1/14. Peripheral nerve injury after brief lithotomy for transurethral collagen injection.Two patients with prior prostate surgery sustained peripheral nerve injuries after transurethral collagen injection for the treatment of urinary incontinence. In the first patient, brief lithotomy positioning caused a gluteal compartment syndrome and sciatic neuropathy. In the second patient, obturator neuropathy was due to leakage of collagen along the course of the obturator nerve. This is the first report of peripheral nerve injury in patients undergoing transurethral collagen injection.- - - - - - - - - - ranking = 1keywords = leak (Clic here for more details about this article) |
2/14. Orbital compartment syndrome mimicking cerebral herniation in a 12-yr-old boy with severe traumatic asphyxia.OBJECTIVE: To report a case of orbital compartment syndrome mimicking cerebral herniation in a boy with severe traumatic asphyxia. DESIGN: Case report. SETTING: A tertiary-care pediatric intensive care unit. SUBJECT: A 12-yr-old boy with traumatic asphyxia syndrome. INTERVENTION: Mechanical ventilation, chest tube drainage, nitric oxide, lateral canthotomies, intracranial pressure monitoring. MEASUREMENTS AND MAIN RESULTS: A patient is presented with severe traumatic asphyxia syndrome complicated by prolonged hypoxemia, massive capillary leak syndrome, and acute onset of pupillary dilation and loss of reactivity to light. Ophthalmologic examination confirmed bilateral orbital compartment syndrome, which was treated emergently with bilateral canthotomies at the bedside. The procedure was followed by prompt return of pupillary size and function and decrease in intraocular pressure. The patient experienced complete recovery of vision in the right eye, but vision in the left eye was severely impaired. CONCLUSIONS: Our case report emphasizes the importance of considering orbital compartment syndrome in patients with traumatic asphyxia syndrome. Recognition of orbital compartment syndrome is important in this setting because prompt operative intervention may reduce the likelihood of permanent vision loss.- - - - - - - - - - ranking = 14844.028480515keywords = capillary leak syndrome, capillary leak, leak syndrome, capillary, leak (Clic here for more details about this article) |
3/14. Compartment syndrome.Compartment syndrome is a limb-threatening and occasionally life-threatening injury. It occurs whenever the tissue pressure (referred to as interstitial pressure) within a closed anatomic space is greater than the perfusion pressure. Untreated, compartment syndrome leads to tissue necrosis, permanent functional impairment and, if severe in large compartments, renal failure and death. Compartment syndrome can occur within any muscle group located in a compartment. It is most common following an event that severely damages a muscle, like a crushing or twisting injury. Mechanisms of injury that involve circumferential burns, ischemia and tourniquets can cause compartment syndrome. Motorcyclists who suffer lower-extermity injuries in accidents are a high-risk group. A tough membrane referred to as a fascia covers muscle groups, forming a compartment for the muscle. In normal circumstances, this arrangement allows the muscle to function more efficiently, but if the muscle is injured in any way, the fascia limits the amount of swelling that can occur. This in turn restricts the flow of blood through the affected region. The first compromised function within the compartment is the flow of lymph and venous blood. If there are sensory nerves running through the compartment, they will not function correctly, causing the numbness, tingling and, later, the pain associated with compartment syndrome. With more swelling, arterial flow is compromised, pain worsens and motor function is impaired. An artificial way of producing a compartment syndrome is to place a cast or splint around a damaged extermity, compressing it. This is a way emergency personnel can compromise an injury and cause long-term consequences for the patient. Recovery is achieved by surgically opening the compartment involved (a fasciotomy) and releasing the pressure. The muscle at first will swell outside the compartment, but then it recovers, swelling is reduced and normal function can be recovered. Prehospital treatment of extremity injuries that will prevent or limit compartment syndrome is immobilization, elevation and cooling. Recognition of the syndrome later in its course, as in this case, requires the EMT to remove the patient to an appropriate emergency department. Prehospital providers need to recognize that many mechanisms of injury can produce this syndrome, even those that seem relatively minor. All injured patients should be educated to seek care should the symptoms of numbness, deep pain and coolness to the distal extremity occur. This case involved a patient who, from a relatively minor mechanism of trauma, experienced an internal disruption of the muscle group controlling the thumb (thenar mass). The early swelling in the thenar compartment resulted in the patient experiencing a tingling sensation in his left thumb. In many cases, such an injury would be referred to as a "stinger" (a temporary neurological deficit due to a sudden and excessive stimulation of a neurologic plexus or junction). But this patient had more swelling in the compartment, resulting in a lack of circulation manifested by a cool extremity, poor capillary refill and decreased pulse oximetry. Luckily, this officer recognized the need for medical evaluation of what appeared to be a minor injury and was returned to duty with no permanent impairment.- - - - - - - - - - ranking = 7.7901808518649keywords = capillary (Clic here for more details about this article) |
4/14. Translumbar extraperitoneal decompression for abdominal compartment syndrome after endovascular treatment of a ruptured AAA.PURPOSE: To report an unusual case of abdominal compartment syndrome (ACS) following endovascular repair of a ruptured abdominal aortic aneurysm (rAAA) that had been treated with a stent-graft 3 years prior. CASE REPORT: A 68-year-old man with a 3-year-old Vanguard bifurcated aortic stent-graft experienced sudden back pain and collapse. Aneurysm rupture documented by computed tomography was due to dislocation of the left graft limb. A Talent aortomonoiliac graft was deployed, followed by a femorofemoral bypass. No endoleak was evident. A few hours later, the patient became oliguric and hemodynamically unstable. Increased intra-abdominal pressure (IAP) was recorded. Abdominal decompression was performed, removing 1500 mL of blood from the retroperitoneum through an 18-cm lumbotomy; the peritoneum was opened, and another 500 mL of blood was aspirated. The IAP fell immediately, followed by diuresis a few hours later. The patient recovered and was discharged after 27 days. CONCLUSIONS: Some of the perioperative complications seen after conventional rAAA repair are also encountered after endovascular treatment. ACS requires urgent decompression, and less invasive approaches, such as translumbar extraperitoneal decompression, may be a good alternative to a midline laparotomy.- - - - - - - - - - ranking = 1keywords = leak (Clic here for more details about this article) |
5/14. Compartment syndrome after compression sclerotherapy.Acute limb compartment syndrome is a condition in which raised pressure within a closed fascial space reduces capillary perfusion below a level necessary for tissue viability. Although it is a rare but potentially disastrous complication of orthopedic injury to the extremities, it may occur spontaneously without a history of trauma, and any insult that tends to increase resistance to flow in the capillary bed in any anatomical situation may result in a compartment syndrome. We report an extremely rare case of compartment syndrome following compression sclerotherapy.- - - - - - - - - - ranking = 15.58036170373keywords = capillary (Clic here for more details about this article) |
6/14. The "fistula VAC," a technique for management of enterocutaneous fistulae arising within the open abdomen: report of 5 cases.BACKGROUND: Management of intestinal fistulae in open abdominal wounds remains a significant clinical challenge for those caring for patients surviving damage control abdominal operations. Breaking the cycle of tissue inflammation, infection, and sepsis, resulting from leakage of enteric contents, should be a major goal in the approach to these complex patients. We describe a technique utilizing vacuum assisted closure (VAC) which achieves control of enteric flow from fistulae in open abdominal wounds. methods: The fistula-VAC is fashioned from standard sponge supplies, negative pressure pumps, and ostomy appliances. The fistula-VAC was changed every three days prior to split thickness skin grafting, and every five days following grafting. RESULTS: Five patients underwent application of the fistula-VAC. All patients had complete diversion of enteric contents. This enteric diversion allowed for successful skin grafting in all patients. CONCLUSION: Application of the fistula-VAC should be considered a useful option in treating patients with intestinal fistulae in open abdominal wounds.- - - - - - - - - - ranking = 1keywords = leak (Clic here for more details about this article) |
7/14. Systemic capillary leak syndrome associated with compartment syndrome and rhabdomyolysis.Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by recurrent spontaneous episodes of hypovolaemic shock due to marked plasma shifts from the intravascular to the extravascular space. This presents as the characteristic triad of hypotension, haemoconcentration and hypoalbuminemia often with an associated monoclonal gammopathy. We describe a patient with SCLS who required aggressive fluid resuscitation and emergency fasciotomies for compartment syndrome with rhabdomyolysis. At presentation the patient was considered to have severe erythrocytosis and was therefore initially referred to a haematologist, which appears to be a frequent sequence of presentation for patients with SCLS. This patient also highlights the importance of muscle compartment pressure monitoring during volume resuscitation in patients with SCLS.- - - - - - - - - - ranking = 74220.142402577keywords = capillary leak syndrome, capillary leak, leak syndrome, capillary, leak (Clic here for more details about this article) |
8/14. Capillary leakage complicated by compartment syndrome necessitating surgery.A single episode of systemic capillary leak syndrome is reported in a hiv-positive patient. The shock had necessitated the infusion of large amounts of fluid with concomitant diffuse swelling and weight gain leading to compartment syndrome of both legs. This required surgical relief. The initial high hematocrit (62%) and low serum protein concentration (48 g/l) with normal factor v (molecular weight above 300,000) concentrations are the hallmark of capillary leak when they are associated with hypovolemic shock. It must be emphasized that fluid resuscitation may worsen the muscle damage with ultimate compartment syndrome. Therefore, it appears reasonable to monitor muscular pressure during volume expansion in patients with capillary leak syndrome, severe shock and muscular swelling.- - - - - - - - - - ranking = 42212.386215665keywords = capillary leak syndrome, systemic capillary leak syndrome, systemic capillary leak, capillary leak, leak syndrome, systemic capillary, capillary, leak (Clic here for more details about this article) |
9/14. Idiopathic capillary leak syndrome complicated by massive rhabdomyolysis.Idiopathic systemic capillary leak syndrome (Clarkson's disease) is characterized by recurring attacks of increased capillary permeability, resulting in severe hypovolemic shock due to plasma extravasation. Additional laboratory features include association with a monoclonal gammopathy, extreme hemoconcentration, and hypoalbuminemia. Rare manifestations of this syndrome are renal damage and rhabdomyolysis due to increased compartment pressure and ischemic myonecrosis. We present the findings in two patients with capillary leak syndrome complicated by severe rhabdomyolysis, in one case leading to acute renal failure. We review therapeutic aspects of this rare syndrome and emphasize the importance of early diagnosis and of prompt and aggressive fluid replacement.- - - - - - - - - - ranking = 98835.992422563keywords = capillary leak syndrome, systemic capillary leak syndrome, systemic capillary leak, capillary leak, leak syndrome, systemic capillary, capillary, leak (Clic here for more details about this article) |
10/14. Postoperative compartment syndrome and the lithotomy position: a report of three cases and analysis of potential risk factors.There exists a definite association between the placement of patients in the modified lithotomy position and the development of postoperative compartment syndrome. It must be appreciated that this syndrome is potentially life-threatening and frequently results in long-term sequelae. We report three cases which illustrate the problem and analyze the multifactorial etiology of this condition and propose a strategy for its prophylaxis. The combination of direct pressure on the posterior compartment of the calf, elevation of the legs above heart level, a number of intraoperative variables, the preexistence of any lower limb arterial insufficiency, and in some cases, the use of intraoperative compression boots, may lead to a state of hypoperfusion in the anterior and posterior compartment musculature. Upon completion of the operation, removal from the lithotomy position, and correction of the etiological factors, a reperfusion occurs with the development of a capillary leak with subsequent tissue edema causing an increase in compartmental pressure which may result in neurovascular compromise. This is the compartment syndrome. Emphasis must be placed on the identification of high-risk patients, the prevention or rapid correction of any etiological factors, the early diagnosis of the problem, and an aggressive approach to its treatment.- - - - - - - - - - ranking = 2756.2978960164keywords = capillary leak, capillary, leak (Clic here for more details about this article) |
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