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@#Giant cell tumour (GCT) is a benign tumour but can be locally aggressive and with the potential to metastasise especially to the lungs. Successful treatments have been reported for long bone lesions; however, optimal surgical and medical treatment for spinal and sacral lesions are not well established. In treating spinal GCTs, the aim is to achieve complete tumour excision, restore spinal stability and decompress the neural tissues. The ideal surgical procedure is an en bloc spondylectomy or vertebrectomy, where all tumour cells are removed as recurrence is closely related to the extent of initial surgical excision. However, such a surgery has a high complication rate, such as dura tear and massive blood loss. We report a patient with a missed pathological fracture of T12 treated initially with a posterior subtraction osteotomy, who had recurrence three years after the index surgery and subsequently underwent a three level vertebrectomy and posterior spinal fusion.
ABSTRACT
Objective To evaluate the risk factors of massive blood loss in resection of giant liver hemangioma.Method The clinical data of 141 patients who underwent giant liver hemangioma resection were retrospectively studied.These data included general physical condition,laboratory tests,radiologic findings,and various surgical parameters.The patients were divided into the massive blood loss group (＞ 1 000 ml,n =27) and the minor blood loss group (≤1 000 ml,n =114).Logistic regression was performed to determine the risk factors of intraoperative massive blood loss.Results The average diameter of the liver hemangioma was significantly greater in the massive blood loss group than that in the minor blood loss group [(21.7 ± 8.5) cm vs.(14.1 ± 5.3) cm,P ＜ 0.05].The incidences of preoperative leukopenia,anemia,thrombocytopenia and prolonged prothrombin time were higher in the massive blood loss group than that in the minor blood loss group (48.1％ vs.16.7％,37.0％ vs.11.4％,25.9％ vs.3.5％,22.2％ vs.3.5％,respectively,all P ＜ 0.05).Hepatic hemangioma with compressed hepatic veins,inferior vena cava and porta hepatis were more frequently found in the massive blood loss group than in the minor blood group (55.6％ vs.14.9％,44.4％ vs.14.0％,55.6％ vs.12.3％,respectively,all P＜0.05).Logistic regression analysis demonstrated a diameter of hemangioma greater than 15 cm was a risk factor of intraoperative massive blood loss during surgical resection.Conclusions Giant hepatic hemangioma may cause disorders in the hematological and coagulation systems.Compression of major hepatic vessels raised technical difficulty and risks in surgery.Hemangioma with a diameter greater than 15 cm was recognized as a high-risk factor of intraoperative massive blood loss.
ABSTRACT
Se realizó una investigación descriptiva, retrospectiva y transversal, con vistas a caracterizar la morbilidad materna extremadamente grave por pérdida masiva de sangre, con choque hipovolémico o sin este, en el Hospital Ginecoobstétrico Docente "Tamara Bunke Bider" de Santiago de Cuba, durante el bienio 2010-2011. De las 68 pacientes con el cuadro clínico, 35 correspondieron al primer año del estudio y representaron 1,4 % de la morbilidad, mientras que las 28 afectadas del segundo año constituyeron 0,78 %. En la serie, los datos se extrajeron de los registros de morbilidad hospitalaria y fueron recogidos en una planilla confeccionada para plasmar las variables de interés. Como resultado sobresaliente, se observó una disminución general del número de féminas que evolucionaron con morbilidad materna extremadamente grave.
A descriptive, retrospective and cross-sectional investigation, aimed at characterizing the extremely severe maternal morbidity due to massive blood loss, with hypovolemic shock or without it, was carried out in "Tamara Bunke Bider" Teaching Gynecological and Obstetrical Hospital from Santiago de Cuba during the biennium 2010-2011. Of the 68 patients with the clinical pattern, 35 corresponded to the first year of the study and they represented 1.4% of the morbidity, while the 28 affected women of the second year constituted 0.78%. In the series, data were collected from morbidity records of the hospital and they were gathered in an application form to register the variables of interest. As an outstanding result there was a general decrease of females with a clinical course of extremely severe maternal morbidity.