Immediate Control Of Hemorrhage Research Articles

A «Push&Plug» Lifesaving Device to Prevent Exsanguination

Introduction:Severe bleeding from external wounds is a major reason for death. Immediate control of hemorrhage is of highest priority. We present the novel Acute Wound Occluder (AWO) which was developed for rapid and targeted wound occlusion. Here, we present the design, in-vitro testing, and in-vivo performance compared to QuikClot® using a clinically-relevant pig model.Method:AWO is made of an applicator with pushing function into which a self-expanding, Silicone coated Nitinol meshgraft is mounted to enable plugging into the wound-channel. In-vitro tests included biocompatibility, cytotoxicity, skin sensitization, and aging validation. Next, 12 pigs underwent standardized sized femoral-artery puncture to mimic life-threatening bleeding and were either treated with the AWO (n=6) or QuikClot® (control). Animals were followed-up for 4hrs, before device-removal macroscopic assessment.Results:The AWO successfully passed all in-vitro tests. The AWO could be delivered within 40±15 seconds to the wound to achieve instant bleeding control, and no additional manual compression needed. Quick Clot application was less convenient, with approximately four minutes (application 56±8ss, plus three minutes of manual compression) to achieve bleeding control. In all AWO treated pigs, exsanguination could be prevented immediately, no major blood-pressure drops occurred, with four pigs where bleeding could be completely stopped, and two pigs with irrelevant oozing which stopped within 75-150 seconds leading to minimal blood-loss of 12ml and 2ml. Tissue-analysis showed only small hematomas in five out of six animals. In contrast, QuickClot treated pigs showed significant bleeding and a blood-loss of 19ml. All six pigs showed substantial hematomas, two out of six showed very large hematomas. AWO application appeared to be safe with no peri-procedural adverse-events (AEs) or collateral damage to surrounding tissues.Conclusion:The AWO enables rapid and targeted control of life-threatening bleeding without any AEs. The AWO may represent a promising hemostatic device for bullet or knife-stab wounds.

Saving The Uterus; Our Experience In Uterine Artery Embolization For Acquired Uterine Vascular Abnormalities.

Acquired uterine vascular abnormalities are a rare cause of potentially life threatening bleeding. These include uterine artery pseudoaneurysms (UAP)and acquired arteriovenous malformations. The objective of this study was to describe our experience with the diagnosis of acquired uterine vascular abnormalities and its treatment with uterine preservation. It was a retrospective cohort study. Eight patients were enrolled from the hospital database who presented to our Interventional Radiology department from April 2017 to March 2021 for uterine artery embolisation (UAE) with a history of iatrogenic/acquired uterine vascular abnormalities confirmed on imaging. These included two patients with uterine artery pseudoaneurysm (PA) concurrently with arteriovenous malformation (AVM), one with uterine artery PA and five having uterine AVMs. Embolisation agents used were histoacryl glue, lipiodol, PVA particles, and gelfoam slurry. Medical records, imaging studies, and telephonic contact with patients were assessed for patient presentation, intraprocedural details, and follow up to record treatment success. Statistical analysis was performed using descriptive statistics. Bilateral UAE was performed in six patients, while two patients underwent unilateral UAE. Three of the patients presented with life-threatening bleeds requiring multiple transfusions. Clinical as well as angiographic success was achieved in all patients with immediate control of haemorrhage. No complications were observed during follow-up. Two of the patients were able to conceive normally within one year, though it resulted in a miscarriage. Acquired/iatrogenic uterine vascular abnormalities are a rare but important cause of life-threatening haemorrhage that can be expertly managed and successfully treated using UAE, which is rapid, safe, and minimally invasive, with the added advantage fertility preservation.

Endovascular Management of Patients with Head and Neck Cancers Presenting with Acute Hemorrhage: A Single-Center Retrospective Study.

Acute hemorrhage associated with cancers of the head and neck is a life-threatening condition that requires immediate action. The aim of this study was to assess the safety and efficacy of endovascular embolization for acute hemorrhage in patients with head and neck cancers. Data were retrospectively collected from patients with head and neck cancers who underwent endovascular embolization to treat acute hemorrhage. The primary endpoint was the rate of immediate control of hemorrhage during the first 24h after embolization. The secondary endpoints were technical or clinical complications, rate of re-hemorrhage 24h after the procedure, time from embolization to re-hemorrhage, hospitalization time, mortality rate, and time from embolization to death. Fifty-one patients underwent endovascular embolization. The primary endpoint was achieved in 94% of patients. The rate of technical complications was 5.8%, and no clinical complication was observed. Twelve patients (23.5%) had hemorrhage recurrence after an average time of 127.5days. The average hospitalization time was 7.4days, the mortality rate during the follow-up period was 66.6%, and the average time from embolization to death was 132.5days. Endovascular embolization to treat acute hemorrhage in patients with head and neck cancers is a safe and effective method for the immediate control of hemorrhage and results in a high rate of hemorrhage control. Larger studies are necessary to determine which treatment strategy is best for improving patient outcomes.

FRII-02 THE MANAGEMENT OF GENITOURINARY TRAUMA IN WORLD WAR II

You have accessJournal of UrologyHistory of Urology: History Forum II1 Apr 2016FRII-02 THE MANAGEMENT OF GENITOURINARY TRAUMA IN WORLD WAR II Joseph Sterbis, Ronald Caras, John Musser, and Ryan Speir Joseph SterbisJoseph Sterbis More articles by this author , Ronald CarasRonald Caras More articles by this author , John MusserJohn Musser More articles by this author , and Ryan SpeirRyan Speir More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2923AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES During the course of World War II, the United States lost over 400,000 service members, with more than 600,000 wounded. Genitourinary injury accounted for approximately 0.5% of those wounded. Our intent is to review the injuries and treatment modalities from that time, allowing for contemporary comparison. METHODS Primary and secondary literature sources were reviewed from World War II and the post-war era. These sources were surveyed to determine the organ-specific incidences of injury, the nature of combat-related genitourinary trauma, and the surgical and medical therapies utilized in both forward and rear echelons. RESULTS Reports of organ-specific injury rates demonstrate varied incidences: Kidney: 25-40%, External Genitalia: 30-56%, Bladder: 12-15%, Ureter: 1-3%. Reports following the war that discuss treatment modalities focus on immediate control of hemorrhage, urinary drainage, and infection control. Preoperative imaging of the kidney was considered of great importance when feasible, with authors recommending a one-shot intravenous pyelogram as a minimum. Conservative management of blunt renal trauma was advocated. Renorraphy was performed when feasible in penetrating trauma. Vascular repair was also considered, though no reported cases were identified. Upper ureteral injuries were managed with early repair over a catheter, while lower injuries were reimplanted. The Davis intubated ureterotomy, first reported in 1946, was advocated as a means for management of post-traumatic stricture. Extraperitoneal bladder injuries were managed conservatively or with repair if surgery for other injuries was planned. Intraperitoneal bladder injuries were managed with repair and suprapubic cystostomy. Posterior urethral injuries were managed via suprapubic diversion and early surgical approximation, the nature of which was ill-defined. Neurogenic bladder from spinal cord injury was generally managed with suprapubic cystostomy, with authors very clear that such injuries were not to be managed with intermittent catheterization. CONCLUSIONS With this year marking the 71st anniversary of the conclusion of World War II, review of historic data provides perspective informing our contemporary combat trauma management. With the notable exception of neurogenic bladder, many management principles have been preserved over time. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e521 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Joseph Sterbis More articles by this author Ronald Caras More articles by this author John Musser More articles by this author Ryan Speir More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Lactatio falsa bei der Ziege – Fallsammlung und Erfahrungen mit der Amputation des Gesäuges

Hobby keeping of goats and sheep confronts veterinarians with new challenges that rarely have to be faced in livestock husbandry. During the last five years five goats were presented to the Clinic for Animal Reproduction, Faculty of Veterinary Medicine, Freie Universität Berlin, Germany, with inappropriate lactation syndrome. Four of these animals had been previously treated with cabergoline without enduring success. According to the request of the owners (informed consent) and the clinical severity of the cases, a mastectomy was performed in all five animals. Surgery was performed under general anaesthesia using ketamine and xylazine, and with the patients in a recumbent position. Mastectomy in small ruminants requires knowledge of the anatomy of the udder and the possible positions of the supplying blood vessels. Our patients displayed a variety of dispositions of the Vena epigastrica caudalis superficialis. Special attention should be paid to a careful and blunt dissection of the mammary gland, and immediate control of haemorrhage, to maintain a clear view on the anatomic structures. Furthermore, dissection of the glandular tissue should be strictly avoided to prevent milk contamination of the surgical area. A sufficient skin flap has to be left to cover the surgical area after removal of the udder. Even though udder amputation appears to be a radical and high-risk procedure, all five goats survived the surgery. The wound healing occurred in a reasonable time without any severe complications. In goats that are kept as "hobby animals" and in which an inappropriate lactation syndrome cannot be treated conservatively, mastectomy is a reasonable and promising therapy.

A Dorsal Approach for the Removal of the Nasal Septum in the Horse

To describe and evaluate a technique involving a dorsal approach for the removal of the nasal septum in adult horses. Retrospective clinical study. Four client-owned horses. Access for partial nasal septum resection was through a dorsal nasal bone flap. Septum resection was performed because of reduced airflow from septal deviation and/or thickening caused by traumatic insult or neoplasia. Preoperative clinical signs and diagnostic results were recorded. Intra- and postoperative complications were noted and follow-up information was obtained from telephone interviews of owners or by clinical examination. The abnormal segment of the nasal septum was completely removed in all horses. A dorsal nasal bone flap approach provided excellent access to the septum and allowed immediate control of hemorrhage; blood transfusion was not needed. Cosmetic results were considered good to excellent by owners and horses returned to their previous level of work without perceived limitations associated with airway function. Nasal septum resection by the dorsal approach permits good observation of the abnormal septum, and provides exposure that facilitates removal of nasal masses and reduction of depression fractures with minimal complications. A dorsal nasal bone flap approach should be considered for horses that require nasal septum resection because it can be achieved with minimal hemorrhage, good cosmetic results, and return to function.

Endovascular treatment of penetrating injury of axillary vein with viabahn endoprosthesis

Penetrating injuries of the axillary or subclavian venous system are associated with extensive blood loss and are fatal in more than 50% of cases. Patients are usually unstable and are treated with surgical exploration. We present a case of axillary venous injury that was treated in the operating room with intravenous placement of a self-expanding Viabahn endoprosthesis (W.L. Gore). The device was delivered to the injured site percutaneously via a basilica vein, with immediate control of hemorrhage.

Vascular intervention in the thorax: bronchial artery embolization for haemoptysis.

Massive haemoptysis is defined as the expectoration of more than 600 mls of blood in 48 h. Many patients are not surgical candidates because of the presence of severe bilateral pulmonary disease and these individuals are best managed by bronchial artery embolization. Occlusion of both the bronchial arteries and hypertrophied non-bronchial systemic arteries is essential if bleeding is to be controlled. A pulmonary arterial source of haemorrhage is uncommon but should always be considered in a patient who has further haemoptyses shortly after a technically successful embolization of bronchial and non-bronchial systemic arteries. The immediate control of haemorrhage is achieved in the majority of patients although subsequent rebleeding on longterm follow-up is not uncommon.

Treatment of acute gastroesophageal variceal hemorrhage

About 30% to 35% of patients with portal hypertension bleed from gastroesophageal varices and mortality remains high reflecting the challenges of effectively dealing with the bleeding event itself and the problems of underlying liver disease. Careful resuscitation and control of risk of complications is the most essential element of medical therapy (Fig. 2). Use of newer, more effective drug combinations with vasopressin or somatostatin permit control of hemorrhage in the majority of patients with fewer drug-induced complications. Endoscopic sclerotherapy and, more recently, banding therapy provide immediate control of hemorrhage and eradication of varices and rebleeding in up to 90% of patients. Persistent, recurrent bleeding in the small number of remaining patients can be effectively managed by "portacaval shunt rescue" or orthotopic liver transplantation in selected cases with acceptable surgical morbidity and mortality. The contribution and role of the TIPS procedure is unknown but very promising; at least as a bridge procedure in patients awaiting transplantation. Until appropriate prospective, comparative trials are performed, the role of TIPS as a long-term alternative to portacaval shunt surgery or other endoscopic or surgical options remains unknown.

The management of acutely bleeding varices by injection sclerotherapy.

Acutely bleeding varices present a therapeutic dilemma because of the limited efficacy and high complication rates of conventional treatments. Over a period of 26 months, 56 episodes of acutely bleeding varices were treated with injection sclerotherapy as the initial management. Immediate control of haemorrhage was achieved in 91% of patients and control of bleeding during the hospital admission in 84%. Balloon tamponade and surgery were reserved for those patients in whom bleeding was not controlled by sclerotherapy; in 66% of patients the bleeding was controlled by sclerotherapy alone. Of the 56 episodes, 75% survived their admission to hospital. Acute injection sclerotherapy is as least as effective as conventional therapies in the control of bleeding with a low incidence of complications. The technique can be used in all patients irrespective of the severity of their liver disease and, when bleeding is controlled, allows the physician the choice of all the available prophylactic therapies.

Emergency endoscopic sclerotherapy for bleeding esophageal varices: a prospective study in patients not responding to balloon tamponade

To assess the efficacy of endoscopic paravariceal sclerotherapy (EPS) compared to balloon tamponade, 25 patients with massive hemorrhage from esophageal varices not responding to Sengstaken or Linton tube tamponade were treated by emergency EPS. None of the patients had received vasopressin. Immediate control of hemorrhage was achieved in 92%. Recurrent bleeding occurred in 17.4% of patients during their primary admission. Minor complications resulting from EPS were observed in three patients (12%): esophageal ulcer, esophageal stenosis, and pleural effusion. Ten patients (40%) died in the hospital, seven of them despite arrested hemorrhage. Fifteen patients were discharged and followed at 3-month intervals for a mean of 21.3 months (range, 8.8 to 29.7). During this period one death due to liver failure without recurrent hemorrhage and three rebleeding events in two patients were observed (rebleeding risk per patient month, 9.4 x 10(-3). We conclude that EPS is very effective in controlling acute bleeding from esophageal varices, even in poor risk patients with ineffective balloon tamponade.

Surgical technic for treatment of splenic rupture

In nine baboons and one dog, a technic for suturing the injured spleen and also providing immediate control of hemorrhage is described. By placing Silastic strips along the wound edges of the transverse incision into the spleen and along the surface and bottom edges of the wound after resection, it was possible to control bleeding with deep U sutures passing through the Silastic bolsters and the spleen tissue. The procedure appears to provide a reliable method of salvaging splenic tissue and thus avoiding the hazard of postsplenectomy sepsis.

Selective mesenteric arterial infusions in the management of massive diverticular hemorrhage.

Abstract Mesenteric arteriography was performed on 15 patients with massive lower gastrointestinal hemorrhage from colonic diverticular disease. In each case, the bleeding site was localized, and selective mesenteric arterial infusion of vasoconstricting drugs was successful in providing immediate control of hemorrhage. No local complications developed at the femoral arterial puncture site, and there was no evidence of intestinal ischemia as a result of the infusion. Seven of the 15 patients received no further therapy and have been followed for six to 30 months without rebleeding. Of the remaining eight patients four had elective partial colectomies after a period of hemostasis, and four underwent surgery for bleeding that recurred after cessation of the infusion. (N Engl J Med 288:1269–1272, 1973)

The Immediate Control of Hemorrhage from Gynecologic Malignancies by Cryosurgery

The Immediate Control of Hemorrhage from Gynecologic Malignancies by Cryosurgery

A method for the immediate control of hemorrhage from duodenal ulcer at operation.

Bleeding from a duodenal ulcer almost always arises from either the superior or the inferior pancreaticoduodenal artery as they enter the scarred, noncontractile base of the ulcer. When an emergency operation is undertaken for continuing bleeding, the hemorrhage into the bowel may be so severe as even to be fatal while the operation is in progress, before the ulcerated portion of the bowel can be dissected free from the open, bleeding vessel, or even before the bleeding vessel can be transfixed. A method is presented which has proved of great value in controlling the hemorrhage immediately after the laparotomy incision has been made. This method consists in applying a rubber- or linen-shod clamp across the duodenum just distal to the area of ulceration and another similar clamp across the stomach just proximal to the pylorus. Any further hemorrhage which may arise from the bleeding vessel is then confined to this