Severe Lacerations Research Articles

757 Outcomes of elective induction of labor at 39 weeks compared to expectant management by age

To assess whether obstetric outcomes among women managed with elective induction of labor compared to expectant management at 39 weeks of gestation vary based on maternal age. We conducted a retrospective cohort study of singleton, non-anomalous, deliveries in California between 2007-2011 to assess outcomes among nulliparous women undergoing elective induction of labor at 39 weeks of gestation compared with expectant management. We defined elective induction of labor as induction of labor without medical indication and women with planned cesarean sections were excluded. Maternal race/ethnicity, pre-pregnancy body mass index, educational attainment, public health insurance, and smoking status were assessed as potential confounders. Chi-squared and multivariable logistic regression analyses were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance. In our cohort, women 20-34 years and ≥35 years undergoing elective induction of labor have a lower adjusted odds of cesarean section and a higher adjusted odds of operative vaginal delivery compared to expectant management. Women <20 years and 20-34 years undergoing elective induction of labor have a lower adjusted odds of postpartum hemorrhage and chorioamnionitis, and their neonates have a lower adjusted odds of NICU admission. Compared to expectant management, neonates of women <20 years and women 20-34 years undergoing elective induction had a lower odds ratio of respiratory distress. There were no statistically meaningful differences by age between the elective induction and expectant management regarding severe maternal morbidity or lacerations. Our study demonstrates that obstetric outcomes vary when stratified by age in women undergoing elective induction of labor at 39 weeks’ gestation compared to expectant management. These findings illustrate the importance of understanding age-related differences in outcomes associated with elective induction of labor.

Assessing seal carcasses potentially subjected to grey seal predation

In order to conduct an objective evaluation of potential ecological effects of grey seal predation on marine mammals, it is essential to establish a broad knowledge base helping in the thorough identification of such cases during post-mortem examination. The aim of this work is to report and discuss outcomes resulting from a retrospective evaluation of harbour (Phoca vitulina) and grey seal (Halichoerus grypus) stranding and necropsy data (n = 3274). In addition, the results are compared to a recent case of definite grey seal predation from Germany as well as reports from other countries. Carcasses potentially subjected to grey seal predation show severe lacerations with a circular pattern leaving a smooth, linear and cut-like wound margin. Large parts of skin and underlying tissue are detached from the body and loss of blubber is common. Occurrence frequencies of encountered lesions are presented and a list of parameters to be used for the assessment of similar cases as well as a complementary decision tree are suggested. With the proposed parameters, categories and tools, a baseline can be built in order to facilitate the standardised recognition of predation cases during post-mortem examinations of seals between groups working with populations across several geographic ranges.

The efficacy and safety of bronchoscopy for treating transluminal broncholiths

We aim to reveal the clinical features of transluminal broncholiths and to evaluate the efficacy and safety of bronchoscopy for treating transluminal broncholiths. Patients with transluminal broncholiths were enrolled in this retrospective study in Lanzhou University Second Hospital between January 2010 and December 2018. Then age, gender, symptoms, and signs, imaging characteristics, treatment methods, outcomes as well as complications were retrospectively analyzed. Twenty-eight patients with 36 pieces of transluminal broncholiths were diagnosed using chest CT and bronchoscopy, of which two patients underwent broncholiths removal via an elective surgical procedure and six patients were treated with one-time removal of broncholiths by bronchoscopy. Among the six patients who received one-time removal of stones by bronchoscopy, two underwent massive hemorrhage and one suffered from bronchial wall laceration in the process of broncholiths removal, all of the three patients received surgical treatment eventually. No serious complications occurred in the other 20 patients who underwent broncholiths removal via repeated bronchoscopy. Removal of transluminal broncholiths by bronchoscopy are effective and safe with less complications. When it is difficult to remove the transluminal broncholith completely at one time, repeated bronchoscopy could be chosen: First, to remove the portion which causes airway obstruction; and then to remove the remaining part by repeated bronchoscopy during the follow-up period. In case that severe distal lung tissue injury, massive hemoptysis or bronchial wall laceration occurs or the diagnosis of broncholiths is unclear, surgical treatment is required.

A Case of Severe Soft Birth Canal Laceration After Cervical Ligation

Li Yue, Family instead of narration: second child, After 37 weeks of pregnancy, Paroxysmal lower abdominal pain 2 hours into...

Assessing harbour porpoise carcasses potentially subjected to grey seal predation

As a follow-up on the data presented for seals, we herein report and discuss outcomes resulting from a retrospective evaluation of harbour porpoise stranding and necropsy data from Schleswig–Holstein, Germany (n = 4463) to enable an objective evaluation of potential ecological effects of grey seal predation on porpoises. Results are compared to a recent case of definite grey seal predation as well as to reports from other countries. Porpoise carcasses potentially subject to grey seal predation show severe lacerations, with large parts of skin and underlying tissue being detached from the body. Loss of blubber tissue is common. Based on the occurrence frequencies of encountered lesions, a list of parameters as well as a complementary decision tree are suggested to be used for future assessments. The results shown add to an increasingly standardised assessment protocol of suspected grey seal predation cases making respective results comparable between different areas and countries. The usage of a standardised protocol may increase the awareness of grey seal predation and the reporting of such cases. By this, differences in the predation and feeding patterns as well as the potential ecological relevance of this behaviour may be elucidated.

Paediatric injuries due to falls from windows and balconies: an 8-year prospective and retrospective review.

Unintentional falls from windows and balconies pose a serious health risk to children. Limited Canadian data describing such falls currently exist. This study aimed to describe the frequency, demographic characteristics, injury patterns, and risk factors associated with paediatric falls from windows and balconies. This study employed both prospective data collection and retrospective medical record review. Prospectively, consenting families were enrolled from February 2015 to February 2017; retrospectively, charts from January 2009 to December 2014 were reviewed. Children 0 to 16 years of age, who presented to the Stollery Children's Hospital (Edmonton, Alberta) emergency department due to a fall from a window or balcony, were included. A total of 102 children were included; thirty were enrolled prospectively and 72 retrospectively. Median age was 4.5 years (interquartile range 2.83 to 6.83) with 63.7% (65 of 102) males. About 87.2% (89 of 102) of falls were from windows and 12.8% (13 of 102) from balconies. The median estimated height of fall was 4.1 m (interquartile range 3.04 to 4.73). About 58.4% (59 of 101) had at least one major injury (i.e., concussion, fractured skull, internal injury, fractured limb, severe laceration), 36.6% had minor injuries only (i.e., abrasions, contusions, sprains), and 5.0% had no documented injuries. There were no fatalities. About 30.4% (31 of 102) were admitted, with 48.4% of these children (15 of 31) requiring surgery. Most falls from windows and balconies occurred in children under the age of 5 years and were associated with serious morbidity, high admission rates, and need for surgery. Child supervision as well as installation of key safety features in windows may help minimize paediatric fall-related injuries.

Increased risk of postpartum depression following severe obstetric lacerations in women with low resilience.

Increased risk of postpartum depression following severe obstetric lacerations in women with low resilience.

Severe obstetric lacerations associated with postpartum depression among women with low resilience – a Swedish birth cohort study

Women's levels of resilience and attitudes towards perineal lacerations vary greatly. Some women see them as part of the birthing process, while others react with anger, depressed mood or even thoughts of self-harm. A previous study has reported increased risk of postpartum depressive (PPD) symptoms in women with severe perineal lacerations. The aim of this study was to assess the association between severe obstetric perineal lacerations and PPD. A secondary objective was to assess this association among women with low resilience. Nested cohort study. Uppsala, Sweden. Vaginally delivered women with singleton pregnancies (n=2990). The main exposure was obstetric perineal lacerations. Resilience was assessed in gestational week 32 using the Swedish version of the Sense of Coherence Scale. A digital acyclic graph was used to identify possible confounders and mediators. Logistic regression was used to estimate odds ratios(OR) and 95% confidence intervals (CI). A sub-analysis was run after excluding women with normal or high resilience. Postpartum depression, assessed with the Depression Self-Reporting Scale, completed at 6weeks postpartum. There was no significant association between severe obstetric perineal lacerations and PPD at 6weeks postpartum. However, a significant association was found between severe lacerations and PPD in women with low resilience (OR=4.8, 95% CI 1.2-20), persisting even after adjusting for confounding factors. Healthcare professionals might need to identify women with low resilience, as they are at increased risk for PPD after a severe perineal laceration. Severe perineal lacerations associated with postpartum depression in women with low resilience in a Swedish cohort.

Obstetric Anal Sphincter Injuries: Compliance With ACOG Postpartum Care Recommendations [22L

INTRODUCTION: Severe obstetric lacerations that include the anal sphincter complex are associated with increased risk for short and long term complications. ACOG gives postpartum care recommendations to improve outcomes, including stool softeners and oral laxatives with counseling to avoid constipation, pain management with NSAIDs and opiate-containing analgesics, and one dose of perioperative antibiotics. The objective of this study was to assess compliance with these ACOG recommendations at a tertiary care hospital in Central Illinois. METHODS: An IRB-approved retrospective observational study was done on patients that had vaginal deliveries complicated by OASIS in the calendar year of 2018. Compliance percentages were obtained for each recommendation. Anything less than 100% compliance was considered inadequate. RESULTS: A total 45 patients were found to have vaginal deliveries complicated by OASIS in 2018. One wound complication was identified to date. Compliance was less than 100% in all parameters. Only 20% received perioperative antibiotics. While inpatient, compliance rates varied from 49% to 87% of patients receiving adequate postpartum care. Upon discharge from the hospital in the postpartum period, compliance rates varied from 4% to 47% of patients receiving adequate prescriptions or counseling for medication use. CONCLUSION: Our results indicate that compliance with ACOG guidelines is inadequate at a busy tertiary care center in Central Illinois. Of particular concern is the lack of patients receiving adequate counseling and prescriptions for medications (stool softeners, NSAIDs, opiates) upon discharge from the hospital. Interventions are currently being investigated and the results of implementation will be a source of future studies.

Use of balloon tamponade in management of vaginal laceration and its possible complication of urinary stress incontinence: a case report

BackgroundPostpartum haemorrhage from vaginal lacerations can occasionally be refractory to suturing and vaginal packing. Bakri uterine balloon has been widely adopted to stop uterine bleeding, but its use to stop bleeding in vaginal lacerations and its possible complications have seldom been reported.Case presentationWe report a patient who had vacuum delivery for fetal distress and subsequently had postpartum hemorrhage due to previous caesarean uterine scar rupture and multiple vaginal lacerations. The severe bleeding persisted despite total abdominal hysterectomy, pelvic embolization and vaginal gauze packing, but was finally controlled by a Bakri balloon tamponade inserted into the vagina. The patient suffered from severe stress incontinence after delivery. The possible use of balloon tamponade in vaginal lacerations and the different types of vaginal balloons that are available in the market for this purpose are reviewed. The possible causes leading to stress incontinence is reported to alert the obstetrician that such management is not free of complications.ConclusionThe use of Bakri balloon can help to control bleeding in severe vaginal lacerations that are unresponsive to traditional vaginal gauze packing. Further studies are needed to evaluate the risks of stress incontinence as a possible complication of vaginal balloon tamponade.

Suprapatellar nailing of fractures of the tibia.

Intramedullary nailing of tibia fractures via asuprapatellar, transarticular approach with the knee joint in 20-30° of flexion and the use of specific protection tubes to preserve intra-articular structures. Extra-articular fractures of the proximal tibia; simple and comminuted fractures of the tibia diaphysis; segmental diaphyseal fractures of the tibia; extra-articular fractures of the distal tibia and fractures with simple intra-articular distal extension; floating knee injuries. Gustilo grade3C open fractures of the tibia; severe soft tissue laceration, contamination or infection in the suprapatellar area; ipsilateral knee joint prosthesis; knee arthrodesis; implants blocking the nail entry point. Via asuprapatellar, transarticular approach an intramedullary tibia nail is inserted after anatomical reposition of the tibial fracture with the knee joint in 20-30° of flexion. Use of specific protection tubes to preserve intra-articular structures. The proximal and distal locking configuration depends upon the specific fracture characteristics. In all, 61 patients underwent suprapatellar tibia nailing and were under follow-up at least until fracture union. Twelve patients suffered from an open fracture. A total of 17patients had adistal third fracture, 8sustained aproximal third fracture and 36 had ashaft fracture. Follow-up focused on patients with distal fractures; 6/17 patients sustained open fractures. Average time to union was 9weeks. One fracture did not heal and required exchange nailing. Two patients complained about anterior knee pain. Functionally, full range of motion was regained in all patients.

505 Car accident, an unusual cause of acute severe mitral regurgitation due to anterolateral papillary muscle rupture

Abstract A 52-year-old man was admitted to the emergency department of the University Hospital after being involved in a car crash. At first he was alert with stable vital parameters. There was bilateral rales on lung auscultation, without further prominent aberrant findings at the initial clinical examination. Shortly after, he became agitated with respiratory distress, resulting into respiratory insufficiency. Computed tomography (CT) scan of the thorax showed multiple rib fractures, a translated sternal fracture and pulmonary contusion. After intubation and stabilization he was transferred to the Intensive Care Unit (ICU), where his respiratory and cardiovascular parameters progressively worsened, leading to cardiogenic shock. An urgent chest X-ray revealed a tension pneumothorax with mediastinal shift to the right, for which a chest tube was inserted in the left hemithorax. No or little improvement was seen after this intervention. Therefore, an emergency transthoracic echocardiography (TTE) was performed. Subcostal view showed a severe mitral regurgitation with a mass in the left atrium. Because of a limited transthoracic window, we proceeded to a transoesophageal echocardiogram (TEE). A completely ruptured anterolateral papillary muscle of the mitral valve was seen, protruding in the left atrium and resulting in severe mitral regurgitation (Figure). Other echocardiographic findings were a hyperdynamic systolic function of the left ventricle, a hypo-contractile right ventricle with a mild-to-moderate quantity of pericardial effusion. Taking into account the increased cardiovascular risk profile of the patient, a coronary angiography was performed and showed normal coronary anatomy. Consequently, urgent surgical intervention was performed. Perioperative assessment confirmed the earlier described echocardiographic findings. Due to severe laceration of the left ventricular wall at the level of the attachment site of the anterolateral papillary muscle, reconstructive surgery was not possible. The anterolateral papillary muscle head with the attached mitral valve leaflet was fully excised with repair of the concealed myocardial rupture site. A mechanical mitral valve prosthesis and an intra-aortic balloon pump for hemodynamic support were placed. After four days the balloon pump was removed and the tenth day after admission the patient was extubated. Conclusion Acute severe mitral regurgitation due to papillary muscle rupture is a rare but potential fatal complication of a blunt trauma. TOE is essential in early diagnosis. Abstract 505 Figure 1

1114: Operative vaginal delivery and rates of primary cesarean in California hospitals

Rates of primary cesarean section and obstetric anal sphincter injury (OASIS) are quality metrics and patient safety indicators for hospitals in the United States. Over the last decade, rates of cesarean section have risen while operative vaginal deliveries have fallen out of favor. We examined hospital-level rates of cesarean section associated with third- and fourth-degree laceration. This is retrospective study of California hospital deliveries from 2007-2011. We excluded hospitals with < 50 deliveries per year. Hospital rates of primary cesarean section and severe (3rd/4th degree) laceration in nulliparous, term, singleton, vertex (NSTV) deliveries were calculated. Rates of each respective variable were used to generate a scatter plot. Pearson correlation was used to calculate covariance in order to examine the relationship between each delivery method. We identified 269 hospitals meeting inclusion criteria. The mean proportion of primary cesarean section was 0.164 ± 0.035, and the mean proportion of NSTV deliveries with severe perineal lacerations was 0.064 ± 0.027. The proportion of primary cesarean deliveries is overall negatively correlated with the proportion of severe perineal laceration among NSTV deliveries (correlation coefficient = -0.21, p< 0.001). There is an inverse relationship between hospital-level rates of primary cesarean delivery and severe OASIS injury in NSTV deliveries. Strategies to reduce numbers of patient safety indicators like OASIS injury may result in higher rates of primary cesarean.

Hysteropexy in the Treatment of Total Uterine Prolapse in a Brazilian Molosser Bitch

Background: Uterine prolapse is an obstetric emergency because the exposed tissue can present edema, devitalization or even gangrene, depending on the evolution time and on the severity of circulatory changes. Haemorrhage due to the rupture of ovarian or uterine vessels can evolve rapidly to hypovolemic shock. More rarely, secondary thromboembolism to the uterine strangulation can be developed, complication that can also lead to death. This study reports the case of a Brazilian Molosser bitch treated by reducing total uterine prolapse, complemented with hysteropexy, in order to prevent recurrence and maintain its reproductive ability. Case: A 5-year-old Brazilian Molosser bitch was attended presenting double firm and tubular mass protruding through the vulva. The patient gave birth to five live pups, the last two of which needed to be pulled. Two days after parturition, she had abdominal contraction when a mass protruded from the vagina. A total uterine prolapse was diagnosed, since both uterine horns were found exposed and inverted, with exposition of the endometrium and the areas of placental implantation, together with the body of the uterus. The tissue was apparently edematous and lightly parched, with the presence of strange bodies, but without signals of circulatory complications or lacerations that could turn a possible reduction and maintenance of the uterus unfeasible. Due to interest of the tutor in preserving the reproductive ability, an internal reduction via ventral medial celiotomy and the fixation of the uterus in the lateral abdominal wall (hysteropexy) was chosen in order to diminish the possibility of relapse in future parturition.Discussion: The definitive treatment of the uterine prolapse can be realized through ovariohysterectomy when the exposed uterine tissue is highly compromised or there is vessel rupture or no reproductive purpose for the female. The amputation of everted tissue through the vulva is also an option, but the risk of intracavitary bleeding during tissue resection must be considered when the uterine and ovarian artery and vein escape to the interior of the abdomen without according hemostasis. In cases which there are no complications of the prolapsed tissue and is desired to maintain the reproductive ability of the female, the internal reduction with hysteropexy is recommended. As the etiology of the uterine prolapse is a condition bound to several factors, in between them multiple pregnancies, relaxation of the uterine ligaments and genetic factors, conditions which can be associated to the cause of the prolapse in the mentioned patient, the hysteropexy was preferred as a complementary technique to uterine preservation and prevention of the prolapse relapse in a possible new parturition. In this case, the reduction of prolapse followed by hysteropexy was preferred, because the female dog was apparently well, without signs of complication of the prolapsed tissue and with satisfactory preoperative evaluation. Adding these to the request of the tutor in maintaining the reproductive ability of the female, since the procedure would not pose as a life risk to it. The absence of severe lacerations and circulatory complications in the prolapsed uterus of the bitch under study and the non-detection of toxemia and septicemia corroborated to the reduction and preservation of the uterus. Even though the uterine prolapse is a rare disease, it is necessary to improve surgical techniques that enable the conservation of the female dog in reproduction. In situations of viability of the prolapsed tissue, the technique of hysteropexy in abdominal wall showed itself effective, concluding that hysteropexy is feasible and efficient as a complementary procedure to the reduction of uterine prolapse, having contributed to avoid relapse and maintaining the reproductive of the subject related in this article.

Current status and research progress of minimally invasive surgery for flail chest.

Chest trauma accounts for ~13.5% of all traumas, and direct death from chest trauma accounts for 20–25% of all traumatic deaths. Chest trauma is the second cause of death from trauma. Frequent rib fractures, especially in patients with flail chest, often cause severe pain, chest wall softening, abnormal breathing and severe lung contusion and laceration, usually requiring thoracic surgery. In recent years, the open reduction and internal fixation treatment of rib fractures with flail chest has achieved satisfactory results, and some surgical indications have reached consensus. A number of scholars and medical centers have demonstrated the practicality and cost-effectiveness of rib fixation in flail chest, including the small incidence of pulmonary complications, the short ICU mechanical ventilation time, and the reduction of digestive tract inhibition. Open reduction and internal fixation of rib fractures involves multiple ribs. Conventional rib fractures require a large incision to achieve satisfactory exposure. Chest wall muscles, blood vessels and nerves (long thoracic and thoracodorsal nerves) are injured, resulting in a high infection rate of the incision and postoperative dysfunctions, such as limited upper limb, shoulder and back function, and long time numbness on the affected side of the chest. Therefore, the damage of muscles and nerves caused by conventional surgical methods limits the development of such surgical technique. Although the video-assisted thoracoscopic technique has become a necessary technical means for the treatment of thoracic trauma and has been applied to thoracic exploration and hemostasis, there is no report on the application of open reduction and internal fixation for rib fracture. The difficulty lies in the tightly combined bony thorax and the soft tissue of the chest wall. Therefore, experts have explored a variety of minimally invasive surgical methods for the flail chest. The current status and research progress of minimally invasive surgery for thoracic surgery are reviewed.

Investigating the association between neuroticism and adverse obstetric and neonatal outcomes

Neuroticism is not only associated with affective disorders but also with certain somatic health problems. However, studies assessing whether neuroticism is associated with adverse obstetric or neonatal outcomes are scarce. This observational study comprises first-time mothers (n = 1969) with singleton pregnancies from several cohorts based in Uppsala, Sweden. To assess neuroticism-related personality, the Swedish universities Scales of Personality was used. Swedish national health registers were used to extract outcomes and confounders. In logistic regression models, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for the outcomes by an increase of 63 units of neuroticism (equalling the interquartile range). Analyses were adjusted for maternal age, educational level, height, body mass index, year of delivery, smoking during pregnancy, involuntary childlessness, and psychiatric morbidity. Main outcomes were mode of delivery, gestational diabetes mellitus, gestational hypertension, preeclampsia, induction of delivery, prolonged delivery, severe lacerations, placental retention, postpartum haemorrhage, premature birth, infant born small or large for gestational age, and Apgar score. Neuroticism was not independently associated with adverse obstetric or neonatal outcomes besides gestational diabetes. For future studies, models examining sub-components of neuroticism or pregnancy-specific anxiety are encouraged.

Do We Know How to Avoid OASIs in Non-Supine Birth Positions? A Retrospective Cohort Analysis.

To evaluate the association between the upright and supine maternal positions for birth and the incidence of obstetric anal sphincter injuries (OASIs). Retrospective cohort study analyzed the data of 1,728 pregnant women who vaginally delivered live single cephalic newborns with a birth weight of 2,500 g. Multiple regression analyses were used to investigate the effect of the supine and upright positions on the incidence of OASIs after adjusting for risk factors and obstetric interventions. In total, 239 (13.8%) births occurred in upright positions, and 1,489 (86.2%) in supine positions. Grade-III lacerations occurred in 43 (2.5%) patients, and grade-IV lacerations occurred in 3 (0.2%) women. Supine positions had a significant protective effect against severe lacerations, odds ratio [95% confidence interval]: 0,47 [0.22-0.99], adjusted for the use of forceps 4.80 [2.15-10.70], nulliparity 2.86 [1.44-5.69], and birth weight 3.30 [1.56-7.00]. Anesthesia (p < 0.070), oxytocin augmentation (p < 0.228), shoulder dystocia (p < 0.670), and episiotomy (p < 0.559) were not associated with the incidence of severe lacerations. Upright birth positions were not associated with a lower rate of perineal tears. The interpretation of the findings regarding these positions raised doubts about perineal protection that are still unanswered.

Behavioural and pathological insights into a case of active cannibalism by a grey seal (Halichoerus grypus) on Helgoland, Germany

First reports on cases of grey seal predation on other marine mammals from different parts of Europe have been published in recent years, but few cases provide sufficient detail. Here we report a case of active cannibalism by a grey seal, which has been witnessed and recorded in detail on the German island of Helgoland, describing particular behavioural aspects and lesions. In March 2018, a subadult male grey seal was observed catching, killing and feeding extensively from a juvenile grey seal. The carcass showed severe cutaneous lacerations, starting in the head region and following around the trunk in a circular pattern. These results are discussed with regard to the previously reported cases to form a solid knowledge base for retrospective and future assessments of carcasses potentially subjected to grey seal predation. The correct assignment of predated seals is important to determine the potential influence this behaviour may have on seal populations.

Surgical corrections and postsurgical complications of epiglottic entrapment in Thoroughbreds: 12 cases (2009-2015).

ABSTRACTTwelve Thoroughbred racehorses were diagnosed as epiglottic entrapment at the Korea Racing Authority equine hospital. Four different surgical correction techniques were used to treat epiglottic entrapment: the transnasal hook bistoury, transoral unshielded hook bistoury, transnasal shielded hook bistoury, and transendoscopic laser techniques. Eleven cases were surgically resolved eventually, with one case of recurrence. Five complications related to surgical correction occurred: a severe nasal passage laceration and bleeding (n=1), epiglottic laceration (n=1), epiglottis tip burns (n=2), and moderate nasal passage laceration (n=1). Intraoperative complications occurred in approximately 41.7% of cases. Thus, the possibility of surgical complication should be considered thoroughly when choosing a surgical technique for correction of epiglottic entrapment.

Successful Management of Severe Liver Laceration Secondary to Lund University Cardiopulmonary Assist System Cardiopulmonary Resuscitation Complicated by Systemic Heparin for Extracorporeal Membrane Oxygenation and Dual Antiplatelets After ST Elevation Myocardial Infarction

Successful Management of Severe Liver Laceration Secondary to Lund University Cardiopulmonary Assist System Cardiopulmonary Resuscitation Complicated by Systemic Heparin for Extracorporeal Membrane Oxygenation and Dual Antiplatelets After ST Elevation Myocardial Infarction