Cases reported "Postoperative Hemorrhage"

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1/29. natural history of congenital arteriovenous fistula.

    There is no more difficult lesion to manage than congenital arteriovenous fistula. The advanced lesions are extremely vascular and unless they lend themselves to total excision, prompt recurrence is the rule. For the same reason, embolization is not successful and as the major feeding vessels are occluded, access to the tumor becomes more and more limited. In order to obliterate the tumor, it must be destroyed at the microvascular level. So far, only ethanol has proved effective in this regard, and this agent must be used conservatively to avoid excessive destruction of normal tissue and systemic damage.
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keywords = fistula
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2/29. Vascular complications in lumbar spinal surgery: percutaneous endovascular treatment.

    Four patients underwent endovascular treatment of vascular injuries complicating lumbar spinal surgery. In two patients with massive retroperitoneal hemorrhage, the extravasating lumbar arteries were successfully embolized with microcoils. Two patients with large iliac arteriovenous fistula (AVF) were treated, one with embolization using a detachable balloon and coils, which failed, and the other with placement of a stent graft after embolization of distal runoff vessels, which occluded the fistula. We conclude that acute arterial laceration or delayed AVF complicating lumbar spinal surgery can be managed effectively with selective embolization or stent-graft placement, respectively.
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ranking = 0.4
keywords = fistula
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3/29. Fatal fungal infection complicating aortic dissection following coronary artery bypass grafting.

    The case of a 52-year-old man with severe coronary atheroma/ischaemic heart disease, who underwent successful triple vessel coronary artery bypass grafting is described. One month later this was complicated by aortic dissection arising at the aortic cannulation site. An emergency resection and Dacron graft placement were performed. Five weeks later he represented with haemoptysis. Despite inconclusive investigations the patient went on to suffer a massive fatal haemoptysis. autopsy revealed candida infection of the graft with a secondary aortobronchial fistula.
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ranking = 0.2
keywords = fistula
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4/29. Recurrent hemoptysis following a systemic-to-pulmonary anastomosis in a child with a complex congenital cardiomyopathy.

    A 14-year-old boy with a history of congenital cardiopathy is presented. At age 4, a left systemic-to-pulmonary fistula was performed, using a tubular prosthesis to anastomose the left subclavian artery to the left pulmonary artery. Following this procedure, he developed recurrent episodes of hemoptysis, cough, and left upper lobe consolidation. Treatment resulted in clinical but no radiologic resolution. At age 6, a new right systemic-to-pulmonary anastomosis was needed, as the left one was no longer functioning. After placement of the second shunt, the hemoptysis disappeared. At age 14, flexible bronchoscopy revealed a foreign body granuloma at the left secondary carina. Rigid bronchoscopy and laser photoresection showed it to be the left vascular prosthesis, placed 10 years before. Surgery failed to remove it.
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keywords = fistula
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5/29. Successful management of massive blood loss to extremely low hemoglobin in an elderly woman receiving spinal surgery.

    blood transfusion is absolutely indicated in acute anemia when the hemoglobin concentration falls below 6 g/dL. Sometimes it challenges the anesthesiologists if the blood intended for urgent transfusion is not readily or quickly available. In this case report, we describe an 81-year-old lady who accidentally sustained acute anemia after spinal surgery with the hemoglobin concentration falling to 1.4 g/dL. During the long wait for the process of cross-matching tests and delivery of blood from the blood bank in the city remote from the hospital, we could do nothing but administer crystalloid and colloid solutions to maintain the circulatory volume to prevent low cardiac output. epinephrine was given when systolic blood pressure fell below 70 mmHg. central venous pressure and arterial blood pressure were monitored to guide all the treatment. Fortunately, patient fully recovered on postoperative day 3 without any adverse events.
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ranking = 0.032258493989085
keywords = dental
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6/29. Tracheo-innominate fistula after initial percutaneous tracheostomy.

    We report a tracheo-innominate fistula formation after tracheostomy in a 68-year-old man with guillain-barre syndrome. The initial percutaneous tracheostomy had to be revised surgically after the tube dislodged from its insertion site in the trachea. Three days later, massive bleeding occurred and emergency surgery revealed a fistula. This was surgically repaired but subsequently re-bled with a fatal outcome. The post mortem report found an aneurysmal ectatic innominate artery with a fistula involving the anterior tracheal wall. The aetiology, diagnosis and management of tracheo-innominate fistula are discussed.
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ranking = 1.6
keywords = fistula
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7/29. Use of intraligamentary anesthesia in a patient with severe hemophilia and factor viii inhibitor.

    This article reviews the therapeutic problems that arise in the dental management of hemophilia patients with inhibitor and suggests an anesthesia technique that may eliminate the need for factor replacement during restorative procedures. Intraligamentary anesthesia was used during restorative procedures that were performed throughout an 8-year period on a patient with factor viii inhibitor. Multiple restorative procedures were accomplished without the use of replacement factor and with no postoperative bleeding. This technique, in consultation with the patient's physician, may be performed by most general practitioners in their private offices.
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ranking = 0.032258493989085
keywords = dental
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8/29. DDAVP (desmopressin; 1-deamino-cys-8-D-arginine-vasopressin) treatment in children with haemophilia B.

    We tested the response to desmopressin (1-deamino-cys-8-D-arginine-vasopressin; DDAVP) in four patients with haemophilia B [factor ix (F IX) at diagnosis 1.4-5%]. The activated partial thromboplastin time (aPTT) was significantly shortened in all patients. Although there was an up to 1.4-fold increase in F IX levels in three patients, maximal F IX activity remained below 10%. Much more prominent were the increases in F VIII (three- to fourfold), in von willebrand factor antigen (VWF:Ag; 2.5-fold) and particularly in VWF collagen-binding activity (VWF:CBA; fivefold). These changes were reflected by the prophylactic efficacy of DDAVP for dental surgery. After pretesting, DDAVP could be a useful drug for reducing the need for plasma products for prevention of minor surgical bleeding in patients with mild to moderate haemophilia B.
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keywords = dental
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9/29. Late lethal secondary hemorrhage after laser supraglottic laryngectomy.

    Since 1971, a number of articles have been published regarding the complications encountered with laser surgery of the larynx. Most investigations focus on complications such as accidental burns caused by the reflection of the laser beam, endotracheal explosion, special anesthesiologic problems, edema of the mucosa leading to airway obstruction, and abnormal scar formation with functional problems. Secondary hemorrhage has played a subordinate role, and in the few articles that have focused on it, cases requiring postoperative treatment have been reported only sporadically. All of these cases occurred within the first postoperative week, and no case resulting in the death of a patient was reported. We describe a patient in whom a lethal secondary hemorrhage occurred 10 days after a laser supraglottic laryngectomy. Because of the increase of laser applications in the treatment of laryngeal carcinoma, similar complications may be encountered. We comment on possible pathophysiological mechanisms and consequences.
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keywords = dental
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10/29. Anaemia, osteogenesis imperfecta and valve diseases. The preoperative treatment with epoetin-alpha to increase haematocrit and haemoglobin levels in patients with high risk of perioperative bleeding.

    The case of a patient with osteogenesis imperfecta is reported who underwent surgery for mitral valve replacement. osteogenesis imperfecta is a hereditary disease of the connective tissue, associated with bone fragility, bluish colouring of the sclerae, loss of hearing and dental anomalies. osteogenesis imperfecta is included in a group of hereditary pathologies with ehlers-danlos syndrome, Hurler syndrome, pseudoxanthoma elasticum and marfan syndrome. In the literature there are few cases of patients with osteogenesis imperfecta operated for mitral valve disease secondary to such disease. The patient also has a positive family history and a severe anaemia: this was treated with epoetin-alpha and ferrous sulphate during the three weeks before surgery. The response to epoietin treatment was good while clinical outcome was poor due to rupture of the posterior ventricular wall in the 12th postoperative hour. The use of epoietin-alpha is discussed.
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ranking = 0.032258493989085
keywords = dental
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