1/10. Symmetrical peripheral gangrene and dopamine.We describe a case of a 55-year-old man with hypovolemic shock who developed a symmetrical peripheral gangrene (SPG) on hands and feet. The SPG syndrome consists of sudden onset of symmetrical gangrene of the fingers, toes and rarely, the nose, upper lip, ear lobes or genitals without large vessel obstruction or vasculitis. Vasopressors have been implicated directly or as a contributory cause in many cases. In this case, dopamine was used with high dose (> 20 microg/kg/min) which is inappropriate in hypovolemic shock states. SPG might be a severe and rare complication of dopamine. Care should be taken with the use of dopamine in patients with shock.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/10. Symmetrical peripheral gangrene: association with noradrenaline administration.The syndrome of symmetrical peripheral gangrene is characterised by distal ischaemic damage in two or more extremities, without large vessel obstruction. Four patients with bilateral pedal ischaemia are described and their haemodynamic profiles presented. In all four cases the syndrome developed in association with noradrenaline administration, sepsis and DIC, despite a high cardiac output and a low calculated systemic vascular resistance index. Early treatment with epoprostenol was instituted in the final case and was successful.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/10. Postcoital haemoperitoneum: a cause for shock.Postcoital haemoperitoneum rarely occurs without evident vaginal injury. A 21-year-old second gravida woman presented to the ED in shock with a history of 8 weeks amenorrhoea and abdominal pain of 20 h duration. The ultrasound examination revealed a live intrauterine pregnancy and fluid in peritoneal cavity. There was a history of coitus 2 hours prior to the onset of pain. At laparotomy, more than 2 L of free blood was found in the peritoneal cavity. A small bleeding peritoneal vessel in pouch of Douglas was identified and ligated.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/10. Embolization of transected vertebral arteries in unstable trauma patients.The aim of this paper is to report our experience with coil embolization for the treatment of vertebral artery transection in unstable trauma patients. The course of four patients admitted to our units between 1998 and 2003 with traumatic injuries of the upper thorax or neck is described. All had unstable hemodynamic parameters at presentation. Emergent arteriogram revealed vertebral artery transection, which was managed by immediate coil embolization proximal to the injury site. Initial technical success was achieved in all four patients, with hemodynamic improvement. No further treatment or surgery to control the vessel injury was needed. There were no immediate or late complications of the procedure and no neurological sequelae. Emergency coil embolization is an effective endovascular technique for use in unstable patients with angiography findings of a transected vertebral artery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/10. Injuries to the large abdominal vessels during lumbar nucleotomy.The rare complication of iatrogenic damage to the large abdominal blood vessels during lumbar intervertebral disc operations is demonstrated by three case reports. A sudden decrease in blood pressure and tachycardia are major signs of such vessel lacerations. Due to a valve mechanism which prevents a dorsal blood leakage through the intervertebral space, early detection of this problem by the surgeon or anesthesiologist may prove to be difficult. myocardial infarction, pulmonary embolism, abnormal volume distribution after positioning, dysfunction of circulatory regulation due to anesthesia or faulty positioning, obstruction of the subclavian artery due to false placement of chest padding, all occur more frequently and therefore must be considered and excluded. A wrong interpretation of this acute occurrence carries a mortality of 70%. Even immediate intervention by vascular surgery shows a mortality rate of 50% for this uncommon emergency. In order to prevent the disastrous sequelae to this complication, blood vessel injury should be suspected for every unexplained intraoperative decrease in blood pressure during lumbar nucleotomy. Only a rapid termination of the operation and appropriate preparation for vascular surgery can lower the mortality of this rare occurrence.- - - - - - - - - - ranking = 7keywords = vessel (Clic here for more details about this article) |
6/10. Endoscopic injection treatment in patients with shock and gastrointestinal bleeding or stigmata of recent hemorrhage.Forty cases of upper gastrointestinal bleeding were studied. Twenty-three patients had shock and active bleeding (3 spurting, 12 oozing and 2 a clot with oozing) or stigmata of recent hemorrhage (4 with a clot and 2 with a visible vessel). Nineteen of these were submitted to endoscopic injection. In 4 cases with multiple acute hemorrhagic lesions and shock, and in 17 patients with stigmata of recent bleeding without shock, the technique was not carried out. None of the patients had a rebleed. One patient was submitted to surgery 24 hours after injection for a large acute gastric ulcer in the process of perforating, and died of pulmonary embolism 4 days later. No technique-related complications were observed. We believe endoscopic injection treatment might be the technique of choice in patients with shock and active bleeding or stigmata of recent hemorrhage of the upper gastrointestinal tract.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/10. Reversible hypovolaemic shock and myocardial ischaemia caused by contrast medium administered during diagnostic cardiac angiography. A case report.A 65-year-old white man with severe symptomatic four-vessel atherosclerotic coronary artery disease underwent selective coronary arteriography. Two hours after this procedure he developed hypovolaemic shock secondary to the hyperosmolar contrast medium, as well as severe angina pectoris accompanied by myocardial ischaemia. This diagnosis was established with the aid of Swan-Ganz catheterisation and the patient was successfully managed with intravenous fluid replacement and emergency coronary artery bypass graft surgery. Pathophysiological aspects are discussed with comments on the possible prevention of such a potentially life-threatening complication of selective coronary angiography.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/10. MAST: medical antishock trousers.MAST are a simple, safe and sound device with applicability in all shock states; they provide a number of benefits to the hypotensive patient. The main benefits seem to be autotransfusion of peripherally pooled blood originating from the MAST encased areas, increase in peripheral vascular resistance, external tamponade of bleeding vessels and an aid to stabilization of fractured bones of the pelvis and lower extremities. Because an area of hypoperfusion can lead to complications, the pathophysiologic effects of MAST must be understood. The greatest complications occur when MAST are too rapidly removed. They must be removed in an appropriate place by trained physicians under controlled conditions. The key is to deflate the MAST over a prolonged period of time using a gradual release of external pressure. Volume status and acid-base balance must be carefully monitored. In the last few years MAST have had an ever expanding role in both the pre-hospital and hospital phases of care of the critically ill and injured patients. All physicians involved in the care of these patients must be familiar with this device. Applied and removed properly, MAST will sustain blood pressure and save lives.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/10. liver infarction produced by dual vessels occlusion due to trauma and TAE: long follow up using CT, US, and MRI.The cause of liver infarction previously reported [1-4] are mainly due to occlusion of hepatic artery. Herein, we report the case of liver infarction resulted from simultaneous occlusion of hepatic artery and portal vein due to trauma and therapeutic transcatheter arterial embolization (TAE), and we followed up the infarcted lesion with computed tomography (CT), ultra sonography (US) and magnetic resonance imaging (MR imaging) until it disappeared.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
10/10. Massive intraperitoneal hemorrhage and hypovolemic shock due to rupture of a coronary vessel of a uterine leiomyoma: a report of two cases.Intraperitoneal hemorrhage due to uterine leiomyoma is extremely rare. Recently, we encountered such two cases and herein describe them. Case 1 involved a 34-year-old, nulliparous woman referred to our hospital because of a sudden onset of shock while she was playing a softball game. She had a large abdominal tumor and a hemoperitoneum, and was diagnosed as having a ruptured ovarian tumor. Exploratory laparotomy showed a rupture of the coronary vein of a large uterine leiomyoma. The patient was treated with myomectomy and did well postoperatively. Case 2 involved a 44-year-old, multiparous woman referred to our hospital because of sudden onset of lower abdominal pain while defecating. She had a uterine leiomyoma and a hemoperitoneum, and was diagnosed as having a ruptured splenic artery. Exploratory laparotomy showed rupture of the coronary artery of a uterine leiomyoma. The patient was treated with total abdominal hysterectomy and did well postoperatively. These cases suggest that intraperitoneal hemorrhage associated with uterine leiomyoma, although rare, should be considered in women with hypovolemic shock and a large pelvic mass.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
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