1/22. Internal iliac artery embolisation for intractable bladder haemorrhage in the peri-operative phase.Intractable haemorrhage from the bladder wall during transurethral resection of bladder tumour is uncommon but potentially catastrophic. Internal iliac artery embolisation is a minimally invasive technique, which is now widely practised to stop bleeding from branches of these arteries is situations including pelvic malignancy, obstetric and gynaecological emergencies and trauma. We report its successful use peri-operatively, in an unfit, elderly patient with uncontrolled bleeding.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/22. life-threatening haemorrhage following obturator artery injury during transurethral bladder surgery: a sequel of an unsuccessful obturator nerve block.In spite of prior blockade of the obturator nerve with 1% mepivacaine (8 ml) utilizing a nerve stimulator, violent leg jerking was evoked during transurethral electroresection of a bladder tumour approximately 1 h after the blockade in a 68-year-old man. The patient became severely hypotensive immediately following the jerking, and a large lower abdominal swelling concurrently developed. The urgent laparotomy indicated that the left obturator artery was severely injured by the resectoscope associated with the bladder perforation, causing acute massive haemorrhage. The patient recovered uneventfully after adequate surgery. Investigation of the literature suggested that both our nerve stimulation technique and anatomical approach were appropriate. It was therefore unlikely that our block resulted in failure because of an inappropriate site for deposition of the anaesthetic. However, consensus does not appear to have been obtained as to the concentration and volume of the anaesthetic necessary for prevention of the obturator nerve stimulation during the transurethral procedures. The concentration and volume of mepivacaine we used might have been too low and/or small, respectively, to profoundly block all the motor neuron fibres of the nerve. Alternatively, stimulation of the obturator nerve might occur because of the presence of some anatomical variant, such as the accessory obturator nerve or its abnormal branching. In conclusion, some uncertainty appears to exist in the effectiveness of the local anaesthetic blockade of the obturator nerve. In order to attain profound blockade of the motor neuron fibres of the obturator nerve and thereby prevent the thigh-adductor muscle contraction which can lead to life-threatening situations, we recommend, even with a nerve stimulator, to use a larger volume of a higher concentration of local anaesthetic with a longer duration in the obturator nerve block for the transurethral procedures.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
3/22. Use of recombinant factor viia (NovoSeven) in a haemophilia A patient with inhibitor in kuwait.Development of inhibitors is a known complication in some haemophiliacs receiving coagulation factor replacement therapy. We report on the successful management of a young boy with haemophilia A with inhibitor using recombinant factor viia. We had failed to control bleeding in this patient following his circumcision, despite infusion with high doses of factor viii concentrate for 2 weeks. Recombinant factor viia is a useful 'factor viii bypassing agent' for the control of bleeding in patients with haemophilia A and B who develop inhibitors. We suggest that severely affected haemophiliacs should be absolved of ritual circumcision as a protective measure against what might become a life-threatening haemorrhage - especially in those with inhibitors.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
4/22. Effect of haemorrhage on plasma propofol concentrations in a patient undergoing orthotopic liver transplantation.We report a patient who underwent repeat orthotopic liver transplantation complicated by intraoperative blood loss of more than 59 litre. During liver transplantation, a constant rate propofol infusion was given and plasma samples were obtained throughout the procedure for propofol assay. Before the anhepatic phase of the procedure, plasma propofol concentrations reached a plateau at 1 microgram ml-1, and these concentrations were consistent with those predicted using a pharmacokinetic model. During the anhepatic phase of surgery, serum propofol concentrations increased progressively and exceeded those predicted by the pharmacokinetic model. Large intravascular fluid shifts associated with blood loss and subsequent blood replacement influenced plasma propofol concentrations observed in this patient.- - - - - - - - - - ranking = 0.8keywords = haemorrhage (Clic here for more details about this article) |
5/22. Fatal retroperitoneal haemorrhage: an unusual complication of percutaneous endoscopic gastrostomy.A 93-year-old lady with dementia, neurological dysphagia and aspiration pneumonia, died from massive retroperitoneal haemorrhage which developed as a rare and, it is believed, hitherto unreported, complication of percutaneous endoscopic gastrostomy (PEG), which was performed for feeding purposes. It is postulated that the initial, unsuccessful attempt at needle puncture of the stomach, under endoscopic guidance, had resulted in iatrogenic perforation and laceration of the splenic and superior mesenteric veins close to their confluence with the portal vein. It would also appear that dense fibrous adhesions between the pyloro-antral region of the stomach and the posterior hepatic surface had altered the immediate anatomical relations of the stomach in such a manner as to have predisposed to these events.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
6/22. Postpartum acquired haemophilia: clinical recognition and management.Postpartum acquired haemophilia is a rare but serious complication of an otherwise normal pregnancy. patients usually present with postpartum haemorrhage (PPH) or uncontrolled bleeding following surgical interventions, which fail to respond to conservative treatment. A high index of clinical suspicion along with early laboratory diagnosis and prompt institution of appropriate therapy is essential for the management of acute bleeding episodes. Our patient, a 32-year-old female, presented with severe PPH and shock. She had undergone dilation and curettage three times, with subsequent total abdominal hysterectomy and internal iliac artery ligation, before she was diagnosed with acquired haemophilia (factor viii autoantibodies) and an inhibitor level of 8 Bethesda units (BU). The patient underwent an abdominal laparotomy for removal of the abdominal packing used in the previous operation, and blood and blood clots, and was given FEIBA(R) therapy. The patient responded to these measure and the factor viii inhibitor level decreased to 2 BU at the time of discharge 10 weeks later.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
7/22. Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature.The significant increase in the use of alternative medicine in general and the herbal and dietary supplement in particular represents a challenge to the health care professionals. Because of their unregulated use, physicians are encountering increasing numbers of toxicities and untoward events. We report a case of severe intraoperative haemorrhage in a patient who was taking the herb Saw Palmetto. His bleeding time which was prolonged, normalized few days after he stopped the herb. This case should increase the awareness of physicians to such possible complications and encourage them to enquire thoroughly about the use of any dietary supplement in all their patients.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
8/22. Protein A sepharose immunoadsorption: immunological and haemostatic effects in two cases of acquired haemophilia.Acquired haemophilia is a life-threatening disorder caused by circulating auto-antibodies that inhibit factor viii coagulant activity (FBIII:C). Immunoadsorption on protein A sepharose (IA-PA) was performed in two bleeding patients with acquired haemophilia: we observed a dramatic and quick decrease in the anti-FVIII:C inhibitor titre leading to a normal, albeit transient, haemostatic status. In one case, IA-PA was the only procedure which succeeded in stopping massive haemorrhage. In the second case, IA-PA reinforced the haemostatic effect of recombinant activated factor VII by increasing the endogenous plasma factor viii level. The efficacy of IA-PA was sustained with immunosuppressive treatment introduced, respectively, 10 and 15 d before the IA-PA procedures. Our experience with IA-PA suggests that this extracorporeal anti-FVIII:C removal procedure is a valuable therapeutic tool for acquired haemophilia and can alleviate life-threatening haemorrhages.- - - - - - - - - - ranking = 0.4keywords = haemorrhage (Clic here for more details about this article) |
9/22. The use of recombinant factor viia in controlling surgical bleeding in non-haemophiliac patients.Recombinant factor viia (rFVIIa, NovoSeven) is effective and appears safe in the management of bleeding episodes and provision of surgical cover in haemophilia patients with inhibitors. Additionally, rFVIIa has been considered as a universal haemostatic agent, prompting its use in the management of severe uncontrolled surgical bleeding in patients without pre-existing coagulopathies. Recombinant FVIIa has been used in 5 patients (aged 2.5 to 73.0 years; median 48 years) with uncontrolled bleeding during or after open-heart surgery. Satisfactory haemostasis was achieved with a single dose or rFVIIa 30 microg/kg, that resulted in reduction of blood loss from a mean of 4,170 ml (650-8,000 ml) to 262.5 ml (220-334 ml). No significant adverse events were reported. Recombinant FVIIa was also successfully used in controlling post-surgical bleeding in two patients with Crohn's disease, one patient with bleeding duodenal ulcer and another with false thoracic aneurysm. It was also effective in controlling bleeding post-splenectomy in a patient with chronic myeloid leukaemia, and following anterior exenteration in a patient with cervical carcinoma. A randomised study comparing the efficacy of a single perioperative dose of rFVIIa with placebo in patients undergoing transabdominal prostatectomy was conducted by Levi and colleagues [6]. An interim analysis showed a significant reduction in mean blood loss from 2,450 /- 350 ml to 1,400 /- 190 ml between placebo and rFVIIa groups respectively (p = 0.007). Among trauma patients, Kenet et al. reported success in treating uncontrolled bleeding from a gun-shot wound to the inferior vena cava, using two doses of rFVIIa 60 microg/kg [7]. This treatment has subsequently been used in 6 surgical patients with uncontrolled bleeding and in 7 cases of traumatic bleeding, with remarkable results. In conclusion, rFVIIa appears to be effective and safe in the management of uncontrolled surgical and traumatic haemorrhage in patients not known to have inherited coagulopathy.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
10/22. Emergency pelvic packing to control intraoperative bleeding after a Piver type-3 procedure. An unusual way to control gynaecological hemorrhage.We report a case of gynaecologic haemorrhage after a Piver type-3 procedure treated by a packing technique. The postoperative course was uneventful and the packs were removed after six days. Intra-abdominal packing should be familiar to both obstetricians and gynecologists because when any other attempt to provide hemostasis fails, it can be the last successful way to control a life-threatening haemorrhage.- - - - - - - - - - ranking = 0.4keywords = haemorrhage (Clic here for more details about this article) |
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