1/8. Controlled tamponade of severe presacral venous hemorrhage: use of a breast implant sizer.Hemorrhage from the presacral venous plexus is a potentially life-threatening complication of pelvic operations. The morbidity and mortality that stems from severe hemorrhage has led to the development of various hemostatic techniques. Although suture ligature, packing, and placement of tacks can be very effective, they can often be unsuccessful. When these conventional hemostatic techniques fail, alternative approaches are required. We describe the successful use of an expandable breast implant sizer and outline the practical, theoretical, and financial advantages of applying this technique when more conservative approaches have failed.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
2/8. Video-assisted thoracic surgery for mediastinal extramedullary haematopoiesis.Extramedullary haematopoiesis is a rare cause of an intrathoracic mass. We report a case of posterior mediastinal extramedullary haematopoietic mass in a 50-year-old man who presented with non-specific symptoms and a paravertebral mass on chest X-ray. Diagnosis was achieved by using video-assisted thoracic surgery.- - - - - - - - - - ranking = 0.052407275166538keywords = chest (Clic here for more details about this article) |
3/8. The inadvisability of thoracoscopic lung biopsy on patients with pulmonary hypertension.The use of video-assisted thoracoscopic surgery (VATS) sometimes leads to additional and unnecessary risks compared with thoracotomy. We report a troubling case of VATS lung biopsy in a 43-year-old woman with mild pulmonary hypertension. A progressive elevation of pulmonary artery pressure (PAP) was noted after the commencement of right unilateral ventilation. When the systolic PAP reached 90 mm Hg (390 min after induction of anesthesia), a massive blood discharge through the chest drain occurred. At repeat thoracotomy, continuous blood spouting was seen from > 10 of the surgical sites. It was supposed that the endoscopic staplers were unable to maintain hemostasis with such a high PAP.- - - - - - - - - - ranking = 0.052407275166538keywords = chest (Clic here for more details about this article) |
4/8. Late bleeding from right internal mammary artery after HeartMate left ventricular assist device implantation.Postoperative bleeding is one of the major complications after implantation of left ventricular assist devices. We experienced 5 unusual cases, which had bleeding from the right internal mammary artery between 5 and 69 days after implantation of a HeartMate (Thoratec Corporation, Pleasanton, CA) device. It was evident that the outflow graft had eroded through the vessel. Sudden decreases in device flow, hypotension, bleeding from the driveline or chest tube sites, and a drop in hematocrit were the initial manifestations. Chest roentgenogram and transthoracic echocardiography were effective in identifying hemothorax and cardiac tamponade. Four out of 5 patients survived to heart transplantation and were discharged from the hospital. When identified and treated appropriately, this complication does not impair patient outcome.- - - - - - - - - - ranking = 0.052407275166538keywords = chest (Clic here for more details about this article) |
5/8. Large extrapleural hematoma in an anticoagulated patient after a thoracic blunt trauma.We report the 7th case of a traumatic extrapleural hematoma that developed in an anticoagulated patient with a thoracic blunt trauma and rib fractures, and required an emergency surgical treatment. Extrapleural hematoma is a rare and life-threatening condition characterized by a collection of blood between the pleura parietalis and the endothoracic fascia. Related symptoms and chest x-ray findings are not characteristic and may present several hours after the injury, leading to delayed diagnosis and treatment. Etiological, surgical and prognostic implications of this finding are briefly discussed.- - - - - - - - - - ranking = 0.052407275166538keywords = chest (Clic here for more details about this article) |
6/8. Disseminated intravascular coagulopathy: manifestations after a routine dental extraction.Clinical signs and symptoms of acute disseminated intravascular coagulopathy (DIC) include bleeding from body orifices, such as the nose, mouth, or ear, bleeding from an intravenous (IV) site, areas of ecchymosis, or blood in the urine or stool. The underlying disease triggering DIC usually determines the clinical presentation. However, patients with chronic DIC (compensated DIC) may possess subclinical signs and symptoms, and the bleeding disorder may only be identified through laboratory findings. In this compensated form, the triggering factor is exposed slowly and in small amounts (seen in malignancies and vasculitis), allowing replenishing of the augmented factors by the liver, adequate reticuloendothelial clearance of fibrin degradation products, and increased production of platelets, which prevent secondary fibrinolysis and the signs of bleeding. 1,4 We report a case of an 82-year-old male who presented to the emergency room 24 hours after a routine dental extraction with bleeding from the tooth socket, severe hypotension, and presence of ecchymosis on his chest. Clinical and radiographic exam revealed multiple thoracic and abdominal aortic aneurysms, as well as infrarenal and iliac aneurysms, continuous oral hemorrhage, and a unique presentation rarely documented in the literature: a bleeding tooth socket as the initial clinical sign and presentation of DIC.- - - - - - - - - - ranking = 0.052407275166538keywords = chest (Clic here for more details about this article) |
7/8. Recombinant factor viia for refractory bleeding after cardiac surgery secondary to anticoagulation with the direct thrombin inhibitor lepirudin.A 56-year-old man with heparin-induced thrombocytopenia with thrombosis syndrome (HITTS) received anticoagulation with recombinant hirudin (lepirudin) for emergency coronary artery bypass graft (CABG) surgery and aortic valve replacement. The patient experienced life-threatening refractory bleeding that was successfully treated with recombinant factor viia. He had a history of infective endocarditis that resulted in severe aortic insufficiency, three-vessel coronary artery disease, and acute renal failure requiring hemodialysis. The patient was transferred from another hospital for the emergency surgery, but before his transfer, he developed HITTS secondary to therapeutic heparin for a deep vein thrombosis of the lower extremity. The presence of HITTS, the urgent nature of the case, and the availability of the direct thrombin inhibitor led the surgical team to select lepirudin for anticoagulation to facilitate cardiopulmonary bypass. After separation from cardiopulmonary bypass, the patient was in a coagulopathic state due to the inability to reverse the lepirudin and the slowed elimination of the drug secondary to inadequate renal function. As a result, the patient experienced excessive generalized oozing that was unresponsive to traditional therapies and blood product transfusions. Recombinant factor viia 35 microg/kg was given as rescue therapy. The bleeding slowed, which allowed placement of chest tubes and closing of the sternum. The patient was transferred to the intensive care unit in stable condition with no evidence of thrombosis in the freshly placed bypass grafts or on the bioprosthetic valve. Recombinant factor viia appears to be a suitable option as salvage therapy in patients with refractory bleeding secondary to anticoagulation with a direct thrombin inhibitor during cardiac surgery.- - - - - - - - - - ranking = 0.052407275166538keywords = chest (Clic here for more details about this article) |
8/8. Bleeding following retropubic prostatectomy: simple digital rectal pressure could be lifesaving.PURPOSE: A technique to control venous bleeding after retropubic prostatectomy is described. MATERIALS AND methods: A man underwent retropubic prostatectomy for an enlarged benign prostate following which hemorrhage occurred. RESULTS: After failure of other more traditional methods of hemostasis, the bleeding was stopped by direct anterior digital rectal pressure. CONCLUSIONS: Simple digital rectal pressure is a safe, effective and logical method of controlling venous bleeding from the dorsal venous or other plexus between the rectum and symphysis pubis.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |