1/43. A hypothesis to explain the occurence of inner myometrial laceration causing massive postpartum hemorrhage.BACKGROUND: Inner myometrial lacerations were found in three patients who developed uncontrollable postpartum massive bleeding despite the usual treatment for uterine atony. Because all the patients suffered from hemorrhage shock and their medical status deteriorated, their uteri were surgically removed to stop bleeding. After removal, one of them died. postpartum hemorrhage was caused by inner myometrial laceration. We hypothesized a cause of inner myometrial laceration, using the three resected uteri, an assumed model of the uterine body, and 34 women. methods: The subjects were 37 women, of whom three were patients with inner myometrial laceration, 23 were women without inner myometrial laceration who underwent cesarean section, and 11 were women in the first stage of labor. The three resected uteri were examined both macroscopically and microscopically. We measured the thickness of the wall of the uterine muscle at the widest point of the uterine corpus and the thickness of the myometrial wall at a transverse section of the uterine cervix, as well as the radius of the inner lumen at the widest point of the uterus in 23 women during cesarean section. We also measured the thickness of the myometrial wall at the widest point of the uterine corpus in 11 women at the end of the first stage of labor during ultrasonic examination. The data were then used to estimate the stress on the uterine muscle. RESULTS: The stress on the uterine cervix was stronger than that on the uterine corpus during labor. When the stress on the uterine muscle is stronger than a specific value, inner myometrial lacerations develop on the right and/or left side of the uterine cervix. These lacerations may involve large vessels. CONCLUSIONS: We have discovered another cause of postpartum hemorrhage which we have named inner myometrial laceration. These lacerations appeared to result from a strong stress on the uterine cervix caused by an abnormal rise in intrauterine pressure during labor.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/43. Penetrating injury to the great vessels. Case reviews and management approaches for West Indian surgeons.Penetrating injury to the great vessels in the thorax is an increasingly common and alarming clinical scenario in the west indies, and in jamaica in particular. The management of these often life-threatening injuries involves careful surgical planning and prompt operation, with close adherence to the principles of adequate pre-operative stabilization and investigations, and intra-operative exposure and repair. While this may be more easily accomplished in tertiary care centres, the geographical realities of the west indies require that every surgeon be familiar with these techniques. A report of the management of some recent cases is followed by a review of the subject and recommended treatment strategies are outlined.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
3/43. Left internal mammary artery graft perforation repair using polytetrafluoroethylene-covered stents.The increase in the use of the left internal mammary artery (LIMA) as graft of choice to the left anterior descending coronary artery for conventional and minimally invasive coronary artery bypass surgery has led to an increased incidence of LIMA pathologic lesions early after surgery. The lesion, commonly located in the body of the LIMA graft, is usually caused by mechanical injury during harvesting of the vessel. In this context, percutaneous intervention with stent implantation can be complicated by vessel rupture, which usually requires emergency surgical repair. We describe two cases of stent implantation in newly placed LIMA grafts complicated by vessel rupture, which were successfully repaired using polytetrafluoroethylene-covered stents.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
4/43. Missiles in the heart causing coronary artery disease 44 years after injury.We present a case of two missiles in the heart causing coronary artery disease with first onset 44 years after the injury. The missiles were close to the right coronary artery and the left anterior descending coronary artery. The missiles initiated local arteriosclerosis in these vessels, with an extremely stretched time frame from injury to the onset of symptoms for coronary artery disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/43. Coil embolization of intradural pseudoaneurysms caused by arterial injury during surgery: report of two cases.Intradural pseudoaneurysms arose in two patients as a result of arterial injury incurred during surgery. In the first patient, the pseudoaneurysm developed in the middle cerebral artery, at the site of vessel perforation during aneurysmal surgery. In the second patient, the pseudoaneurysm developed in the anterior communicating artery after removal of a tuberculum sellae meningioma. These aneurysms had small ostia and were successfully embolized with electrolytically detachable coils. The clinical features and the treatment of intracranial pseudoaneurysms are discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/43. Recovery of an impalement and transfixion chest injury by a reinforced steel bar.A 36-year-old man was admitted to our hospital because of impalement injury due to a downwards fall upon some reinforced steel rods. An emergency operation was performed using percutaneous cardiopulmonary support (PCPS). The steel rods were taken out in the operating room. The heart, great vessels, vertebrae, and spinal cord were not involved in the impalement wounds. We performed a bronchoplasty of the torn and separated right main bronchus, and repaired the impaled left lung without any pulmonary resection. He recuperated without sequelae.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/43. Different types of coronary artery wall injury following cutting balloon angioplasty.The cutting balloon is a device that enlarges atherosclerotic coronary arteries by a combination of plaque incision and dilation. This peculiar mechanism would account for a better immediate result achieved at the cost of minimal vessel wall trauma. Coronary perforation is however a potential complication. No systematic data have been reported as to which angiographic lesion characteristic may predict the occurrence of complications after cutting balloon angioplasty. This case report study deals with different types of coronary artery wall injury complicating cutting balloon angioplasty and detected by intravascular ultrasound.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/43. Coil embolization of a left pulmonary artery pseudoaneurysm after penetrating injury.PURPOSE: To report successful coil embolization of a rare traumatic pulmonary artery pseudoaneurysm. CASE REPORT: A 57-year-old man developed a pulmonary artery pseudoaneurysm 14 days after he had been stabbed with a knife in the left lung. The pseudoaneurysm was diagnosed with contrast-enhanced computed tomography and confirmed by pulmonary arteriography. Coils were deployed in the feeding vessels to occlude the defect. CONCLUSIONS: pulmonary artery pseudoaneurysm after penetrating chest injury can be treated by percutaneous catheter embolization, which is less invasive than surgery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/43. Percutaneous management of concomitant post-traumatic high vertebrovertebral and caroticojugular fistulas using balloons, coils, and a covered stent.PURPOSE: To describe the endovascular management of vertebrovertebral and caroticojugular fistulas in the same patient using a combination of endovascular techniques including covered stent placement in the high extracranial internal carotid artery. CASE REPORT: A 22-year-old man presented with ipsilateral vertebrovertebral and caroticojugular fistulas at the C1 level several weeks after sustaining a solitary penetrating knife injury below the right ear. The right vertebral artery was sacrificed after a failed endovascular attempt to close the vertebrovertebral fistula. The caroticojugular fistula was treated with a self-expanding covered stent (Wallgraft) with exclusion of the fistula and preservation of flow through the carotid artery. CONCLUSIONS: Preservation of the extracranial arteries should be the preferred goal of treatment in traumatic extracranial arteriovenous fistulas. The use of covered stents in the extracranial vessels can accomplish this goal.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/43. 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) |
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