Abundant Bleeding Research Articles

A Rare Complication: Aorta-Cutaneous Fistula with Abundant Bleeding

Pseudoaneurysm and aorto-cutaneous fistula following surgical procedures of the aorta are rare complications with potentially catastrophic results that require rapid diagnosis and urgent surgical treatment. We performed a successful life-saving operation using hypothermic circulatory arrest with femoral artery and vein cannulation. The patient had undergone open heart surgery in our clinic twice, and there was active and abundant bleeding from aorta-cutaneous fistula that occured 5 years after the last surgery.

Development of a Non–Heart-Beating Donor Program and Results After the First Year

Our lung transplant unit began activity in October 2008. We have performed 37 lung transplants with a hospital mortality of 2.7% (n = 1). The need for a greater number of donors and the presence of an already existent non–heart-beating donor (NHBD) program for abdominal grafts and tissues encouraged us to consider assessing lung grafts from these donors. It was necessary to develop a new multiorgan preservation methodology, “bithermia preservation.” The clinical experience with which during the first year June 2010 to July 2011, including 15 NHBDs is presented herein. The chest x-ray was normal in 6 donors (40%) and 7 had pulmonary infiltrates. Bronchoscopy was normal in 8 donors (53%) but 3 had abundant bleeding airway secretions and signs of bronchoaspiration. Preservation procedures were performed in 6 donors. Pulmonary functional evaluation in 4 donors showed gas measurements to be adequate in 75% of cases. Three double-lung grafts were judged to be valid for implantation, among which we performed 3 lung transplantations, 1 bilateral and 2 unilaterals, while 2 grafts were offered to the National Transplant Organization for other units. No transplant suffered primary graft dysfunction; all 3 showed excellent function allowing early extubation in 2 cases. There was no in-hospital mortality. All 3 patients are alive and leading normal lives; none has bronchiolitis obliterans syndrome. In conclusion, the “bithermia preservation” methodology achieved adequate lung preservation in NHBDs, allowing liver, kidneys, and lungs to be obtained from the same donor.

Some chemical and biochemical aspects of the problem of atherosclerosis

This review summarizes the most important data relating to the chemical and biological aspects of the problem of atherosclerosis – one of the most severe cardiovascular diseases, which currently leads to significant numbers of lethal outcomes. The causes of this chronic disease and its main therapeutic and biochemical parameters are discussed. Methods for the treatment of atherosclerosis are considered, along with an assessment of the drugs used, including the most convenient syntheses of these drugs. Cardiovascular diseases remain the leading cause of death in humans and atherosclerosis is one of the most serious causes of these conditions [1]. This is a chronic disease characterized by increases in the thickness and density of arterial walls due to connective tissue growth, the formation of atherosclerotic plaques, narrowing of vessel lumens, and degradation of tissue blood supply. Intermediate and large arteries are lesioned in atherosclerosis. At the early stages, the inner coats of arteries show visible traces of lipids. Further deposition (of fats and cholesterol) then occurs and solid formations appear – so-called atheromas or atherosclerotic plaques. Finally, necrosis starts within the depth of these plaques. Further progression of these processes leads to rupture of plaques, hemorrhage, and the formation of thrombi. Decreases in the strength of vessel walls lead to the formation of aneurysms. Blood pressure within the aorta gradually weakens the vessel walls, which lose the elasticity required for maintenance of normal blood pressure, such that aneurysms increase, spread, and can rupture, with abundant bleeding. The complications of atherosclerosis include ischemic heart disease (sclerosis of one or several coronary arteries). A blood supply inadequate to the demands of cardiac tissue leads to attacks of pain – angina. When blood flow is completely blocked (because of clot formation, thrombosis), myocardial infarction or sudden death occur. Methods for treating atherosclerosis are described below, along with assessments of the drugs used.

Thromboelastometry during intraoperative transfusion of fresh frozen plasma in pediatric neurosurgery

Normal blood coagulation is essential in pediatric neurosurgery because of the risk of abundant bleeding, and therefore it is important to avoid transfusion of fluids that might interfere negatively with the coagulation process. There is a lack of transfusion guidelines in massive bleeding with pediatric neurosurgical patients, and early use of blood compounds is partly controversial. We describe two pediatric patients for whom fresh frozen plasma (FFP) infusion was started at the early phase of brain tumor surgery to prevent intraoperative coagulopathy and hypovolemia. In addition to the traditional laboratory testing, modified thromboelastometry analyses were used to detect possible disturbances in coagulation. Early transfusion of FFP and red blood cells preserved the whole blood coagulation capacity. Even with continuous FFP infusion, fibrin clot firmness was near to critical value at the end of surgery despite increased preoperative values. By using FFP instead of large amounts of crystalloids and colloids when major blood loss is expected, blood coagulation is probably less likely to be impaired. Our results indicate, however, that the capacity of FFP to correct fibrinogen deficit is limited.

Clinicopathological Features of Hemangioma in Two Young Horses

The clinicopathological and immunohistochemical features of two vascular tumors in two young horses are described in the present work. These animals were referred to the Veterinary Teaching Hospital of the University of Córdoba because of the presence of hyperpigmented plaques located in the medial aspect of the left leg and also around the hock (case 1) and in the right front leg (case 2). Some of the lesions showed deep ulceration and severe protrusion with abundant bleeding. The histopathological study revealed that lesions were composed of nonencapsulated, proliferated, closely packed small blood vessels, some of which showed irregular shape, whereas others were similar to capillaries, arterioles, and venules. Neoplastic cells expressed vimentin and factor VIIIar, suggesting their endothelial nature, whereas in the wall of some proliferated vessels, some cells expressed vimentin, α-smooth muscle actin and desmin, an immunophenotype consistent with pericytes, and small muscle cells. These features agree with those reported in human juvenile hemangioma rather than with hemangioma in adult horses.

Massive hemorrhage of upper gastrointestinal tract caused by gastrointestinal stromal tumor of the stomach: Case report

Acute bleeding from the upper gastrointestinal system is a medical emergency which is followed by high mortality rate, ranging from 6 to 15% in spite of modern diagnostic methods and treatment. Bleeding from the upper gastrointestinal system may be caused by gastrointestinal stromal tumors of the stomach, which are mainly characterized by occult bleeding, while profuse bleeding rarely occurs accompanied by hemorrhagic shock. Gastrointestinal stromal tumors of stomach are the most common mesenchimal tumors of the gastrointestinal tract. In our study we showed a 60-year-old female patient with profuse bleeding from the stomach and the clinical picture of severe hemorrhagic shock, caused by gastrointestinal stromal tumor. An ovoid junction, raised towards the lumen, covered with ulcerated mucosa in several places and followed by massive arterial bleeding was found intraoperatively, after the performed gastrotomy. Histopathological examination with immunohistochemical analysis confirmed that this was a gastrointestinal stromal tumor of the stomach. Acute bleeding from the digestive system is a sudden and serious condition of the body. Urgent esophagogastroduodenoscopy is a sensitive and specific diagnostic and therapeutic method of choice. Massive bleeding from the upper gastrointestinal tract is very rarely caused by gastrointestinal stromal tumors, whose clinical picture is very heterogeneous and depends on tumor size and location. Abundant bleeding from the tumor is an indication for urgent surgical intervention. According to the literature massive hemorrhage of the upper digestive system can rarely be caused by gastrointestinal stromal tumor of the stomach. It is shown that abundant hemorrhage of the upper digestive tract can be caused with gastric gastrointestinal stromal tumor. Surgical resection is the main form of treatment of gastrointestinal stromal tumors of the digestive system and bleeding from these tumors caused by failure of endoscopic hemostasis.

Surgical hemostatic agents: Assessment of drugs and medical devices

Surgical hemostatic agents are indicated to improve hemostasis when conventional techniques (compression, sutures or electrocoagulation) are inadequate. The National French Authority for Health (Haute Autorité de santé [HAS]) set out to assess these products (medical devices and agents) to determine their optimal utility. This evaluation included one class of products containing some form of human fibrinogen and thrombin and eight classes of medical devices and automated devices to prepare autologous fibrin. The assessment was based on a systematic review of the literature and expert opinion of health care professionals. The main measures of effectiveness of hemostatic agents were the success rate as expressed in terms of the time necessary to obtain adequate hemostasis, the volume of intra and/or postoperative blood loss, the need for blood transfusions, complication rate, duration of operations and hospital stay. A meta-analysis and 52 controlled randomized studies were selected involving cardiac or vascular surgery (19), ENT surgery (11), gastrointestinal surgery (5), urology (4), orthopedic surgery (4). Approximately half of the studies retained in this analysis evaluated blood derived agents (fibrin sealants) while the other half evaluated medical devices. The working group considered that there is not any evidence that these surgical hemostatic agents decrease the rates of transfusion, complications, reoperation, mortality, duration of operation and/or hospital stay. The working group considered that the use of surgical hemostatic agents to improve the safety of hemostasis in the absence of identified bleeding as an alternative to adequate conventional hemostasis was not justified. Surgical hemostatic agents can be used in ad hoc settings, as a complement to conventional methods to control persistent bleeding after conventional hemostatic techniques, or when abundant bleeding has led to biologic hemostatic disorders. The working group also distinguished several particular settings (mouth and dental care in patients under antiagregant or anticoagulation therapy, central nervous system surgery or acute aortic dissection). Comparative data are insufficient to determine if one product is superior to another for a specific use. To evaluate the clinical value of these products, methodologically sound clinical studies are necessary.

Premedication with oral clonidine decreases intraoperative bleeding and provides hemodynamic stability in cesarean section

Background: Intentional lowering of blood pressure helps to produce a desirably clean surgical field. Many drugs can be used to induce a hypotensive state, but due to their high potency and rapid effect, drugs that more easily and safely control the induction of hypotension are desirable. Objectives: To investigate the effects of premedication with oral clonidine on intraoperative bleeding and hemodynamic variables in patients undergoing cesarean sections. Patients and Methods: A total of 110 patients classified as American Society of Anesthesiologists (ASA) physical status I and II and who were scheduled for elective cesarean section under general anesthesia were enrolled. The patients were randomized to receive either oral clonidine (0.2 mg) or identical-looking placebo tablets 90 minutes before arriving at the operating room. Induction of anesthesia was performed by the same standard protocol in all patients. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were recorded before and after induction; immediately after intubation; 5, 10, and 15 minutes thereafter; at the time of extubation; and one hour after the operation. The surgeons were asked to rate the quality of the operative field on a four-point scale that ranged from mild (1) to abundant bleeding (2). Results: Intraoperative SBP was lower in the clonidine group. After both intubation and extubation, the increases in SBP, DBP, and HR in clonidine-treated subjects were significantly less than the changes in the control patients. The amount of fentanyl given to control blood pressure and HR was significantly less in the clonidine group (18 38 vs. 39 53 ?g, P = 0.02). The responses to the four-point scale indicated that intraoperative bleeding in the clonidine group was less than in the placebo group (1.2 0.4 vs. 1.7 0.6, P < 0.05). Conclusions: Premedication with oral clonidine can improve the hemodynamic management of cesarean cases.

Psychosocial quality of life in hereditary haemorrhagic telangiectasia patients

The aim of this study was to evaluate psychosocial quality of life (PQoL) in patients with Hereditary Haemorrhagic Telangiectasia (HHT). A retrospective study was performed on PQoL in HHT patients presenting with epistaxis. One hundred fifteen patients were interviewed using a questionnaire designed by two sociologists and a head and neck surgeon. Changes over time were assessed according to information on psychosocial well-being, social life, family support, occupation, and medical and demographic data regarding age, gender and patient appearance. Analysis of Psychosocial Quality of Life (PQoL) revealed no statistical difference in relation to gender, marital status, household income or place of residence (rural or urban); however, a significant difference was observed with age. Elderly patients had a poorer PQoL than younger patients. Workers had a better PQoL than unemployed patients. Epistaxis and professional duties were correlated: workers with less than one episode of epistaxis per month were more active. Frequent episodes of epistaxis and abundant bleeding decreased PQoL. These patients felt different and often experienced a desire to withdraw compared to others. Epistaxis in hereditary haemorrhagic telangiectasia patients was associated with the impairment of many PQoL criteria, together with relationship modifications.

Premedication with oral clonidine decreases intraoperative bleeding and provides hemodynamic stability in cesarean section

Background:Intentional lowering of blood pressure helps to produce a desirably clean surgical field. Many drugs can be used to induce a hypotensive state, but due to their high potency and rapid effect, drugs that more easily and safely control the induction of hypotension are desirable.Objectives:To investigate the effects of premedication with oral clonidine on intraoperative bleeding and hemodynamic variables in patients undergoing cesarean sections.Patients and Methods:A total of 110 patients classified as American Society of Anesthesiologists (ASA) physical status I and II and who were scheduled for elective cesarean section under general anesthesia were enrolled. The patients were randomized to receive either oral clonidine (0.2 mg) or identical-looking placebo tablets 90 minutes before arriving at the operating room. Induction of anesthesia was performed by the same standard protocol in all patients. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were recorded before and after induction; immediately after intubation; 5, 10, and 15 minutes thereafter; at the time of extubation; and one hour after the operation. The surgeons were asked to rate the quality of the operative field on a four-point scale that ranged from mild (1) to abundant bleeding (2).Results:Intraoperative SBP was lower in the clonidine group. After both intubation and extubation, the increases in SBP, DBP, and HR in clonidine-treated subjects were significantly less than the changes in the control patients. The amount of fentanyl given to control blood pressure and HR was significantly less in the clonidine group (18 ± 38 vs. 39 ± 53 μg, P = 0.02). The responses to the four-point scale indicated that intraoperative bleeding in the clonidine group was less than in the placebo group (1.2 ± 0.4 vs. 1.7 ± 0.6, P < 0.05).Conclusions:Premedication with oral clonidine can improve the hemodynamic management of cesarean cases.

Alcohol and B1 vitamin deficiency-related stillbirths

Objective. The present study attempts to determine whether prenatal thiamine (B1 vitamin) deficiency and prenatal alcohol exposure are risk factors for stillbirths.Methods. From conception to parturition, Wistar rat dams were exposed to the following treatments: (1) Rat dams consuming a thiamine-deficient diet; (2) 12% alcohol/water drinking mothers; (3) mothers drinking 12% alcohol/water + thiamine hydrochloride mixture. Appropriate pair-fed controls and ad libitum controls were assessed. Gestation outcome and fetal parameters, including spontaneous abortion, still-born fetuses, litter size and birth weight, were assessed from the dams of each experimental group.Results. Both alcohol and thiamine deficiency during pregnancy increased fetal death (48.26%vs. 84.47%), reduced litter size (44.54%vs. 72.7%), respectively, and lowered birth weight. Thiamine administration reversed the effects of alcohol-induced fetal death, suggesting that a part of deleterious actions of alcohol on fetal death was mediated by thiamine deficiency. Prenatal thiamine deficiency increased singularly spontaneous abortion with abundant bleeding (40%), rising the occurrence of stillbirth. Such a pathology was not observed in alcohol group.Conclusions. The results indexed thiamine deficiency as a potent risk factor for stillbirths. The vitamin supply during pregnancy prevents stillbirths related to chronic alcoholism and different facets of malnutrition.

Recombinant activated factor VII and intraoperative use of cell saver in neurosurgical treatment of arteriovenal malformation

Arteriovenous (AV) malformation of brain causes abundant intraoperative bleedings, because of increased blood flow, which complicates operative treatment. The use of cell saver for intraoperative salvage of blood and recombinant activated factor VII (rFVIIa) significantly reduces complications during operative treatment. We present a 29-year old male patient with AV malformation of the 4th degree on Spetzler-Martin scale. Because of the possibility of abundant bleeding, a cell saver (Sequestra 1000 Metronic, USA) was used, and to achieve and control adequate haemostasis, we used rFVIIa. The use of cell saver for intraoperative blood salvage and rFVIIa proved successful in operative treatment of AV malformation of 4th degree.

Endovascular therapy in the management of moderate and massive haemoptysis

The aim of this study was to retrospectively evaluate 140 patients with severe (97 massive, 43 moderate) haemoptysis treated by bronchial artery embolisation. Between January 1997 and April 2005, 140 patients (120 males and 20 females, aged 23-71 years) with severe haemoptysis considered surgically inoperable because of limited pulmonary reserve were treated by embolisation. The cause of haemoptysis was tuberculosis in 136 patients and malignancy in four. Embolisation succeeded in controlling haemoptysis immediately after the intervention in 138 patients (98.5%) and at 1 month in 126 patients (90%). Severe haemoptysis recurred in 11 patients with prior massive haemoptysis and 3 patients with prior moderate haemoptysis in a mean time of 3.7 months (1-7 months) after the last intervention. The bleeding source was detected during angiography and embolised in 12 of these patients. Two patients with malignant tumour died because of abundant bleeding, following an asymptomatic period of 30 days. There were no procedure-related major complications. Bronchial artery embolisation is a safe and effective palliative treatment alternative in moderate and massive haemoptysis.

179: Burch Laparoscopic Colposuspension

179: Burch Laparoscopic Colposuspension

Petits maux de la grossesse

45% to 89% of pregnant women experience nausea and vomiting. The treatment is nutritional (well accepted food, 4 to 6 meals per day). Pyridoxine (750 mg/day) is more effective on vomiting than on nausea. Antiemetic drugs (metopimazine, metoclopramide) are more or less efficient; some authors recommend homeopathic drugs or acupuncture. Persistent vomiting after 14 amenorrhea weeks suggests a psychological or an organic cause. There is no effective treatment for ptyalism. Constipation is first treated with an appropriate diet (fruits and both fresh and cooked vegetables for each meal); lactulose, vaseline oil and mucilage (ispaghul) or macrogol can then be used. Pyrosis occurs in late pregnancy, mainly when lying on the back and during night time: alginates are first prescribed and if they are not efficient enough, ranitidine or omeprazole can be used. In case of persistent pyrosis, oesophagoscopy may help detecting oesophagitis or hiatal hernia. Night cramps are highly painful: basic treatment is magnesium supplements for 2 to 3 weeks. Quinine (150 to 300 mg per dosing) is a symptomatic treatment and is not contraindicated. There is no effective treatment for the pelvic girdle relaxation that spontaneously recovers post partum. Lumbosacral pain is treated by lumbar lordose reduction: antalgesic drugs are not efficient. Massages and hydrotherapy reduce such pain. The treatment of congestive rhinitis is based on antihistaminic drugs: local vasoconstrictive drugs are contraindicated. In hypertrophic gingivitis, tooth brushing should be replaced by hydrojet. Epulis is uncommon and rarely requires surgery, except in abundant bleeding. Striae albae are common and there is no really effective treatment; moisturizing milks and creams can be applied to reduce dry skin.

Repair of lacerated inferior vena cava with the intravascular tube graft in redo cardiac surgery

Laceration of the proximal inferior vena cava (IVC) is a rare but fatal complication of redo cardiac surgery if it is situated at the posterior supradiaphragmatic, juxtadiaphragmatic, or retrohepatic region of the IVC. Redo valve and congenital cardiac operations, which are performed by the transatrial approach, may carry the risk of IVC laceration. Laceration of the IVC, mostly at its posterior wall, may occur during application of a snare or Cooley clamp or from stretching of the incompletely liberated adherent IVC during traction on the atrium for valve exposure. The laceration may extend for a variable distance down the IVC. Not infrequently, this complication may also be encountered in other cardiovascular interventions (ie, IVC filter implantation, thrombectomy), some upper abdominal operations (ie, IVC fistula repair, thoracoabdominal aneurysm surgery, hepatic surgery), and in blunt or penetrating chest traumas. Different methods have been proposed to repair this complication, such as atriocaval shunt, lateral phleborrhaphy, patch plasty, total vascular occlusion, tube graft or duplicated saphenous interposition, and diaphragmatic or pericardial flap repair. However, the inaccessible location of some lacerations and the high mortality are still a problem. 1-5 We are presenting a case of an IVC laceration at an inaccessible location treated by means of a novel approach. Clinical summary. A 53-year-old woman who had a closed mitral commissurotomy operation 22 years earlier because of rheumatic valve disease was admitted to our hospital for mitral restenosis and insufficiency and 3+ tricuspid regurgitation. The operation was conducted as usual with aorta-bicaval cannulation, intermittent cold cardioplegia, and moderate hypothermia (28°C). Abundant bleeding appeared around the IVC after the cannulas were drawn back into the right atrium. External interventions to stop the bleeding proved futile and total circulatory arrest had to be established. Tactile exploration from the right atrium revealed a long laceration extending down the IVC for an indeterminate distance in the

養殖魚類の疾病に関する研究-I

A number of blackened specimens among normal ones of the yellow tail in fish-farms establishments in Akamizu and Urajiri Bays of Nobeoka City, Miyazaki Prefecture were compared with the control with special reference to pathological histology. The results run as follows: 1. The number of red corpuscles of the control fish amounted to 3, 620, 000±500, 000 per mm3 whereas 3, 060, 000±560, 000 in blackened Akamizu and 1, 610, 000±420, 000 in morbid Urajiri ones respectively, significant difference existing between the normal and Urajiri blackened specimens (F146(0.05)4.41<F0=44.53). But Akomizu sick fish did not stand significantly at variance with the healthy ones in this respect. 2. Liver fat was scanty in the unhealthy ones. Sudan III staining gave a reading which was significantly different from that of the normal (F'55(0.05)=4.02<F0=29.515). 3. Examination of liver lipids did not reveal existence of neutral ones but indicated a small quantity of denatured lipoids occurring in the liver. 4. Cloudy swelling of constituent cells accompanied by shrinkage of their nuclei was a general featurs of morbid liver. Forcal necrosis was found obtaining sometimes in the organ. 5. Morbidity of the kidney was characterized by (a) shrinkage of Bowman's capsule, (b) dilatation, swelling, and denaturation of nephritic tubule, and (a) abundant bleeding in interstice. Advancement of sickness led to fibrosis. Interstice was mostly rich in fibrous matter, hardened thereby. 6. Almost nothing particular was seen in unhealthy spleen, except anemia. 7. Atrophy consequent on chronic catarrhal inflammation was evident in alimentary canal of the morbid. 8. Anemia and deficiency of fat were seen in dark muscle of the sick specimens. From the above findings, severe symptoms of metabolic endogenous toxication were evident.

FATAL HEMORRHAGE FROM ERODED ARTERIA CYSTICA OF THE GALLBLADDER

Two acute dangers threaten the life of persons suffering from chronic peptic ulcer: the perforation of the ulcer into the peritoneal cavity, and fatal hemorrhage from eroded blood vessels. Fatal hemorrhages are comparatively rare events in chronic gastric ulcers. Da Costa 1 reports that only 3 to 8 per cent, of persons actually die of hemorrhage. The spread of an ulcer sometimes, though not as often as it is generally considered, causes obstruction of the blood vessels in its base by inflammatory changes in the vessel walls and by thrombosis. In this way larger hemorrhages may be prevented. But, on the other hand, the contractibility of a blood vessel embedded in the firm, cicatrized tissue of the ulcer may be impaired and so increase the possibility of abundant bleeding from smaller vessels. My own experience is based on fifty-five cases in which the patients have died from peptic ulcer of