1/18. hemorrhage after the preoperative use of complementary and alternative medicines.The preoperative use of certain complementary and alternative medicines may predispose surgical patients to an acquired coagulation disorder resulting in excessive bleeding. Many herbs and dietary supplements inhibit platelet adhesion and aggregation or contain coumarins. We report the case of a patient undergoing breast surgery at the University of colorado health Sciences Center Denver, Colo, who had extensive postoperative bleeding requiring surgical re-exploration. Preoperatively the patient consumed vitamin e and several herbs with potential to alter the hemostatic process combined with the drugs quinine sulfate and sertraline hydrochloride. These combinations of alternative and conventional drugs may have contributed to inhibition of coagulation.- - - - - - - - - - ranking = 1keywords = vera (Clic here for more details about this article) |
2/18. Migration of steel-wire coils into the stomach after transcatheter arterial embolization for a bleeding splenic artery pseudoaneurysm: report of a case.Transcatheter arterial embolization (TAE) represents the primary, and often definitive, mode of therapy for bleeding splanchnic artery pseudoaneurysms (PSA). Nevertheless, a number of complications associated with this procedure have been described. We report herein the case of a 59-year-old man with chronic pancreatitis who was referred to us with hematemesis and hemorrhagic shock. Computed tomography revealed a splenic artery PSA bleeding into a pancreatic pseudocyst, and TAE was performed using steel-wire coils, placed inside the aneurysmal cavity, which resulted in the immediate cessation of bleeding. However, several weeks later some of the coils were found to have dislodged through a gastropseudocystic fistula. Furthermore, an early gastric cancer was incidentally found proximal to the fistula. We finally performed open surgery to treat both disorders; primarily for the gastric cancer, but also for the pseudocyst and fistula, with the intermittent discharge of the steel-wire coils. To our knowledge, migration into the stomach of steel-wire coils after TAE has not been described before. It is generally believed that the embolization procedure should occlude normal portions of the artery both distal and proximal to the PSA with embolization materials. By occluding the PSA in this way, the subsequent migration of steel-wire coils into the pseudocyst and stomach might have been prevented in our patient.- - - - - - - - - - ranking = 1keywords = vera (Clic here for more details about this article) |
3/18. Unusual presentation of factor xiii deficiency.factor xiii deficiency is a rare inherited bleeding disorder that is often difficult to diagnose. The standard screening tests are normal in these patients and their bleeding phenotype may be variable. We report the case of a 3-year-old girl who presented with an intracranial haemorrhage. Several confounding factors, such as the suspicion of an arteriovenous malformation and the development of a deep venous thrombosis, led to a delay in the diagnosis of factor xiii deficiency. Subsequently, her brother was also found to have severe factor xiii deficiency. This case highlights the importance of a detailed history and of screening families in which index cases have been identified. It should also remind physicians that bleeding disorders may have unusual presentations and should be sought when investigating unexplained bleeding.- - - - - - - - - - ranking = 1keywords = vera (Clic here for more details about this article) |
4/18. Successful treatment by selective arterial embolization of severe retroperitoneal hemorrhage secondary to bone marrow biopsy in post-polycythemic myelofibrosis.Severe retroperitoneal hemorrhage represents an infrequent and serious complication of bone marrow biopsy. A 53-year-old man, diagnosed with polycythemia vera 12 years earlier, was submitted to a bone marrow biopsy due to the appearance of anemia with clinical and hematological features suggesting myelofibrotic transformation, a diagnosis that was confirmed by the marrow study. At 2 h of a right anterior iliac bone marrow trephine biopsy, the patient suddenly developed severe pain in the area of the biopsy, with antialgic flexion of the right leg. Computed tomographic (CT) scan of the abdomen showed a 5 x 9.5 cm hematoma in the right iliac and psoas muscles. The patient was initially managed with analgesics and transfusional support, but the pain persisted and a continuous fall in the hematocrit was observed in the following days. Angiographic examination of the right external iliac artery showed contrast extravasation arising from the circumflex iliac branch, which was embolized using polivinyl alcohol particles and one coil. Following such procedure, the patient recovered uneventfully and was discharged in good condition a few days later. This case illustrates the effectiveness of an endovascular approach in providing a fast and minimally invasive treatment for this life-threatening complication of bone marrow trephine biopsy.- - - - - - - - - - ranking = 1keywords = vera (Clic here for more details about this article) |
5/18. Haemorrhagic peritonitis as a late complication of echocardiography guided pericardiocentesis.Clinically significant pericardial effusion is an uncommon complication after cardiac surgery. pericardiocentesis can be performed either through a mini-sternotomy or under echocardiography guidance. echocardiography guidance is a relatively safe procedure and it avoids the need for another general anaesthetic. However, in this post cardiac surgical patient echocardiography guided pericardiocentesis was complicated several days later by haemorrhagic peritonitis.- - - - - - - - - - ranking = 1keywords = vera (Clic here for more details about this article) |
6/18. Large extrapleural hematoma in an anticoagulated patient after a thoracic blunt trauma.We report the 7th case of a traumatic extrapleural hematoma that developed in an anticoagulated patient with a thoracic blunt trauma and rib fractures, and required an emergency surgical treatment. Extrapleural hematoma is a rare and life-threatening condition characterized by a collection of blood between the pleura parietalis and the endothoracic fascia. Related symptoms and chest x-ray findings are not characteristic and may present several hours after the injury, leading to delayed diagnosis and treatment. Etiological, surgical and prognostic implications of this finding are briefly discussed.- - - - - - - - - - ranking = 1keywords = vera (Clic here for more details about this article) |
7/18. Possible interaction between sevoflurane and aloe vera.OBJECTIVE: To describe a patient with massive intraoperative bleeding after oral consumption of aloe vera tablets. CASE SUMMARY: A 35-year-old woman lost 5 L of blood during surgery as a result of a possible herb-drug interaction between aloe vera and sevoflurane. DISCUSSION: aloe vera is a common herb used for antiinflammatory and antiarthritic activity, as well as antibacterial, hypoglycemic, and lipid-lowering effects. Compounds contained within aloe vera can cause a reduction in prostaglandin synthesis, which may inhibit secondary aggregation of platelets. Sevoflurane inhibits thromboxane A(2) formation by suppression of cyclooxygenase activity, impairs platelet aggregation, and prolongs bleeding. Although the vascularity and size of the hemangioma were the most important factors for the massive intraoperative blood loss, concomitant use of sevoflurane and aloe vera played a contributory role. An objective causality assessment revealed that this adverse event was possible as a result of the sevoflurane and aloe vera interaction. CONCLUSIONS: There is a potential herb-drug interaction between aloe vera and sevoflurane based on the antiplatelet effects of these 2 agents. Herbal medications with antiplatelet potential should be discontinued before anesthesia and surgery.- - - - - - - - - - ranking = 11keywords = vera (Clic here for more details about this article) |
8/18. morbidity and economic complications following mucogingival surgery in a hemophiliac hiv-infected patient: a case report.BACKGROUND: This report describes the surgical treatment of a gingival recession in a hemophiliac hiv-infected patient. To our knowledge, mucogingival surgery has not been described previously in these patients. methods: Under the supervision of the patient's hematologist, a subepithelial connective tissue graft procedure was carried out to treat the recession. The treatment was performed after substitution therapy with factor viii concentrate, supported by local antifibrinolytic treatment with epsilonaminocaproic acid. RESULTS: One week after surgery, the grafted zone showed a normal healing, but an area of necrosis appeared at the donor palatal site with spontaneous bleeding. The administration of factor viii concentrate had to be prolonged to arrest the hemorrhage. In total, 44,500 units of factor viii concentrate were used, the cost of which reached around $20,000. After 1 month the donor site had re-epithelialized by secondary intention. The root coverage was around 85% successful. CONCLUSIONS: Because of the surgical risk and the high economic cost in the use of the factor VIII concentrate, we do not recommend performing mucogingival surgery in hiv-infected hemophiliacs unless it is absolutely necessary. Prevention and early treatment must be the goal in the management of these patients.- - - - - - - - - - ranking = 1keywords = vera (Clic here for more details about this article) |
9/18. Control of suture hole bleeding after aortic valve replacement by application of BioGlue during circulatory arrest.Bleeding from suture holes in aortic valve replacement (AVR) may represent a difficult problem especially if the aortic wall is friable. We describe a case in which suture hole bleeding after AVR was present at the posterior aortic wall close to the pulmonary artery. Following several attempts to suture the leak using felt pledget armed prolene sutures, deep hypothermic circulatory arrest was induced and BioGlue in combination with Tabotamp was applied for successful sealing of the bleeding source.- - - - - - - - - - ranking = 1keywords = vera (Clic here for more details about this article) |
10/18. Use of recombinant activated factor VII (rFVIIa-NovoSeven) in the treatment of uncontrolled postsurgical hemorrhage in a patient with deep venous thrombosis and caval filter. A case report.A 37-year-old woman affected by renal insufficiency was submitted to renal transplantation from cadaver donor. After a few days she had a severe and life-threatening hemorrhage at the surgical site and a deep venous thrombosis at her lower right limb. Since anticoagulant therapy was contraindicated, a filter was inserted in the inferior vena cava. After several red blood cell, fresh plasma and platelet transfusions, and after repeated unsuccessful surgical procedures, a single dose of 70 microg/kg of body weight of recombinant activated factor VII (rFVIIa) was administered as last resource. The drug was successful in obtaining the complete and rapid resolution of the hemorrhagic episode. Despite the patient had two factors which could have favoured a thrombotic complication, e.g. deep venous thrombosis and caval filter, administration of rFVIIa did not worsen the underlying thrombotic process. rFVIIa is a new hemostatic agent that was initially used in hemophiliac patients. Later it has been successfully used in nonhemophiliac patients to treat different inherited or acquired coagulation disorders. A potential thrombogenic effect of rFVIIa was hypothesized on the basis of some clinical case reports but large controlled trials do not exist. In this case report the use of rFVIIa was successful and safe despite the concomitant presence of several thrombogenic factors.- - - - - - - - - - ranking = 2keywords = vera (Clic here for more details about this article) |
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