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Zhang D, Dyer GSM, Earp BE. The Relationship Between Preoperative International Normalized Ratio and Postoperative Major Bleeding in Total Shoulder Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00010. [PMID: 38569086 PMCID: PMC10994459 DOI: 10.5435/jaaosglobal-d-23-00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/26/2024] [Accepted: 03/01/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION This study aimed to assess the relationship between preoperative international normalized ratio (INR) levels and major postoperative bleeding events after total shoulder arthroplasty (TSA). METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried for TSA from 2011 to 2020. A final cohort of 2405 patients with INR within 2 days of surgery were included. Patients were stratified into four groups: INR ≤ 1.0, 1.0 < INR ≤ 1.25, 1.25< INR ≤ 1.5, and INR > 1.5. The primary outcome was bleeding requiring transfusion within 72 hours, and secondary outcome variables included complication, revision surgery, readmission, and hospital stay duration. Multivariable logistic and linear regression analyses adjusted for relevant comorbidities were done. RESULTS Of the 2,405 patients, 48% had INR ≤ 1.0, 44% had INR > 1.0 to 1.25, 7% had INR > 1.25 to 1.5, and 1% had INR > 1.5. In the adjusted model, 1.0 < INR ≤ 1.25 (OR 1.7, 95% CI 1.176 to 2.459), 1.25 < INR ≤ 1.5 (OR 2.508, 95% CI 1.454 to 4.325), and INR > 1.5 (OR 3.200, 95% CI 1.233 to 8.302) were associated with higher risks of bleeding compared with INR ≤ 1.0. DISCUSSION The risks of thromboembolism and bleeding lie along a continuum, with higher preoperative INR levels conferring higher postoperative bleeding risks after TSA. Clinicians should use a patient-centered, multidisciplinary approach to balance competing risks.
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Affiliation(s)
- Dafang Zhang
- From the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA (Dr. Zhang, Dr. Dyer, and Dr. Earp), and the Harvard Medical School, Boston, MA (Dr. Zhang, Dr. Dyer, and Dr. Earp)
| | - George S. M. Dyer
- From the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA (Dr. Zhang, Dr. Dyer, and Dr. Earp), and the Harvard Medical School, Boston, MA (Dr. Zhang, Dr. Dyer, and Dr. Earp)
| | - Brandon E. Earp
- From the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA (Dr. Zhang, Dr. Dyer, and Dr. Earp), and the Harvard Medical School, Boston, MA (Dr. Zhang, Dr. Dyer, and Dr. Earp)
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2
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Lisitano L, Röttinger T, Thorne T, Förch S, Cifuentes J, Rau K, Vounatsos PD, Mayr E. A comprehensive analysis of intraoperative factors associated with acute-on-chronic kidney injury in elderly trauma patients: blood loss as a key predictor. Aging Clin Exp Res 2023; 35:2729-2737. [PMID: 37646924 PMCID: PMC10628037 DOI: 10.1007/s40520-023-02540-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Postoperative acute kidney injury (AKI) is a critical issue in geriatric patients with pre-existing chronic kidney disease (CKD) undergoing orthopedic trauma surgery. The goal of this study was to investigate modifiable intraoperative risk factors for AKI. METHODS A retrospective study was conducted on 206 geriatric patients with CKD, who underwent orthopedic trauma surgery. Several variables, including intraoperative blood loss, postoperative hypoalbuminemia, intraoperative blood pressure and long-term use of potentially nephrotoxic drugs, were analyzed. RESULTS Postoperative AKI (KIDGO) was observed in 25.2% of the patients. The 1-year mortality rate increased significantly from 26.7% to 30.8% in patients who developed AKI. Primary risk factors for AKI were blood loss (p < 0.001), postoperative hypoalbuminemia (p = 0.050), and potentially nephrotoxic drugs prior to admission (angiotensin-converting enzyme inhibitors, angiotensin-II receptor antagonists, diuretics, antibiotics, NSAIDs) (p = 0.003). Furthermore, the AKI stage negatively correlated with propofol dose per body weight (p = 0.001) and there was a significant association between AKI and the use of cement (p = 0.027). No significant association between intraoperative hypotension and AKI was observed in any statistical test. Femur fracture surgeries showed the greatest blood loss (524mL ± 357mL, p = 0.005), particularly intramedullary nailing at the proximal femur (598mL ± 395mL) and revision surgery (769mL ± 436mL). CONCLUSION In geriatric trauma patients with pre-existing CKD, intraoperative blood loss, postoperative hypoalbuminemia, and pre-admission use of potentially nephrotoxic drugs are associated with postoperative AKI. The findings highlight the necessity to mitigate intraoperative blood loss and promote ortho-geriatric co-management to reduce the incidence and subsequent mortality in this high-risk population.
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Affiliation(s)
- Leonard Lisitano
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Timon Röttinger
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Tyler Thorne
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Stefan Förch
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Jairo Cifuentes
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Kim Rau
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Panagiotis Daniel Vounatsos
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Edgar Mayr
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
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Singh DK, Shankar D, Sharma G, Kaif M. Delayed Postoperative Hemorrhage in Epidermoid Tumors: A Unique and Catastrophic Complication. Neurol India 2022; 70:462-463. [PMID: 35263953 DOI: 10.4103/0028-3886.338686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
| | - Diwakar Shankar
- Department of Neurosurgery, RMLIMS, Lucknow, Uttar Pradesh, India
| | - Gaurav Sharma
- Department of Neurosurgery, RMLIMS, Lucknow, Uttar Pradesh, India
| | - Md Kaif
- Department of Neurosurgery, RMLIMS, Lucknow, Uttar Pradesh, India
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Desborough MJR, Obaji S, Lowe GC, Doree C, Thomas W. Management of surgery, menorrhagia and child-birth for patients with unclassified bleeding disorders: a systematic review of cohort studies. Blood Coagul Fibrinolysis 2021; 32:366-372. [PMID: 33973892 DOI: 10.1097/mbc.0000000000001045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Unclassified bleeding disorders account for 2.6% of all new bleeding disorder registrations in the UK. The management of the bleeding phenotype associated with these disorders is poorly described. Systematic review and meta-analysis to determine the bleeding rates associated with tranexamic acid, desmopressin, platelet transfusion, plasma transfusion and recombinant activated factor VII, for patients with unclassified bleeding disorders undergoing surgery, childbirth or with menorrhagia. We searched for randomized controlled trials in MEDLINE, Embase, The Cochrane Central Register of Controlled Trials, PubMed, ISI Web of Science and the Transfusion Evidence Library from inception to 24 February 2020. Wherever appropriate, data were pooled using the metaprop function of STATA. Two studies with 157 participants with unclassified bleeding disorders were identified. The pooled risk of minor bleeding for patients undergoing surgery treated with peri-operative tranexamic acid was 11% (95% confidence interval 3--20%; n = 52; I2 = 0%); the risk for desmopressin and tranexamic acid in combination was 3% (95% confidence interval 0--7%; n = 71; I2 = 0%). There were no instances of major bleeding. In one procedure, 1 of 71 (1.4%), treated with a combination of desmopressin and tranexamic acid, the patient had a line-related deep vein thrombosis. There were too few patients treated to prevent postpartum haemorrhage or for menorrhagia to draw conclusions. The GRADE quality of evidence was very low suggesting considerable uncertainty over the results. However, both tranexamic acid, and the combination of tranexamic and desmopressin have high rates of haemostatic efficacy and have few adverse events. PROTOCOL REGISTRATION PROSPERO CRD42020169727.
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Affiliation(s)
- Michael J R Desborough
- Haemostasis and Thrombosis Centre, Guy's and St Thomas' NHS Foundation Trust, London
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust
- Radcliffe Department of Medicine, University of Oxford, Oxford
| | - Samya Obaji
- Cardiff Haemophilia Centre, University Hospital of Wales
| | - Gillian C Lowe
- Comprehensive Care Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood and Transplant, Oxford
| | - Will Thomas
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Fujita Y, Terashita M, Yazawa M, Yamasaki Y, Imamura T, Kibayashi J, Sawai T, Hidaka Y, Ohtani K, Inoue N, Shibagaki Y. Eculizumab for Severe Thrombotic Microangiopathy Secondary to Surgical Invasive Stress and Bleeding. Intern Med 2020; 59:93-99. [PMID: 31902910 PMCID: PMC6995713 DOI: 10.2169/internalmedicine.3315-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Atypical hemolytic uremic syndrome (aHUS) is an extremely rare condition caused by an excessive activation of the complement pathway based on genetic or acquired dysfunctions in complement regulation, leading to thrombotic microangiopathy (TMA). A complement-amplifying condition (CAC) can trigger aHUS occurrence along with complement abnormality. We herein report a case of severe TMA after laparoscopic myomectomy in a healthy woman. This case was eventually diagnosed as complement-mediated TMA secondary to surgical invasive stress as a CAC, with no definitive diagnosis of aHUS despite a genetic test. The patient fully recovered after several eculizumab administrations.
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Affiliation(s)
- Yoko Fujita
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Maho Terashita
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Masahiko Yazawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Yukitaka Yamasaki
- Department of Infectious Disease, St. Marianna University School of Medicine, Japan
| | - Tomonori Imamura
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Police Hospital, Japan
| | | | - Toshihiro Sawai
- Department of Pediatrics, Shiga University of Medical Science, Japan
| | - Yoshihiko Hidaka
- Department of Molecular Genetics, Wakayama Medical University, Japan
- The Japanese Association for Complement Research, Japan
| | - Katsuki Ohtani
- The Japanese Association for Complement Research, Japan
- Department of Food and Health Sciences, Rakuno Gakuen University, Japan
| | - Norimitsu Inoue
- Department of Molecular Genetics, Wakayama Medical University, Japan
- The Japanese Association for Complement Research, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
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Ceballos-Vasquez A. Concomitant feline immunodeficiency virus (FIV) and Mycoplasma haemofelis in a barn cat. Can Vet J 2018; 59:307-310. [PMID: 29599561 PMCID: PMC5819052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 5-year-old male barn cat was presented with lethargy and excessive bleeding following castration. The patient developed hemolytic anemia and diagnostic tests revealed infection with feline immunodeficiency virus and Mycoplasma haemofelis. This case serves as a reminder of the importance of testing for infectious diseases and educating owners on feline infectious disease prevention and management.
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Cucchini U, Muraru D, Badano LP. Cardioembolic Stroke in Patient With Transcatheter Occluded Left Atrial Appendage. J Invasive Cardiol 2018; 30:E7-E8. [PMID: 29289951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A cerebral ischemic event in a patient managed with left atrial appendage (LAA) transcatheter obliteration is illustrated. Transesophageal echocardiography allowed identification and accurate definition of the LAA device leakage.
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Affiliation(s)
- Umberto Cucchini
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Via Giustiniani, 2, 35128 Padova, Italy.
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Behera UC, Panda L, Gupta S, Modi RR. Subconjunctival hemorrhage and vision loss after regional ocular anesthesia. Int Ophthalmol 2017; 38:1309-1312. [PMID: 28434070 DOI: 10.1007/s10792-017-0539-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/17/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To report two cases of retinal vascular occlusion and associated subconjunctival hemorrhage in needle optic nerve injury during local bulbar anesthesia. METHODS Surgical records of these two subjects who presented with acute vision loss after cataract extraction were studied, and systemic workup and ocular imaging were carried out to establish the cause. RESULTS Computerized tomography showed evidence of optic nerve injury. CONCLUSION Subconjunctival hemorrhage could be an associated clinical finding in hypodermic needle injury-related retinal vascular occlusion during ocular anesthesia.
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Affiliation(s)
| | - Lapam Panda
- L V Prasad Eye Institute, Patia, Bhubaneswar, Odisha, 751024, India
| | - Sumi Gupta
- Srikrishna Eye Institute, N-71 Shivalik Nagar, Haridwar, Uttarakhand, 249403, India
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9
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Khattar NK, Parry PV, Agarwal N, George HK, Kretz ES, Larkin TM, Gruen GS, Abla AA. Total Hip Arthroplasty Complicated by a Gluteal Hematoma Resulting in Acute Foot Drop. Orthopedics 2016; 39:e374-6. [PMID: 26966944 DOI: 10.3928/01477447-20160307-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/23/2015] [Indexed: 02/03/2023]
Abstract
Total hip arthroplasty is a prevalent orthopedic intervention in the United States. Massive postoperative hematomas are a rare albeit serious complication of the procedure. Sequelae of these hematomas can include lower extremity paralysis from compression of the sciatic nerve. A 66-year-old woman taking aspirin and clopidogrel for coronary stents presented with a complete foot drop, paresthesias, and lower extremity pain 10 days after a total hip arthroplasty. The patient was initially seen by a neurology service at another hospital and thought to have lateral recess stenosis. At the authors' center, magnetic resonance imaging of the lumbar spine failed to show lateral recess stenosis. Urgent pelvic computed tomography showed a large hematoma and raised suspicion of sciatic nerve compression. Hip magnetic resonance imaging showed a right gluteal hematoma compressing the sciatic nerve. The patient was then taken to the operating room for the clot to be evacuated and was later referred for rehabilitation. Massive hematomas after total hip arthroplasty are an important consideration in the differential diagnosis of nontraumatic acute foot drop. Prompt diagnosis may correlate with improved neurological outcome and help reduce overall morbidity.
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10
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Ito S, Morita M, Nanbara S, Nakaji Y, Ando K, Hiyoshi Y, Okamoto T, Saeki H, Oki E, Kawanaka H, Tanoue Y, Maehara Y. Cardiac tamponade due to bleeding as a potential lethal complication after surgery for esophageal cancer. Anticancer Res 2015; 35:407-411. [PMID: 25550580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Cardiac tamponade, due to bleeding in the pericardial space after esophagectomy for esophageal cancer, is an extremely rare complication and may be associated with sudden hemodynamic instability that can lead to death unless there is prompt diagnosis and appropriate treatment. CASE REPORT A 76-year-old man underwent sub-total esophagectomy via a cervico-right thoracoabdominal approach and reconstruction with a gastric tube through the retrosternal route. On postoperative day 4, the patient developed hypotension due to cardiac tamponade caused by bleeding into the pericardial space and he had a decreased level of consciousness. Pericardial resection and open drainage via a minimal left anterior thoracotomy was performed that resulted in hemodynamic improvement followed by an uneventful recovery. CONCLUSION Cardiac tamponade due to postoperative bleeding, which is a rare but life-threatening complication, should be considered as a cause of hemodynamic instability in the early postoperative period after esophagectomy.
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Affiliation(s)
- Shuhei Ito
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaru Morita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sho Nanbara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yu Nakaji
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Ando
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukiharu Hiyoshi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tatsuro Okamoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Saeki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirofumi Kawanaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihisa Tanoue
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Horstmann W, Kuipers B, Ohanis D, Slappendel R, Kollen B, Verheyen C. Autologous re-transfusion drain compared with no drain in total knee arthroplasty: a randomised controlled trial. Blood Transfus 2014; 12 Suppl 1:s176-s181. [PMID: 24120589 PMCID: PMC3934246 DOI: 10.2450/2013.0072-13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/16/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Post-operative anaemia following total knee arthroplasty is reported to impede functional mobility in the early period following surgery, whereas allogeneic blood transfusions, used to correct low post-operative haemoglobin levels, have concomitant disadvantages. The use of a post-operative autologous blood re-transfusion drainage system as well as no drainage system following total knee arthroplasty have been shown to reduce peri-operative blood loss and allogeneic blood transfusions, compared to the regularly used closed-suction drains. No randomised studies have been performed, to the best of our knowledge, that indicate the superiority of either method. MATERIALS AND METHODS An open, randomised controlled study was conducted in 115 patients undergoing total knee arthroplasty who were randomly allocated to an autotransfusion drain or no drainage system. The primary end-point was haemoglobin level on the first post-operative day. RESULTS In the autotransfusion group 515 mL (0-1,500 mL) of drained blood was re-transfused within the first 6 hours after surgery. Haemoglobin levels on the first (11.6 vs 11.0 g/dL), second (11.0 vs 10.3 g/dL) and third (10.5 vs 9.8 g/dL) days after surgery were significantly higher in the autotransfusion group. Total peri-operative net blood loss (1,576 mL vs 1,837 mL; -P=0.03) and allogeneic transfusion rates (10.2% vs 19.6%; P=0.15) were lower in the autotransfusion group. There were no differences in pain scores, range of motion or adverse events during hospital stay and the first 3 months after surgery. DISCUSSION Compared with no drainage, the use of a post-operative autologous blood re-transfusion drainage system following total knee arthroplasty results in higher post-operative haemoglobin levels and less total blood loss.
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Affiliation(s)
| | | | | | - Robert Slappendel
- Department of Quality and Safety, Amphia Hospital, Breda, The Netherlands
| | - Boudewijn Kollen
- Department of General Practice, University Medical Center Groningen, University of Groningen, The Netherlands
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12
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Ting MJ, Chen Y, Chang SC. Factors affecting the duration of mechanical ventilation in patients after intestinal transplantation: preliminary results. ACTA ACUST UNITED AC 2013; 51:108-11. [PMID: 24148738 DOI: 10.1016/j.aat.2013.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 06/03/2013] [Accepted: 06/06/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Intestinal transplantation (ITx) is a definitive therapy for patients with intestinal failure. However, postoperative respiratory care in such patients remains a clinical challenge. In this study, we investigated the factors affecting the duration of mechanical ventilation in patients who underwent ITx. METHODS In this observational study, eight patients who underwent ITx between 2007 and 2013 were studied. They were divided into two groups, with Group E including three patients who could be successfully extubated within 72 hours and Group V including the remaining five, who could not be extubated. The differences in demographical and clinical data between the two groups were evaluated. RESULTS The surgery success rate, patient survival rate, and graft survival rate were 100%, 88%, and 75%, respectively. Compared with Group E, postoperative bleeding was significantly higher in Group V (700 ± 420.7 mL vs. 50.0 ± 2.0 mL, p = 0.021). In addition, postoperative respiratory complications including pleural effusion and pneumonia (p = 0.017 and p = 0.0714, respectively) were prone to occur in Group V. Other variables including demographic parameters and clinical data showed no significant differences between the two groups. It was not unexpected that the duration of ventilator use and the length of intensive care unit stay were significantly shorter in Group E. CONCLUSION Postoperative blood loss and postoperative respiratory complications might be the factors responsible for delayed extubation in ITx patients. Because the study had few examinees, further studies with a larger population are needed to verify these issues.
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Affiliation(s)
- Man-Ju Ting
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
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13
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Minck S, Robinson K, Saxon B, Spigiel T, Thomson A. Patient blood management -- the GP's guide. Aust Fam Physician 2013; 42:291-297. [PMID: 23781528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND There is accumulating evidence of a strong association between blood transfusion and adverse patient outcomes. Patient blood management aims to achieve improved patient outcomes by avoiding unnecessary exposure to blood products through effective conservation and management of a patient's own blood. OBJECTIVE To introduce the general practitioner's role in patient blood management. DISCUSSION There are a number of ways in which GPs can contribute to patient blood management, particularly in the care of patients scheduled for elective surgery. These include awareness, identification, investigation and management of patients with or at risk of anaemia; assessment of the adequacy of iron stores in patients undergoing planned procedures in which substantial blood loss is anticipated; awareness and assessment of medications and complementary medicines that might increase bleeding risk; and awareness of and ability to discuss with patients, the possible risks associated with blood transfusion and alternatives that may be available.
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Affiliation(s)
- Sandra Minck
- Transfusion Clinical Governance Unit, Australian Red Cross Blood Service, Brisbane, Queensland, Australia.
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14
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Affiliation(s)
- N N Lang
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh EH16 4SU, UK.
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15
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Abstract
Significant gastrointestinal (GI) bleeding in the postoperative period is an uncommon complication of surgery. The management of GI bleeding within the postoperative period is complex because of a larger differential for the source of bleeding and a more complex risk/benefit analysis. There is minimal published literature specific to the management of postoperative GI bleeding, and the infrequency, complexity, and variability of the clinical setting of this complication confound simplistic consideration of its cause and therapy. This article outlines a systematic evaluation of the patient, treatment options, and assessment of risk/benefit ratio for various treatment options.
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Affiliation(s)
- Seon Jones
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN 37212-3755, USA
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16
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Bloomfield MR, Patterson RW, Froimson MI. Complications of anticoagulation for thromboembolism in early postoperative total joint arthroplasty. Am J Orthop (Belle Mead NJ) 2011; 40:E148-E151. [PMID: 22016874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In the study reported here, we analyzed the complications associated with anticoagulation in total joint arthroplasty patients treated for venous thromboembolism (VTE) in the early postoperative period. Twenty-nine consecutive cases from a 1-year period were identified and retrospectively reviewed. VTE treatment, which in most instances (79%) consisted of a heparin drip, was begun a mean of 2.3 days after surgery. Patients received a mean (SD) of 4.4 (5.0) units of packed red blood cells. There were no differences in bleeding parameters with respect to timing of initiation of anticoagulation. Local and systemic bleeding complications were common. The proportion of patients who were transfused was significantly (P<.0001) higher for VTE patients than for control patients, and transfused VTE patients received significantly (P = .0004) more blood products. In total joint arthroplasty patients, VTE treatment began 2.3 days after surgery and had a high incidence of complications related to bleeding.
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Zhong T, Yuan JQ, Story DA. Airway management in adults with bleeding airways. Anaesth Intensive Care 2011; 39:140. [PMID: 21375112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Van Cann EM, Koole R. [An emergency tracheotomy in case of airway compromise after post-operative bleeding associated with the use of an antidepressant]. Ned Tijdschr Tandheelkd 2009; 116:544-546. [PMID: 19957492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Selective serotonin reuptake inhibitors block the uptake ofserotonin into thrombocytes. One of the functions of serotonin in thrombocytes is to promote platelet aggregation. When serotonin levels are depleted after several weeks of treatment, the altered platelet function leads to increased risk of abnormal bleeding. In patients taking a combination of a selective serotonin reuptake inhibitor and a non-steroidal anti-inflammatory drug, the risk ofabnormal bleeding is thought to be even higher. A case is reported of abnormal bleeding after treatment in the oral cavity, associated with simultaneous use of a selective serotonin reuptake inhibitor and a non-steroidal anti-inflammatory drug. A large haematoma in the floor of mouth caused airway compromise which necessitated an emergency tracheotomy. Until greater insight is achieved by means of additional research, increased attentiveness for these patients seems to be called for and extra care should be employed. Additional haemostatic measures could be considered.
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Affiliation(s)
- E M Van Cann
- Uit de afdeling Mondziekten, Kaak- en Aangezichtschirurgie en Bijzondere Tandheelkunde van bet Universitair Medisch Centrum Utrecht te Utrecht.
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Malvasi A, Tinelli A, Tinelli R, Rahimi S, Resta L, Tinelli FG. The post-cesarean section symptomatic bladder flap hematoma: A modern reappraisal. J Matern Fetal Neonatal Med 2009; 20:709-14. [PMID: 17763270 DOI: 10.1080/01674820701450573] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The bladder-flap hematoma (BFH) is an unusual complication of the cesarean section (CS) performed by Misgaw Ladach method or Stark CS (performed without peritoneal closure) and it is an usual event after the visceral peritoneal closure performed during the traditional method. A BFH is generally thought of as a blood collection located in a space placed between the bladder and lower uterine segment (LUS), called vescico-uterine space. If, during a Stark CS, pathological fluid collections arise in this space by uterine suture bleeding, these decant into the large peritoneal cavity causing a hemoperitoneum. This last complication can be easily and accurately detectable by ultrasonography, which can be utilised by non-invasive monitoring as a guide for the clinical follow-up. In the authors' experience, the CS by Stark method is associated with a lower febrile and infective morbidity and it is possible also to perform a successful conservative laparoscopy for the BFH management. Laparoscopical treatment of BFH offers to patients the potential clinical benefits of the minimally invasive endoscopical treatments, but it should be reserved for surgeons trained in extensive laparoscopic procedures.
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Affiliation(s)
- A Malvasi
- Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy.
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Dunn AL. Necrotizing enterocolitis as a result of postcircumcision bleeding in a neonate with haemophilia A. Haemophilia 2008; 14:1115-6. [PMID: 18510567 DOI: 10.1111/j.1365-2516.2008.01790.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Habler O, Meier J, Pape A, Kertscho H, Zwissler B. [Tolerance to perioperative anemia. Mechanisms, influencing factors and limits]. Orthopade 2007; 36:763-76; quiz 777-8. [PMID: 17701087 DOI: 10.1007/s00132-007-1126-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The expected cost explosion in transfusion medicine increases the socio-economic significance of specific institutional transfusion programs. In this context the estimated use of the patient's physiologic tolerance represents an integral part of any blood conservation concept. The present article summarizes the mechanisms, influencing factors and limits of this natural tolerance to anemia and deduces the indication for perioperative red blood cell transfusion. The current recommendations coincide to the effect that perioperative transfusion is unnecessary up to a Hb concentration of 10 g/dl (6.21 mmol/l) even in older patients with cardiopulmonary comorbidity and is only recommended in cases of Hb <6 g/dl (<3.72 mmol/l) in otherwise healthy subjects including pregnant women and children. Critically ill patients with multiple trauma and sepsis do not seem to benefit from transfusions up to Hb concentrations >9 g/dl (>5.59 mmol/l). In cases of massive hemorrhaging and diffuse bleeding disorders the maintenance of a Hb concentration of 10 g/dl (6.21 mmol/l) seems to contribute to stabilization of coagulation.
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Affiliation(s)
- O Habler
- Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerztherapie, Krankenhaus Nordwest GmbH, Frankfurt.
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Abstract
BACKGROUND Gravid oophorectomy past mid-pregnancy may be necessary, but the alterations of blood flow to supply the placenta may present risks to the mother and fetus. CASE A salpingo-oophorectomy for a mucinous cystadenoma resulted in a postoperative hemorrhage of 2 L and fetal death. The placenta demonstrated a unique lesion that was consistent with global hypoperfusion of the placenta. CONCLUSION The postoperative hemorrhage occurred despite good immediate operative hemostasis. Blood flow was shunted from the uteroplacental circulation due to the large utero-ovarian collateral circulation.
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Affiliation(s)
- Robert W Bendon
- Kosair Children's Hospital, Louisville, Kentucky 40202, USA.
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Gravante G, Delogu D, Venditti D. Post-endoscopic polypectomy delayed bleeding concomitant with an abdominoperineal resection: a case report. Eur Rev Med Pharmacol Sci 2007; 11:355-357. [PMID: 18074943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We describe the case of a delayed bleeding that occurred concomitantly with an abdominoperineal resection. The patient underwent endoscopy without apparent complications. During surgery, and in the immediate postoperative hours, 4 blood units were required to achieve stable conditions even if the surgical technique was correct, no major bleeding occurred and no blood was seen inside the lumen at bowel transection. On the 7th postoperative day (9th from polypectomy) the patient shocked for the first time. Two days later, massive clots appeared from the stoma and he shocked again. CT scan found the bleeding occurring from the polypectomy site and angiographic embolization finally ended the hemorrhage. The increased risk of delayed hemorrhages and their dramatic clinical manifestations render the post-polypectomy "window" period worth to be followed-up strictly. We believe that further invasive procedures, especially major surgery, should be postponed unless emergent and necessary to save the patient's life.
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Affiliation(s)
- G Gravante
- Department of General Surgery, University of Tor Vergata in Rome, Italy.
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Inuzuka K, Unno N, Yamamoto N, Mitsuoka H, Sagara D, Suzuki M, Nishiyama M, Konno H. Hemorrhagic shock with delayed retroperitoneal hemorrhage after deployment of an inferior vena cava filter: report of a case. Surg Today 2007; 37:618-21. [PMID: 17593486 DOI: 10.1007/s00595-006-3450-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Accepted: 12/20/2006] [Indexed: 02/02/2023]
Abstract
Although inferior vena cava (IVC) filter placement has demonstrated an excellent therapeutic efficacy in preventing pulmonary embolism, several filter-related complications have been reported. Among them, retroperitoneal hemorrhage due to IVC perforation is one of the most serious complications. We report herein a female patient who underwent TrapEase IVC filter placement with anticoagulation and thrombolytic therapy for treatment of pulmonary embolism, and later demonstrated hemorrhagic shock 5 days after filter placement. The patient's blood pressure stabilized after the anticoagulant therapy was stopped and she received a blood transfusion. We should therefore carefully observe patients after IVC filter placement, particularly those receiving simultaneous anticoagulation therapy.
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Affiliation(s)
- Kazunori Inuzuka
- Division of Vascular Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
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Baumann C, Westphalen K, Fuchs H, Oesterwitz H, Hierholzer J. Interventional Management of Renal Bleeding after Partial Nephrectomy. Cardiovasc Intervent Radiol 2007; 30:828-32. [PMID: 17508241 DOI: 10.1007/s00270-007-9033-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 01/23/2007] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Partial nephrectomy (PN) has emerged as a serious alternative to nephrectomy in oncologic therapy of renal tumours. While complications are rare in general, renal hemorrhage may occur und necessitate angiographic embolization. In this retrospective study, we evaluate the clinical, imaging and procedural findings of seven interventions in five patients with renal hemorrhage after PN. In four out of five patients (80%) the bleeding could be treated successfully by embolotherapy. CONCLUSION Angiographic embolization in patients with renal hemorrhage after PN is feasible and has a high success rate. The procedure might facilitate avoidance of nephrectomy.
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Affiliation(s)
- Clemens Baumann
- Department of Diagnostic and Interventional Radiology, Klinikum Ernst von Bergmann, Charlottenstrasse 72, 14467 Potsdam, Germany.
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Gangireddy C, Rectenwald JR, Upchurch GR, Wakefield TW, Khuri S, Henderson WG, Henke PK. Risk factors and clinical impact of postoperative symptomatic venous thromboembolism. J Vasc Surg 2007; 45:335-341; discussion 341-2. [PMID: 17264013 DOI: 10.1016/j.jvs.2006.10.034] [Citation(s) in RCA: 186] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 10/12/2006] [Indexed: 01/30/2023]
Abstract
BACKGROUND Although common risk factors for venous thromboembolism (VTE) are well known, little data exist concerning the clinical impact of VTE in postoperative patients outside of controlled studies. This study evaluated prospective perioperative demographic and clinical variables associated with occurrence of postoperative symptomatic VTE. METHODS Demographic and clinical data were collected on surgical patients undergoing nine common general, vascular, and orthopedic operations presenting to the Veterans Health Administration Hospitals between 1996 and 2001 as part of the National Surgical Quality Improvement Program (NSQIP). The association between covariates and the incidence of postoperative symptomatic VTE (includes deep venous thrombosis and pulmonary embolism) was assessed using bivariable and multivariable regression. RESULTS Complete demographic and clinical information for analysis were available for 75,771 patients. The mean patient age was 65 years, and 96.6% were men. Major comorbidities included diabetes mellitus (DM), 25%; chronic obstructive pulmonary disease (COPD), 18.3%; and congestive heart failure (CHF), 3.9%. Symptomatic VTE was diagnosed in 805 patients (0.68%), varied significantly with procedure (0.14% for carotid endarterectomy vs 1.34% for total hip arthroplasty), and was associated with increased 30-day mortality (16.9% vs 4.4%, P < .0001). The incidence of VTE did not decline substantially between 1996 and 2001 (0.72% vs 0.68%). Preoperative factors associated with symptomatic VTE were older age, male gender, corticosteroid use, COPD, recent weight loss, disseminated cancer, low albumin, and low hematocrit (all P < .01) but not DM. Postoperative factors associated with VTE were myocardial infarction (MI), blood transfusion (>4 units), coma, pneumonia, and urinary tract infection (UTI), whereas those with hemodialysis-dependent renal failure were less likely to experience VTE (all P < .01). In multivariable analysis, adjusting for age and the variables significant by bivariable analysis, the strongest positive predictors of symptomatic VTE included UTI (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3 to 2.5), acute renal insufficiency (OR, 1.9; 95% CI, 1.1 to 3.2), postoperative transfusion (OR, 2.3; 95% CI, 1.4 to 3.7), perioperative MI (OR, 2.4; 95% CI, 1.5 to 3.9), and pneumonia (OR, 2.7; 95% CI, 2.1 to 3.5). In contrast, hemodialysis (OR, 0.3; 95% CI, 0.07 to 0.71), DM (OR, 0.75; 95% CI, 0.61 to 0.93), and higher preoperative albumin levels (OR, 0.8; 95% CI, 0.74 to 0.96, per mg/dL change) were protective from symptomatic VTE. CONCLUSIONS Although the overall incidence of symptomatic VTE is low in surgical patients, it is associated with significantly increased 30-day mortality. In addition to previously recognized risk factors, patients who have postoperative complications of an infectious nature, bleeding, or MI are at particular risk.
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Affiliation(s)
- Chethan Gangireddy
- University of Michigan School of Medicine Section of Vascular Surgery, Ann Arbor, MI, USA
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Abstract
OBJECTIVES To analyse the circumstances of mortality in post-tonsillectomy bleeding cases, in order to better manage serious problems during resuscitation. DESIGN Reports of inquiry committees on post-tonsillectomy mortalities. SETTING State of Israel Ministry of Health committees. PARTICIPANTS Senior otolaryngologists and related professionals, and the involved medical staff who participated in the inquiry committees. MAIN OUTCOMES MEASURES Identification of actions causing undesirable effects on resuscitation outcomes. RESULTS In recent years, the post-tonsillectomy mortality rate in Israel has been one in 12,000. The two main causes of death have been severe haemorrhagic shock and airway obstruction. CONCLUSIONS Active bleeding should be treated, rather than waiting for spontaneous resolution. An efficient airway should be established early during resuscitation, either by intubation (within two minutes) or by cricothyroidotomy. The two main factors endangering the patient's life during resuscitation are severe blood loss, interfering with effective cardiac output, and airway obstruction. Blood loss should be quickly substituted.
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Affiliation(s)
- D Cohen
- Department of Otolaryngology/Head and Neck Surgery, Shaare Zedek Medical Centre, Jerusalem, Israel.
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Bowles KM, Callaghan CJ, Taylor AL, Harris RJ, Pettigrew GJ, Baglin TP, Park GR. Predicting response to recombinant factor VIIa in non-haemophiliac patients with severe haemorrhage. Br J Anaesth 2006; 97:476-81. [PMID: 16914465 DOI: 10.1093/bja/ael205] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Despite increasing use of recombinant factor VIIa (rFVIIa) in non-haemophiliac patients, it is unclear when rFVIIa might be effective. METHODS A single centre review of consecutive non-haemophiliac patients receiving rFVIIa for the management of severe haemorrhage. Treatments with rFVIIa were at a dose of 90 mug kg(-1) repeated at three hourly intervals at the clinicians' discretion. RESULTS Eighteen patients received rFVIIa. Six patients survived to discharge and 12 patients died in hospital. The median (range) Sequential Organ Failure Assessment (SOFA) score at the time of administration of rFVIIa for the group that survived was 8.0 (5-12) compared with the group that died 12.0 (7.0-14.0) (P=0.03). One of the patients who survived (17%) had organ failure at the time of rFVIIa administration compared with 11 of those who died (92%) (P=0.004). Fifteen patients survived long enough to consider a second dose of rFVIIa, one patient who survived to discharge needed more than one dose (1/6, 17%), compared with seven of those who later died in hospital (7/9, 78%) (P=0.04). The survivors had a significant reduction in blood product requirements after rFVIIa, while patients who died did not. Neither the prothrombin time nor the activated partial thromboplastin time before or after rFVIIa predicted survival. CONCLUSIONS High SOFA score and failure to respond to one adequate dose of rFVIIa appear to identify patients with poor prognosis. These observations may help in determining when rFVIIa treatment is likely to be futile.
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Affiliation(s)
- K M Bowles
- Department of Haematology, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
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Marson F, Farnia A, Callegher L, Casagrande L, Surdu M, Sarpellon M. Use of recombinant activated factor VII (rFVIIa-NovoSeven) in the treatment of uncontrolled postsurgical hemorrhage in a patient with deep venous thrombosis and caval filter. A case report. Minerva Anestesiol 2006; 72:675-82. [PMID: 16865086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A 37-year-old woman affected by renal insufficiency was submitted to renal transplantation from cadaver donor. After a few days she had a severe and life-threatening hemorrhage at the surgical site and a deep venous thrombosis at her lower right limb. Since anticoagulant therapy was contraindicated, a filter was inserted in the inferior vena cava. After several red blood cell, fresh plasma and platelet transfusions, and after repeated unsuccessful surgical procedures, a single dose of 70 microg/kg of body weight of recombinant activated factor VII (rFVIIa) was administered as last resource. The drug was successful in obtaining the complete and rapid resolution of the hemorrhagic episode. Despite the patient had two factors which could have favoured a thrombotic complication, e.g. deep venous thrombosis and caval filter, administration of rFVIIa did not worsen the underlying thrombotic process. rFVIIa is a new hemostatic agent that was initially used in hemophiliac patients. Later it has been successfully used in nonhemophiliac patients to treat different inherited or acquired coagulation disorders. A potential thrombogenic effect of rFVIIa was hypothesized on the basis of some clinical case reports but large controlled trials do not exist. In this case report the use of rFVIIa was successful and safe despite the concomitant presence of several thrombogenic factors.
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Affiliation(s)
- F Marson
- Department of Anesthesia and Intensive Care, S. Maria dei Battuti Hospital, ULSS 9, Treviso, Italy.
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Huang SC, Ko WJ, Han YY, Chen YS, Wang SS, Lee YC. Mechanical Circulatory Support for Profound Cardiac Circulatory Shock Status Due to Postoperative Pulmonary Artery Bleeding. Thorac Cardiovasc Surg 2006; 54:214-5. [PMID: 16639688 DOI: 10.1055/s-2005-873064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 77-year-old patient suffering from life-threatening pulmonary artery bleeding after pulmonary lobectomy was resuscitated but had refractory cardiogenic shock after the bleeding was controlled. We used mechanical circulatory support with extracorporeal membrane oxygenation and intra-aortic balloon pump to overcome the hemorrhagic shock-related cardiac suppression and multi-organ injury in the post-resuscitation critical period.
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Affiliation(s)
- S-C Huang
- Department of Surgery, National Taiwan University Hospital, National Taiwan University School of Medicine, Taipei, Taiwan
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Warburton G, Brahim JS. Intraorbital Hematoma After Removal of Upper Third Molar: A Case Report. J Oral Maxillofac Surg 2006; 64:700-4. [PMID: 16546653 DOI: 10.1016/j.joms.2004.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2004] [Accepted: 10/01/2004] [Indexed: 10/24/2022]
Affiliation(s)
- Gary Warburton
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892, USA
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Abstract
OBJECTIVE To determine the rate of anastomotic stricture (AS) after radical retropubic prostatectomy (RRP) performed by one experienced surgeon, and to identify factors predisposing to its formation. PATIENTS AND METHODS In all, 708 men were prospectively monitored for the development of AS after RRP. Potential risk factors for AS were analysed. RESULTS There were no significant differences in age, Gleason score, nerve-sparing status, intraoperative blood loss, degree of extravasation on initial cystography, or duration of the indwelling urinary catheter between men who developed AS and men who did not. The mean postoperative blood loss was significantly higher in men who developed AS. The incidence of AS was also significantly higher in men whose bladder necks were reconstructed more narrowly. CONCLUSION The amount of bleeding and the calibre of the reconstructed bladder neck were significantly associated with AS formation after RRP. The development of a haematoma from bleeding might explain the increased likelihood of AS. The mechanism of AS formation is unrelated to the degree of urinary extravasation on cystography, providing that a urinary catheter is left indwelling until extravasation resolves.
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Affiliation(s)
- George Huang
- Department of Urology, New York University School of Medicine, New York, NY 10016, USA
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Fenig DM, Slova D, Lepor H. Postoperative Blood Loss Predicts the Development of Urinary Extravasation on Cystogram Following Radical Retropubic Prostatectomy. J Urol 2006; 175:146-50; discussion 150. [PMID: 16406894 DOI: 10.1016/s0022-5347(05)00051-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Revised: 06/06/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE We determined if the degree of postoperative bleeding predicts the extent of urinary extravasation on initial postoperative cystogram. MATERIALS AND METHODS Between October 2000 to June 2004, 879 men underwent radical retropubic prostatectomy performed by a single surgeon. Of these men 97% underwent the initial postoperative cystogram 3 to 8 days following radical prostatectomy. Postoperative bleeding was expressed as the absolute change in hematocrit between hematocrit values measured immediately upon arrival into the recovery room and hospital discharge. Three hematocrit points were added to the change in postoperative hematocrit for every unit of blood transfused postoperatively. The relationship between the change in postoperative hematocrit and the extent of extravasation was examined. RESULTS None, mild, moderate and marked extravasation was observed on the initial cystogram in 82.7%, 7.9%, 8.8% and 0.6% of cases, respectively. A significant relationship was observed between changes in postoperative hematocrit and the extent of extravasation on initial cystography (p <0.001). Postoperative changes in absolute hematocrit points of less than 2, 2 to 6 and greater than 6 identified clinically meaningful risk groups for urinary extravasation. The degree of extravasation was not significantly related to risk of anastomotic stricture or urinary incontinence. CONCLUSIONS The extent of postoperative bleeding predicts the extent of urinary extravasation on initial cystography. It may be a useful measurement for identifying men who can safely undergo early catheter removal without cystography.
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Affiliation(s)
- David M Fenig
- Department of Urology, New York University School of Medicine, New York, New York, USA
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Raux M, Chiche L, Vanhille E, Riou B. Recombinant activated factor vii to control massive post operative bleeding after septic aortobifemoral grafting. Eur J Anaesthesiol 2005; 22:805-7. [PMID: 16211789 DOI: 10.1017/s026502150526132x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Sciatic nerve palsy is a recognised complication of primary total hip replacement. In our unit this complication was rare with an incidence of < 0.2% in the past ten years. We describe six cases of sciatic nerve palsy occurring in 355 consecutive primary total hip replacements (incidence 1.69%). Each of these palsies was caused by post-operative haematoma in the region of the sciatic nerve. Cases, which were recognised early and surgically-evacuated promptly, showed earlier and more complete recovery. Those patients for whom the diagnosis was delayed, and who were therefore managed expectantly, showed little or no recovery. Unexpected pain and significant swelling in the buttock, as well as signs of sciatic nerve irritation, suggest the presence of haematoma in the region of the sciatic nerve. It is, therefore, of prime importance to be vigilant for the features of a sciatic nerve palsy in the early post-operative period as, when recognised and treated early, the injury to the sciatic nerve may be reversed.
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Affiliation(s)
- A J Butt
- Kilcreen Regional Orthopaedic Hospital, Kilcreen, County Kilkenny, Ireland.
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Cook TM, Silsby J, Simpson TP. Airway rescue in acute upper airway obstruction using a ProSeal?Laryngeal mask airway and an Aintree Catheter?: a review of the ProSeal?Laryngeal mask airway in the management of the difficult airway. Anaesthesia 2005; 60:1129-36. [PMID: 16229699 DOI: 10.1111/j.1365-2044.2005.04370.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report the successful use of a ProSeal Laryngeal mask airway (PLMA) to rescue the airway when emergency tracheal intubation and ventilation of the lungs were impossible after haemorrhage into the neck following carotid endarterectomy, despite evacuation of the clot. The airway was re-established after placement of a PLMA. Fibreoptic examination of the airway revealed severe supraglottic swelling compromising airway patency. An Aintree catheter was placed in the trachea under fibreoptic guidance and a tracheal tube railroaded over this. The use of the PLMA in seven cases of difficult airway management and 11 cases of airway rescue is reviewed. Use of the PLMA was associated with high levels of success, often rescuing the airway when other techniques had failed. No complications of use of the PLMA were reported in these cases. The PLMA appears to be a useful device to assist in management of the difficult airway and for airway rescue. Potential advantages over the classic laryngeal mask airway include improved airway seal and reduced risk of aspiration. The gum elastic bougie-guided insertion technique is recommended when the PLMA is used for airway rescue.
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Affiliation(s)
- T M Cook
- Department of Anaesthesia, Royal United Hospital, Combe Park, Bath, BA1 3NG, England.
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Lee ES, Santilli SM, Olson MM, Kuskowski MA, Lee JT. Wound infection after infrainguinal bypass operations: multivariate analysis of putative risk factors. Surg Infect (Larchmt) 2005; 1:257-63. [PMID: 12594881 DOI: 10.1089/109629600750067183] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Reported wound infection rates for infrainguinal bypass operations range from 17% to 44%, but there is limited appreciation of which characteristics of patients or operations are reliable markers of increased wound infection risk. The purpose of the present study was to analyze all wound infections observed after infrainguinal bypass operations during 20 years of practice in a large teaching institution. Independent risk factors for wound infection development were identified. During the 20-year period ending 31 December, 1997, 978 male patients underwent infrainguinal bypass operations at the Minneapolis Department of Veterans Affairs Medical Center. Wound infections complicated the recovery of 129 of these patients during a 30-day postoperative surveillance interval. Multivariate logistic regression analysis was used to test the association between wound infection occurrence and putative risk factors that were either features of patients or characteristics of the operations. The following variables were examined: obesity, prosthetic graft placement, diabetes mellitus, steroid use, anticoagulation use, length of preoperative hospital stay, development of incisional hematoma, duration of operation, and the preoperative presence of a non-healing wound in the extremity being revascularized. The overall wound infection rate was 13.2% (129/978). In a final logistic regression model, obesity was a significant and independent predictor of wound infection (Relative Risk 2.6, 95% confidence interval, 1.35-4.90), as was development of a post-operative incisional hematoma (Relative Risk 6.44, 95% confidence interval, 2.95-14.08). No other explanatory variable was significantly associated with wound infection development.
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Affiliation(s)
- E S Lee
- Department of Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
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Rajani R, Blauth C, Chambers J. Images in cardiology: Right ventricular rupture. Clin Cardiol 2005; 28:201. [PMID: 15869056 PMCID: PMC6654426 DOI: 10.1002/clc.4960280411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ronak Rajani
- Department of Cardiology and Cardiothoracic Surgery, St Thomas' Hospital, Lambeth Palace Road, London, UK
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40
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Fournet X, Dubernet-Gaudiot P, Treilhaud M, Blanloeil Y. Utilisation de protéine C activée recombinante (rPCa) humaine (Xigris®) pour sepsis sévère en présence d'un épanchement péricardique après chirurgie cardiaque récente. ACTA ACUST UNITED AC 2005; 24:435-6. [PMID: 15826797 DOI: 10.1016/j.annfar.2005.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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41
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Body SC, Collard CD. Competing risks: preoperative myocardial infarction or postoperative bleeding? J Cardiothorac Vasc Anesth 2005; 19:1-3. [PMID: 15747261 DOI: 10.1053/j.jvca.2004.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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42
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Affiliation(s)
- Deepak K Tempe
- Department of Anaesthesiology, G.B. Pant Hospital, New Delhi, India.
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Karahan M. Effect of drain use in the early postoperative period after arthroscopically assisted anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft. Am J Sports Med 2004; 32:1776; author reply 1776. [PMID: 15517697 DOI: 10.1177/036354650403200730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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44
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Affiliation(s)
- Ian Thomas
- Department of Anaesthetics, Royal United Hospital, Bath BA1 3NG.
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Mingoli A, Assenza M, Petroni R, Antoniozzi A, Brachini G, Clementi I, Modini C. Large extrapleural hematoma in an anticoagulated patient after a thoracic blunt trauma. Ann Ital Chir 2004; 75:83-5; discussion 86. [PMID: 15283394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
We report the 7th case of a traumatic extrapleural hematoma that developed in an anticoagulated patient with a thoracic blunt trauma and rib fractures, and required an emergency surgical treatment. Extrapleural hematoma is a rare and life-threatening condition characterized by a collection of blood between the pleura parietalis and the endothoracic fascia. Related symptoms and chest x-ray findings are not characteristic and may present several hours after the injury, leading to delayed diagnosis and treatment. Etiological, surgical and prognostic implications of this finding are briefly discussed.
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Affiliation(s)
- A Mingoli
- Department of Surgery Pietro Valdoni, University of Rome, La Sapienza, Italy, Servizio Speciale di Chirurgia d'Urgenza 1.
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46
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Moghadam HG, Caminiti MF. Life-threatening hemorrhage after extraction of third molars:case report and management protocol. J Can Dent Assoc 2002; 68:670-4. [PMID: 12513934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Few dental procedures have fatal complications, but severe postoperative hemorrhage can result in preventable death. This report describes a case of postextraction hemorrhage that led to airway compromise necessitating emergency airway management. This complication is rare, and a review of the literature revealed little in the way of case reports and treatment protocols. This article reviews the causes of and risk factors related to severe postoperative bleeding and presents an algorithm for management both in the dental office and in the hospital.
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Affiliation(s)
- Hassan G Moghadam
- Oral and Maxillofacial Surgery, The Toronto General Hospital, Toronto, Ontario, Canada
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47
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Affiliation(s)
- A K H Kwok
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, People's Republic of China.
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48
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Affiliation(s)
- M Ita
- Department of Oral and Maxillofacial Surgery, Yamaguchi University, School of Medicine, Japan.
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49
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Sieders E, Peeters PM, TenVergert EM, de Jong KP, Porte RJ, Zwaveling JH, Bijleveld CM, Slooff MJ. Prognostic factors for long-term actual patient survival after orthotopic liver transplantation in children. Transplantation 2000; 70:1448-53. [PMID: 11118088 DOI: 10.1097/00007890-200011270-00009] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Orthotopic liver transplantation has become the treatment of choice for children with end-stage liver disease. Although results have improved the last decades, still a considerable number of children die after transplantation. The aim of this study was to analyze long-term actual survival and to identify prognostic factors for such survival rates. METHODS A consecutive series of 66 children receiving transplants who had or could have had a follow-up of at least 5 years was retrospectively analyzed. Actual survival and prognostic factors in relation to patient, donor, and operation related variables were assessed after multivariate analysis. RESULTS Actual 1-, 3-, and 5-year patient survival was 86%, 79%, and 73%, respectively. A high Child-Pugh (C-P) score or C-P class C, high donor age, high blood loss index, and retransplantation were predictive factors for actual patient survival. A high blood loss index was correlated with biliary atresia, low recipient age and weight, and with previous upper abdominal operations. The duration of stay of the donor at the intensive care unit (ICU) was a predictive factor for retransplantation. CONCLUSIONS Children with diseases eligible for liver transplantation should be seen early in the course of their disease in a transplantation center. All possible measures should be taken during the transplantation procedure to keep the blood loss at a minimum. Children with biliary atresia deserve special attention in this respect. The choice of donors has implications for survival.
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Affiliation(s)
- E Sieders
- University Hospital Groningen, Department of Surgery, The Netherlands.
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50
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Weidmann E, Hartschuh W, Petzoldt D, Rausch H, Tetz MR. [Periorbital lipogranuloma following endonasal sinus surgery]. Hautarzt 1999; 50:739-42. [PMID: 10550361 DOI: 10.1007/s001050051060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A 60-year-old woman developed a periorbital lipogranuloma after endonasal surgery on her paranasal sinuses. The granulomatous inflammation was caused by nonabsorbable lipids introduced by the postoperative nasal tamponade which was soaked in antibiotic ointment. These lipids were transported into the periorbital tissue by the postoperative hemorrhage. Since the course of the inflammatory process is chronic, surgical removal is the best treatment.
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