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11/166. survival after haemorrhage from the brachiocephalic truncus following tracheostomy.

    A patient with two massive haemorrhages from the brachiocephalic truncus after tracheostomy is reported. An analysis of 6 previously reported long-term survivors following this complication shows that the initial care in controlling the haemorrhage is of major importance. The operation method of choice is permanent division of the brachiocephalic truncus. Transitory or no neurological postoperative complications were found.
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keywords = haemorrhage
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12/166. Fatal haemorrhage from the innominate artery complicating tracheostomy.

    A fatal haemorrhage of the innominate artery complicating tracheostomy for obstructive carcinoma of the larynx is reported. The possible mechanism of the rupture is discussed and methods of management are suggested.
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keywords = haemorrhage
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13/166. A patient whose cerebral aneurysm ruptured soon after an operation to remove a maxillary cyst.

    A hypertensive woman complained of a headache soon after an operation to remove a maxillary cyst. A computed tomogram showed evidence of subarachnoid haemorrhage and on angiogram an aneurysm of an anterior cerebral artery. The aneurysm was treated by clipping and the patient recovered.
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ranking = 0.16666666666667
keywords = haemorrhage
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14/166. Primary aorto-oesophageal fistula due to oesophageal carcinoma. Report of a successfully managed case.

    Aorto-oesophageal fistula is a rare but often fatal entity causing upper gastrointestinal bleeding. Amongst the different aetiologies described, the commonest is rupture of a thoracic aortic aneurysm into the oesophagus. This entity was first reported in 1818, and only recently have successfully treated cases been published. Other causes such as postoperative complications, tuberculosis and trauma are less common. Oesophageal malignancy perforating the aorta is a rarity. The authors describe a case of aortic perforation secondary to an oesophageal carcinoma, treated with initial success. The clinical onset was a massive upper gastrointestinal haemorrhage. The diagnosis, once the bleeding was controlled, was arrived at after CT-scanning and arteriography. A Dacron prosthesis was interposed into the descending thoracic aorta to restore aortic flow; later an oesophagectomy plus oesophagostomy and jejunostomy were carried out.
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ranking = 0.16666666666667
keywords = haemorrhage
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15/166. Bilateral frontal haemorrhages associated with continuous spinal analgesia.

    We report a case of intracerebral haemorrhages associated with continuous spinal analgesia. Continuous spinal analgesia is frequently employed for postoperative analgesia in high-risk patients in our institution. The analgesia is administered via a 20 gauge catheter passed through an 18 gauge Tuohy needle (Portex). A 71-year-old man with severe respiratory impairment had an intrathecal catheter placed for postoperative analgesia. He had a difficult postoperative course, including wound dehiscence, and died from respiratory failure some five weeks postoperatively. On day nine postoperatively he had two tonic-clonic seizures and was subsequently found to have developed bilateral frontal intracerebral haemorrhages. There was no previous history of seizures. Although several confounding variables exist, the most likely explanation for the intracerebral event appears to be an association with the dural puncture and intrathecal catheter Possible mechanisms and risk factors are discussed.
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keywords = haemorrhage
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16/166. Cerebral vasospasm following transsphenoidal removal of a pituitary adenoma.

    We report a case of pituitary macroadenoma that developed symptomatic vasospasm 12 days after transsphenoidal removal, but showed an excellent recovery following active treatment identical to those for vasopasm following aneurysmal subarachonid haemorrhage. Subarachnoid haematoma in the basal cisterns secondary from postoperative intracapsular haemorrhage was the most probable cause of the vasopasm.
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keywords = haemorrhage
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17/166. Post-tonsillectomy bleed: a delayed diagnosis of duodenal ulceration.

    Post-operative haemorrhage is one of the commonest complications of tonsillectomy. We report a case of a 36-year-old lady who presented with three haemorrhagic episodes following tonsillectomy. Although initially treated as secondary tonsillar haemorrhage, the actual cause of the bleeding was later identified to be a duodenal ulcer. The case is presented with a review of the literature.
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keywords = haemorrhage
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18/166. Delayed aneurysm rerupture following total endovascular occlusion.

    Endovascular coiling is a well established technique for the treatment of selected intracranial aneurysms, but its long-term efficacy, including the rate of rehaemorrhage from treated lesions, remains to be clearly determined. We report a case in which the rerupture of a small aneurysm occurred 12 months after embolization, despite angiographic occlusion on immediate post-procedural and 6-month check angiography.
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ranking = 0.16666666666667
keywords = haemorrhage
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19/166. Severe postoperative haemorrhage and airway obstruction following high-dose enoxaparin.

    Unfractionated heparin infusion may be a more suitable choice of anticoagulant treatment in patients with venous thromboembolism in the immediate postoperative period.
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keywords = haemorrhage
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20/166. Tracheal granulation tissue after percutaneous tracheostomy treated with Nd:Yag laser: three cases.

    Three adult patients who received percutaneous serial dilatational tracheostomy post-cardiac surgery developed histologically confirmed tracheal granulation tissue superior to the point of entry of the tracheostomy tube into the trachea. This tissue significantly occluded the trachea in all patients and, in two, led to serious haemorrhage. Each patient had serial dilatational percutaneous tracheostomy using the Cook/Ciaglia technique. On each patient fibre-optic bronchoscopy confirmed satisfactory position of the guidewire and tracheostomy tube. Nd:Yag laser therapy was applied to areas of tracheal granulation tissue and was also employed to secure haemostasis. In each patient endobronchial Nd:YAG laser therapy successfully cleared the granulation tissue and secured haemostasis. Follow-up bronchoscopy showed no recurrence. Fibre-optic bronchoscopy at the time of tracheal decannulation may identify granulation tissue requiring appropriate referral and intervention.
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ranking = 0.16666666666667
keywords = haemorrhage
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