Search

Objective: This study aimed to describe the safety and feasibility of transcatheter "thrombin-blood patch" (TBP) injection to treat catheterization-related arterial vascular access perforation., Background: Vascular access complications are infrequent but potentially life threatening conditions related to percutaneous procedures. Surgical vascular repair are associated with high rates of morbidity and mortality due to advanced cardiovascular disease., Methods: From October 2007 to July 2010 we studied 23 patients who presented active access arterial bleeding after percutaneous procedures and underwent transcatheter angiographic guided TBP injection across the entry site of the arterial perforation as a primary approach., Results: The mean age of the population was 67 years, predominantly female (78.3%) with high rate of comorbidities including diabetes (30.4%), prior coronary revascularization (50.0%), chronic renal failure (43.5%), and heart failure (56.5%). Thirteen patients (56.5%) developed severe hypotension after the index procedure. The repair procedure had a mean duration of 82 ± 57 minutes. TBP was injected in all patients. One case additionally required covered-stent to obtain hemostasis. Angiographic success was achieved in the 23 patients; however, one case required a second intervention due to recurrent bleeding, which was effectively treated using covered-stent. All patients were discharged alive and no major cardiovascular events, including myocardial infarction/stroke, were observed., Conclusions: Transcatheter "thrombin-blood patch" injection is a safe, novel technique that allows prompt percutaneous approach to treat catheterization-related arterial perforation. This strategy appears particularly attractive to treat patients who cannot tolerate "open" vascular reconstruction and repair., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: Retroperitoneal hemorrhage (RPH) is a serious but infrequent complication of percutaneous coronary intervention (PCI). This study aimed to describe the clinical outcomes of patients who developed RPH following PCI in the current practice era, with particular focus on treatment strategies and the related prognostic value of abdominal/pelvic computed tomography (CT)., Methods: Among 20,904 patients undergoing PCI, we identified 93 RPH (0.45%) confirmed by CT or by unequivocal surgical findings. We identified three groups with RPH for comparison: patients who developed refractory shock (systolic blood pressure <80 mm Hg for ≥30 min despite fluids and vasopressors, n = 16 [17.2%]); patients with transient hypotension (<30 min, n = 34 [36.6%]); and patients without hypotension (n = 43 [46.2%]). The primary endpoint was a composite of in-hospital mortality, myocardial infarction, and cerebral vascular accident (CVA)., Results: Baseline clinical, angiographic, and procedural characteristics were similar among the three groups. Patients who developed refractory shock had significantly more bleeding quantified by abdominal/pelvic CT (P < 0.001), had a higher rate and amount of red blood cell transfusion (P < 0.001), and were managed invasively more frequently (68.7%) than the rest of the population. The primary endpoint trended higher in patients presenting with refractory shock; however, this difference was not statistically significant. The volume of bleeding quantified by CT and the timing of imaging diagnosis did not correlate with the primary endpoint. Red blood cell transfusion, but not clopidogrel discontinuation, was associated with the primary endpoint., Conclusions: RPH remains as a serious complication of PCI and is associated with high rates of mortality and morbidity independently of the therapeutic strategy. In patients who were hemodynamically stable, RPH volume as quantified by non-contrast abdominal/pelvic CT did not contribute to prognosis., (Copyright © 2011 Wiley Periodicals, Inc.)

It's present the case of a patient from nineteen years with acute abdominal pain with debut in the day of presentation. Biological investigations is negative, with exception VSH = 40 mm/h. The gynecological examination raise the doubt of a strangled and floating ovary balloon. It's operate in emergency--it's about a mechanic obstacle from the small intestine (adenocarcinoma) with slide the small intestine into the small intestine with three cylinders. Reduction the small intestine slide-segmental enterectomy. Recovery. The mechanic obstacle from the small intestine with slide the small intestine into the small intestine through a cancer, to young patients, is a rare disease. The small intestine adenocarcinoma is meeting particularly at grown-up and old patients (3-4% from the digestive cancers) (2). The case in face is alone in personal statistics.

It's present the clinic case of one patient with false clinical description of right crural abscess (crural ganglion abscess). Operated in emergency--it's no crural ganglion abscess. It's about acute generated and perforated appendicitis with septic in the stargule crural hernia. It's performed appendicectomy from crural way--abdominal surgical exploration from peritoneal wash the evacuation of Douglas--the multiple parietal evacuation--the seam of crural ring--wash and crural evacuation. The evolution it's complicated with parietal sepsis. Recovery. The case it's singular from personal statistical (8.000 appendicectomy in the period 1983-1999).

It's present an original method in the treatment of perforated duodenal ulcer (antro-duodenoplasty or antro duodenal aposition). To a group of 256 patients with gastro-duodenal ulcer operated in the period 1985-1995, it is fancy an apply these method to 56 patients (21%). These method applied is simple and performed in any surgical service and it't not necessary a special technical organization. The evolution of 56 patients there is no incidents. The originality consist in your simplicity, but and in the fact that these method it's not communicated in the surgical literature of Romania or anywhere in the latest ten years.

The authors discuss the optimal surgical attitude in the cases of 44 patients with cancers of the transverse colon (excluding the angular localizations), representing 5.4% of the total number of colic cancers operated in the Clinic over the last 20 years. All the patients were in stages C and D (according to the Turnbull and Dukes classification), and the general index of resectibility of 79%. Segmental transverse colectomy should be reserved for patients of advanced age, as well as for those with organic disturbances, altered general condition, of when there is extensive loco-regional involvement, or metastases at distance. Fifteen patients were included in these categories. Extended transverse colectomy, with radical intent from the oncological standpoint, appears to be the optimal attitude in the cases of patients which do not have any of the contraindications mentioned above. Twenty patients were in this group. The postoperative death rate was 11.4% for the entire group of patients in whom resections were performed. Five patients (25%) have survived according to our data between 5 and 11 years after extensive radical colectomy.