1/523. Large and giant middle to lower basilar trunk aneurysms treated by surgical and interventional neuroradiological methods.Treatment of large and giant aneurysms of the basilar artery remains difficult and controversial. Three large or giant aneurysms of the lower basilar artery were treated with a combination of surgical and interventional neuroradiological procedures. All patients underwent the balloon occlusion test with hypotensive challenge (blood pressure reduced to 70% of the control value). The third patient did not tolerate the test. In the first patient, both vertebral arteries were occluded through a craniotomy. In the second patient, both the aneurysm and the basilar artery were occluded by detached balloons. In the third patient, one vertebral artery was occluded by surgical clipping and the other by detached helical coils and fiber coils. In spite of anti-coagulation and anti-platelet therapy, postoperative thrombotic or embolic ischemia occurred in the second and third patients. Fibrinolytic therapy promptly corrected the ischemic symptoms, but the second patient developed hemorrhagic complications at the craniotomy area 2 hours later. At follow-up examination, the first patient had only 8th cranial nerve paresis, the second patient who had a hemorrhagic complication was bed-ridden, and the third patient had no deficit. Interventional occlusion requires a longer segment of the parent artery compared to surgical occlusion of the parent artery and might cause occlusion of the perforating arteries. However, selected use of various coils can occlude only a short segment of the parent artery. Thus, the postoperative management of thromboembolic ischemia after the occlusion of the parent artery is easier using the interventional technique.- - - - - - - - - - ranking = 1keywords = coagulation (Clic here for more details about this article) |
2/523. thrombosis of mitral valve prosthesis presenting as abdominal pain.A 67-year-old woman presented with abdominal pain, anemia, and leukocytosis. Five years previously, the patient had undergone mitral valve replacement with a St. Jude bileaflet mechanical prosthesis. After her admission, echocardiography confirmed an immobile leaflet of the prosthetic valve. At urgent surgery, thrombosis and pannus, obstructing the disc, were found, and the mechanical valve was replaced with a bioprosthesis. The incidence of mitral valve thrombosis is low, ranging from 0.1% to 5.7% per patient per year. patients who receive inadequate anticoagulation, particularly with valve prostheses in the mitral position, have an increased risk for thrombus or pannus formation. Presentation varies, from symptoms of congestive heart failure or systemic embolization, to fever or no symptoms. New or worsening symptoms in a patient with a prosthetic heart valve should raise concerns about prosthetic dysfunction. Aggressive investigation and, if indicated, urgent or emergency surgery for treatment can be lifesaving.- - - - - - - - - - ranking = 1keywords = coagulation (Clic here for more details about this article) |
3/523. Complications of treatment: pulmonary embolism following craniotomy for meningioma.We present two case reports of patients who suffered a pulmonary embolism (PE) in the week following surgery for removal of a meningioma. Both patients were anticoagulated in the first week following surgery, and as a result, both suffered intracerebral bleeds requiring further surgery. An inferior vena caval (IVC) filter was then used in both patients to prevent further embolic events. Following our experience, we believe that it is dangerous to use intravenous anticoagulation within 6 days of cranial surgery for removal of a meningioma. We have reviewed the literature concerning the present guidelines for thromboembolic prophylaxis in patients requiring neurosurgery and believe that consideration of subcutaneous low-molecular-weight heparin should now be given to all patients requiring craniotomy for removal of a meningioma.- - - - - - - - - - ranking = 1keywords = coagulation (Clic here for more details about this article) |
4/523. vitamin k deficiency with hemorrhage after kidney and combined kidney-pancreas transplantation.vitamin k deficiency is a common occurrence in the surgical and intensive care unit population, but its incidence in kidney and combined kidney-pancreas allograft recipients has not been described. We report four patients who received cadaveric kidney or combined kidney-pancreas allografts and subsequently developed significant bleeding associated with deficiency of vitamin K. Their coagulopathy promptly resolved with the parenteral administration of vitamin K. Treatment with vitamin K should be considered in kidney or combined kidney-pancreas allograft recipients with a prolonged prothrombin or partial thromboplastin time during the first postoperative week to avoid hemorrhagic complications.- - - - - - - - - - ranking = 1.0954594901983keywords = coagulopathy (Clic here for more details about this article) |
5/523. Primary antiphospholipid syndrome: a cause of catastrophic shunt thrombosis in the newborn.This is a unique report of systemic-to-pulmonary artery shunt thromboses secondary to primary antiphospholipid syndrome and antithrombin iii deficiency in a neonate with cyanotic congenital heart disease. This infant with tricuspid atresia experienced thromboses of two modified Blalock-Taussig shunts en route to a bidirectional cavo-pulmonary shunt and potential future Fontan operation. Chronic warfarin anticoagulation has prevented additional thrombo-embolic events.- - - - - - - - - - ranking = 1keywords = coagulation (Clic here for more details about this article) |
6/523. Fatal ulcerative panenteritis following colectomy in a patient with ulcerative colitis.A 37-year-old man, previously submitted to colectomy for ulcerative pancolitis unresponsive to medical therapy, presented with nausea, vomiting, epigastric pain, and bloody diarrhea. An upper gastrointestinal endoscopy revealed mucosal friability, petechiae, and erosions throughout the duodenum, whereas prestomal ileum showed large ulcers and pseudopolyps. Histologically, a dense inflammation chiefly composed of lymphocytes and plasma cells with few neutrophils was detected. No bacteria, protozoa, and fungi could be detected. Despite intensive care, intra-1194 venous antibiotics and steroids, the patient died of diffuse intravascular coagulation and multiorgan failure. At post-mortem examination severe ulcerative lesions were observed scattered throughout the duodenum up to the distal ileum. The dramatic clinical presentation with fatal outcome, the widespread ulcers throughout the intestine, and the histological picture are peculiar features in our patient which can not be ascribed to any type of the ulcerative jejunoenteritis so far reported. patients with pancolitis and diffuse ileal involvement do not necessarily have Crohn's disease but rather may have ulcerative colitis.- - - - - - - - - - ranking = 5.268890159128keywords = intravascular coagulation, coagulation, intravascular (Clic here for more details about this article) |
7/523. Fatal pulmonary embolism after atrial septal defect closure in a paediatric patient.A four-year-old girl died of massive acute bilateral pulmonary embolism 11 days after direct closure of a secundum atrial septal defect (ASD II), despite postoperative anticoagulation until the patient was ambulatory. An autopsy showed thrombotic deposits on the suture line of the ASD closure, bilateral 90% occlusion of the pulmonary arteries, and haemorrhagic ulcerative ischaemic colitis of the descending colon and the sigmoid.- - - - - - - - - - ranking = 1keywords = coagulation (Clic here for more details about this article) |
8/523. Transmission of factor vii deficiency through liver transplantation.The liver is the primary site of synthesis for the majority of coagulation factors. There are published accounts of liver donor-to-recipient transmission of protein c deficiency with dysfibrinogenemia and factor xi deficiency. In this article, we report what we believe to be the first observation, of transmission of factor vii deficiency, a rare, autosomal recessive coagulation disorder, from an affected liver donor to a naive liver recipient. At 300 days after transplantation, the recipient remains with an isolated prolongation of the prothrombin time and a below-normal level of factor VII, and has had no bleeding complications.- - - - - - - - - - ranking = 2keywords = coagulation (Clic here for more details about this article) |
9/523. disseminated intravascular coagulation.OBJECTIVES: To provide an overview of the pathophysiology, manifestations, diagnosis, and treatment of disseminated intravascular coagulation (DIC) as it occurs in cancer. DATA SOURCES: Published articles, research reports, and book chapters. CONCLUSIONS: The syndrome of DIC is a serious hypercoagulation state that in its acute form may be life-threatening. The hemorrhage and intravascular coagulation that occur with DIC may lead to irreversible morbidity and mortality. Prompt recognition and emergency treatment are necessary to help minimize morbidity and mortality. IMPLICATIONS FOR NURSING PRACTICE: nurses can play an important role in early recognition of DIC to allow for prompt intervention. nurses caring for patients affected by DIC will be providing complex nursing care, in addition to psychosocial support to patients and families.- - - - - - - - - - ranking = 29.178576490336keywords = intravascular coagulation, coagulation, intravascular (Clic here for more details about this article) |
10/523. Right ventricular thrombosis early after bidirectional Glenn shunt.thrombosis in the right ventricle occurred early after bidirectional superior cavopulmonary shunt in 2 patients with pulmonary atresia with intact ventricular septum and major right ventricular coronary artery communication, and perioperative brain infarction occurred in 1 patient. Clinicians should be aware of the hazards of this potentially lethal complication, and transfusion of platelets and fresh plasma should be minimized. Although the hemodynamic state is good, echocardiography should be performed frequently and strict anticoagulation should be started as early as possible.- - - - - - - - - - ranking = 1keywords = coagulation (Clic here for more details about this article) |
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