Removal Of Blood Clots Research Articles

Craniotomy treatment for ventricular hemorrhage

Objective To investigate the techniques,effectiveness of interhemispheric transcorpus callosal approach with septostomy or frontal transcortical approach for the management of primary hypertensive ventricular hemorrhage.Methods Eighteen patients with primary ventricular hemorrhage or thalamicorcaudate hemorrhage complicated by ventricular hemorrhage received operation for removal of intraventricular blood clots by the interhemispheric,transcorpus callosal approach with septostomy or frontal transcortical approach.All patients received brain CT examination before and after surgery.The clinical outcomes were assessed 3 months after surgery by GOS.Results Good clinical outcomes ( GOS ≥4) were achieved in 50％ of patients.The overall mortality rate at 3 months postsurgery was 6％.Conclusions The interhemispheric transcorpus callosal approach with septostomy or frontal transcortical approach is safe and effective for direct removal of intraventricular blood clots for the treatment of supratentorial ventricular hemorrhage with obstructive hydrocephalus. Key words: Intraventricular hemorrhage; Craniotomy; Interhemisphere trancorpus callosal approach; Frontal transcortical approach

Rate of post-tonsillectomy hemorrhage after elective bipolar microcauterization of nonbleeding vessels

The objective of this paper is to describe an extended microscopic hemostasis technique involving cauterization of exposed blood vessels that were not actively bleeding in tonsillar fossa after bipolar tonsillectomy and to assess the rate of post-tonsillectomy hemorrhage with this technique in children who had bipolar tonsillectomy. The medical records of children who underwent microscopic bipolar tonsillectomy with extended hemostasis between June 2008 and January 2011 were reviewed. Relevant history and physical examination, diagnosis, and characteristics of postoperative hemorrhage were recorded; 994 children (531 males, 463 females), aged between 1 and 18 years (6 ± 3 years), underwent tonsillectomy; of the 994 patients, 11 (1.1%) developed post-tonsillectomy hemorrhage. No primary post-tonsillectomy hemorrhage occurred. The hemorrhage was seen 6-13 days after the surgery. One patient had bleeding after having trauma to the neck on postoperative day 13. Of the 11 patients with post-tonsillectomy bleeding, 3 had blood clot with no active bleeding and 8 exhibited active bleeding after removal of blood clot. Of the 994 patients, 8 (0.8%) needed intervention to control active bleeding. Compared to previous studies of bipolar tonsillectomy, extended microscopic hemostasis achieved by cauterization of tonsil fossa non-bleeding blood vessels appeared to reduce bleeding rate after bipolar cautery tonsillectomy. The present study did not include a control arm; further randomized controlled studies are needed to establish the definite effect of extended microscopic hemostasis technique on the rate of hemorrhage rates after tonsillectomy techniques.

Key role of the molecular autopsy in sudden unexpected death

Sudden Cardiac Death (SCD) is a major and tragic complication of a number of cardiovascular diseases. While in the older populations, SCD is most frequently caused by underlying coronary artery disease and heart failure, in those aged under 40 years, the causes of SCD commonly include genetic disorders, such as inherited cardiomyopathies and primary arrhythmogenic diseases. As part of the evaluation of families in which SCD has occurred, the role of genetic testing has evolved as an important feature in both establishing an underlying diagnosis and in screening at-risk family relatives. Specifically, in cases where no definitive cause is identified at postmortem, i.e. Sudden Unexpected Death (SUD), the "molecular autopsy" has emerged as a key process in the investigation of the cause of death. The combination of clinical and genetic evaluation of families in which SUD has occurred provides a platform for early initiation of therapeutic and prevention strategies, with the ultimate goal to reduce sudden death among the young in our communities.

Minimally invasive evacuation of spontaneous intracerebral hemorrhage using sonothrombolysis

Catheter-based evacuation is a novel surgical approach for the treatment of brain hemorrhage. The object of this study was to evaluate the safety and efficacy of ultrasound in combination with recombinant tissue plasminogen activator (rt-PA) delivered through a microcatheter directly into spontaneous intraventricular (IVH) or intracerebral (ICH) hemorrhage in humans. Thirty-three patients presenting to the Swedish Medical Center in Seattle, Washington, with ICH and IVH were screened between November 21, 2008, and July 13, 2009, for entry into this study. Entry criteria included the spontaneous onset of intracranial hemorrhage ≥ 25 ml and/or IVH producing ventricular obstruction. Nine patients (6 males and 3 females, with an average age of 63 years [range 38-83 years]) who met the entry criteria consented to participate and were entered into the trial. A ventricular drainage catheter and an ultrasound microcatheter were stereotactically delivered together, directly into the IVH or ICH. Recombinant tissue plasminogen activator and 24 hours of continuous ultrasound were delivered to the clot. Gravity drainage was performed. In patients with IVHs, 3 mg of rt-PA was injected; in patients with intraparenchymal hemorrhages, 0.9 mg of rt-PA was injected. The rt-PA was delivered in 3 doses over 24 hours. All patients had significant volume reductions in the treated hemorrhage. The mean percentage volume reduction after 24 hours of therapy, as determined on CT and compared with pretreatment stability scans, was 59 ± 5% (mean ± SEM) for ICH and 45.1 ± 13% for IVH (1 patient with ICH was excluded from analysis because of catheter breakage). There were no intracranial infections and no significant episodes of rebleeding according to clinical or CT assessment. One death occurred by 30 days after admission. Clinical improvements as determined by a decrease in the National Institutes of Health Stroke Scale score were demonstrated at 30 days after treatment in 7 of 9 patients. The rate of hemorrhage lysis was compared between 8 patients who completed treatment, and patient cohorts treated for IVH and ICH using identical doses of rt-PA and catheter drainage but without the ultrasound (courtesy of the MISTIE [Minimally Invasive Surgery plus T-PA for Intracerebral Hemorrhage Evacuation] and CLEAR II [Clot Lysis Evaluating Accelerated Resolution of Intraventricular Hemorrhage II] studies). Compared with the MISTIE and CLEAR data, the authors observed a faster rate of lysis during treatment for IVH and ICH in the patients treated with sonolysis plus rt-PA versus rt-PA alone. Lysis and drainage of spontaneous ICH and IVH with a reduction in mass effect can be accomplished rapidly and safely through sonothrombolysis using stereotactically delivered drainage and ultrasound catheters via a bur hole. A larger clinical trial with catheters specifically designed for brain blood clot removal is warranted.

Bleeding after Endoscopic Biliary Sphincterotomy

Bleeding during endoscopic sphincterotomy is a common complication. Sometimes bleeding occurs as a late complication after endoscopic retrograde cholangiopancreatography (ERCP). We describe a case in which bleeding happened during ERCP but detection was done after the completion of the procedure. The detection of bleeding allowed further evaluation and detection of hemobilia in this case. The removal of blood clots from inside common bile duct by repeat ERCP however led to an uneventful recovery without any morbidity.

Male post-coital gross hematuria: are there any complications?

Background Male post-coital gross hematuria is an unsettling condition, and various causes have been reported. However, despite the clinical investigation of this disease, many questions remain unresolved. The objective of this study was to analyze clinical features of male patients displaying post-coital massive hematuria. Materials and Methods From 2002 to 2010, 15 males complaining of massive hematuria following sexual intercourse presented to our clinic. Backgrounds and general conditions were analyzed. Furthermore, medical findings and clinical course were evaluated. Results The mean age of the 15 patients was 45.0 ± 15.1 (range = 26–70) years. Three patients exhibited bladder tamponade, which necessitated the removal of blood clots from the urinary bladder by trans-urethral irrigation. Hematospermia was observed in four subjects. Anti-coagulation agents were administered in three cases. Benign prostatic hyperplasia and cystic lesion of the prostate were diagnosed in three and one patient, respectively. Positive urine cytology was not detected. Treatment for post-coital gross hemorrhage included administration of antibiotics, hemostatic agents, and careful observation. Ten patients experienced recurrent post-coital gross hematuria; however, this condition generally resolved without serious complications. Conclusions Male post-coital gross hematuria is an unsettling condition characterized by occasional recurrence. However, no serious underlying diseases were observed.

Obstructive jaundice secondary to haemobilia from calcifying fibrous pseudotumor

Calcifying fibrous pseudotumor (CFT) is an uncommon lesion hat was first described by Fetsch et al. [1], and is charcterized histologically by hypocellular hyalinized collagenous issue with calcifications and patchy lymphocyte infiltration. t can develop at any site, but obstructive jaundice caused y abdomen CFT is extremely rare, and has never been eported. A 60-year-old man presented to our department with 1-month history of progressive jaundice. Laboratory data ere all in normal range except for elevated total biliruin (192 mol/L). Computed tomography (CT) showed multiple alcified nodules in the abdomen (Fig. 1a), obstruction of ilar bile duct and intrahepatic duct dilatation. A tentative iagnosis of hilar cholangiocarcinoma was made. Exploratory aparotomy was performed; during surgery, we found muliple round and oval nodules of diverse sizes disseminated hroughout the mesentery (Fig. 1b), though no hilar space ccupying lesions were visible. Unexpectedly massive blood lots were found in the common bile duct (CBD) after inciion for exploration. After removal of the blood clots, massive leomorphic cluster microcalcifications were seen under the choleochoscope in the intima of the CBD, which had destroyed he inner membrane of CBD and caused haemorrhage. Finally, holedochojejunostomy was performed and the largest nodules ere resected for pathological examination. The postoperative ourse was uneventful, and CFT was confirmed histologically Fig. 2).

Analysis of thrombin-antithrombin complex contents in plasma and hematoma fluid of hypertensive intracerebral hemorrhage patients after clot removal

Animal experiments indicate that the cerebral thrombin is associated with secondary brain damage after intracerebral hemorrhage (ICH). This study was aimed to investigate the concentrations of thrombin-antithrombin complex (TAT) in hematoma fluid and plasma of the patients with ICH after surgery and analyze the correlation between TAT complex levels and severity of ICH. Sixty patients with ICH were enrolled. Craniotomy for removal of intracranial blood clot was performed within 24h after ICH. Hematoma fluid and plasma were collected on postoperative days 1, 2, and 4. The plasma obtained from healthy subjects and cerebrospinal fluid from patients without cerebrovascular diseases served as controls, respectively. Enzyme-linked immunosorbent assay was used to determine the concentrations of TAT complex in the patients and controls. TAT complex concentrations in both postoperative plasma and hematoma fluid of patients with ICH were significantly higher than those of the controls (P<0.01). In patients with ICH, hematoma fluid had a higher TAT complex level than plasma (P<0.01). The preoperative hemorrhage volume and postoperative TAT complex levels in plasma and hematoma fluid correlated positively with National Institutes of Health stroke scale and negatively with Glasgow coma score (P<0.01). This study indicates that TAT complex levels of plasma and hematoma fluid correlate positively with the severity of ICH. Determination of the plasma TAT complex concentration is helpful for the evaluation of the severity of post-ICH brain injury.

A Pilot Study into the Removal of Blood Clots using tPA Delivered Locally through the ‘GP’ Mechanical Thrombectomy Device

A Pilot Study into the Removal of Blood Clots using tPA Delivered Locally through the ‘GP’ Mechanical Thrombectomy Device

Editorial: Nursing education: developments in the UK

[Extract] There has been a breathrough in nursing education in the UK. The regulatory body for nursing, the NMC (Nursing & Midwifery Council 2008), has for the first time in the history of the UK nursing agreed that 'The minimum academic award for pre-registration nursing programmes will be degree'. The significance of the breakthrough is twofold: first, its novelty and, second, this brings the UK into line with nursing in much of the developed world. UK academics who visit other countries will be able, at least in terms of the education of nurses for the national register, to hold their heads high at last.

Removal of particles from holes in submerged plates with oscillating bubbles

This study is motivated by a common problem in submerged tubes and structures, which is the blockage of the tubes by pollutant particles or debris from the surrounding fluid. To clear the obstruction from the tube, an expanding bubble is used to propel the obstruction away from the tube (the tube is represented as a submerged transparent plate with a hole in our experiments). In some cases the obstruction removal effect is reinforced by the impacting jet of such a collapsing bubble. The bubble is generated via a simple low voltage electric spark discharge circuit. The pressure generated by the oscillating bubble effectively pushes the particle away from the tube, thereby successfully clearing the obstruction. High-speed photography is used to record and analyze the phenomenon. The speed of the particle is found to be around 1 m/s shortly after the collapse of the bubble. Interestingly, there is a clear difference between air-backed plates and water-backed plates in terms of bubble and particle dynamics. The bubbles in the current study are typically of millimeter size. Since the physics are similar for smaller bubbles, the process can possibly be downsized for other microapplications such as the removal of blood clots in vessels [S. R. Visuri et al., U.S. Patent No. 6428531 (August 6, 2002)].

The “GP” Mechanical Thrombectomy Device

We present data concerning the extraction of clots using the newly invented "GP" mechanical thrombectomy device (MTD). Artificial and porcine clots of various lengths were used in plastic tube models of an artery. We investigate the pressures and times taken for clot extraction together with the volumes of fluid extracted. We also investigate the impact of using a funnel structure mounted on the end of the device, on clot removal times and fluid removed. Finally, we present results involving clot extraction from the posterior popliteal artery of a cadaver. Our data indicated that: The embedded GP MTD is the most effective device regarding artificial and porcine blood clot removal. This result is consistent with previous published data on this device. The GP MTD was effective in removing clots positioned in the posterior popliteal artery of a cadaver. The embedded GP device removes less fluid compared with the end-mounted GP device. This confirms previous studies. There appears to be a relationship between funnel angle and pressure. Lower extraction pressures are required for larger funnel angles mounted on the GP device. Shorter times of clot extraction are required for larger funnel angles.

Distal cap to facilitate removal of blood clots during endoscopic hemostasis for upper gastrointestinal bleeding

Endoscopic treatment is available for var-iceal and nonvariceal upper gastrointesti-nal (UGI) bleeding [1,2]. Blood clots in thestomach hamper endoscopic treatmentby obscuring the bleeding source. Aspira-tion of clots, however, results in obstruc-tion of the working channel, while grasp-ing clots with a basket or snare leads tocutting up of the clots [3]. We describethe usefulness of an attachable distal capto remove blood clots from the stomachduring endoscopic treatment of UGIbleeding.Two patients in the intensive care unithad active UGI bleeding with hemody-namic instability requiring transfusion.Urgent UGI endoscopy revealed bloodclots filling the stomach, obscuring thebleeding source. Attempts to remove theclots using aspiration and a polypectomysnare were unsuccessful. To improve theaspiration force and contact surface, weattached a distal cap intended for esopha-geal endoscopic mucosal resection (Dis-posable Distal Attachment D-206-04;Olympus Medical Systems Corp., Tokyo,Japan). This cap has an oblique shape(18 mm diameter) with a distal rim. Ascan been seen from l

Clinical Trials, Devices, Unproven Treatments, and Clinical Equipoise

The importance of unbiased comparative research trials to answer clinical questions that guide best treatment practices is unquestionable. Large multicenter clinical trials are critical for answering important clinical questions that cannot be answered by observational data. These studies depend on adequate recruitment from unbiased samples of patients from the population of interest. Investigators participating in such trials must also have clinical equipoise that the treatment under study may or may not be better than the standard treatments available. If such clinical equipoise does not exist, then recruitment will be biased and potentially delayed. In recent years, stroke clinical trials have struggled to enroll patients to acute trials for a variety of reasons, including narrow eligibility time windows and, most recently, to the growing list of available, although not necessarily safe or efficacious, therapies. In January 2008, the US Food and Drug Administration cleared the second device for removal of blood clots from the central nervous system vasculature, the Penumbra System.1 The device was cleared based on demonstration of substantial equivalence to legally marketed predicate devices, in this case, the Merci Retriever models X5 and X6 in bench, in vitro, in vivo, and in clinical testing. The clinical data were presented as a late-breaking abstract at the …

Cyclical and Dose-Dependent Responses of Adult Human Mature Oligodendrocytes to Fingolimod

Fingolimod is a sphingosine-1-phosphate (S1P) analogue that has been used in clinical trials as a systemic immunomodulatory therapy for multiple sclerosis. Fingolimod readily accesses the central nervous system, raising the issue of its direct effects on neural cells. We assessed the effects of active fingolimod on dissociated cultures of mature, myelin-producing oligodendrocytes (OLGs) derived from adult human brain. Human OLGs express S1P receptor transcripts in relative abundance of S1P5>S1P3>S1P1, with undetectable levels of S1P4. Low doses of fingolimod (100 pmol/L to 1 nmol/L) induced initial membrane elaboration (2 days), subsequent retraction (4 days), and recurrence of extension with prolonged treatment (8 days). Higher doses (10 nmol/L to 1 mumol/L) caused the opposite modulation of membrane dynamics. Retraction was rescued by co-treatment with the S1P3/S1P5 pathway antagonist, suramin, and was associated with RhoA-mediated cytoskeletal signaling. Membrane elaboration was mimicked using the S1P1 agonist SEW2871. Fingolimod rescued human OLGs from serum and glucose deprivation-induced apoptosis, which was reversed with suramin co-treatment and mimicked using an S1P5 agonist. High doses of fingolimod induced an initial down-regulation of S1P5 mRNA levels relative to control (4 hours), subsequent up-regulation (2 days), and recurrent down-regulation (8 days). S1P1 mRNA levels were inversely regulated compared with S1P5. These results indicate that fingolimod modulates maturity- and species-specific OLG membrane dynamics and survival responses that are directly relevant for myelin integrity.

Periprocedural Stroke and Cardiac Catheterization

Case presentation : During cardiac catheterization, a 65-year-old man suddenly complained of nuchal pain, vertigo, and nausea and rapidly became unconscious, presumably from a stroke. The operator was unsure what type of imaging and management should be undertaken in this infrequent clinical setting. He paged the neurologist, asking him to urgently provide a strategy for diagnosis and management. Although the overall rate of stroke after left heart catheterization or percutaneous coronary intervention (PCI) is low, ranging from 0.2% to 0.4% (Tables 1 and 2⇓),1–5 it is the most debilitating complication from the patient’s perspective, associated with a high rate of morbidity and mortality (Figure 1).1–8 In 20 679 consecutive patients who underwent PCI in a large-volume center, stroke occurred in 0.44%.4 Multivariate analysis has shown that the occurrence of stroke was more frequently associated with diabetes mellitus, hypertension, prior stroke, or renal failure and was independently associated with in-hospital death. Patients who suffered a stroke had previously undergone longer cardiac catheterization procedures, using more contrast, were more likely to have had the procedure for urgent reasons, and to have had intraaortic balloon counterpulsation, a procedure that is itself known to increase the risk of stroke.9 Possible explanations for this latter characteristic include the greater propensity for hemodynamic compromise in these patients, which may increase the risk of ischemic stroke, and less meticulous care in advancing the catheter through the aorta during urgent PCI, which increases the risk of embolization by scraping of aortic plaques with subsequent embolization of debris to the brain. Indeed, scraping of aortic plaques occurs in >50% of PCI cases and more frequently with large than with small catheters.10 Cerebral microembolism is thought to be the main mechanism of periprocedural ischemic stroke occurring with PCI. This finding is supported …

Blood clots in the cumulus–oocyte complex predict poor oocyte quality and post-fertilization development

Assessment of oocyte maturity and quality (morphological appearance) at the time of retrieval is difficult as the egg is obscured by a large cumulus mass that hinders adequate scoring. Since no data are available on the possible relationship between the cumulus–oocyte complex (COC) and oocyte morphology, this prospective intracytoplasmic sperm injection study was set up in 87 consecutive patients. COC were grouped according to expansion of both corona radiata and cumulus matrix. Special emphasis was placed on recording morphological anomalies of COC (inclusion of blood clots and amorphous clumps). For all mature ovae, quality was assessed and preimplantation development followed up to blastocyst stage if fertilized. The risk of not harvesting an oocyte was higher in COC with blood clots compared with normal cumulus matrices (P = 0.004). COC expansion did not allow for prediction of either nuclear status or quality of the egg. The presence of blood clots within the cumulus matrix was associated with reduced oocyte quality (dense central granulation), fertilization rate and blastocyst formation, compared with unaffected COC (P < 0.05). It may be postulated that COC showing blood inclusions derive from poor quality follicles, which has a detrimental effect on oocyte quality and further cleavage to blastocyst stage. Consequently, mechanical removal of blood clots cannot rescue the corresponding embryo.

Video‐assisted thoracic surgery for spontaneous haemopneumothorax

The aim of this study was to review the treatment options for spontaneous haemopneumothorax (SHP) by video-assisted thoracoscopic surgery (VATS). Records from 16 patients (14 male, age 16-38 years, mean age 26.1 years) with prominent SHP (blood loss over 400 cc in the first 24 h) undergoing VATS from July 1994 to December 2005 and treated by one thoracic surgeon in four medical centres or community hospitals of North and Mid-Taiwan were reviewed retrospectively. Thirteen patients (81.3%) were identified to have a prominent bleeding source intraoperatively. Torn engorged vessels from the parietal pleura to adjacent bullae were found in nine patients, and bleeders adjacent or over the parietal part of the adhered pleura were found in the other four. Ruptured bullae/blebs or air leakage were found in 14 (87.5%). All underwent removal of intrapleural blood clot, control of bleeders and their bullae/blebs were resected through three-port VATS (n = 13, 81.2%) or mini-thoracotomy and VATS (n = 3, because of unstable vital signs or conversion because of dense adhesion). Mechanical or chemical pleurodesis was carried out in all patients. The mean operative time was 53.8 +/- 21.7 min. There was no postoperative mortality. However, recurrent bleeding requiring reoperation occurred in one patient, and one other patient had a prolonged air leakage (>7 days) postoperatively and recovered spontaneously. The mean duration of chest tube drainage was 3.8 days and the median follow-up period was 3.2 years. SHP complicated by severe bleeding is a surgical emergency. VATS is a reasonable treatment for patients with SHP.

Endoscopic management of postoperative stapled colorectal anastomosis hemorrhage

Rectal bleeding following colorectal anastomosis is common but usually self-limited. Continuous hemorrhage is rare, and when it occurs, often requires further treatment. The most frequently used strategies for treatment of stapled anastomotic hemorrhage are clinical observation with or without blood transfusion, rectal packing, angiographic identification of the bleeding site with vasopressin infusion or embolization, and endoscopic eletrocoagulation. We report the case of a 49-year-old man with uncomplicated diverticular disease who was treated by laparoscopic sigmoidectomy, with double-stapled colorectal anastomosis. Six hours later, the patient presented intense rectal bleeding and was taken to the operation room for urgent colonoscopic examination. After complete removal of blood clots inside the rectum, a bleed localized at the anastomotic site was identified and submucosal peri-anastomotic injection of 10 ml adrenaline (1:200 000) in saline was performed with immediate bleeding control.

Interhemispheric transcorpus callosal approach in the treatment of ventricular hemorrhage with obstructive hydrocephalus

Background Intraventricular hemorrhage, a frequent complication of intracerebral supratentorial hemorrhage, is associated with high rates of morbidity and mortality. Several methods have recently been developed for accelerating the clearance of intraventricular blood clots, especially during massive IVH. The present study was conducted to evaluate the interhemispheric, transcorpus callosal approach with septostomy for the management of supratentorial hemorrhage with intraventricular extension. Methods Eighteen patients with primary IVH or thalamic/caudate hemorrhage complicated by IVH received an operation for removal of intraventricular blood clots by the interhemispheric, transcorpus callosal approach with septostomy. All patients received a brain CT examination before and after surgery. Clinical outcomes were assessed 6 months after surgery by the GOS. Results Good clinical outcomes (GOS scores ≥4) were achieved in 45.6% of patients. In the patients with poor clinical outcome, the mean age was older ( P = .001) and diabetes mellitus was more common ( P = .04). Patients with thalamic hemorrhage with rupture into the third ventricle had worse clinical outcomes ( P = .04). The overall mortality rate at 6 months postsurgery was 5.6%. Conclusion The interhemispheric, transcorpus callosal approach with septostomy is safe and effective for direct removal of intraventricular blood clots during treatment of supratentorial hemorrhage with intraventricular extension. Further investigations involving more cases are needed to assess more fully the extent of improvement in clinical outcome attributable to this approach.