Anticoagulantes, Antiplaquetarios y sus implicaciones en cirugía: una revisión de la literatura / Anticoagulants, Anti-platelets, and their implications in Surgery: A Literature review

All health care providers should be aware of the impact of bleeding disorders on their patients during any surgical procedures. The knowledge of the mechanisms of hemostasis and optimized management are very important. Initial recognition of a bleeding disorder, in such patients with a systemic pathologic process, may occur in surgical practice. The surgical treatment of those patients might be complicated during the surgery due to the use of anticoagulant and/or antiplatelet medications raises a challenge in the daily practice of surgical professionals. Adequate hemostasis is critical for the success of any surgical procedure because bleeding problems can give rise to complications associated with important morbidity-mortality. Besides, prophylactic, restorative, and surgical care of patients with any bleeding disorders is handled skillfully by practitioners who are well educated regarding the pathology, complications which could arise, and surgical options associated with these conditions. The purpose of this paper is to review common bleeding disorders and their effects on the surgical aspect. Many authors consider that patient medication indicated for the treatment of background disease should not be altered or suspended unless so indicated by the prescribing physician. Local hemostatic measures have been shown to suffice for controlling possible bleeding problems resulting from surgery.

Colecistitis hemorrágica: reporte de caso y revisión de la literatura / Hemorrhagic cholecystitis: case report and literature review

Resumen Introducción: La colecistitis hemorrágica es una complicación poco frecuente de la colecistitis aguda con una alta mortalidad. Materiales y Método: Paciente con dolor abdominal en hipocondrio derecho e ictericia. Los exámenes de laboratorio y ultrasonido hepatobiliar mostraron datos sugestivos de colecistitis aguda; durante su estancia hospitalaria presenta deterioro de su estado general, realizándose tomografía computarizada mostrando imágenes sugestivas de colecistitis hemorrágica y hemoperitoneo. Resultados: Laparotomía de urgencia, corroborando los hallazgos tomográficos y resolviéndose satisfactoriamente con la colecistectomía. Discusión: El diagnóstico de colecistitis hemorrágica es difícil ya que sus manifestaciones clínicas de inicio no difieren de la colecistitis aguda, por lo que la sospecha clínica y el adecuado estudio de imagen son importantes para su detección. Conclusión: A pesar que la colecistitis hemorrágica con perforación y hemoperitoneo es una patología muy poco común, de diagnóstico confuso, es importante establecer la realización de una tomografía computarizada abdominal con contraste endovenoso en pacientes con sospecha de colecistitis aguda grave.

Introduction: Hemorrhagic cholecystitis is a rare complication of acute cholecystitis with a high mortality. Materials and Method: Patient with abdominal pain in right hypochondrium and jaundice. Laboratory analyses and hepatobiliary ultrasound suggested acute cholecystitis, however, general worsening during hospital stay was observed and a computed tomography was performed, revealing hemorrhagic cholecystitis and hemoperitoneum. Results: Urgent laparotomy which confirmed tomographic results, successfully solved with cholecystectomy. Discussion: Hemorrhagic cholecystitis diagnosis is difficult as symptoms at the beginning do not differ from acute cholecystitis, then, clinical suspicion and a correct image analysis is crucial for its detection. Conclusion: Although, perforated hemorrhagic cholecystitis with hemoperitoneum is a very rare entity with confused diagnosis, an abdominal computed tomography with intravenous contrast is very important in any patient with severe acute cholecystitis suspicion.

A Novel Approach for the Treatment of Radiation-Induced Hemorrhagic Cystitis with the GreenLight™ XPS Laser

The treatment of pelvic malignancies with radiotherapy can develop severe sequelae, especially radiation-induced hemorrhagic cystitis. It is a progressive disease that can lead to the need for blood transfusion, hospitalizations, and surgical interventions. This tends to affect the quality of life of these patients, and management can at times be difficult. We have evaluated the GreenLight Xcelerated Performance System (XPS) with TruCoag, although primarily used for management of benign prostatic hypertrophy (BPH), for the treatment of radiation-induced hemorrhagic cystitis.

Can lumbar hemorrhagic synovial cyst cause acute radicular compression? Case report / O cisto sinovial hemorrágico lombar pode causar compressão radicular aguda? Relato de caso

Lumbar synovial cysts are an uncommon cause of back pain and radiculopathy, usually manifesting with gradual onset of symptoms, secondary to involvement of the spinal canal. Rarely, intracyst hemorrhage occurs, and may acutely present as radicular - or even spinal cord - compression syndrome. Synovial cysts are generally associated with degenerative facets, although the pathogenesis has not been entirely established. We report a case of bleeding complication in a synovial cyst at L2-L3, adjacent to the right interfacet joint, causing acute pain and radiculopathy in a patient on anticoagulation therapy who required surgical resection.

Cistos sinoviais da coluna lombar são uma causa incomum de dor na coluna e radiculopatia, geralmente com evolução gradual dos sintomas, que são secundários ao comprometimento do canal vertebral. Raramente, há hemorragia intracística, que pode se manifestar de forma aguda com síndrome compressiva radicular ou mesmo medular. Habitualmente, os cistos sinoviais associam-se a doença degenerativa facetária, embora a patogênese não esteja completamente estabelecida. Relatamos aqui um caso em que uma complicação hemorrágica em um cisto sinovial no nível L2-L3, adjacente à interfacetária direita, causou dor lombar e radiculopatia em um paciente em terapia anticoagulante, sendo necessária a ressecção cirúrgica.

[Pancreatic pseudocysts complicated by hemorrhage and infection]

The occurrence of bleeding complications secondary to the development of pancreatic pseudocysts is rare but associated with high mortality. To report a case of pancreatic pseudocyst complicated by hemorrhage and infection A 62 years old patient with history of severe acute pancreatitis two months ago consulted for abdominal pain associate with fever and internal bleeding. CT scan showed a heterogeneous PK complicated by hematoma of the ACE and hemoperitoneum. The emergency surgical treatment showed a PK superinfected with erosion of the splenic artery. It was directed by a left splenopancreatectomy Therapeutic management of hemorrhagic complications of pancreatic pseudo cysts is surgery despite the contribution of art‚rio-embolisation

Life saving surgery for ruptured pseudo aneurysm of external iliac artery: case report / Cirurgia para salvamento de vida após ruptura de pseudoaneurisma da artéria ilíaca: relato de caso

The incidence of pseudo aneurysm after total hip arthroplasty is extremely rare. The most common mechanism of vascular injury is due to direct trauma during the operative procedure, and the most reported cases are acute in presentation. We reported an unusual case of ruptured pseudo aneurysm and control of life-threatening intra-operative hemorrhage of the external iliac artery in a male patient, 68 years old, with displaced total hip arthroplasty (THA), planned for removal, occurring 2 years after the last hip surgery, in Armed Forces hospital, Southern region, Saudi Arabia. This case highlights the importance of prompt recognition of life-threatening intra-operative hemorrhage to save the patient's life and the limb.

A incidência de pseudoaneurisma após a artroplastia total de quadril é extremamente rara. O mecanismo mais comum de lesão vascular deve-se ao trauma direto durante o procedimento cirúrgico, e os casos mais relatados são de apresentação aguda. Relatamos um caso incomum de ruptura de pseudoaneurisma e controle de hemorragia intraoperatória com risco de morte da artéria ilíaca externa em um paciente do sexo masculino, de 68 anos, com artroplastia total do quadril deslocada, planejada para remoção, ocorrendo 2 anos depois da última cirurgia de quadril, no Hospital das Forças Armadas, região sul da Arábia Saudita. Este caso destaca a importância do pronto reconhecimento da hemorragia intraoperatória com risco de morte para salvar a vida e o membro do paciente.

Could spontaneous retroperitoneal haematoma present with scrotal mass?

Retroperitoneal haematoma could be caused by different factors. It is increasing due to an increase in the use of antithrombotic and anticoagulant therapy. Diagnosis of retroperitoneal haematoma forms a big challenge in daily clinical practice. Patients with retroperitoneal haematoma could present with leg paresis, abdominal pain, shock or abdominal compartment syndrome. Retroperitoneal haematoma could be treated conservatively but surgical interference or embolization of the bleeding vessels is always an option. To present a case with spontaneous retroperitoneal haematoma presenting with scrotal haematoma together with a mini- review of retroperitoneal haematoma. Retroperitoneal haematoma may present with a scrotal swelling and could be treated conservatively depending on the presentation and severity of the bleeding

Uso adjunto de NovoSeven (factor VII-a recombinante) en trauma cardiaco penetrante / Adjunct use of NovoSeven (recombinant factor VIIa) for penetrating cardiac trauma

BACKGROUND: Uncontrolled bleeding leads to 40-86% of preventable deaths due to trauma. Use of NovoSeven (rFVIIa) in trauma is promising, although data supporting its utilization are limited. CASE REPORT: We report the case of a patient who sustained a penetrating grade V cardiac injury (AAST-OIS) and presented postoperative massive coagulopathic bleeding arrested by the administration of platelet pools and NovoSeven. DISCUSSION: This report represents our initial experience and the very first case of successful use of NovoSeven for the treatment of traumatic coagulopathic hemorrhage at the Central Military Hospital in Mexico City. A further prospective trial justifying its use in our institution is warranted.

Packing pelviano retroperitoneal en fracturas inestables de pelvis: reporte de un caso y descripción de la técnica / Retroperitoneal packing in unstable pelvic fractures: case report and description of the technique

Pelvic fractures in hemodynamically unstable patients are associated with high rates of morbidity and mortality. The optimal management strategy for hemorrhage control remains controversial. We present a clinical case that was successfully treated with retroperitoneal pelvic packing. The technique is described and discussed.

Las fracturas de pelvis con inestabilidad hemodinámica se asocian a altas tasas de morbilidad y mortalidad. No existe consenso sobre la mejor manera de controlar hemorragia asociada. Se presenta un caso manejado exitosamente mediante la realización de un packing pelviano retroperitoneal. Se describe la técnica quirúrgica y se discuten sus alcances.

Reconstrucción torácica primaria con material protésico en trauma torácico extenso / Prosthetic chest reconstruction after extensive chest trauma: report of one case

Es nuestro objetivo comunicar un caso clínico del Hospital Clínico Herminda Martin, en el cual se realizó una reparación torácica con material protésico en un tiempo como consecuencia de un traumatismo penetrante torácico por arma de fuego con pérdida de pared, con buenos resultados.

We report a 21 years old woman that was admitted in the emergency room due to a extensive chest trauma caused by a gunshot. The patient was subjected to an emergency thoracotomy. A right lung lower and middle lobectomy, partial hepatectomy, diaphragmatic suture and mastectomy were performed. A primary chest closure was done, using a Marlex prosthesis covered by a cutaneous flap. During the postoperative period, the patient had a surgical wound infection, that was treated conservatively and was discharged 42 days after surgery.

case of carotid artery secondary hemorrhage successfully managed by extra anatomic axillary-internal carotid bypass

Carotid artery rupture post oncologic Head and Neck surgery is relatively rare but potentially lethal complication. To the best of the author's knowledge, the management options are restricted to ligation and resection of the pathologic segment of the artery accepting with helplessness a potential of stroke and sometimes mortality secondary to interruption of the blood supply of the brain. A patient with recurrent tongue cancer post resection and radiofrequency ablation. Salivary leak and infection in the neck resulted in a "Blow out" of the bifurcation of the carotid artery. Bleeding was controlled by minimal digital pressure, awakening test during cross clamping of the internal carotid artery lead to neurologic deficit. An extra-anatomic bypass was constructed with the inflow from the axillary artery and the outflow at the internal carotid artery at the skull base above and separate from the infected area and the tunnel in the posterior triangle of neck away from infection. The patient suffered no neurologic deficit. The vascular exposure wounds healed uneventfully .The patient was sent to chemotherapy. Occlusion of the graft occurred silently and hence left well alone. We hope that this bypass, or perhaps any other better option, proves to offer a management option for this frustrating morbidity that carries the risk of adding a neurologic deficit to the misery of the advanced head and neck malignancy

Evaluation of distal splenorenal shunt as an urgent surgical intervention in the management of acute variceal bleeding

The aim of the work was to evaluate distal splenorenal shunt as an urgent surgical intervention in management of acute variceal bleeding in Egyptian patients with portal hypertension. This study included 26 patients with acute variceal bleeding needing urgent surgery. All patients underwent distal splenorenal shunt, and patients were followed up for at least one year. Preoperatively and during the follow up period hepatic functions, portal homodynamic, and the state of varices were assessed. Control of bleeding was achieved in 88.46% of patients, re bleeding varices was reported in 3 patients [11.54%]. No infra-operative mortality, with a reasonable operative time of 148.00 +/- 50.05 minutes. The immediate post-operative mortality was 7.69%, and one patient died during follow up. Post operative morbidity was in the form of encephalopathy in 23.08% of patients, severe ascites in 15.38%, and partial wound dehiscence in 11.54% of patients. The mean follow up period was 21 +/- 4.34 months. Distal splenorenal shunt is a good surgical option for management of urgent variceal bleeding after failure of conservative measures, provided that there are available well trained personnel

Cefaloematoma calcificado: considerações sobre cinco casos / Calcified cephalohematoma: considerations about five cases

O cefaloematoma é o acúmulo de sangue entre o periósteo e o crânio. É uma condição comum em neonatos. Tem evolução benigna na maioria dos casos, podendo complicar-se ocasionalmente. Entre as complicações, temos o cefaloematoma calcificado, cujo tratamento é cirúrgico e com resultado excelente. Os autores apresentam cinco casos de Cefaloematoma calcificado, quatro do sexo masculino e um feminino. Quatro haviam nascido de parto fórceps e o outro de parto normal. Radiografia simples de crânio demonstrou traço de fratura em dois e a tomografia computadorizada craniana apresentou cefaloematoma e presença de lesões associadas como fraturas e comprometimento de partes moles adjacentes. O tratamento cirúrgico foi instituído em todos os casos e com resultados cosméticos excelentes.

Parallel Technique of Endobronchial Balloon Catheter Tamponade for Transient Alleviation of Massive Hemoptysis

Endobronchial balloon tamponade is an alternative method that can be used to control massive hemoptysis. Several different techniques have been used for this purpose. We describe a new parallel method, in which biopsy forceps introduced through a bronchoscope channel is used to grasp a balloon catheter. As the bronchoscope is advanced to the bleeding site, the balloon catheter is pulled into position, and subsequently inflated. There are several advantages of this technique. It needs no specialized catheter or guide wire, the procedure is relatively easy to perform, and applicable to other purposes such as introduction of an additional suction catheter.

Contribuicao ao estudo da desvascularizacao da transicao esofagogastrica no tratamento das varizes sangrantes do esofago / Bleeding varices of the esophagus: treatment by desvascularization of the esophagogastric junction

Os autores apresentam nova variante tecnica de Desconexao Azigoportal para tratamento das hemorragias provocadas por varizes de esofago na hipertensao portal. A variante tecnica apresenta-se fundamentada na tecnica descrita por Espindula (1978) e as principais modificacoes propostas sao: A) Objetivando se a possivel reducao da transudacao ao nivel das areas cruentas reperitoniza-se 1) a curvatura gastrica menor desnudada pela VGP; 2) a area do peritonio posterior corresponde ao hilo esplenico e cauda do pancreas; 3) a area desnudada do esofago distal, atraves de fundoplicatura a Lind (1965); B) Realiza-se fundoplicatura a Lind com a finalidade de se obter eficiente valvula anti-refluxo...

Control de la terapia anticoagulante en prótesis valvulares cardiacas / Anticoagulant therapy control

Objetivo. Evaluar la eficacia de dos pruebas de laboratorio empleadas para el control de la terapia anticoagulante de pacientes con prótesis valvulares cardiacas. Material y métodos. Se revisaron 240 notas médicas y 240 resultados de laboratorio provenientes de 20 pacientes (12 mujeres y ocho hombres). Se registraron los datos concernientes con el tiempo de protrombina y la relación internacional normalizada (RIN) recabados durante 12 controles mensuales. Fueron comparados los resultados de las pruebas de laboratorio con los episodios de sangrado. Se determinó el valor predictivo positivo, el valor predictivo negativo, la sensibilidad, la especificidad y la eficacia global de las pruebas en reto. Resultados. Se documentaron 25 episodios de sangrado: 20 fueron menores (80 por ciento) y cinco mayores (20 por ciento). De estos episodios, 18 ocurrieron con un tiempo de protrombina adecuado; en estos casos, el valor predictivo positivo fue de 15 por ciento, el valor predictivo negativo de 94 por ciento, la sensibilidad de 72 por ciento; la especificidad de 52 por ciento y la eficacia global de 54 por ciento. En cambio hubo 14 episodios con RIN recomendable y 11 con una RIN mínima efectiva; el valor predictivo positivo fue de 11 por ciento; el valor predictivo negativo de 90 por ciento; la sensibilidad de 56 por ciento, la especificidad de 50 por ciento y la eficacia global de 51 por ciento con p<0.05. Conclusiones. El tiempo de protrombina tiene mayor eficacia global que la relación internacional normalizada. Existe una relación directa entre la intensidad de la anticoagulación y los episodios de sangrado

Evaluación a largo plazo de una variente de trasección esofágica en la operación de Sugiura-Futagawa / Long term evaluation of a variant of oesophageal transection in Suigiura Futagawa operation

Se presenta la experiencia a largo plazo (5 años) con una variante de la transección esofágica en la operación de Sugiura-Futagawa. La variante coloca un surgete continuo en toda la circunferencia de el cilindro mucosos sin abrirlo, que oblitera los plexos varicosos. Fueron operados treinta pacientes, quince del sexo femenino, con edad promedio de 43 años. Veintiséis pacientes en Child-Pugh A y cuatro en B. Dieciocho con cirrosisi hepática, siete con hipertensión idiopática y una fibrosis portal congénita. La mortalidad operatoria fue de 6 por ciento y la recurrencia de hemorragia del 10 por ciento. En un caso se presentó fístula (3 por ciento) y un caso de dehiscencia (3 por ciento) con escape controlado. Un caso de estenosis postoperatoria que requirió dilatación. La frecuencia de fístula y estenosis con la transección propuesta es inferior a la reportada en la literatura de transecciones, con frecuencia equiparable de recurrencia de hemorragia

Patología vásculo encefálica / Brain vascular pathology

Se realizó un estudio retrospectivo de 119 pacientes con PATOLOGIA VASCULO ENCEFALICA, internados en el servicio de Neurocirugía del Hospital de Clínicas Universitario de la ciudad de La Paz durante los años de 1991 al 1995. Se determino que la incidencia de Accidente Vascular Encefálico (AVE) de tipo hemorrágico por causa hipertensiva es muy alta, 55,5, la edad de mayor frecuencia esta entre los 40 y 60 años; el sexo femenino es el más afectado por ésta patología. La edad más frecuente de presentación de hemorragia intracraneal por traumatismo craneo encefálico, está en la cuarta década de la vida. El tratamiento médico fué el más utilizado en este estudio 66,4 el tratamiento quirúrgico fué realizado en el 33,8.