Cases reported "Emergencies"

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1/48. ovarian cysts in childhood.

    This is a review of cases of ovarian cyst encountered in childhood in the Manchester children's hospitals. The patients presented with acute or recurrent abdominal pain or an abdominal or pelvic mass. The commonest cyst found was a teratoma, which was discovered because of its size or because of a complication. All but one of the girls with teratomas had not reached puberty. After puberty the cysts were follicular or luteal in type, although there was one case of cystadenoma. Complications in the form of torsion, rupture which haemoperitoneum or haemorrhage into the cyst were common. Treatment consisted of ovarian cystectomy, oophorectomy or salpingo-oophorectomy, and the results were satisfactory.
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ranking = 1
keywords = haemorrhage
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2/48. Hemorrhagic adrenal cyst: an unusual reason of acute hypovolemia.

    Adrenal cysts are often asymptomatic and included in the larger "incidentaloma" group. They may reach significant size without onset of compressive symptoms and are often left undiagnosed until an ultrasound or CT scan are performed for a vague lumbar or flank discomfort. Intracystic hemorrhage is a rare but life-threatening complication since a sudden and significant blood loss may occur without any evident clinical source, hypovolemic shock resulting as the first symptom. The authors report their personal experience in two patients along with a review of the literature on this insidious emergency, its diagnosis and therapeutic approach.
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ranking = 3.4628533980274
keywords = blood loss
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3/48. Emergency and elective surgical treatment of portal hypertension. A review of 23 years' experience.

    A retrospective review of surgical treatment for portal hypertension during a 23-year period in a regional unit is reported and the immediate and subsequent management of patients with bleeding oesophageal varices is discussed. Fifty-four patients with recurrent varix haemorrhage uncontrolled by conservative methods have been treated by oesophageal transection with a mortality of 22.2% (26.6% for cirrhotic patients). Thirty-two per cent of the cirrhotics were alive after 2 years. Only a minority (12%) of the survivors were considered suitable for a subsequent shunt procedure. Therapeutic portacaval anastomosis has been performed on 65 patients with a 51.2% 5-year survival (43-5% for cirrhotic patients). Further haemorrhage due to shunt thrombosis occurred in 5-3% of cases. The frequent occurrence of portal-systemic encephalopathy, increasing with duration of time following a shunt, is emphasized. The high morbidity and mortality in the poor-risk cirrhotic indicated that this type of patient is unsuitable for a portal-systemic shunt and is better treated by medical means.
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ranking = 2
keywords = haemorrhage
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4/48. Ambulance transport of obstetric emergencies.

    Ninety-eight patient records from obstetric flying squad calls were reviewed. The reasons for call-out and the effect of transport on maternal and foetal cardiovascular parameters were analysed. The main reason for calling the flying squad is now antepartum haemorrhage. Transporting the patient to hospital has little effect on the cardiovascular state.
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ranking = 1
keywords = haemorrhage
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5/48. Subarachnoid haemorrhage: a clinical overview.

    Subarachnoid haemorrhage affects up to 9,000 people a year in the UK (Lindsay and Bone 1997) and is a devastating condition. Although many patients make a good physical recovery, some are left with cognitive and perceptual deficits. Early rehabilitation and support is essential, and caring for these patients and their families is a major challenge for nurses.
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ranking = 5
keywords = haemorrhage
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6/48. Benign rectal ulcer: an underground cause of inpatient lower gastrointestinal bleeding.

    BACKGROUND: Although it is uncommon, significant bleeding per rectum presents one of the most difficult emergency problems. Bleeding from a rectal ulcer is not well recognized as a cause of such bleeding. methods: From July 2000 through December 2000, 195 consecutive patients with significant blood loss per rectum were reviewed. RESULTS: Forty-eight cases in whom significant gastrointestinal (GI) bleeding occurred following prior hospitalization were identified. Sources of bleeding were gastroduodenal in 38 cases (79%) and colorectal in 10 cases (21%). The causes of inpatient colorectal bleeding were benign rectal ulcer (n = 4), ischemic colitis (n = 3), neoplasia (n = 2), and diversion colitis (n = 1). CONCLUSION: The differential diagnosis for inpatients who develop new inpatient GI bleeding differs from that of patients who develop outpatient GI bleeding. Careful examination of the rectum following rectal instrumentation is critical. In addition to the standard resuscitative measures, the identification and treatment of rectal ulcers in this group of patients is of paramount importance. The treatment options for bleeding rectal ulcer include conservative therapy, cauterization, embolization, banding, and local excision.
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ranking = 3.4628533980274
keywords = blood loss
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7/48. Emergency pelvic packing to control intraoperative bleeding after a Piver type-3 procedure. An unusual way to control gynaecological hemorrhage.

    We report a case of gynaecologic haemorrhage after a Piver type-3 procedure treated by a packing technique. The postoperative course was uneventful and the packs were removed after six days. Intra-abdominal packing should be familiar to both obstetricians and gynecologists because when any other attempt to provide hemostasis fails, it can be the last successful way to control a life-threatening haemorrhage.
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ranking = 2
keywords = haemorrhage
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8/48. life threatening haemorrhage after anterior needle aspiration of pneumothoraces. A role for lateral needle aspiration in emergency decompression of spontaneous pneumothorax.

    Needle aspiration is a recognised emergency treatment of spontaneous pneumothorax and in the case of suspected tension is usually performed before chest radiography. Three cases are described of apparent life threatening haemorrhage after anterior aspiration in the second intercostal space, mid-clavicular line (2ICS MCL) requiring resuscitation, and transfer to a cardiothoracic unit. In these patients there was no evidence of haemothorax on initial presentation. Lateral needle aspiration, in the site recommended for chest drain insertion, the 5th intercostal space, anterior axillary line (5ICS ALL) is technically easy and may be a potentially safer option for decompressing pneumothoraces.
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ranking = 5
keywords = haemorrhage
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9/48. Cardiac rupture after thrombolytic therapy: the use of aprotinin to reduce blood loss after surgical repair.

    Emergency cardiac surgery after recent thrombolytic therapy is associated with increased blood loss. A patient underwent emergency repair of a ruptured left ventricle after intravenous streptokinase treatment for acute coronary occlusion. High dose aprotinin was given during the operation to reduce the expected blood loss. Surgical repair was successful without bleeding complications. Total postoperative blood loss was 365 ml.
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ranking = 10.388560194082
keywords = blood loss
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10/48. Emergency surgery in patients in extremis from blunt torso injury: heroic surgery or futile care?

    BACKGROUND: Trauma strikes unexpectedly, frequently in the young and fit. When trauma victims arrive in the emergency room all possible steps, including surgery, are often undertaken in an attempt to achieve a successful outcome. However, for patients presenting in extremis, with cardiac arrest or exsanguinating blunt chest injury, the results of resuscitation and emergency surgery are extremely poor. PATIENTS AND SETTING: Eight patients in extremis with a mean injury severity score of 36, presented to the resuscitation room of Queens Medical Centre during 2001. On arrival all were in extremis or cardiac arrest after significant blunt injury to the torso, and during resuscitation had a brief loss of cardiac output. They underwent emergency surgery to control haemorrhage and correct injuries in an attempt to preserve life. Seven patients died within hours of their initial presentation either in theatre or the intensive care unit and one patient survived. CONCLUSIONS: Futile care in the management of severely injured patients is a controversial concept although the literature defines four concepts of futility within surgery. At present, while there remains even the remotest possibility of survival, there remains a strong incentive to act and reports of isolated survivors from studies of trauma patients in extremis or cardiac arrest continue to emerge. This may be seen as justification for either an aggressive surgical approach or an indication that surgery is futile. In an emerging culture of guidelines regarding effectiveness of treatment, is this an area in which such guidelines can or should be applied?
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ranking = 1
keywords = haemorrhage
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