic previable premature rupture of membranes with intra-amniotic injection of platelets and cryoprecipitate (amniopatch): preliminary experience.OBJECTIVE: Our aim was to describe the treatment of iatrogenic previable premature rupture of membranes with the intra-amniotic injection of platelets and cryoprecipitate (amniopatch). STUDY DESIGN: patients with iatrogenic previable premature rupture of membranes and without evidence of intra-amniotic infection underwent transabdominal intra-amniotic injection of platelets and cryoprecipitate through a 22-gauge needle. The study was approved by the Institutional review Board of St Joseph's Hospital in Tampa, florida, and all patients gave written informed consent. RESULTS: Seven patients with iatrogenic preterm premature rupture of membranes underwent placement of an amniopatch. Membrane sealing was verifiable in 6 of 7 patients. Three patients had iatrogenic preterm premature rupture of membranes after operative fetoscopy, 3 cases were after genetic amniocentesis, and 1 was after diagnostic fetoscopy. Three pregnancies progressed well, with restoration of the amniotic fluid volume and no further leakage. Two patients had unexplained fetal death despite successful sealing. One case of bladder outlet obstruction had no further leakage, but oligohydramnios persisted and did not allow unequivocal documentation of sealing. One patient miscarried from twin-twin transfusion, but the amniotic cavity was sealed. CONCLUSIONS: Iatrogenic preterm premature rupture of membranes can be treated effectively with an amniopatch. The technique is simple and does not require knowledge of the exact location of the defect. Unexpected fetal death from the procedure may be attributable to vasoactive effects of platelets or indigo carmine. Although the appropriate dose of platelets and cryoprecipitate needs to be established, the amniopatch may mean that iatrogenic preterm premature rupture of membranes no longer needs to be considered a devastating complication of pregnancy.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
2/9. Iatrogenic drug dependence--a problem in intensive care? Case study and literature review.Use of sedative and analgesic pharmacological agents is a widespread practice in intensive care units (ICUs). Mainly, this involves opioid and benzodiazepine analogues, both known to induce dependence/tolerance states. This paper is based on a clinical scenario in which a patient treated with these agents developed problems when they had been discontinued, and exploration of the extent of such problems generally. The problems range across a wide range of domains and may include physical discomfort, difficulty weaning from respiratory assistance and the drugs, and the problems of short- and long-term psychological distress. Although there may be a recognition that these drugs can typically cause dependence problems, little emphasis has traditionally been given to assessing these problems in ICUs. Yet the ICU may be an area where these drugs are used in high volumes. The recognition, physiology, management and prevention of iatrogenic drug dependence/tolerance in critical care environments is elucidated, with reference to relevant literature.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
3/9. Myospherulosis complicating cortical block grafting: a case report.BACKGROUND: Myospherulosis of the oral cavity is an inflammatory, granulomatous lesion historically associated with the use of petrolatum-based antibiotic ointment placed in third molar extraction sites to prevent postoperative infection. methods: A case of bilateral myospherulosis is presented, in which large lesions complicated the procurement of a cortical block graft used to prepare a mandibular molar edentulous space for implant placement. By obtaining the block graft from a more lateral location on the mandible, an adequate graft was procured and was successfully grafted into an atrophic edentulous ridge. RESULTS: The cortical block graft was successfully incorporated by the recipient site, which received a wide-body, threaded dental implant 6 months later. Healing was uncomplicated, and a functional implant-supported restoration was successfully achieved. CONCLUSIONS: Myospherulosis, though rare today, may present a significant obstacle to the procurement of cortical block grafts. In this case, thorough debridement of the material resulted in subsequent healing of the myospherulosis defect, but prevented procurement of the cortical graft from the planned site. The dimension and volume of the neighboring cortical bone were adequate, and the augmented edentulous space was subsequently restored with a functional endosseous implant. The success seen in these 2 sites would seem to confirm the assumption that size and location of myospherulosis defects are critical factors in obtaining a successful clinical result in implant patients.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
4/9. Iatrogenic vertebral arteriovenous fistula treated with a hemobahn stent-graft.PURPOSE: To illustrate the utility of color flow duplex ultrasound (CFDU) in the diagnosis and stent-graft treatment of a rare arteriovenous fistula (AVF) involving the vertebral artery and vein. CASE REPORT: An iatrogenic AVF involving the right vertebral artery and vein was diagnosed in a 45-year-old man using CFDU. Treatment was recommended due to the large volume of blood shunted through the fistula and the associated loud bruit. Endoluminal treatment involved deployment of a covered stent within the vertebral artery to exclude the fistula. Postoperative CFDU confirmed the success of the treatment. CONCLUSIONS: CFDU can be utilized to accurately diagnose unusual lesions, such as AVFs involving the vertebral artery. The technique is also useful in planning treatment and monitoring the durability of stent-grafts implanted to obliterate this type of defect.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
5/9. Acquired arterio-venous fistulas. Report of 223 operated cases.More than 200 years ago William Hunter described the first arteriovenous fistula (a.v.). Fragments of low velocity are the most frequent cause for a combined vascular trauma. However, a.v. fistulas may also develop after a skull fracture, after surgical interventions (lumbar disc operation, suture ligation for the removal of an organ like the kidney, the spleen and others). Three circulatory disorders may follow an a.v. fistula. Local signs at the location of trauma (machinery murmur, varicose veins). Cardiac dilatation due to the increase of heart volume. Degenerative changes and aneurysm formation in the artery above the fistula. Late complications may arise in the dilated central segment of the artery (aneurysm or thrombosis). The etiology of 223 traumatic a.v. fistulas (1939-1973) were in the majority (82%) of patients caused by war time injuries. Fractures and stab wounds were also common causes of a.v. fistulas. The location of a.v. fistulas was in about 50% in the lower extremities and only in 3% in the trunk. As to therapy - in contrast to the older quadruple ligature - the separation method should be the method of choice. The repair in arterio-venous fistulas should be done as early as possible. The operative cure rate in our series was 96%.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
6/9. Iatrogenic postoperative left ventricular outflow tract obstruction.A 56-year-old female, who underwent aortocoronary bypass graft for occlusion of anterior descending artery is reported, who postoperatively developed a harsh systolic murmur, mitral regurgitation, and intraventricular systolic pressure gradient suggestive of hypertrophic subaortic stenosis. The above findings were due to the administration of dobutamine hydrochloride for hypotension in association with afterload reduction (intra-aortic balloon pumping) and disappeared almost immediately after left ventriculography (volume load).- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
7/9. Iatrogenic ruptures of the stomach after balloon tamponade. Two case reports: viscoelastic model.Two cases of gastric rupture as a rare complication of balloon tamponade for esophageal varices are presented. In both cases, the rupture was caused by instillation of irrigation fluid without previous aspiration of stomach contents. In an experimental study, the stomachs of 11 corpses were filled with water to determine rupture pressure and volume. The mean rupture pressure was 73 /- 13 mm Hg (9.7 /- 1.7 kPa) and the mean rupture volume was 2,670 /- 410 ml. A viscoelastic model was used for the representation of the relations between pressure and volume as well as pressure and time. Measured values are significant particularly for the explanation and medicolegal evaluation of iatrogenic ruptures of the stomach that occur during gastric lavage, positive pressure respiration, incorrect intubation, or forced mask respiration during resuscitation.- - - - - - - - - - ranking = 3keywords = volume (Clic here for more details about this article) |
8/9. Iatrogenic compartment syndrome from hypertonic saline injection in Bier block.A case study of an iatrogenic forearm compartment syndrome is presented. The patient underwent intravenous regional anesthesia (Bier's block) for an attempted closed reduction of a Bennett's fracture. Hypertonic saline (23.4%) was inadvertently used as a lidocaine diluent for the Bier's block, and after tourniquet release, the patient developed signs and symptoms of an acute compartment syndrome. An emergent fasciotomy was required. A review of the theoretical pathogenesis of compartment syndrome resulting from intravenous injection of hypertonic saline is presented. While vein sclerosis from i.v. hypertonic saline may play a role in the development of a compartment syndrome, we speculate that the major factor was an increase in the extracellular tissue fluid volume resulting from osmotic equilibrium after the tourniquet was released. The need for meticulous attention to details when performing this technique is emphasized.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
9/9. Management of hyperstimulation syndrome.A case of hyperstimulation syndrome secondary to Pergonal therapy is presented. Successful management was based principally on severe sodium and fluid restriction without the use of volume expanders. The rationale for this therapeutic approach is presented and discussed. Although this iatrogenic disease should be virtually eliminated with the monitoring of daily urinary estrogens, severe hyperstimulation may still occur as a result of laboratory error.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |