Cases reported "Blood Loss, Surgical"

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1/103. Successful thrombolysis for massive pulmonary embolism after pulmonary resection.

    We report the successful use of thrombolysis for acute massive pulmonary embolism 2 days after right lower lobectomy for bronchial adenocarcinoma. Pulmonary angiography revealed extensive clot unsuitable for surgical embolectomy. A bolus infusion of recombinant tissue plasminogen activator produced an immediate improvement in the patient's hemodynamic state. There was substantial blood loss requiring the transfusion of 21 units of blood over the postoperative period. The patient made a successful recovery and remained well at 1 year.
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ranking = 1
keywords = blood loss
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2/103. 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.
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ranking = 0.0032409976221065
keywords = haemorrhage
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3/103. 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.
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ranking = 0.0032409976221065
keywords = haemorrhage
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4/103. 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.
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ranking = 0.0006481995244213
keywords = haemorrhage
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5/103. safety and efficacy of three arthroscopic procedures using holmium: Yag laser in two high-responder haemophiliacs.

    We report here on the efficacy and safety of three arthroscopic procedures using a holmium: Yag laser in two high-responder haemophiliacs. The two patients were treated with an activated prothrombin complex concentrate (FEIBA; Immuno, Vienna, austria). Treatment was started just before surgery and continued for 4-8 days. On one occasion antifibrinolytics were concomitantly used without thromboembolic complication. Post-operative blood loss was slight, joint mobility was rapidly acceptable and full weight bearing without pain was possible on day 4. Such a procedure would appear to be superior to conventional arthroscopic synovectomy utilizing mechanical devices in haemophiliacs, because it might improve the quality of local haemostasis and the rapidity of post-operative recovery. In addition, it is also the technical procedure of choice in haemophilic patients with inhibitors who need synovectomy.
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ranking = 1
keywords = blood loss
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6/103. Extracorporeal bypass using a centrifugal pump during resection of malignant liver tumors.

    BACKGROUND/AIMS: Total hepatic vascular exclusion (THVE) during extracorporeal bypass is used for hepatic resection in patients with malignant liver tumors. The aim of this study was to determine the efficacy of hepatectomy during total hepatic vascular exclusion using a centrifugal pump (Bio-pump). METHODOLOGY: Fourteen patients with malignant liver tumors who underwent hepatectomy during total hepatic vascular exclusion using the Bio-pump were studied retrospectively. RESULTS: In 3 of 14 patients, insufficient hepatic vascular exclusion was achieved. Six patients underwent tumor resection during total hepatic vascular exclusion, without extracorporeal bypass. In the remaining 5 patients, flow exclusion averaging 1500 ml was achieved with the Bio-pump, and hepatectomy was performed during the procedure. In these 5 patients, the mean operative time and blood loss were 11 hours 38 minutes and 6850 /- 2451 ml. The Bio-pump bypass time, the excluded blood flow and the mean blood pressure were 82 minutes, 1650 ml and 108/53 mmHg, respectively. The arterial ketone body ratio (AKBR) decreased from a pre-operative value of 1.85-0.32 during total hepatic vascular exclusion. CONCLUSIONS: Total hepatic vascular exclusion was useful for hepatectomy in patients with tumor invasion into the hepatic vein and inferior vena cava, or tumor thrombus in the inferior vena cava and right atrium. However, this technique did not decrease blood loss or improve outcome in patients undergoing hepatectomy.
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ranking = 2
keywords = blood loss
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7/103. laparoscopy extends the indications for liver resection in patients with cirrhosis.

    BACKGROUND: Clinical or biological evidence of liver failure is usually considered a contraindication to open liver surgery as it is associated with a prohibitive risk of postoperative death. methods: This report describes three patients who had resection of a superficial hepatocellular carcinoma suspected either to be ruptured, or at high risk of rupture, using the laparoscopic approach. All three patients had intractable ascites, in two superimposed on active hepatitis. Surgery was per- formed under continuous carbon dioxide pneumoperitoneum with intermittent clamping of the hepatic pedicle. RESULTS: Intraoperative blood loss was between 100 and 400 ml; no blood transfusion was required. The postoperative course was uneventful except for a transient leak of ascites through the trocar wounds. Duration of in-hospital stay was 6-10 days. liver function tests had returned to preoperative values within 1 month of surgery in all patients. CONCLUSION: The laparoscopic approach may enable liver resection in patients with cirrhosis and evidence of liver failure that would contraindicate open surgery.
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ranking = 1
keywords = blood loss
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8/103. 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.
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ranking = 2.0025927980977
keywords = blood loss, haemorrhage
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9/103. antithrombin iii concentrate in the acute phase of thermal injury.

    BACKGROUND: Thermal injury disrupts homeostasis by inducing subclinical disseminated intravascular coagulation, fibrinolysis. and an acquired deficiency of antithrombin iii (ATIII), a natural anticoagulant. As a result, thermally injured patients have a high incidence of hypercoagulability and thrombosis. OBJECTIVE: ATIII (Human) concentrate was given to a thermally injured patient to evaluate safety, and dosage requirements in this setting. DESIGN: The patient was a 40 yr old male with a 68% total burn surface area, right femoral comminuted fracture, and C5-C6 subluxation sustained in a vehicular crash. He received nine infusions of AT III (H) concentrate (100-50 u/kg) within the first four days of injury. RESULT: The ATIII plasma level increased from 45% on admission (normal = 100 /-20%) to 120 /-25% in the next four days. During the 64 day hospitalization, there were 11 grafting procedures with an estimated blood loss (EBL)/procedure: 1140 cc; and EBL/grafted surface area ratio: 0.6 cc cm2. The average time to healing of the meshed autograft was 6.4 days. CONCLUSION: ATIII (H) concentrate can be safely utilized in the acute phase of thermal injury: no excessive bleeding or prolongation of wound healing was documented.
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ranking = 1
keywords = blood loss
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10/103. Successful use of recombinant VIIa (Novoseven) and endometrial ablation in a patient with intractable menorrhagia secondary to FVII deficiency.

    menorrhagia is a well-recognized complication of inherited bleeding disorders. In the past, the only viable option for women who were unresponsive to medical therapy was hysterectomy. Endometrial ablation has been recently developed as an alternative therapy for these patients and is associated with decreased morbidity. We report the successful use of activated recombinant factor VII (FVIIa) and endometrial ablation in the treatment of excessive menstrual blood loss in a 34-year-old women with severe factor VII (FVII) deficiency. Recombinant FVIIa (40 microg/kg) was administered pre-operatively and every 6 h (20 microg/kg) for 24 h postoperatively. The procedure was uncomplicated with a 200 ml surgical blood loss. FVIIa was used because it allowed FVII replacement with a recombinant product and also has the ability to bind to tissue factor expressed at the site of vascular injury, resulting in site-specific thrombin generation. We believe that endometrial ablation with recombinant VIIa should be considered in patients with severe FVII deficiency and menorrhagia unresponsive to medical therapy.
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ranking = 3.6423298858672
keywords = surgical blood loss, blood loss, surgical blood
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