- How we treat the platelet glycoprotein defects; Glanzmann thrombasthenia and Bernard Soulier syndrome in children and adults. [Review]
- BJBr J Haematol 2018 Aug 17
- The inherited platelet glycoprotein deficiencies, Glanzmann thrombasthenia (GT) and Bernard Soulier syndrome (BSS) are rare but important long-term bleeding disorders. Once diagnosed, affected patien...
The inherited platelet glycoprotein deficiencies, Glanzmann thrombasthenia (GT) and Bernard Soulier syndrome (BSS) are rare but important long-term bleeding disorders. Once diagnosed, affected patients should be referred to a specialist centre for bleeding disorders for general advice and ongoing management. Patients do not require prophylactic treatment and so the management of GT and BSS focuses around prophylactic treatment prior to high risk procedures and treatment in response to non-surgical bleeding events and, in women, the management of menorrhagia and pregnancy. There is no consistent approach to the treatment or prevention of bleeding complications. Management must be tailored for each individual and the approach may not be the same for different events, even for the same patient, depending on the type of accident or invasive procedure, the extent of bleeding and the presence or not of platelet refractoriness.
- [Optimizing the laparoscopic steps in right colectomy with complete mesocolic excision to reduce the intraoperative vascular injuries]. [Journal Article]
- ZWZhonghua Wai Ke Za Zhi 2018 Aug 01; 56(8):573-577
- Laparoscopic right colectomy by the rule of complete mesocolic excision is becoming a standard operation for right colon cancer. Intraoperative iatrogenic vascular injuries are rare but disastrous co...
Laparoscopic right colectomy by the rule of complete mesocolic excision is becoming a standard operation for right colon cancer. Intraoperative iatrogenic vascular injuries are rare but disastrous complications. In addition to the dissection along the embryonic plane, reducing iatrogenic bleeding is of crucial importance to safeguard the surgical procedure. Keeping the operative field clear by gentle suction to have a good exposure is essential to identify the origin of bleeding, and then to make decision how to control the bleeding by bipolar coagulation, clipping and transection, suturing or conversion to open surgery. For small bleeding, the grasping forceps with bipolar coagulation or clipping would usually be effective. When there is laceration locating on the stem of superior mesenteric vein or Henle trunk, suturing with 4-0 or 5-0 prolene monofilament is suggested. Self-saphenous graft or bridge is advised for stem stricture after suturing. The ileocolic vessels are most anatomically constant, but with a different relationship between the artery and the vein. The tributaries to form the Henle trunk vary quite often, and they usually have close relation to the middle colic vein. Right colic artery rarely arises from the superior mesenteric artery, and the right colic vein seldom drains into the superior mesenteric vein. Anatomical variations are commonly observed in the pancreaticoduodenal area, where bleeding happens frequently. Selecting an optimal laparoscopic approach and dissecting order, awareness of vascular variation, and understanding the anatomical configuration of superior mesenteric vessels and their tributaries are important to minimize the intraoperative iatrogenic injuries during the meticulous dissections.
- Primary aortoduodenal fistula: A case report and review of literature. [Journal Article]
- IJInt J Surg Case Rep 2018 Jul 26; 50:80-83
- CONCLUSIONS: In our case, the patient presented with hematemesis and a pulsatile abdominal mass on physical examination and had a history of untreated AAA, which helped in prompt diagnosis of PADF. CT findings suggesting PADF include disappearance of the fat plane between the aneurysm and duodenum, air in the retroperitoneum or within the aortic wall, and contrast enhancement within the duodenum. The recommended surgical approach for PADF consists of aortic reconstruction (in situ aortic reconstruction or extra-anatomical bypass) and duodenal repair.Our report affirms that CT and open surgery are effective diagnostic and treatment options, respectively, for PADFs.
- Patient with a Subarachnoid Headache. [Journal Article]
- CPClin Pract Cases Emerg Med 2018; 2(3):193-196
- Subarachnoid hemorrhage (SAH) is a life-threatening cause of headache. The diagnostic approach to this entity continues to evolve with a recent questioning of the classic workup of computed tomograph...
Subarachnoid hemorrhage (SAH) is a life-threatening cause of headache. The diagnostic approach to this entity continues to evolve with a recent questioning of the classic workup of computed tomography and lumbar puncture. We report a risk management case of a patient with a missed SAH resulting in a fatal outcome. When there are multiple diagnostic strategies, the patient may be involved with shared decision-making. Some of the medical and legal implications of the diagnosis of SAH will be discussed.
- Strategies to increase the use of forearm approach during coronary angiography and interventions. [Review]
- CRCardiovasc Revasc Med 2018 Jul 05
- The aim of this article is to focus on the utilization of forearm approach for cardiac catheterization in challenging groups of patients. Radial and ulnar approaches have gained significant popularit...
The aim of this article is to focus on the utilization of forearm approach for cardiac catheterization in challenging groups of patients. Radial and ulnar approaches have gained significant popularity among the majority of interventional cardiologists. Multiple studies have demonstrated the feasibility, safety and efficacy of forearm route for cardiac catheterization and have highlighted the significant reduction in bleeding complications by avoiding the puncture of the groin. In this review we present the strategies need to be followed in order to apply the forearm approach in challenging group of patients.
- The approach and safety of esophageal dilation for treatment of strictures in children with epidermolysis bullosa. [Journal Article]
- JPJ Pediatr Gastroenterol Nutr 2018 Jul 26
- CONCLUSIONS: The characteristic esophageal lesion in EB is a single, proximal esophageal stricture. EB patients can safely undergo repeat pneumatic esophageal balloon dilations with minimal risk for severe complication. We observed a trend towards increased use of retrograde esophageal dilation.
- [Coil Embolization of Vertebral Artery Aneurysm Using Direct Percutaneous Puncture of Vertebral Artery:A Technical Report]. [Journal Article]
- NSNo Shinkei Geka 2018; 46(7):599-605
- Although direct puncture of the cervical vertebral artery(VA)is not commonly performed in neuroendovascular therapy, it is sometimes inevitable for procedural or technical reasons. We report a case o...
Although direct puncture of the cervical vertebral artery(VA)is not commonly performed in neuroendovascular therapy, it is sometimes inevitable for procedural or technical reasons. We report a case of a ruptured VA aneurysm that required direct cervical VA puncture for treatment. A 79-year-old man was transferred to our hospital with the diagnosis of subarachnoid hemorrhage. Cerebral angiography revealed a right VA-posterior inferior cerebellar artery aneurysm. The aneurysm showed downward projection due to retrograde flow of the right VA caused by chronic occlusion of the right subclavian artery. For endovascular treatment, the approach through the VA union via the left VA was thought to be most appropriate;however, the left VA was very tortuous and the microcatheter could not cross the VA union. We performed percutaneous direct puncture of the left cervical VA. An 18-G intravenous catheter needle(Surflo<sup>®</sup>)was advanced and set into the C5/6 segment of the VA under biplane fluoroscopic road-mapping guidance. The microcatheter reached the aneurysm and coil embolization was successfully performed. The patient was kept intubated under general anesthesia overnight, to monitor for cervical subcutaneous hematoma. Several procedures for direct VA puncture have been reported. The major problem is the difficulty with hemostasis and maintenance of the airway is important. Although the indication is limited due to the difficulty of adjunctive techniques and postoperative antithrombotic therapy, direct VA puncture under biplane fluoroscopic guidance was useful in this case.
- Predictive Factors for Surgical Morbidities and Adjuvant Chemotherapy Delay for Advanced Ovarian Cancer Patients Treated by Primary Debulking Surgery or Interval Debulking Surgery. [Journal Article]
- IJInt J Gynecol Cancer 2018 Jul 20
- CONCLUSIONS: Comorbidities and intraoperative bleeding are the most relevant findings related to surgical complications. Surgical approach (PDS or IDS) was not related with complications. Surgical complications were significantly related to ACD.
- Comparison of Genetic and Self-Identified Ancestry in Modeling Intracerebral Hemorrhage Risk. [Journal Article]
- FNFront Neurol 2018; 9:514
- Background: We sought to determine whether a small pool of ancestry-informative DNA markers (AIMs) improves modeling of intracerebral hemorrhage (ICH) risk in heterogeneous populations, compared wit...
Background: We sought to determine whether a small pool of ancestry-informative DNA markers (AIMs) improves modeling of intracerebral hemorrhage (ICH) risk in heterogeneous populations, compared with self-identified race/ethnicity (SIRE) alone. Methods: We genotyped 15 preselected AIMs to perform principal component (PC) analysis in the ERICH study (a multi-center case-control study of ICH in whites, blacks, and Hispanics). We used multivariate logistic regression and tests for independent samples to compare associations for genetic ancestry and SIRE with ICH-associated vascular risk factors (VRFs). We then compared the performance of models for ICH risk that included AIMs and SIRE alone. Results: Among 4,935 subjects, 34.7% were non-Hispanic black, 35.1% non-Hispanic white, and 30.2% Hispanic by SIRE. In stratified analysis of these SIRE groups, AIM-defined ancestry was strongly associated with seven of the eight VRFs analyzed (p < 0.001). Within each SIRE group, regression of AIM-derived PCs against VRFs confirmed independent associations of AIMs across at least two race/ethnic groups for seven VRFs. Akaike information criterion (AIC) (6,294 vs. 6,286) and likelihood ratio test (p < 0.001) showed that genetic ancestry defined by AIMs achieved a better ICH risk modeling compared to SIRE alone. Conclusion: Genetically-defined ancestry provides valuable risk exposure information that is not captured by SIRE alone. Particularly among Hispanics and blacks, inclusion of AIMs adds value over self-reported ancestry in controlling for genetic and environmental exposures that influence risk of ICH. While differences are small, this modeling approach may be superior in highly heterogeneous clinical poulations. Additional studies across other ancestries and risk exposures are needed to confirm and extend these findings.
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- Microsurgical Resection of a Ventral Pontine Cavernoma via Supratrigeminal Zone by Anterior Transpetrosal Approach: 2-Dimensional Operative Video. [Journal Article]
- ONOper Neurosurg (Hagerstown) 2018 Jul 19
- Brainstem cavernomas with recurrent bleeding and gradual neurological deterioration should be considered an indication for surgical treatment. However, surgery is challenging for cavernous hemangioma...
Brainstem cavernomas with recurrent bleeding and gradual neurological deterioration should be considered an indication for surgical treatment. However, surgery is challenging for cavernous hemangiomas located in the ventral part of the pons. In such cases, safe surgical access to the brainstem is limited and obtaining a good surgical field, regardless of the approach selected, is often difficult. Here, we show a 73-year-old man with a history of 3 episodes of intracranial bleeding associated with a cavernous hemangioma located in the right ventral pons. The hemangioma was removed via the supratrigeminal zone of the brainstem using an anterior transpetrosal approach (ATPA). ATPA was first described in 1985 for upper petroclival lesions by Kawase T.1 This approach requires epidural subtemporal procedures to expose the petrous apex adequately. The petrous apex must be totally resected and the dura of the temporal lobe and posterior fossa is then cut to ligate the superior petrosal sinus and tentorium.In this procedure, the most important things are to preserve the internal carotid artery (C2 segment) and greater superficial petrosal nerve (GSPN). To identify the GSPN, facial nerve integrity monitor (Medtronic Inc, Dublin, Ireland) is very useful. In the extradural bone removal, Sonopet Ultrasonic Aspirator (Stryker Ltd, Portage, Michigan) is a very excellent surgical tool for avoiding the injury of the internal carotid artery. As demonstrated by Cavalcanti DD2, ATPA is particularly useful for accessing lesions located in the upper ventral pons via the supratrigeminal zone because it provides a wide and shallow surgical field above the trigeminal nerve without requiring retraction of the cerebellum. We received written informed consent from the patient for this publication.