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1/232. pituitary apoplexy after cardiac surgery presenting as deep coma with dilated pupils.

    Acute clinical deterioration due to infarction or haemorrhage of an existing, often previously unrecognized, pituitary tumour is a rare but well-described complication. It can occur spontaneously or may be caused e.g. by mechanical ventilation, infection or surgical procedures. We report on a case of pituitary apoplexy occurring in a 64-year-old patient 3 weeks after cardiac surgery. The patient presented with deep coma and dilated pupils. magnetic resonance imaging revealed a haemorrhagic pituitary tumour. After prompt endocrinologic replacement therapy with levothyroxine and hydrocortisone the patient regained consciousness. Neurological examination revealed right oculomotor nerve palsy and bilateral cranial nerve VI palsy. Subsequent trans-sphenoidal removal of a nonfunctional macroadenoma with large necrotic areas was performed. The patient recovered completely. To our knowledge, pituitary tumours presenting with a combination of deep coma and dilated pupils must be considered exceedingly rare. Possible pathophysiologic mechanisms are discussed. As our case illustrates, even in severe cases complete recovery is possible if the diagnosis is suspected, and diagnostic and therapeutic measures are initiated in time.
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ranking = 1
keywords = haemorrhage
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2/232. Carotid ligation for carotid aneurysms.

    Thirty patients with subarachnoid haemorrhage due to rupture of a carotid aneurysm were treated by ligation of the common carotid artery. Two patients died as a result of the procedure, two patients developed persisting hemisphere deficit. Eight of the ten patients who developed cerebral ischemia after the operation were operated within ten days after the bleeding. At present out aim is to guide the patient safely through the first ten days after his haemorrhage and perform ligation at the end of the second week. After a follow up period of 1-8 years recurrent haemorrhage did not occur. Common carotid ligation, preferably with control of carotid artery end pressure, cerebral blood-flow and EEG is considered to be a valuable method to treat ruptured intracranial carotid aneurysm.
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ranking = 3
keywords = haemorrhage
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3/232. Neuro-ophthalmic complication after maxillary surgery.

    We report an unusual case of ophthalmoplegia after maxillofacial surgery. A thirteen year old girl with unilateral left cleft lip and palate underwent maxillary advancement by distraction osteogenesis. Postoperatively she developed diplopia. The diplopia was not due to orbital lesions, most often seen after maxillofacial surgery, but to a haemorrhage posterior to the cavernous sinus.
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ranking = 1
keywords = haemorrhage
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4/232. 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 = 1.3629279655053
keywords = blood loss
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5/232. adult respiratory distress syndrome after extensive cytoreductive surgery. A case report.

    BACKGROUND: adult respiratory distress syndrome (ARDS) is characterized by progressive hypoxemia, diffuse bilateral pulmonary infiltrates and normal left ventricular function. CASE: A 58-year-old woman developed ARDS following extensive cytoreductive surgery for a widely disseminated intraperitoneal leiomyosarcoma. The patient had a favorable outcome after 10 days of ventilatory support, sedation, analgesia, parenteral and enteral nutrition, and fluid restriction. The ARDS might have been caused by multiple transfusions or the massive cytoreductive surgery and was probably mediated by cytokines and tumor necrosis factors. CONCLUSION: Gynecologic oncologists should be alert to postoperative ARDS in patients undergoing massive cytoreduction with excessive blood loss and multiple transfusions.
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ranking = 1.3629279655053
keywords = blood loss
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6/232. Postbulbar duodenal ulcer.

    Postbulbar duodenal ulceration is not common, but when present is difficult to diagnose and treat. Between January 1965 and September 1971, 1,080 patients with duodenal ulcers were treated surgically at St James Hospital. Forty-one ulcers were found at operation to lie distal to the duodenal bulb. pain was the most common indication for surgery. In six-patients it was clinically indistinguishable from biliary pain, giving rise to diagnostic difficulty. Twelve patients (29%) presented with haemorrhage, a percentage similar to the 25% of bulbar ulcers presenting with this complication over the period of this study. This is contrary to the finding in most other series, that postbulbar ulceration is more frequently complicated by haemorrhage than is bulbar ulceration. Perforation and stenosis are uncommon complications. Postbulbar ulceration is easily overlooked in conventional barium studies. Only one-third of the patients subjected to barium meal x-ray examination had their ulcers identified in the first study. In a further third the presence of an ulcer was suspected, and the remainder required multiple investigations for undiagnosed symptoms before the condition was demonstrated. duodenoscopy was not performed in a sufficient number of patients for its value to be assessed, but other reports indicate that it should be a valuable manoeuvre. The technical difficulties and potential hazards of Polya gastrectomy are discussed and special reference is made to the surgical management of bleeding postbulbar ulcers.
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ranking = 2
keywords = haemorrhage
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7/232. postoperative complications of repeat hepatectomy for liver metastasis from colorectal carcinoma.

    BACKGROUND/AIMS: When a repeat hepatectomy is possible, it is the most effective treatment modality for recurrent colorectal liver metastasis. The aim of this study was to evaluate the surgical risks of repeat hepatectomy for liver metastasis from colorectal carcinoma. METHODOLOGY: Between 1986 and 1996, 60 patients with hepatic metastasis from colorectal carcinoma underwent surgery in the Department of Surgery I, Oita Medical University. Ten of them underwent a repeat hepatectomy. The cases of these 10 patients were studied retrospectively; in particular, postoperative complications and intraoperative blood loss were compared between the initial and second operation. RESULTS: During the second surgery, recurrence was detected adjacent to the hepatic stump in 9 of the 10 patients. During the initial surgery, 6 underwent non-anatomic resections, and 4 had anatomic resection, including 1 extended lobectomy, 1 lobectomy, and 2 segmentectomies. For the second surgery, 3 had anatomic resections, including 2 lobectomies, and 1 segmentectomy, and 7 underwent non-anatomic resections. There were no mortalities during the initial or second operation. There was no morbidity following the initial surgeries and 7 postoperative complications (intraabdominal abscess, 4 cases; biloma, 3 cases) following the second surgeries. Mean blood loss during the second operation (1044 mL) was significantly greater than during the initial operation (561 mL). CONCLUSIONS: The present results show that repeat hepatectomy for recurrent liver metastasis from colorectal carcinoma resulted in significantly greater intraoperative blood loss and postoperative complications than those of the initial surgeries. The blood loss and complications in the second operation, the one for the recurrence, were directly associated with the fact that the recurrence was so close to the hepatic stump. Since the resection line in the second surgery was adjacent to the hepatic hilus, resection of the lesion caused much more injury to the main bile duct and main portal vein than that caused by the.
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ranking = 4.0887838965158
keywords = blood loss
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8/232. Haematemesis and Melaena: surgical management.

    A prospective study of the surgical management of 100 consecutive patients with benign, non-variceal upper gastrointestinal bleeding is presented. The manner of presentation, precipitating factors, investigations and associated medical problems are discussed. Chronic duodenal ulceration was the most common cause of haemorrhage. vagotomy and drainage with oversewing or excision of the bleeding ulcer was the surgical procedure performed in 71 of the patients in the series. The incidence of recurrent bleeding was 7%; no patient in this category required further operation. The mortality rate was 6%, and there were no deaths recorded in the patients who underwent vagotomy and drainage. The reasons for the relatively low surgical mortality are discussed.
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ranking = 1
keywords = haemorrhage
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9/232. Posterior-fossa haemorrhage after supratentorial surgery--report of three cases and review of the literature.

    We present clinical details of three patients with posterior fossa haemorrhage after supratentorial surgery and discuss possible pathomechanisms of this rare complication. All patients were males of advanced age. Two patients presented with a history of hypertension. In all patients the occurrence of haemorrhage was associated with loss/removal of large amounts of cerebrospinal fluid (CSF) either intra-operatively (one patient undergoing aneurysm surgery) or postoperatively (all three patients: drainage of subdural hygromas or chronic subdural haematomas in two, external ventricular drainage in one patient). Treatment consisted in haematoma evacuation and/or external ventricular drainage. Two patients died, one patient recovered completely. Although haematomas distant from a craniotomy site are a well known entity, a review of the literature identified only 25 published cases of posterior fossa haemorrhage after supratentorial procedures in the CT era. Most often disturbances of coagulation, positioning of the patient and episodes of hypertension have been associated with this complication. Only one author described the occurrence of a haemorrhage after drainage of a supratentorial hygroma. We suggest that the loss of large amounts of CSF intra-operatively and post-operatively may lead to parenchymal shifts or a critical increase of transmural venous pressure with subsequent vascular disruption and haemorrhage.
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ranking = 9
keywords = haemorrhage
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10/232. Aneurysms in the ascending aorta adherent to the sternum after cardiac surgery.

    sternotomy in a patient with an aneurysm in the ascending aorta adherent to the sternum after cardiac surgery can result in fatal hemorrhage or brain damage unless the distal ascending aorta can be identified and secured immediately. A left anterolateral thoracotomy was used in three patients with adherent aneurysms. The distal ascending aorta was isolated, and dissection was performed between the aneurysm and the sternum. There was no complication. This method was safe, and blood loss was minimized.
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ranking = 1.3629279655053
keywords = blood loss
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