The introduction to and inspiration from haematological management of major haemorrhage: a British Society for Haematology guideline / 中国输血杂志

Evidenced based and practical guidelines have important role in the decrease of mobility and mortality of the patients with major haemorrhage. Recently, British Society for Haematology updated a guideline on haematological management of major haemorrhage, which provides the recommendations in general and on alternatives to transfusion, obstetric haemorrhage, gastrointestinal haemorrhage, trauma and surgery, and the good practice statements for laboratory/organisational support. The comprehensive and instructive recommendations presented in the guideline will be good references for and assist in the education and development of the guidelines or protocols for the management of the patient with major haemorrhage in China.

ANCA vasculitis and membranoproliferative glomerulonephritis associated with Sjögren's syndrome: Case report and literature review

ANCA-associated vasculitis may occur concomitantly with primary Sjögren's syndrome (SS) or arise during its evolution. We present the case of a patient who underwent dry symptoms, a positive Schirmer test and an SS-compatible autoimmunity profile and, simultaneously, deterioration of renal function, anaemia, and dyspnoea, requiring renal biopsy and fibro-bronchoscopy. Complementary studies documented acute necrotizing glomerulonephritis with extracapillary proliferation, and membranoproliferative pattern with immune complex deposition. Bronchoalveolar lavage was compatible with alveolar haemorrhage. Kidney lung syndrome secondary to ANCA vasculitis was diagnosed and treatment with steroid and intravenous cyclophosphamide with clinical and paraclinical improvement was instituted. Mixed renal involvement found in this case is uncommon in patients with SS, and treatment changes significantly, hence the importance of differential diagnosis and reporting in the literature.

La vasculitis asociada con anticuerpos anticitoplasma de neutrófilos-ANCA puede presentarse concomitantemente con síndrome de Sjögren primario o surgir durante su evolución. Se presenta el caso de una paciente que cursó con síntomas secos, test de Schirmer positivo, perfil de autoinmunidad compatible con síndrome de Sjögren y, de forma simultánea, deterioro de la función renal, anemia y disnea, por lo que requirió biopsia renal y fibrobroncoscopia. Los estudios complementarios documentaron glomerulonefritis aguda necrosante con proliferación extracapilar y patrón membranoproliferativo con depósito de complejos inmunes. El lavado broncoalveolar fue compatible con hemorragia alveolar. Se hizo diagnóstico de síndrome de pulmón-rinón secundario a vasculitis ANCA y se instauró tratamiento con esteroide y ciclofosfamida intravenosa, con mejoría clínica y paraclínica. El compromiso renal mixto encontrado en este caso es infrecuente en pacientes con SS, y el tratamiento cambia ostensiblemente, de ahí la importancia del diagnóstico diferencial y el reporte en la literatura.

Recent Cyclones Causing an Increased Incidence of Intracranial Haemorrhage in India — A Cross-sectional Study

Background : Seasonal variations in the incidence of Intracerebral Haemorrhage (ICH) have been extensively evaluated in the studies conducted in various parts of the world. The prevalence per 100,000 person-years of spontaneous cerebral haemorrhage is regularly highest in the winter and lowest in the summer. However, these seasonal variations of ICH in India have not been comprehensively described in any published literature. Methodology : In this retrospective cross-sectional study, data of 15000 patients were collected from various State Government-owned Hospitals of India of the months April, May and June. The present study examined the association between temperature variations and spontaneous ICH incidence during recent severe Cyclonic Storms ‘Yaas’, and ‘Tauktae’ in India with the brain’s Computed Tomography (CT) scans. A CT brain persists in being the investigation of choice in the initial diagnosis of ICH, as it is readily available, accessible and fast. Results : During these Cyclones, there was a significant temperature drop associated with an increased incidence of ICH in the specified time. Conclusion : Sudden temperature drop during a Cyclone can cause spontaneous Hypertension, which causes rupture of arteries in the brain and results in Stroke. The Government, Physicians and the general public need to be made aware of such associations

A Retrospective Study to find out Factors Affecting Maternal Mortality in a Tertiary Care Hospital in Ahmedabad City, Gujarat

Background : Data pertaining to preventable causes of maternal mortality are valuable in each set up to design interventional steps for the significant reduction of the maternal mortality ratio. Objectives : (1) To study the trend on Maternal Mortality Rate (MMR); (2) To find out the factors for the Maternal Mortality. Material and Methods : A retrospective cross-sectional study of maternal death was conducted in the Obstetrics Department of Tertiary Care Hospital of Ahmedabad city. The data of total 9 years from 1st April 2013 to 31st January 2021 were taken in the study. Epidemiological factors and causes affecting maternal mortality were assessed through pretested questionnaire that includes parity, duration between admission and mortality etc. Results: Maternal Mortality Rate (MMR) was 180.2 per 1 lac live births during the study period. Young mothersaged 20 to 30 years (78.5%), and rural residence (76.6%), multiparous mothers (66.7%)were at risk for Maternal Mortality. Obstetric haemorrhage (25.8%) was the most common cause whereas COVID-19 pandemic later on were indirect causes contributing to Maternal Mortality. Conclusion: Great Care should be taken for high-risk pregnancy like young age, multiparous women and also of postpartum women. Postpartum haemorrhage was the commonest direct cause of Maternal Mortality. Strengthening of existing obstetric care facilities, facility for easy transport, appropriate referral linkages are keys to reduce Maternal Mortality to further extent

Intracranial Unruptured Right Internal Carotid Artery Aneurysm in A Cadaver: A Case Report

Background: Dilatations of localised segments of the artery are called ‘aneurysms. Approximately 80% of aneurysms form in anterior circulation of circle of Willis. While 20% form in the posterior circulation of the brain. All aneurysms can cause symptoms because of compression of surrounding structures, thrombosis, rupture of emboli. Material and Methods: During routine dissection for I MBBS students in Department of Anatomy, JSS Medical College during intracranial dissection we encountered unruptured saccular aneurysm of intracranial internal carotid artery on right side Case report: Aneurysm of intracranial internal carotid artery was seen on right side of middle cranial fossa in a male cadaver. The aneurysm was close to right optic nerve and measured about 2.2 cm in width and 1.8 cm antero-posteriorly. No other intracranial pathology or anatomical variations were noted. Conclusion: The anatomical knowledge of aneurysm is important to Neurosurgeons, Endovascular surgeons, ENT surgeons and interventional Radiologists.

Incidence & outcomes of clinically significant bleeding events in critically ill COVID-19 patients receiving Therapeutic dose AntiCoagulanTs: A retrospective cohort study (INTerACT study)

Background & objectives: The high mortality associated with the thrombotic events in hospitalized COVID-19 patients resulted in the usage of anticoagulants in varying doses. Whether high-dose anticoagulants have led to better outcomes or higher incidence of clinically significant bleeding events is debatable. Thus, this study was conducted to find the incidence of clinically significant bleeding events in moderate-to-severe COVID-19 ARDS (acute respiratory distress syndrome) patients on therapeutic anticoagulation and their outcomes. Methods: In this retrospective, single-centre study of 155 critically ill COVID-19 patients, the incidence of clinically significant bleeding was observed. Multivariate regression models were used to evaluate the association between anticoagulant regimen, coagulation and inflammatory markers with the incidence of bleeding and thrombotic events. Results: The incidence of clinically relevant non-major bleeding was 33.54 per cent (26.17-41.46%) and major bleeding was 9.03 per cent (5.02-14.69%). The anticoagulation intensity at baseline had a high odds of major bleeding when enoxaparin and dual antiplatelet therapy were used together [adjusted odds ratio OR of 434.09 (3.81-49502.95), P<0.05]. At admission, bleeders had a poorer PaO2/FiO2 ratio with more patients on invasive ventilation. At the time of bleeding, the bleeders had a higher D-dimer, ferritin, C-reactive protein and procalcitonin compared to non-bleeders. The subhazard ratio for death in bleeders was 3.35 (95% confidence interval, 1.97-5.65; P<0.001). Interpretation & conclusions: The incidence of bleeding in critically ill COVID-19 patients on therapeutic anticoagulation may increase with the severity of the disease as well as with concurrent use of dual antiplatelets. Major bleeding may also contribute to higher mortality.

Role of External Ventricular Drainage (EVD) in Treating Spontaneous Intraventricular Haemorrhage

Background: There is no consensus in the literature on the effects of the development of hydrocephalus on survival and disability after intracerebral haemorrhage (ICH) and the benefits of external ventricular drainage (EVD). This study is planned to describe the role of external ventricular drainage in treating patients of spontaneous, either primary or secondary, intraventricular haemorrhage with hydrocephalus.Material & Methods:A hospital based prospective interventional study was conducted in the Department of Neurosurgery of Dhaka Medical College Hospital, which is a tertiary level hospital, from April 2016 to September 2017.Total 42 patients of spontaneous intraventricular haemorrhage, either primary or secondary, with hydrocephalus were selected for this study. All the collected data were entered into IBM SPSS software, Version 24. For statistical analysis, paired t-test to compare the preoperative GCS with postoperative GCS at 24 hours was done.Results:Among 42 patients, age range was 26-75 years with the mean age 65.2 � 10.87 years. Male were 26 (61.9%) and female were 16 (38.1%). Male-Female ratio was 1.625:1. No patient needed conversion of EVD into VP shunt. EVD drain became blocked in 5 cases which were managed accordingly. 5 patients developed ventriculitis among which 2 patients died and rest 3 improved with antibiotics.Conclusions:The results of present study shows that EVD has a good role in the treatment of spontaneous IVH with hydrocephalus when ICH volume is low (<30ml) and modified Graeb Score is low (?10 found in this in this study. Preoperative higher GCS or initial improvement in GCS or initial improvement in GCS at 24 hours positively correlates with Glasgow outcome scale which is an indication of good function outcome.

Antepartum cerebral angiopathy presenting as middle cerebral artery aneurysm rupture – A rare case report from India

The incidence of middle cerebral artery aneurysm rupture in pregnancy is rare. Rupture of an intracranial aneurysm is the most common cause of subarachnoid hemorrhage in pregnancy and during puerperium. Intracranial aneurysm rupture during pregnancy is disastrous for the mother as well as the fetus. We report a case of a dissecting left middle cerebral artery aneurysm in a 25-year-old woman, G2P1L1, at 18 weeks of gestation, who presented with a 1-day history of giddiness, slurring of speech, and facial deviation to the left.

A Case Report: Vitreous Haemorrhage – A Rare Presentation Of Retinoblastoma

@#Retinoblastoma very rarely presents as vitreous haemorrhage. We are presenting a case of atypical presentation of retinoblastoma in a 3-year-old girl. She initially came with right eye vitreous haemorrhage of unknown cause. B-mode ultrasound showed dense vitreous opacity without evidence of mass. Initial MRI Brain/Orbit was inconclusive. Diagnostic vitrectomy was performed and noted thickened abnormal retina which was suspicious for retinoblastoma. The parents refused for enucleation for diagnostic histopathological examination and opted for conservative management. Repeated MRI Brain/Orbit done six months later showed disease progression through optic nerve involvement and suggestive of retinoblastoma. The parents were re-counselled for enucleation however refused and defaulted. 2 months later, the child was brought back with proptosed and disorganized eye. This time, they agreed for intervention. The patient underwent three cycles of chemoreduction therapy before enucleation. After enucleation, she received six cycles of adjuvant chemotherapy. She was well with no disease recurrence at two-year post treatment.

The incidence and risk factors of periventricular-intraventricular hemorrhage in extremely preterm infants / 中国新生儿科杂志

Objective:To study the incidence and risk factors of periventricular- intraventricular hemorrhage (PIVH) in extremely preterm infants (EPI) with gestational age (GA)<28 weeks.Methods:A retrospective study was performed in 304 cases of EPI hospitalized between January 2016 and December 2018. The infants were assigned into two groups according to whether PIVH occurred. Univariate analysis and Logistic regression analysis were used to determine the risk factors of PIVH.Results:Among the 304 cases,101 (33.2%) developed PIVH and 44 (14.5%) developed severe PIVH.The incidences of PIVH and severe PIVH in EPI with birth weight (BW) <750 g were 50.6% and 31.0%. The incidences of PIVH and severe PIVH in EPI with GA<26 weeks were 51.4% and 27.5%. Logistic regression analysis revealed that advanced GA ( OR=0.697, 95% CI 0.543~0.895, P=0.005) decreased the risk of PIVH. Prolonged invasive mechanical ventilation ( OR=1.121, 95% CI 1.007~1.249, P=0.037) and use of vasoactive drugs ( OR=1.373, 95% CI 1.040~1.812, P=0.025) within the first week of life increased the risk of PIVH. Conclusions:The incidences of PIVH and severe PIVH in EPI are quite high. Smaller GA, longer use of invasive mechanical ventilation and vasoactive drugs within the first week will increase the risk of PIVH in EPI.

An Evaluation of Risk Factors Associated with Pregnancy Related Acute Kidney Injury in Women Admitted to the High Dependency Care Unit at Women and Newborn Hospital, Lusaka-Zambia

Objective:To evaluate factors associated with Pregnancy-related KidneyInjury(PRAKI) inwomen admitted to high dependency care unit at Women and Newborn Hospital in Lusaka, ZambiaMethodology:This was an unmatched case-control study conducted in the high-dependency care unit at Women and Newborn Hospital in Lusaka. Study participantswererecruitedconsecutivelybyconveniencesampling.Participants'medicalrecords were reviewed to capture serum creatinine levels;whileastructuredquestionnairewasadministeredto eligible andconsentedstudy participants to capture data on sociodemographic, obstetric, and medical factors. Serum creatinine levels above 84µmol/l were used as criteria for classifying PRAKI. Excel was used for data cleaningandStatav13usedforanalysis.Descriptive statistics were done for all variables followed by univariate and multivariable logistic regression to determine association. 95% CI was usedand p value of<0.05 was consideredsignificant.Results:Thestudy comprised of185 study participants, split into 85 women with PRAKI (cases) and 100 women without PRAKI (controls). The median age was 29 years with 11years interquartile range. 75.3%of the study participants wereinmarriagerelationships.Pre-existinghypertension was the most prevalent medical condition in both the cases (51.8%) and the controls (38%). Sickle celldisease was much less common at 1.2% in cases and 8% in controls. Among the obstetric conditions, preeclampsia was the most common condition at 77.6% and 60% in cases and controls respectively. Eclampsia was found in 38.8% of cases and 11% of controls. Sepsis was least common at 4.7% of cases. This study found that obstetricfactorssuch as eclampsia (AOR = 5.12, 95% CI [2.14 ­ 12.23]; p≤0.0001), preeclampsia (AOR = 2.46, 95% CI [1.12 ­ 5.39]; p = 0.025), and postpartum haemorrhage were associated with the development of PRAKI. Medical conditions were not associated with PRAKI.

Scorpion Bite Atypically Presenting As Acute Transverse Myelitis And Sub Arachnoid Hemorrhage: A Case Report And Review

Scorpion bite is an important health issue as it has been reportedthatabout tenpersons are killed by a venomous scorpion for each killed by a venomous snake.Scorpion venom may be cardiotoxic, hemotoxic, nephrotoxic or even neurotoxic. It acts on the autonomic nervous system producing parasympathetic and sympathetic manifestations.However, few have reported sub arachnoid haemorrhage and transverse myelitis occurring due to scorpion venom.Case Report:We are reporting a case of 50year old male who prese nted three days after an episode of scorpion bitewith paraplegia and inability to pass urine and stool due to transverse myelitis and subarachnoid hemorrhage. He was investigatedand treated accordingly. Clinical improvement was seen within tendays after the initiation of therapy. Conclusion:Scorpion sting,though rarely may present as SAH and transverse myelitis which are reversible and easily treatable.Clinical Significance:As scorpion bite is treatable,having high index of suspicion for scorpion sting inpatients of SAH and acute transverse myelitis in whom the cause of their clinical features could not be recognised may help in improving the outcome considerably in these cases.

Study Of Maternal And Perinatal Outcome In Patients With Abruption Placenta

Background:Abruptionplacenta is one of a serious obstetrics emergency. It is defined as partial or complete separation of normally implanted placenta after 28 weeks of gestation, prior to delivery of the fetus. Placental abruption complicates about 1% of pregnancies and is aleading cause of vaginal bleeding in the latter half of pregnancy.1 AIMS:To study maternal outcome in patients with abruption placenta. To study perinatal out come in patients with abruption placenta. Material And Methods:A prospective observational study was carried out at tertiary hospital for 6 months from September 2019 to February 2020. 30 cases of abruption placenta were enrolled in this study. Results:Maximum patients (56.6%) were from 26 –30 year age group. (63.3%) were having second gravida. Maximum (56.6%) patients admitted were between 33 –36 week gestational age group. Most of (60%) patients were having revealed type of bleeding. (52.3%) patients were having grade 2. Major maternal morbidities were PPH (36.6%), severe shock (23.3%) and DIC (6.6).(26.6%) babies had birth asphyxia, (16.6%) developed ARDS. Sepsis and ICH was seen in (10%) each whereas necrotizing enterocolitis and stillbirth was found in (13.3%). Perinatal death was seen in (6.6%). Conclusion:Abruption placenta is associatedwith poor maternal and fetal outcome. Early diagnosis and prompt resuscitative measures are essential to prevent both perinal and maternal morbidity and mortality.

Vasospasm and delayed cerebral ischaemia in patients with spontaneous subarachnoid haemorrhage (aneurysmal and pretruncal non-aneurysmal): a centre’s perspective

@#Spontaneous subarachnoid haemorrhage (SAH) is a significant cause of stroke and may lead to severe neurological deficit or death. It is also associated with high morbidity and mortality for patients despite optimal medical and surgical treatment. Based on the World Health Organization the annual incidence of spontaneous SAH varies in different regions of the world between 2.0-22.5 per 100,000 populations with Finland and Japan having the highest incidence and South and Central America with lowest incidence.1

Clinical analysis of vitreous haemorrhage associated with retinal tears / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the clinical characteristics of vitreous hemorrhage associated with retinal tears, so as to provide suggestions for early intervention and improving the prognosis of patients.<p>METHODS: This was a retrospective study. Totally 105 patients(105 eyes)with vitreous haemorrhage associated with retinal tears treated at our hospital from December 2016 to December 2018 including 54 males and 51 females, of who the clinical characters, therapeutic effcet and prognostic facors were retrospectively analyzed.<p>RESULTS: Among the 105 eyes(151 retinal tears), 82 tears were located in the superotemporal area(54.3%), 28 tears were located in the superonasal area(18.5%), 27 tears were located in the inferior temporal area(17.9%), and 14 tears were located in the inferior nasal area(9.3%). The shape of the retinal tears was mostly horseshoe(77.5%). The diameter of the tear was between 1/8-4 papillary diameter(PD), most commonly is 1 PD. Seventy-six patients(72.4%)had visual acuity better than or equal to their preoperative vision. There was no significant difference in corrected visual acuity pre-and postoperative(<i>P</i>>0.05), and there was no statistically significant improvement in visual acuity between the buckling procedure group and the vitrectomy group(<i>P</i>>0.05).<p>CONCLUSION: Retinal tear is an important cause of vitreous haemorrhage. Retinal tears were mostly located in the superotemporal area with horseshoe shape. A comprehensive understanding of the clinical characteristics of rhegmatogenous vitreous haemorrhage helps to detect tears early and avoid serious complications.Patients had preoperative best corrected visual acuity(BCVA)(LogMAR)less than 1.6 and light perception less than 1 m, have poor postoperative vision, as do patients with retinal detachment involving the macula especially along with proliferative vitreoretinopathy(PVR).

The effect of preperitoneal pelvic packing for hemodynamically unstable patients with pelvic fractures / 中华创伤杂志(英文版)

PURPOSE@#Hemodynamically unstable patients with pelvic fractures still represent a challenge to trauma surgeons and have a very high mortality. This study was designed to explore the effect of the interventions of direct preperitoneal pelvic packing for the hemodynamically unstable pelvic fractures.@*METHODS@#This retrospective study enrolled 67 cases of severe pelvic fractures with unstable hemodynamics from October 2011 to December 2019. All patients presented in our emergency center and received preperitoneal pelvic packing were included in this study. The indication was persistent systolic blood pressure ≤90 mmHg during initial resuscitation and after transfusion of two units of red blood cells. Patients with hemodynamic stability who need no preperitoneal pelvic packing to control bleeding were excluded. Their demographic characteristics, clinical features, laboratory results, therapeutic interventions, adverse events, and prognostic outcomes were collected from digital information system of electronic medical records. Statistics were described as mean ± standard deviation or medium and analyzed using pair sample t-test or Mann-Whitney U-test.@*RESULTS@#The patients' average age was 41.6 years, ranging from 10 to 88 years. Among them, 45 cases were male (67.2%) and 22 cases were female (32.8%). Significant difference was found regarding the systolic blood pressure (mmHg) in the emergency department (78.4 ± 13.9) and after preperitoneal pelvic packing in the surgery intensive care unit (100.1 ± 17.6) (p < 0.05). Simultaneously, the arterial base deficit (mmol/L) were significantly lower in the surgery intensive care unit (median -6, interquartile range -8 to -2) than in the emergency department (median -10, interquartile range -14 to -8) (p < 0.05). After preperitoneal pelvic packing, 15 patients (22.4%) underwent pelvic angiography for persistent hypotension or suspected ongoing haemorrhage. The overall mortality rate was 29.5% (20 of 67).@*CONCLUSIONS@#Preperitoneal pelvic packing, as a useful surgical technique, is less invasive and can be very efficient in early intra-pelvic bleed control.

Hypopituitorism happened in patients with aneurysmal subarachnoid haemorrhage in acute stage / 中华内分泌外科杂志

Objective:To explore the risk factors of hypopituitorism after aneurysmal subarachnoid haemorrhage (aSAH) in the acute phase and analysis the effect of hypopituitorism on prognosis.Methods:Patients with aSAH that were diagnosed and treated in China-Japan Union Hospital from Sep. 2017 to Sep. 2018 and undergoing pituitary function evaluation within 3 to 7 days were retrospectively analyzed. 72 patients were enrolled, including 31 males and 41 females. The average age was 50.1 years old (36-71) . The WFNS gradings were Ⅰ, 24; Ⅱ, 20; Ⅲ, 15; Ⅳ, 10; Ⅴ, 3. The Fisher gradings were 2, 21; 3, 38; 4, 13. Acute hydrocephalus happened in 13 cases. Aneurysm located in the Willis circle in 56 cases and not in the Willis circle in 16 cases. 37 cases were treated by microsurgical clipped and 35 cases were treated by embolism. Patients with hypocortisolism were treated by hydrocortisone replacement, and patients with hypothyroidism were given levothyroxine replacement therapy. Patients were followed up at 3 months and their recovery was evaluated by GOS score.Results:Hypopituitorism was detected in 34 patients; the incidence of hypopituitorism was 47.2%. There was no significant correlation between the occurrence of hypopituitorism and age, gender, and hydrocephalus ( P>0.05) . Patients with WFNS grade ≥Ⅳ, Fisher grade 4, aneurysm located in the Willis circle, and treated by clipping were more likely to undergo hypopituitorism. The proportion of patients with good recovery (GOS ≥4) in the hypopituitorism group was smaller than that in the normal pituitary function group at the 3-month follow-up. Conclusions:Patients with WFNS grade ≥Ⅳ, Fisher grade 4, aneurysm located in the Willis circle, and treated by clipping are more likely to undergo hypopituitorism. Hypopituitorism in acute stage affects the prognosis of aSAH patients. Patients with hypocortisolism and hypothyroidism should be treated actively.

Tangled Throughout Life: A Case of Paediatric Ruptured Cerebral Arteriovenous Malformation

@#Arteriovenous malformation (AVM) in children is uncommon occurrence defined as presence of arteriovenous shunting through coiled and tortuous vascular connections. We discussed a case of a 3-year old girl presented with acute left facial asymmetry and right-sided limb weakness. Neurological examination revealed MRC scale of 0 out of 5 for power on her right side. Magnetic Resonance Angiography (MRA) revealed bilateral thalamic AVM. Surgical resection was not advisable in view of deep-seated location. Paediatric AVM most often become apparent following rupture with majority presents with headache. Ruptured paediatric AVM carries high burden of morbidity and mortality. Paediatric intracranial haemorrhage posed tremendous concern regarding its long-term outcome. Treatment would be more appropriate sooner rather than later especially for those presented with ruptured AVM. Surgical resection remains the gold standard treatment for all accessible paediatric AVMs with embolization and radiosurgery as adjunctive therapies. AVM in paediatric population is rare but carries grim prognosis.

Excisão miometrial segmentar e reconstrução da parede uterina na preservação do útero na hemorragia pós-parto associada à placenta prévia e increta / Segmental Myometrial Excision and Uterine Wall Reconstruction in the Preservation of the Uterus in Post Partum Haemorrhage Associated with Placenta Previa and Increta

A Hemorragia Pós-parto é a maior causa mundial de histerectomia periparto. Sua abordagem terapêutica deve ser efetuada por uma sucessão de procedimentos farmacológicos e cirúrgicos antes de se recorrer à histerectomia. O acretismo placentário se apresenta como a etiologia de hemorragia pós-parto que mais dificulta a preservação uterina. Sua incidência se relaciona estritamente com a elevação contemporânea das taxas de cesárea, com os demais procedimentos cirúrgicos no útero e com a implantação segmentar da placenta. Com isso, objetiva-se relatar um caso de placenta prévia central e increta tratado por meio de excisão miometrial segmentar com reconstrução da parede uterina durante cesariana. A abordagem cirúrgica foi instituída seguindo os passos de localização per-operatória da placenta, realização de histerotomia corporal alta transversa, extração fetal, confirmação clínica do incretismo placentário, manutenção da placenta in situ, ligadura bilateral dos ramos ascendentes das artérias uterinas, ressecção de todo o segmento uterino anterior invadido por cotilédones placentários, reconstrução da parede uterina, histerorrafia, salpingotripsia bilateral, revisão da cavidade abdominal e laparorrafia. A técnica cirúrgica adotada foi eficiente na obtenção do controle hemorrágico durante a cesariana e não foi associada a complicações per ou pós-operatórias.

Postpartum Hemorrhage is the largest worldwide cause of peripartum hysterectomy. Its therapeutic approach must be performed by a succession of pharmacological and surgical procedures prior to hysterectomy. Placental accreta presents as the etiology of postpartum haemorrhage that makes uterine preservation more difficult. Its incidence is strictly related to the contemporary elevation of cesarean rates, other surgical procedures in the uterus and segmentar implantation of the placenta. We aim to report a case of central and increta placenta treated through segmental myometrial excision with reconstruction of the uterine wall during cesarean section. The surgical approach was instituted following the perioperative localization of the placenta, transverse corporal hysterotomy, fetal extraction, clinical confirmation of placental invasive aspects, maintenance of the placenta in situ, bilateral ligation of the uterine artery ascending branches, resection of the all anterior uterine segment invaded by placental cotyledons, reconstruction of the uterine wall, hysterorrhaphy, bilateral salpingotripsy, revision of the abdominal cavity and laparorrhaphy. The surgical technique adopted was efficient in obtaining hemorrhagic control during cesarean section and was not associated with per or postoperative complications.

Endovascular Coil Occlusion of a Traumatic Pseudoaneurysm of the Posterior Cerebral Artery: A Case Report

ABSTRACT A 51-year-old male developed traumatic pseudoaneurysms of the right- and left-posterior cerebral arteries following endoscopic resection of a pituitary adenoma. The right-sided aneurysm resolved spontaneously but the left progressed in size. This was treated endovascularly, with successful embolization of the sac. This is the first report of this approach to the management of a pseudoaneurysm of the posterior cerebral arteries to our knowledge.