Major Vessel Injury Research Articles

Type 2 Diabetes and its Implications in Cerebrovascular Disease

Type 2 Diabetes and its Implications in Cerebrovascular DiseaseType 2 diabetes represents an independent risk factor for vascular cerebral pathology, with a 2-3 times greater probability of stroke. The number of diabetic patients with stroke increased substantially from 6.2% to 11.3% during 1996-2006. Ischemic stroke, small or large vessels occlusion, is the main subtype of cerebrovascular disease, while a smaller percentage is attributed to cerebral hemorrhage. Hyperglycemia and hyperinsulinemia, excess free fatty acids, prothrombotic state cause endothelial dysfunction with blood flow disturbance and major cerebral vessels injury. Elevated blood sugar levels are also associated with a poor prognosis during post-stroke phase. From the total number of deaths caused by acute cerebrovascular events, 16% for men and 33% for women are due to diabetes.

Laparoscopic Nephrectomy: A Prospective, Nonrandomized Comparison With Open Surgical Nephrectomy.

Objective: To comparatively study the effectiveness of Laparoscopic nephrectomy vis-‡-vis Open nephrectomy in patients of benign non functioning kidney and early stage renal cell carcinoma. It was a prospective, non-randomized study. Patients and Methods: 160 patients underwent open (n=80) or laparoscopic nephrectomy (n=80).The comparison was made in relation to the operative time, intra-operative and postoperative complications, blood loss and transfusions, pain and analgesia requirements, hospital stay and convalescence. Results: The mean operative time (96 minutes Vs 74 minutes) was more in the laparoscopic group. The mean blood loss (127 ml Vs 104 ml) was more in the open group. The resumption of oral intake (30.3 hours Vs 33.6 hours) and removal of drain (2.35 days Vs 2.6 days) was earlier in the laparoscopic group. Intra-operative complications were more in laparoscopic group (5% Vs 2.5%). A total of 4 patients (5%) had to be converted to open because of failure to progress, and bleeding due to major vessel injury. Post operative complications were significantly more in open group. Mean hospital stay in open group was 6.3 ± 1.34 days, significantly more than laparoscopic group of 4.2 ± 1.22 days. Tumor recurrence was seen in both the groups. Conclusion: Laparoscopic nephrectomy for benign and early stage malignant disease is superior to open surgery in terms of reduced blood loss, postoperative complications, hospital stay and cosmetic outcome. The accumulated follow-up oncological data has shown equal oncological efficacy of laparoscopic radical nephrectomy and the results are comparable to open radical nephrectomy.

Percutaneous nephrolithotomy complications in 671 consecutive patients: a single-center experience.

To evaluate major and minor complications of percutaneous nephrolithotomy (PCNL) and their management in our consecutive cases. We reviewed medical records of 671 patients who had undergone PCNL in our center from March 2000 to March 2006. The demographic data, stone parameters, PCNL complications, and stone-free rate were evaluated. Multiple parameters were evaluated for their association with PCNL complications using Chi-Square test. Complications occurred in 203 (30.3%) patients; renal parenchymal injury in 103 (15.4%), peri-operative bleeding in 42 (6.3%), late bleeding in 6 (0.9%), renal collecting ducts injury in 35 (5.2%), fever in 7 (1.0%), colon perforation in 2 (0.3%), major vessels injury in 3 (0.4%), pneumothorax in 3 (0.4%), and hemothorax in 2 (0.3%) subjects. Mortality occurred in 1 patient with colon perforation (0.15%). Percutaneous nephrolithotomy has low complication rate in experienced hands.

Laparoscopic lymphadenectomy for gynecologic malignancies: evaluation of the surgical approach and outcomes over a seven-year experience

The purpose of this study was to evaluate the feasibility and efficacy of laparoscopic lymphadenectomy in patients with gynecologic malignancies and improve upon the existing published data regarding laparoscopic lymphadenectomy. We conducted a retrospective chart review of 225 patients with various gynecologic malignancies who had undergone laparoscopic pelvic lymphadenectomy (LPL) and/or laparoscopic para-aortic lymphadenectomy (LPAL) at Kangbuk Samsung Hospital between November 2003 and October 2010. One hundred and seventy-two patients underwent both LPL and LPAL, 47 patients underwent LPL alone, and six patients underwent a repeat laparoscopic lymphadenectomy. The median age and body mass index of the patients were 49.4 years (range 23-79 years) and 24.2 kg/m(2) (range 17.5-37.2 kg/m(2)). The median numbers of harvested pelvic and para-aortic lymph nodes were 25.9 (range 3-63) and 10.6 (range 1-34), respectively. The median operating times for the LPL and LPAL were 72.3 min (range 40-120 min) and 40 min (range 20-70 min), respectively. There were seven cases of major vessel injuries, two lymphocytes, two lymphedemas, and two chylous ascites. There was no unplanned conversion to laparotomy. Laparoscopic lymphadenectomy can be considered a technically feasible and safe procedure and has become the alternative modality in the field of gynecologic oncology surgery. And our results could reinforce the existing published data regarding laparoscopic lymphadenectomy.

Surgical and histopathological effects of topical Ankaferd® hemostat on major arterial vessel injury related to elevated intra-arterial blood pressure.

The aim of this study was to assess the surgical and histopathological hemostatic effects of topical Ankaferd blood stopper (ABS) on major arterial vessel injury related to elevated intra-arterial blood pressure in an experimental rabbit model. The study included 14 New Zealand rabbits. ABS was used to treat femoral artery puncture on 1 side in each animal and the other untreated side served as the control. Likewise, for abdominal aortic puncture, only 50% of the aortic injuries received topical liquid ABS and the others did not (control). The experiment was performed under conditions of normal arterial blood pressure and was repeated with a 50% increase in blood pressure. Histopathological analysis was performed in all of the studied animals. Mean bleeding time in the control femoral arteries was 105.0±18.3 s, versus 51.4±9.8 s (p<0.05) in those treated with ABS. Mean blood loss from the punctured control femoral arteries was 5.0±1.5 mg and 1.6±0.4 mg from those treated with ABS (p<0.05). Histopathological examination of the damaged arterial structures showed that ABS induced red blood cell aggregates. ABS administered to experimental major arterial vessel injury reduced both bleeding time and blood loss under conditions of normal and elevated intra-arterial blood pressure. ABS-induced erythroid aggregation was prominent at the vascular tissue level. These findings will inform the design of future experimental and clinical studies on the anti-bleeding and vascular repairing effects of the novel hemostatic agent ABS.

O-028 Acute endovascular management of gun shot injuries to arteries supplying the head & neck and the brain in civilian patients

PurposeTo report the use of endovascular techniques for management of gun shot injuries to arteries in the head and neck requiring emergency intervention.Material and MethodsBetween January 2009 and March 2011,...

1185 “CLOSED” ACCESS IN PEDIATRIC UROLOGIC LAPAROSCOPY—A VIABLE ALTERNATIVE TO “OPEN” ACCESS IN A LARGE, CONTEMPORARY SERIES

You have accessJournal of UrologyPediatrics: Reconstructive Surgery1 Apr 20111185 “CLOSED” ACCESS IN PEDIATRIC UROLOGIC LAPAROSCOPY—A VIABLE ALTERNATIVE TO “OPEN” ACCESS IN A LARGE, CONTEMPORARY SERIES Eric Nelson, Harsha Mittakanti, Shelly Bian, Kirk Jackson, David Roth, and Lars Cisek Eric NelsonEric Nelson Houston, TX More articles by this author , Harsha MittakantiHarsha Mittakanti Houston, TX More articles by this author , Shelly BianShelly Bian Houston, TX More articles by this author , Kirk JacksonKirk Jackson Houston, TX More articles by this author , David RothDavid Roth Houston, TX More articles by this author , and Lars CisekLars Cisek Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.818AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of laparoscopy in pediatric urologic surgery is now routine. Placement of the initial trocar is a critical step and avoidance of bowel and major vessel injury is paramount. The ideal technique for placement has not been explored in the pediatric urologic literature. We hypothesize that a “closed” access method is technically straight-forward, safe, and can be applied to routine pediatric urologic operations. METHODS An Institutional Review Board-approved retrospective chart review was performed of all patients undergoing laparoscopic surgery between 2003 and 2010. Data extracted included: age, procedure, previous surgical history, method and location of access, presence or absence of intra-abdominal adhesions, and intra-operative complications. Method of access was classified as either “open” (Hassan) or “closed” which included: the direct technique, optical access with a Visiport, or use of a Veress needle/Step Trocar system. For the direct access technique, an umbilical incision is made and the skin on either side is elevated in a “lifted table” technique. A bladeless trocar is then pushed and twisted with gentle, firm pressure through the rectus fascia. Intra-abdominal position is confirmed visually and the abdomen is then insufflated. In the Veress/Step Trocar group, a Veress needle confirmed intra-abdominal position and the timing of insufflation varied. RESULTS 668 encounters (631 patients) were identified and average age was 7.53 years (0.13–19.68). The procedures were performed by five surgeons and encompassed a variety of procedures (orchiopexy- related—179, inguinal hernia repair—180, varicocelectomy—160, ureteral reimplant—31, pyeloplasty—102). A “closed” access technique was utilized in 661/668 encounters (direct—475; Veress/Step—164; Visiport—20). 12.3% of the patients had a history of intra-abdominal surgery and significant adhesions were seen in 14 (2.1%). There was one complication during access—a small liver laceration during initial port placement for a pyeloplasty. The bleeding was minimal and required no intervention. An open technique was chosen in seven patients—five of these had concomitant umbilical hernia repair. CONCLUSIONS The “closed” technique for laparoscopic access in the pediatric population is safe and feasible even in patients with previous intra-abdominal surgery. We believe the technique is technically straight-forward and efficient. These data support “closed” access techniques as viable alternatives to the Hassan method for routine use in pediatric laparoscopy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e476 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Nelson Houston, TX More articles by this author Harsha Mittakanti Houston, TX More articles by this author Shelly Bian Houston, TX More articles by this author Kirk Jackson Houston, TX More articles by this author David Roth Houston, TX More articles by this author Lars Cisek Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Surgical and histopathological effects of topical ankaferd hemostat on major arterial vessel injury in relation to the enhanced intra-arterial blood pressure

Surgical and histopathological effects of topical ankaferd hemostat on major arterial vessel injury in relation to the enhanced intra-arterial blood pressure

Air embolism: an unusual cause of delayed death following gunshot wound to the chest

A 29-year-old man was shot in the chest twice sustaining extensive contusion of the right lung. He was, however, clinically stable with no major vessel injury or significant blood loss. Unexpected cardiac arrest occurred hours after hospital admission due to left coronary artery air embolism. Lung parenchymal damage from the passage of two projectiles within the chest wall close to the pleural cavity had occurred, with disruption of the capillary-alveolar interface and passage of air into the pulmonary venous circulation. While tangential gunshot wounds to the chest wall may rarely cause air embolism, symptoms are usually immediate. The present case demonstrates, however, that death may occur unexpectedly some time after the initial trauma in an individual who is considered clinically stable.

Delayed Presentation of an Unusual Transpharyngeal Penetrating Neck Injury by a Wooden stick: A Case Report

Penetrating neck trauma is a horrifying injury. Patients may present with sudden death, or life threatening injuries such as catastrophic haemorrhage, major vessel injury, injuries to the respiratory or digestive tract, neurological deficits, or bony injuries of the cervical spine. Other less life threatening symptoms may be associated with such injuries. We present here a case report of a 2-year-old child who sustained a transpharyngeal penetrating neck injury that occurred while playing with a wooden stick. He presented one month later with an abscess in the posterior triangle of the neck.

Bilateral heterochronic spontaneous hemothorax caused by pulmonary arteriovenous malformation in a gravid: A case report

Bilateral heterochronic spontaneous hemothorax as a result of pulmonary ateriovenous malformation is a very rarely happened disease. A 34-year-old woman presented major symptoms with right-sided chest pain and shortness of breath. The following contrast-enhanced computed tomographic scan of the chest showed a large amount of fluid in the right thorax with mediastinal shift, but without major vessel injury and 2 small dense opacities in the apical segment of the right lower lobe and in the posterior aspect of the left lower lobe. The patient underwent local resection of the right lower lobe. The pulmonary ateriovenous malformation was further identified by pathological examination. One month after she was discharged home, the symptoms described above recurred. A follow-up computed tomographic scan of the chest showed a large amount of fluid in the left thorax. During the emergency operation, we found a bullous lesion in the left lower lobe and a small blood vessel overlying the lesion that was actively bleeding. As stated above, local resection of the left lower lobe was performed once more. Pathological result was the same as observed previously. There were no postoperative complications and she was discharged from the hospital after two weeks. Two months later, she successfully delivered a healthy female infant. Up to now, regular follow-up observation has shown her to be perfectly asymptomatic.

Vascular Injury in Thoracolumbar Spinal Surgeries and Role of Angiography in Early Diagnosis and Management

A retrospective outcomes study. To stress on the importance of early diagnosis with the help of angiography and proper treatment of vascular injuries occurring during thoracolumbar surgeries and to report our results. Vascular injury is a rare but dangerous complication that can develop during thoracolumbar surgeries and if not treated properly then it can lead to severe complications including the death of the patient. The patients included in this study were the ones who were suspected to have a possible vascular injury after a thoracolumbar surgery. Contrast enhanced computed tomography was performed for patients having clinical signs suggesting vascular injury. Among these patients, who were suspected to have active bleeding and major vessel injury on computed tomography were further subjected to angiography. Of the 10 cases included in the study, vascular injury was identified to be arterial in origin in 8 cases and venous in 3 cases. Among the 8 cases of identified arterial injury, angiography was performed in 4 cases, of which 3 were found to have active bleeding and were subjected to immediate intervention. Of the 4 cases in which angiography was not performed, 3 of them expired at variable postoperative periods. Complications developed in total 5 cases including 3 cases of mortality, 1 case of infection, and 1 case of cauda equina syndrome. The vascular injuries during thoracolumbar spinal surgeries need immediate and aggressive treatment. In arterial injuries, we can prevent serious consequences by subjecting the patient to an angiography as early as possible followed by a therapeutic embolization. In contrast, for venous injuries if hemostasis has been confirmed, then an immediate intervention may not be always required.

Correlating first- and second-rib fractures noted on spine computed tomography with major vessel injury

First- and second-rib fractures diagnosed on plain radiographs have been associated with traumatic aortic injury. We examined whether such fractures diagnosed on computed tomography (CT), which is of greater sensitivity than plain radiograms for rib fractures, are associated with traumatic vascular injury. We identified 1,894 patients who had undergone a chest CT angiogram with indication of trauma between 2005 and 2008. Among these, 185 patients were selected at random. The main mechanism of injury was motor vehicle accident or a fall. The patients were divided into two groups: patients with first- and/or second-rib fractures and those without. Proportions of patients with major vessel injury noted on CT angiography were compared between groups. Information regarding displacement of the fracture, location of the fracture, detection upon plain film, and gender of the patients was also evaluated and correlated with incidence of major vessel injury. Fisher's test and χ2 analysis were used to determine significance of the data. Incidence of major vessel injury was similar between patients with and without first- and/or second-rib fractures (7% vs. 9%, respectively; p = 0.59). No subset of type of rib fracture was associated with greater incidence of aortic injury. First- and second-fractures are not associated with greater incidence of aortic injury. Thus, the previous axiom that first- and second-rib fractures should result in increased examination for aortic injury may not hold true.

Major Vessel Injury With Cage Migration

Case report. To report the unique nature of a technique-related complication with major vessel injury in case of lumbar spondylodiscitis. Perioperative major vessel injuries during spinal surgeries are uncommon but are reported complications. The unusual nature of the complication and its prognostic dilemma is the purpose of this case report. A 55-year-old woman presented with infective L3-L4 spondylodiscitis and was offered transforaminal lumbar interbody fusion surgery. Intraoperative manipulation to attain optimum cage position resulted in its dislodgement anteriorly and vessel injury with torrential hemorrhage, which was successfully managed surgically without mortality. On thorough investigation in the postoperative period, the cage was found to have migrated to the left pulmonary artery. The patient recovered completely of her preoperative status and is asymptomatic 6 months after surgery. The presented complication is a catastrophe considering a routine surgical procedure. In cases of spondylodiscitis, spine surgeons should be careful about inflammation of major vessels with friable vessel walls anterior to the vertebrae. This mandates a cautious surgical technique.

Postmortem serum erythropoietin level as a marker of survival time in injury deaths

Circulating erythropoietin (EPO) is mainly derived from the kidneys, and the serum concentration is rapidly increased in response to anemia and hypoxia. The present study investigated postmortem serum EPO levels in injury death cases ( n = 185, postmortem time < 48 h, survival time <7 days: sharp instrument injury, n = 44 and blunt injury, n = 141) with regard to survival time, compared with C-reactive protein (CRP) as a marker of inflammation. Serum levels of both markers were independent of postmortem time. A survival time-dependent increase in serum EPO up to about 100 mU/ml was seen within 6 h of sharp instrument injury to the heart or a proximal major vessel (thoracic aorta or subclavian/carotid artery) and blunt injury with massive hemorrhages, showing high correlations ( r = 0.957 and r = 0.822, respectively, P < 0.0001), whereas the increase was insignificant ( P > 0.05) for sharp instrument injury to a peripheral vessel or lungs/abdominal viscera and blunt injury with minor hemorrhages over the same survival period. A further increase (>100 mU/ml) was often detected in cases of death about 24 h after blunt injury, irrespective of the type of injury. In contrast, a gradual increase in serum CRP level was seen about 12–24 h after blunt injury. These findings suggest that serum EPO can be a marker for investigating survival time within 6 h of major injury involving acute massive hemorrhaging.

Using Perforators as Recipient Vessels (Supermicrosurgery) for Free Flap Reconstruction of the Knee Region

The purpose of this article is to evaluate the feasibility of a perforator as a recipient vessel to reconstruct soft tissue defects of the knee region.From December of 2006 to August of 2008, total of 25 patients underwent reconstructive procedure using either an anterolateral thigh or an upper medial thigh perforator flap. The flaps were anastomosed in a perforator to perforator manner using supermicrosurgery technique.Minimum of 3 perforators were traced around the knee defect. All flaps survived attached to a recipient perforator with artery diameter ranging from 0.4 to 0.9 mm and accompanying veins ranging from 0.4 to 1.2 mm. This approach allowed reduction in time for pedicle and recipient vessel dissection and minimized the trauma involved during isolation of the vessels.Using the perforator as recipient vessel allows an increase in selection for choice of recipient. By using a perforator as recipient, less time is consumed to secure the vessel, does not need long pedicles for flap, is not bound by the condition of major arteries, and minimizes any risk for major vessel injury while having acceptable flap survival.

Thoracotomy in Thoracic Injuries: Results from a Tertiary Referral Hospital.

Critically injured patients may require thoracotomy after a thoracic injury. This study is a retrospective analysis of the results of thoracotomy in patients with thoracic injury. Injured patients with detectable signs of life on arrival at the hospital and who underwent thoracotomy within 4 h of the injury were investigated. Demographic data and medical records were reviewed for associated injuries, indications, intraoperative findings, and outcomes. The factors affecting the mortality were analyzed. Between April 2003 and January 2009, 488 patients with thoracic injury (blunt/penetrating = 73.7%/26.3%) were treated, and 20 (4.1%) underwent thoracotomy (male/female = 17/3, mean age = 27 ± 9 years). The injury was penetrating in 15 (11.7%) and blunt in five (1.4%). None of them required an endotracheal intubation at the scene or in transit. The mean transport time was 58 min. Severe and continuous hemothorax (80%), massive air leak, major vessel injury, and trauma causing an open chest wall defect with bleeding were indications of the thoracotomy. Eighty-five percent survived after the surgery (penetrating/ blunt = 86.6%/80%). The mean injury severity score (ISS) of the survivors was lower (21 ± 9 vs. 39 ± 10, p = 0.05). Mortality was associated with a lower Glasgow coma scale (GCS) (p = 0.03), a higher ISS (p = 0.05), and a longer transport time (p = 0.05). Thoracotomy after thoracic injury is a life-saving procedure in selected cases. Lower GCS and higher ISS are associated with increased mortality. Early transport and quick attempts to diagnose the indications necessitating thoracotomy play a significant role in improving the outcome.

MP-08.05: Tips and Techniques in the Treatment of Major Vessel Injury in Laparoscopic Surgery

MP-08.05: Tips and Techniques in the Treatment of Major Vessel Injury in Laparoscopic Surgery

Transobturator midurethral sling: Surgical technique and outcomes

Transobturator tape midurethral sling is the latest method for treatment of female urinary incont-inence. The authors describe their technique via an outside-in approach under local anesthetic to ensure proper tightening of the sling. Placement through the obturator foramen is straightforward and virtually eliminates risk of serious intraoperative major organ or vessel injury. Although outcome data lack the long-term follow-up of colposuspension and tension-free vaginal tape, similar short-term continence results are encouraging with less associated operative morbidity.

Female urology: What method will you select?

When I was a resident, my leader taught me that the gold standard forpatients with stress incontinence is the Marshall–Marchetti–Krantz(MMK) procedure. But a few years later, urologists who could performadvanced techniques showed me needle suspension as the best methodat a urological meeting. Fortunately my boss gave me a chance for ahand-to-hand lesson of the stamay procedure by the specialist. Sincethen, I have been selecting this procedure for a few years. Withoutdoubt, this needle suspension was the gold standard at that time.But now most urologists do not select this technique because of badresults. After I had mastered the technique of tension-free vaginal tape(TVT), I could see the smiling faces of patients after the operation. Atthat time I believed that TVT would be the gold standard for thiscondition. But the present status is what you know.Recently most specialists, including myself, believe that using‘mesh’ is the best operation for patients with pelvic organ prolapse. Isthis tendency good for the patients in the long run? No one can predictthe results of this procedure more than ten years from now.God knows what procedure will be the gold standard in the future.Assistant Professor Yasuyuki Suzuki