1/7. Use of intraligamentary anesthesia in a patient with severe hemophilia and factor viii inhibitor.This article reviews the therapeutic problems that arise in the dental management of hemophilia patients with inhibitor and suggests an anesthesia technique that may eliminate the need for factor replacement during restorative procedures. Intraligamentary anesthesia was used during restorative procedures that were performed throughout an 8-year period on a patient with factor viii inhibitor. Multiple restorative procedures were accomplished without the use of replacement factor and with no postoperative bleeding. This technique, in consultation with the patient's physician, may be performed by most general practitioners in their private offices.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Ipsilateral intracerebral hemorrhage following carotid stent-assisted angioplasty: a manifestation of hyperperfusion syndrome--a case report.A case of hyperperfusion syndrome manifested as intracerebral hemorrhage following carotid stent-assisted angioplasty while using intravenous abciximab is described. review of literature regarding hyperperfusion syndrome in patients undergoing carotid artery revascularization is presented. Possible mechanisms of hyperperfusion and the role of arterial hypertension, anticoagulation, and antiplatelet treatment in the genesis of hyperperfusion syndrome are discussed. Widening use of percutaneous carotid revascularization necessitates physicians' awareness of early recognition of this complication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Unusual presentation of factor xiii deficiency.factor xiii deficiency is a rare inherited bleeding disorder that is often difficult to diagnose. The standard screening tests are normal in these patients and their bleeding phenotype may be variable. We report the case of a 3-year-old girl who presented with an intracranial haemorrhage. Several confounding factors, such as the suspicion of an arteriovenous malformation and the development of a deep venous thrombosis, led to a delay in the diagnosis of factor xiii deficiency. Subsequently, her brother was also found to have severe factor xiii deficiency. This case highlights the importance of a detailed history and of screening families in which index cases have been identified. It should also remind physicians that bleeding disorders may have unusual presentations and should be sought when investigating unexplained bleeding.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Pontine hemorrhage after frontal craniotomy. Report of a case.This report describes the complication of pontine hemorrhage in a patient who had undergone supratentorial craniotomy for treatment of a frontal intracerebral hematoma. A literature review revealed no previous cases of pontine hemorrhage in this clinical scenario. Abnormal findings on neurological examination in the early postoperative period should alert the physician to the possibility of this complication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Successful reversal of deleterious coagulopathy by recombinant factor viia.Effective treatment of severe or uncontrolled bleeding is a challenge for physicians in the operating room and intensive care unit. However, even aggressive conventional therapy may ultimately fail in some patients. Administration of recombinant activated factor VII (rFVIIa) may be the only remaining therapeutic option to stop life-threatening coagulopathic bleeding. We here describe the clinical course of 5 patients exhibiting severe continuous bleeding that could not be stopped by surgical intervention and appropriate hemostatic management but resolved after a mean dose of 90 microg/kg of rFVIIa (range, 90-120 microg/kg). Four of the five patients recovered completely, and one patient died after developing sepsis in multiorgan failure. In all patients, bleeding from wound surfaces stopped within minutes of the administration of rFVIIa. Coagulation measurements improved, and transfusion requirements declined considerably. No adverse effects associated with rFVIIa were observed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Problems and pitfalls in providing acute and short-term pain relief with nonsteroidal anti-inflammatory agents.NSAIDs are extremely versatile and effective analgesics and anti-inflammatory agents that are generally very safe to use in young, healthy adults. However, physicians should be aware of those patients who are at greater risk of toxicity from their use and avoid or modify NSAID treatment in these individuals. Certain newer NSAIDs seem to offer lower gastric or renal toxicity and might be preferable in high-risk patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. antibiotic prophylaxis--Hobson's choice in burns management.antibiotic prophylaxis is a routine procedure in management of burns. As such it is a safe practice, yet unusual complications can occur with the use of even safest antibiotics and their emergency management may be life saving. Here we present a case of 35% second and third degree burns who was taken for a second sitting of stamp grafting for remnant raw areas, who was administered intraoperative prophylactic antibiotic, developed a series of unusual complications sequentially, which were life threatening. Prompt recognition of signs and symptoms of adverse reactions of the drug used and timely management resulted in the successful outcome. A good team effort by surgeon, anaesthetist and the physician was mandatory.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |