1/15. Fatal pulmonary thromboembolism in gastrectomy intraoperative procedures by gastric adenocarcinoma: case report.The case of a patient with gastric adenocarcinoma with indication for gastrectomy is reported. The surgery took place without complications. A palliative, subtotal gastrectomy was performed after para-aortic lymph nodes compromised by neoplasm were found, which was confirmed by pathological exam of frozen sections carried out during the intervention. At the end of the gastroenteroanastomosis procedure, the patient began to show intense bradycardia: 38 beats per minute (bpm), arterial hypotension, changes in the electrocardiogram's waveform (upper unlevelling of segment ST), and cardiac arrest. resuscitation maneuvers were performed with temporary success. Subsequently, the patient had another circulatory breakdown and again was recovered. Finally, the third cardiac arrest proved to be irreversible, and the intra-operative death occurred. Necropsy showed massive pulmonary embolism. The medical literature has recommended heparinization of patients, in an attempt to avoid pulmonary thromboembolism following major surgical interventions. However, in the present case, heparinization would have been insufficient to prevent death. This case indicates that it is necessary to develop preoperative propedeutics for diagnosing the presence of venous thrombi with potential to migrate, causing pulmonary thromboembolism (PTE). If such thrombi could be detected, preventative measures, such as filter installation in the Cava vein could be undertaken.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
2/15. Pulmonary thromboembolism during transurethral resection of the prostate.Although perioperative pulmonary thromboembolism (PTE) is a common complication of surgery, intraoperative pulmonary thromboembolism is unusual. We report the occurrence of PTE during transurethral resection of the prostate. We believe this to be the first report of such a case.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
3/15. Immediate postoperative thrombolytic therapy: an aggressive strategy for neurologic salvage when cerebral thromboembolism complicates carotid endarterectomy.A 42-year-old man with a high-grade left internal carotid artery (ICA) stenosis demonstrated on a duplex scan was referred to us. A cerebral arteriogram confirmed a greater than 90% left internal carotid stenosis, but with the unexpected finding of a moderate amount of thrombus in the proximal ICA. He underwent emergent left carotid endarterectomy, but during the operation, only a small amount of thrombus was identified as adherent to the atherosclerotic plaque. he awakened in the operating room with a dense right hemiplegia and aphasia. Immediate reexploration demonstrated a patent endarterectomy site, a distal thromboembolectomy was performed without extraction of thrombus, and urokinase (250,000 Units) was infused into the distal ICA. He reawakened with an unchanged right hemiplegia and aphasia. The patient then underwent an urgent postoperative carotid and cerebral arteriogram that demonstrated an embolus to the middle cerebral artery. he was treated with the superselective infusion of urokinase (500,000 Units), with almost complete resolution of the clot. Over the course of the next 48 hours, the patient made a nearly complete neurologic recovery, and he was discharged from the hospital with only a slight facial droop. At 2 months' follow-up he was completely neurologically healthy. To our knowledge this is the first reported case of urokinase administered in the immediate postoperative period in the angiography suite to treat a thromboembolus complicating a carotid endarterectomy.- - - - - - - - - - ranking = 0.66666666666667keywords = thromboembolism (Clic here for more details about this article) |
4/15. Pulmonary thromboembolism during liver transplantation: possible association with antifibrinolytic drugs and novel treatment options.The authors describe two cases of massive intraoperative pulmonary thromboembolism resulting in cardiovascular collapse during liver transplantation. The potential role of antifibrinolytic drugs is discussed, along with the use of treatment modalities not previously applied in this setting.- - - - - - - - - - ranking = 0.83333333333333keywords = thromboembolism (Clic here for more details about this article) |
5/15. Intracoronary thrombolysis and intraaortic balloon counterpulsation for the emergency treatment of probable coronary embolism after repair of an acute ascending aortic dissection.IMPLICATIONS: This report shows that if diffuse coronary thromboembolism is encountered during ascending aortic dissection-repair, the option of combining single-bolus, intracoronary thrombolysis with intraaortic balloon counterpulsation should be considered.- - - - - - - - - - ranking = 0.16666666666667keywords = thromboembolism (Clic here for more details about this article) |
6/15. Intravascular thrombosis and thromboembolism during liver transplantation: antifibrinolytic therapy implicated?This case report describes a patient who underwent orthotopic liver transplantation and developed extensive hyperacute venous and arterial intravascular thromboses and thromboemboli intraoperatively. The patient was receiving antifibrinolytic therapy with aprotinin. The safety of routine aprotinin therapy in liver transplantation is examined. The value of the thrombelastograph (TEG) as a qualitative assessment of the coagulation system is emphasized.- - - - - - - - - - ranking = 0.66666666666667keywords = thromboembolism (Clic here for more details about this article) |
7/15. Retrograde cerebral perfusion with circulatory arrest in aortic arch aneurysms.Two surgical cases of aortic arch aneurysms are presented. Retrograde (venoarterial) cerebral perfusion during circulatory arrest under deep hypothermia was performed to evacuate air and debris in cerebral vessels and preserve cerebral tissue. On postoperative day 1, the patients were conscious and alert with no neurological deficit. This technique is simple and can be applied during standard cardiopulmonary bypass. The technique is useful to avoid cerebral air and thromboembolisms.- - - - - - - - - - ranking = 0.16666666666667keywords = thromboembolism (Clic here for more details about this article) |
8/15. Intra-arterial thrombolysis for left middle cerebral artery embolic stroke during percutaneous mitral commissurotomy.Cerebral thromboembolism is a serious complication. Early recognition and rapid reperfusion can prevent long-term neurological morbidity. We report a case of successful intra-arterial thrombolysis for middle cerebral artery embolic stroke during percutaneous mitral commissurotomy, which resulted in complete neurological recovery.- - - - - - - - - - ranking = 0.16666666666667keywords = thromboembolism (Clic here for more details about this article) |
9/15. Acute hypoxemia after repositioning of patient: a case report.Hypoxemia occurred after induction of anesthesia and repositioning in a patient undergoing hip pinning. The patient had previously presented to the emergency department with multiple fractures and hemodynamic instability sustained in a motor vehicle accident. Three days after admission to the intensive care unit the patient remained intubated with respiratory insufficiency and had developed acute respiratory distress syndrome with marginal oxygen saturation. The patient was transported to the operating room for hip pinning, and anesthesia was induced with midazolam, fentanyl, vecuronium, and isoflurane. When the patient was turned to the left lateral position, oxygen saturation suddenly worsened from 94% to 78%, with Pao2 from arterial blood gas measured at 54 mm Hg. The patient was returned to the supine position, but despite maneuvers to improve oxygen saturation, the patient's saturation remained below 87% and pulmonary thromboembolism was suspected. However, other signs of pulmonary embolus such as hemodynamic deterioration and right ventricular dysfunction were not present. Chest radiographs demonstrated severe left lung atelectasis, and surgery was postponed. Upon return to the intensive care unit, fiberoptic bronchoscopy was performed, and a large mucous plug was removed from his left upper and lower lobes, with subsequent improvement of Pao2 to 77 mm Hg with an oxygen saturation of 94%.- - - - - - - - - - ranking = 0.16666666666667keywords = thromboembolism (Clic here for more details about this article) |
10/15. Surgical treatment for primary cardiac leiomyosarcoma causing right ventricular outflow obstruction.A 55-year-old man was admitted to another hospital because of dry cough and dyspnea that rapidly worsened before admission. Chest computed tomography revealed a low-density mass that nearly obstructed the main pulmonary arterial trunk. Pulmonary thromboembolism was suspected and treated with catheter-directed thrombolysis therapy. Despite optimal thrombolysis and anticoagulant therapy, his symptoms persisted. He was referred for further examination and possible surgery for presumed pulmonary thromboembolism. The mass appeared more likely to be a tumor than a thrombus on careful analysis of the magnetic resonance imaging. At surgery, the anterior wall of the main pulmonary arterial trunk, the pulmonary valve, annulus, and the right ventricular outflow tract were all invaded by what was found to be a tumor and were resected under conventional cardiopulmonary bypass. The resected area was reconstructed with a 25-mm-diameter bioprosthetic valve and Xenomedica patch. Final pathological diagnosis was primary cardiac leiomyosarcoma involving the pulmonary valve. Postoperative course was uneventful, and he was discharged 11 days after surgery without adjuvant therapy because he refused it. Ten months later, the patient was well, but a chest X-ray revealed some coin lesions in the bilateral lung fields that were thought to be metastatic tumor.- - - - - - - - - - ranking = 0.33333333333333keywords = thromboembolism (Clic here for more details about this article) |
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