1/8. Effectiveness of an inferior vena caval filter as a preventive measure against pulmonary thromboembolism after abdominal surgery.In three patients with a previous history of pulmonary thromboembolism, inferior vena caval filters were inserted before elective laparotomies to prevent a recurrent pulmonary thromboembolism. Two patients had colon cancer and underwent colectomies, while the other had myoma uteri, which might have been the cause of deep vein thrombosis, and thus a hysterectomy was performed. In spite of their poor risks, their postoperative courses were fairly good owing to perioperative management including anticoagulant therapy, and no recurrence has been observed since the operation in every case. A pulmonary thromboembolism is a fatal complication which follows deep vein thromboses. In patients with such a previous history, the risk is much higher after a laparotomy because of long-term bed rest, hypercoagulability, and so on. The mortality rate after a recurrence of pulmonary thromboembolism is reported to reach 30% without adequate therapy, whereas it is reduced to 8% with anticoagulant therapy, and to 0.8% with additional inferior vena caval filter placement. Considering the feasibility of insertion and the low incidence of complications, preoperative inferior vena caval filter placement is thus recommended for patients having a previous history of either pulmonary thromboembolism or deep vein thrombosis.- - - - - - - - - - ranking = 1keywords = pulmonary thromboembolism, thromboembolism, embolism (Clic here for more details about this article) |
2/8. Occult colon cancer in a patient with an unexplained episode of pulmonary embolism.The association between venous thromboembolism and cancer has been widely documented and the main factor responsible for cancer-induced venous thromboembolism is considered mostly linked to a hypercoagulation state induced by the cancer itself. There is no consensus on investigative strategies for occult cancer in a patient with a thrombophilic condition. We report a patient who manifested an isolated episode of pulmonary embolism without specific evident sources of venous thromboembolism. The routine clinical and laboratory work-up to detect an occult cancer did not reveal any malignancy. A history of duodenal ulcer in association with a recent slight alteration in bowel habits led us to perform an esophagogastroduodenoscopy which was negative for malignancy, and a barium enema followed by colonoscopy, which revealed the presence of a tumor limited to the large intestine. An unexplained clinically evident hypercoagulation state, even in the presence of mild clinical symptoms, needs more thorough diagnostic strategies when simple methods of screening for occult cancer are negative.- - - - - - - - - - ranking = 0.099782072680605keywords = thromboembolism, pulmonary embolism, embolism (Clic here for more details about this article) |
3/8. Is splenic lobe/segment dearterialization feasible for inferior pole trauma during left hemicolectomy?We discuss splenic salvage by lobe/segment dearterialization, without resection, after intraoperative trauma, and present two cases. We performed a retrospective analysis of 163 patients in whom the colon splenic flexure was mobilized. patients with ileo-rectal anastomosis or urgent cases were excluded. Surgical operations included left hemicolectomy and anterior resection of the rectum. Splenic procedures were splenorrhaphy, dearterialization and splenectomy. spleen lesions occurred in 4 (2.45%) cases. One capsular tear was managed with splenorrhaphy. Three mechanical lesions to capsula and tissue of the inferior pole were managed by either splenectomy (the first case) or dearterialization. overall mortality in the series was 4.3%. Among the patients with splenic procedures, the splenectomized patient died due to pulmonary embolism. The two cases treated by inferior splenic branch and inferior polar artery ligature are presented. In operative trauma to the inferior splenic pole, bleeding can be controlled by lobe/segment dearterialization and by methods of local hemostasis in most cases.- - - - - - - - - - ranking = 0.0025674294686463keywords = pulmonary embolism, embolism (Clic here for more details about this article) |
4/8. Trousseau's syndrome related to adenocarcinoma of the colon and cholangiocarcinoma.Malignancy-related thromboembolism, so-called Trousseau's syndrome, can present as acute cerebral infarction, non-bacterial thrombotic endocarditis (NBTE) and migratory thrombophlebitis. It is usually attributed to a cancer-related hypercoagulable state, chronic disseminated intravascular coagulopathy (DIC), or tumour embolism. We report on two patients with adenocarcinoma of the colon and cholangiocarcinoma who developed widespread thromboembolism during disease progression. Both did poorly despite aggressive institution of anticoagulation therapy. These cases emphasize that cerebral infarction or refractory thromboembolism in cancer-treated patients should prompt investigation for recurrent or metastatic disease or progression of the underlying malignancy. Optimal treatment remains to be established.- - - - - - - - - - ranking = 0.087267760414567keywords = thromboembolism, embolism (Clic here for more details about this article) |
5/8. Acute massive pulmonary embolism: role of the cardiac surgeon.We present the case of a 72-year-old woman who had an acute massive pulmonary embolism after abdominal surgery. The patient had undergone a right hemicolectomy and pancreaticoduodenectomy for locally invasive colonic adenocarcinoma. Six hours postoperatively, she required emergent intubation when she suddenly became cyanotic, severely hypotensive, and tachypneic, with an oxygen saturation of 50%. An acute massive pulmonary embolism was suspected, and an emergency transesophageal echocardiogram confirmed the diagnosis. On the basis of the patient's clinical condition and the echocardiographic findings, we performed an emergent pulmonary embolectomy, with the patient on cardiopulmonary bypass. We evacuated multiple large clots from both pulmonary arteries. The patient recovered and was discharged from the hospital 61 days postoperatively. Herein, we review the current literature on open surgical pulmonary embolectomy. This case supports the use of open pulmonary embolectomy for the treatment of hemodynamically unstable patients on the basis of clinical diagnosis. We discuss the role of emergent transesophageal echocardiography in the diagnosis and management of massive pulmonary embolism.- - - - - - - - - - ranking = 0.017972006280524keywords = pulmonary embolism, embolism (Clic here for more details about this article) |
6/8. A family of Gardner's syndrome with report of an autopsy case.A family with Gardner's syndrome including one autopsy case is reported. A 22 year-old man had multiple polyposis of the colon and the small intestine, epidermal cysts, soft part tumor of the abdominal skin and osteomas in the calvarium and rib, and died of a carcinoma in the transverse colon and embolism of the brain. Histologically, all polyps were diagnosed as adenomatous polyp. The greater their diameter, the higher the tendency of atypism was observed. However, the polyps around the cancer were few, small, and with low atypism, and we could not obtain evidence showing direct transformation of adenomatous polyps into carcinoma. His two elder brothers had multiple polyposis of the colon, epidermal cysts and osteomas in the calvarium or mandibular bone, but are still alive.- - - - - - - - - - ranking = 0.00032283507719344keywords = embolism (Clic here for more details about this article) |
7/8. Thrombus of the ascending aorta as a source of cerebral embolism.A 74-year-old woman presented with a stroke. Transesophageal echocardiography showed evidence of a thrombus attached to the wall of the ascending aorta that was not detected by the transthoracic approach. The thrombus was no longer present after treatment with heparin with no recurrent embolic event. To our knowledge, this is the first report of a thrombus attached to the ascending aorta that was no longer present after treatment with heparin, was detected by transesophageal echocardiography, and was thought to be the source of cerebral embolic event.- - - - - - - - - - ranking = 0.0012913403087738keywords = embolism (Clic here for more details about this article) |
8/8. Fatal air embolism: a complication of manipulation of a cavitating metastatic lesion of the liver.A patient undergoing emergency laparotomy for an acute abdomen developed fatal air embolism as a result of surgical manipulation of a cavitating metastatic lesion of the liver. The diagnosis was made at postmortem examination. This cause of air embolism has apparently not been reported before. The causes and management of air embolism are briefly reviewed. It is concluded that in exceptional circumstances when intubated patients are sent to a recovery area, the continuation of CO2 monitoring into the post-operative period should be considered.- - - - - - - - - - ranking = 0.0022598455403541keywords = embolism (Clic here for more details about this article) |