ABSTRACT
Spinal anesthesia is a technique commonly used for local anesthesia and in obstetric surgeries. Rarely, the formation of an intracranial subdural hematoma (SDH) may result from spinal anesthesia, constituting a serious condition that often leads to severe neurological deficits. The presentation and course of this pathology may occur in a completely different way, which makes its diagnosis and management difficult. In the present article, the authors report two cases of patients with intracranial SDH after spinal anesthesia with completely different presentations and outcomes, demonstrating the variability of the manifestations of this condition. A quick review of key points of its pathophysiology, symptomatology, diagnosis, and treatment was also performed.
Subject(s)
Humans , Female , Adult , Hematoma, Subdural, Intracranial/surgery , Hematoma, Subdural, Intracranial/physiopathology , Hematoma, Subdural, Intracranial/drug therapy , Hematoma, Subdural, Intracranial/diagnostic imaging , Anesthesia, Spinal/adverse effects , Anesthesia, Spinal/methodsABSTRACT
Objective To study plasma coagulation factor Ⅶ effects of intracerebral hemorrhage in patients with craniocerebral injury.Methods 120 cases of patients with traumatic brain injury were treated,for patients admitted to hospital,the hospital after 24 hours,48 hours of live clotting enzyme activation part (APlT),peripheral venous blood specimen testing international standardization ratio (INR)and the activity of platelet and F Ⅶ were detected.According to the intracranial bleeding lesions was expanded or the emergence of a new bleeding lesions,and so on and so forth were divided into research group and the control group,43 patients in the research group,77 cases in the control group.Results The study showed that the two groups of patients with injury to the first CT time, subarachnoid hemorrhage,epidural hematoma,there were no significant difference between the indexes of subdural hematoma,patients in the study group lost 48h PPSB was (653.2 ±489.8)IU,platelet (180.7 ±63.5)mL,plasma (582.7 ±411.3)mL and red blood cells (612.3 ±490.1)mL,which were higher than those of the control group [(465.7 ±278.8)IU,(0.0 ±0.0)mL,(335.1 ±261.9)mL,(378.3 ±46.3)mL],there were statistifically significant differences between the two groups(t =2.399,2.388,2.582,3.231,P =0.020,0.022,0.010,0.001), the platelet and F Ⅶ of the research group were (101.43 ±41.85)×109 /L,(93.04 ±20.98)%,which were lower than those of the control group[(128.37 ±51.49)×109 /L,(107.67 ±20.25)%],there were statistifically significant differences between the two groups(t =2.583,2.893,P =0.010,0.004).Conclusion Lower levels of platelet activity and F Ⅶ of closely associated with intracranial hemorrhage in patients with craniocerebral injury,according to the clinical indicators to predict whether patients with intracranial hemorrhage,in order to for the treatment of patients with timely and accurate to ensure the patient's life and health.
ABSTRACT
There are several excellent alternatives to warfarin on the horizon for atrial fibrillation. Results from the trials, as well as pharmacokinetic data from the edoxaban studies, suggest that dose selection, based on pharmacokinetic and pharmacodynamic properties, is a critical component in the development of novel anticoagulants. Greater flexibility in dosing with edoxaban and the opportunity for dose adjustment throughout the ENGAGE AF-TIMI 48 trial may be advantageous in the competitive field of novel oral anticoagulants.
Existen excelentes alternativas al tratamiento con warfarina en el campo de la fibrilación auricular. Los resultados de los ensayos con RE-LY, ROCKET-AF y ARISTOTLE, así como los datos fármaco cinéticos obtenidos en estudios con edoxaban, sugieren que la selección de la dosis, basada en propiedades fármaco cinéticas y fármaco dinámicas, es un componente crítico en el desarrollo de nuevos anticoagulantes. Una mayor flexibilidad en establecer la dosis de edoxaban y la oportunidad de ajustar la dosis mediante ENGAGE AF-TIMI 48, puede constituir una ventaja en el campo de los nuevos anticoagulantes orales.
Subject(s)
Humans , Anticoagulants/administration & dosage , Atrial Fibrillation/drug therapy , Administration, OralABSTRACT
Multiple myeloma can usually be identified by non-traumatic vertebral fracture or signs of recurrent infection. Without these clinical signs, detection is unlikely. We briefly report a case of extraosseous multiple myeloma presenting as repeated intracranial bleeding and relapsing high fever. In doing so, we highlight the importance of subtle changes in laboratory findings. A 67-year-old man presented with spontaneous acute epidural hematoma, and hematoma evacuation was performed at the same site 3 times. A radiologic work-up failed to reveal any osseous lesions and he made a gradual recovery. In the meantime, he suffered unexplained fever up to 39oC despite normal chest and abdominal radiograms. Blood chemistry showed mild leukocytosis, high ESR and CRP, and a slightly elevated globulin. On his 15th hospital day, immunoglobulin studies confirmed the diagnosis of multiple myeloma. He was treated in the ICU for difficult breathing and uncontrolled fever. In spite of intensive critical care, his leukocyte count fell to below 2,000 and he died on postoperative day 28. Apparently normal laboratory and radiologic findings can hamper swift discovery and ultimate management of multiple myeloma. When there is unexplained repeated intracranial bleeding and accompanying fever, the possibility of hidden malignancy should be assessed to avoid delaying or missing treatment.