Vitreous Hemorrhage after Aneurismal Rupture: Terson Syndrome

Introduction Terson syndrome is described as an intraocular hemorrhage consequent to a spontaneous subarachnoid hemorrhage (SSAH). In the present article, we describe cases of patients who underwent neurosurgical treatment of ruptured cerebral aneurysmat our institution over a period of one year, and who were diagnosed with Terson syndrome. Methods The present study included patients with a diagnosis of SSAH by rupture of a cerebral aneurysm who underwent treatment in our neurosurgical service from December 2009 to December 2010. The patients were followed-up for a minimum of 20 months.We have also performed a literature review and compared the data with those available in the current literature. Results The present study included 34 patients, 18 (53%) of which underwent endovascular treatment, and 16 (47%) who underwent microsurgical clipping. In the sample, the mortality was 14.7% (5 patients), the same percentage of patients who were diagnosed with Terson Syndrome, which is an incidence of 14.7%. Regarding the ophthalmologic evaluation, all patients had vitreous hemorrhage detected by an ultrasound examination, which was unilateral in only two patients. Visual acuity improved in all patients, being incomplete in only one of them. Conclusion Terson syndrome is relatively common and is associated with higher mortality. With the existence of an effective treatment, it should be investigated in all patients with SSAH.

Open abdominal aortic aneurysm repair in the era of endovascular repair / Reparación abierta de la aorta abdominal en la era de la reparación endovascular

OBJECTIVES: The development of minimally invasive techniques for abdominal aortic aneurysm (AAA) repair and the establishment of specialized centres have resulted in improved patient outcomes. This study examines open AAA repair at a non-specialized centre where advanced techniques are not practised. METHODS: We conducted a retrospective analysis on a cohort of 83 patients presenting for AAA repair to a non-specialized hospital, the University Hospital of the West Indies (UHWI). The end points assessed included operative (30-day) mortality, postoperative complications, duration of operation, blood loss, intensive care unit (ICU) stay and overall hospital stay. RESULTS: The overall operative mortality was 9.4% (23% for ruptured aneurysms and 5% for unruptured aneurysms). Mean operating time, blood loss, ICU stay and hospital stay were 326 ± 98 minutes, 2420 ± 1397 mls, 3 ± 5 days and 9 ± 5 days, respectively with no significant differences noted between ruptured and unruptured aneurysms. Mean aneurysm diameter was 6.13 ± 1.59 cm. CONCLUSION: Mortality rates for open aneurysm repair at the UHWI are consistent with findings in the current literature. Open AAA repair remains a safe treatment option in this environment. Continued improvements need to be made with respect to minimizing blood loss and operation duration, particularly in repairs of unruptured aneurysms.

OBJETIVOS: El desarrollo de técnicas mínimamente invasivas para la reparación del aneurisma aórtico abdominal (AAA) y el establecimiento de centros especializados para esos fines, han traído consigo el mejoramiento de los resultados clínicos de los pacientes. Este estudio examina reparaciones del tipo AAA en un centro no especializado, en el que no se practican técnicas avanzadas. MÉTODOS: Se llevo a cabo un análisis retrospectivo en una cohorte de 83 pacientes que acudieron para reparación de AAA a un hospital no especializado - el Hospital Universitario de West Indies (UHWI). Los aspectos finales evaluados incluyeron la mortalidad operatoria (30 días), las complicaciones post-operatorias, la duración de la operación, la pérdida de sangre, la estadía en la unidad de cuidados intensivos, y la estadía general en el hospital. RESULTADOS: La mortalidad operatoria general fue 9.4% (23% para los aneurismas rotos y 5% para los aneurismas no rotos). El tiempo promedio de operación, la pérdida de sangre, la estadía en la UCI, y la estadía hospitalaria fueron 326 ± 98 minutos, 2420 ± 1397 mls, 3 ± 5 días y 9 ± 5 días respectivamente, sin que se observen diferencias significativas entere aneurismas rotos y no rotos. El diámetro promedio de los aneurismas fue 6.13 ± 1.59 cm. CONCLUSIÓN: Las tasas de mortalidad para la reparación abierta de aneurismas en el UHWI concuerdan con los hallazgos en la literatura corriente. Se necesita continuar los esfuerzos por lograr mejorías en cuanto a minimizar la pérdida de sangre, y reducir el tiempo de duración de la operación, especialmente en las reparaciones de aneurismas no rotos.

Utilidad del eco-Doppler en el screening de la aorta abdominal / Usefulness of Doppler ultrasound for the screeining of the abdominal aorta

An aneurysm is a permanent dilatation of an artery due to a weakness in the arterial wall. The aortic aneurysm is defined as the enlargement of the diameter greater than 50% in his original size compared with a previous segment, or greater than 3 cm. If an abdominal aortic aneurysm is suspected on the basis of either the patient history or a prominent aortic pulse, an abdominal ultrasound examination should be done. The presence of an aneurysm is an indication for complete evaluation for strong consideration of surgical treatment. Rupture of an abdominal aneurysm is associated with sudden, massive blood loss. Many of these patients die before reaching a hospital. The striking difference in mortality rates between patients with ruptured aneurysms and those undergoing elective treatment makes a strong case for advising surgery to prevent deaths due to rupture. For these motives it is imperious to indicate ultrasound studies to provide concrete images of this disease. These considerations are expressed in this paper

Fatal traumatic rupture of ascending aortic aneurysm having idiopathic cystic medial necrosis: An autopsy case.

This report describes an autopsy case pertaining to death due to traumatic rupture of aortic aneurysm. A 21 year old deaf and dumb male was assaulted with kicks over the chest. Autopsy revealed external injuries over the body. Internally, a fusiform aneurysmal dilatation of the lumen of the aortic root and tubular segment of the ascending aorta were observed, with tear of the anterior wall of the ascending aorta and resultant haemopericardium. Histologically, the wall of the aneurysm revealed cystic medial necrosis, which appears to idiopathic in nature. A Common complication of aortic aneurysms is dissection, with subsequent spontaneous rupture. In this case, there was no evidence of dissection and the rupture was traumatic in nature. Death was certified as due to cardiac tamponade. The extent of trauma to which the victim was subjected to, appears to be such as would have been insufficient to cause death in an otherwise normal individual. An account of the findings, along with a discussion of the pathology of aneurysms and cystic medial necrosis as also of the mechanism of rupture of aneurysms is provided.

Aneurisma toracoabdominal roto: relato de caso com uso de anel rígido sulcado de Delrin intraluminal na anastomose proximal / Thoracoabdominal aneurysm rupture: case report of the use of a intraluminal rigid Delrin sulcate ring in anastomosis of the proximal aorta

A rotura do aneurisma de aorta toracoabdominal possui altas taxas de mortalidade e morbidades graves como paraplegia, falência renal e cardíaca, sendo de difícil resolução cirúrgica. Paciente de 51 anos, sexo masculino, tem aneurisma de aorta toracoabdominal roto,tipo III, no qual foi utilizado anel rígido proximalmente, sendo queuma anastomose única, biselada, incluindo os ramos viscerais, foi realizada distalmente. O uso do anel e a anastomose distal única, com substituição completa da porção aneurismática, permitiram um tempo cirúrgico e de clampeamento reduzidos, além de baixa morbidadeconstatada. A técnica cirúrgica adotada possibilitou boa evolução pós-operatória.(AU)#S#a

Mortalidade materna no município de Ribeiräo Preto: fatores determinantes e coadjuvantes / Maternal mortality in Ribeiro Preto City: elements determinants and coadjuvants

O propósito deste estudo foi identificar os fatores determinantes e coadjuvantes da mortalidade materna no município de Ribeiräo Preto - SP, nos anos de 1994 a 1996. A populaçäo constou de 14 mulheres que residiam e morreram por causas maternas, no período e no município do estudo. Tratou-se de um estudo descritivo e retrospectivo, com fatores coadjuvantes que levaram as mulheres à morte. A coleta de dados inclui informaçöes fornecidas pelo Comitê de Mortalidade Materna do município, dados dos prontuários médicos do hospital onde ocorreram os óbitos e informaçöes através de questionário aplicado ao familiar da mulher falecida, durante visita domiciliar. As causas das 14 mortes, foram hemorragia, infecçäo, doença hipertensiva específica da gestaçäo, rotura de aneurisma, cardiopatia e distúrbio hidroeletrolítico e metabólico. No que concerne ao local dos óbitos, 13 ocorreram em hospitais e um no domicílio. As complicaçöes do ciclo-gravídico-puerperal foram relativas ao aborto, descolamento prematuro da placenta, óbito fetal, síndrome hipertensivas da gestaçäo, nefropatia, cardiopatia, acidente vascular cerebral hemorrágico, infecçöes urinárias e complicaçöes no parto. Considera-se que na maioria dos casos, as principais causas destas mortes estavam associadas a fatores sociais e a problemas de assintência durante a gestaçäo, parto e puerpério, quer por causas advindas do sistema de saúde quer pela falta de informaçäo por parte da gestante