1/36. Massive postoperative swelling of the tongue: manual decompression and tactile intubation as a life-saving measure.Massive swelling of the tongue due to haemorrhage is a rare but potentially fatal complication secondary to trauma, surgery, tumour invasion or uncontrolled anticoagulant therapy. This article presents a report of bleeding from the left lingual artery secondary to elective excision of a lipoma of the floor of the mouth and subsequent life-threatening upper airway obstruction. In this case, the upper airway obstruction was managed by manual decompression of the tongue and tactile nasal intubation. To our knowledge this case provides the first description of using this method in life-threatening upper airway obstruction caused by massive haemorrhagic swelling of the tongue.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
2/36. Effect of the administration of recombinant activated factor vii (rFVIIa; NovoSeven) in the management of severe uncontrolled bleeding in patients undergoing heart valve replacement surgery.Recombinant activated factor vii (rFVIIa; NovoSeven, Novo Nordisk A/S, Bagsvaerd, denmark) is being increasingly used to secure haemostasis in difficult clinical situations. The role of rFVIIa in the treatment of patients undergoing open-heart surgery for valvular heart disease was evaluated in an open pilot study. Study objectives included evaluation of blood loss, haemostatic effect and safety and laboratory parameters following rFVIIa administration. To date, we have treated five patients (one child aged 2.5 years and four adults) undergoing surgical procedures including arterial switch, closure of atrial septal defect and De Vega's procedure (mitral valve replacement with tricuspid valve repair). Four patients received rFVIIa intraoperatively, while the fifth received it postoperatively. Satisfactory haemostasis was achieved with a single dose (30 microg/kg) of rFVIIa. Four hours after treatment mean blood loss was 262.5 ml for adults (220-334 ml) and 85 ml for the child. No significant adverse events were reported. Laboratory parameters indicated a mean 18.5-fold (range 3.7-42) increase in FVII levels at 30 min postinjection and a mean reduction of 12 s (range 3-39 s) in prothrombin time. In conclusion, rFVIIa represents an effective and well-tolerated treatment for serious bleeding episodes both during cardiac surgery and postoperatively.- - - - - - - - - - ranking = 0.027291881136916keywords = duct (Clic here for more details about this article) |
3/36. Macular hemorrhage after laser in situ keratomileusis for high myopia.We describe 2 women with high myopia of -12.0 and -18.0 diopters who presented with myopic macular hemorrhages 1 and 4 days, respectively, after being treated by laser in situ keratomileusis (LASIK). One hemorrhage was related to a pre-existing choroidal neovascularization and the other to the presence of lacquer cracks. The hemorrhages resolved but resulted in a permanent decrease in vision. A careful fundus examination should be conducted before performing LASIK in highly myopic patients. In cases of similar macular pathology, fluorescein angiography should be done before LASIK.- - - - - - - - - - ranking = 0.027291881136916keywords = duct (Clic here for more details about this article) |
4/36. Severe postoperative hemorrhage attributed to single-dose parenteral ketorolac-induced coagulopathy.ketorolac is a nonsteroidal antiinflammatory drug that has been used as a postoperative analgesic since its introduction in the US in 1990. Although hemorrhagic side effects secondary to its use have been consistently described in the medical literature, its attendant complications have been commonly unappreciated by the medical profession. Two catastrophic, near-fatal, hemorrhagic postoperative events are described in which the use of ketorolac was unquestionably contraindicated.- - - - - - - - - - ranking = 0.027291881136916keywords = duct (Clic here for more details about this article) |
5/36. DDAVP (desmopressin; 1-deamino-cys-8-D-arginine-vasopressin) treatment in children with haemophilia B.We tested the response to desmopressin (1-deamino-cys-8-D-arginine-vasopressin; DDAVP) in four patients with haemophilia B [factor ix (F IX) at diagnosis 1.4-5%]. The activated partial thromboplastin time (aPTT) was significantly shortened in all patients. Although there was an up to 1.4-fold increase in F IX levels in three patients, maximal F IX activity remained below 10%. Much more prominent were the increases in F VIII (three- to fourfold), in von willebrand factor antigen (VWF:Ag; 2.5-fold) and particularly in VWF collagen-binding activity (VWF:CBA; fivefold). These changes were reflected by the prophylactic efficacy of DDAVP for dental surgery. After pretesting, DDAVP could be a useful drug for reducing the need for plasma products for prevention of minor surgical bleeding in patients with mild to moderate haemophilia B.- - - - - - - - - - ranking = 0.027291881136916keywords = duct (Clic here for more details about this article) |
6/36. Late lethal secondary hemorrhage after laser supraglottic laryngectomy.Since 1971, a number of articles have been published regarding the complications encountered with laser surgery of the larynx. Most investigations focus on complications such as accidental burns caused by the reflection of the laser beam, endotracheal explosion, special anesthesiologic problems, edema of the mucosa leading to airway obstruction, and abnormal scar formation with functional problems. Secondary hemorrhage has played a subordinate role, and in the few articles that have focused on it, cases requiring postoperative treatment have been reported only sporadically. All of these cases occurred within the first postoperative week, and no case resulting in the death of a patient was reported. We describe a patient in whom a lethal secondary hemorrhage occurred 10 days after a laser supraglottic laryngectomy. Because of the increase of laser applications in the treatment of laryngeal carcinoma, similar complications may be encountered. We comment on possible pathophysiological mechanisms and consequences.- - - - - - - - - - ranking = 0.33333333333333keywords = obstruction (Clic here for more details about this article) |
7/36. Gingko biloba: a case report of herbal medicine and bleeding postoperatively from a laparoscopic cholecystectomy.An increasing variety of alternative health care products (defined as "over-the-counter," nonprescribed herbal medicines) are taken by patients for a plethora of reasons. Unfortunately these self-prescribed remedies are seldom considered by the patient to be medications and as a result it has been noted that 70 per cent of patients do not reveal herbal use to their allopathic practitioners or hospital personnel. The rapid growth of this herbal self-therapy has important implications for the practice of surgery. A case of post-laparoscopic cholecystectomy bleeding in a patient taking Gingko biloba is reported. This preparation has been reported to cause spontaneous bleeding and may interact with anticoagulants and antiplatelet agents. Other herbal medicines have also been associated with potential increased bleeding including garlic, feverfew, ginger, and ginseng. It is vital for surgeons to be apprised of all substances ingested by patients, to be cognizant of their potential adverse effects and drug interactions, and to be familiar with their therapeutic modality, all of which will help to optimize therapeutic approaches and improve patient outcome.- - - - - - - - - - ranking = 0.027291881136916keywords = duct (Clic here for more details about this article) |
8/36. uterine artery malformation as a hidden cause of severe uterine bleeding. A case report.BACKGROUND: uterine artery malformations are rare, life-threatening conditions. Clinical suspicion is essential for a prompt diagnosis and treatment. CASE: A 29-year-old woman was evaluated for severe uterine bleeding that started abruptly two weeks after elective termination of pregnancy. She underwent dilatation and curettage of the uterine cavity for retained products of conception. The patient presented to the emergency room two weeks later with abrupt onset of profuse vaginal bleeding that would spontaneously subside. magnetic resonance angiography revealed a left uterine artery malformation that was successfully embolized. CONCLUSION: uterine artery malformations should be suspected when heavy vaginal bleeding occurs in spite of medical or surgical treatment.- - - - - - - - - - ranking = 0.027291881136916keywords = duct (Clic here for more details about this article) |
9/36. Severe postoperative haemorrhage and airway obstruction following high-dose enoxaparin.Unfractionated heparin infusion may be a more suitable choice of anticoagulant treatment in patients with venous thromboembolism in the immediate postoperative period.- - - - - - - - - - ranking = 1.3333333333333keywords = obstruction (Clic here for more details about this article) |
10/36. Severe hemorrhagic complication due to acquired factor V inhibitor after single exposure to bovine thrombin product.Hemorrhagic complications have been reported after repeated exposures to bovine thrombin products due to development of factor V inhibitors. Our patient underwent emergency repair of acute aortic dissection and coronary artery bypass grafting. The patient developed leg wound infection at the saphenous vein harvest site, which was debrided and left open. Attempt to reclose the leg wound 1 month later was complicated by a life-threatening hemorrhage with markedly elevated activated partial thromboplastin time. There was no evidence of infection or disseminated intravascular coagulation, and further study identified low factor V level with positive factor V inhibitor. Treatment with plasmapheresis and steroid successfully reversed the coagulopathy. Detailed case review failed to reveal exposure to any thrombin products other than the one used for the aortic dissection repair. This case was unusual because only a single exposure to this product resulted in severe hemorrhagic complication 1 month after surgery.- - - - - - - - - - ranking = 0.19104316795841keywords = duct (Clic here for more details about this article) |
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