ABSTRACT
UNLABELLED: Elderly patients suffering from acute surgical pathology and severe medical comorbidities present serious "mix-cases" and their multiple organ detorioration requires perioperative intensive care. GOAL OF THE STUDY: analysis of outcome of elderly patients, aged 65 years and over, suffering from acute abdominal surgical pathology associated with haemorrhagic shock. MATERIALS AND METHODS: 17,573 patients were treated in the 2nd Chair and Department of Surgery in Jagiellonian University Hospital within 01.07.1997 and 30.06.2003. 365 patients, aged >65 yrs underwent surgery because of acute abdominal pathology; 86 cases out of this group presented haemorrhagic shock, 69 of them had bleeding into the gastrointestinal tract, and in 17 there was diagnosed ruptured abdominal aortic aneurysm. The principles of the diagnosis and the therapy were common for both groups. The analysis included: mortality rate, duration of hospital and intensive care unit (ICU) stay, continuous assessment based on APACHE II (Acute Physiology And Chronic Health Evaluation) and TISS-28 (Therapeutic Intervention Scoring System). RESULTS: Mortality rate was 71.01% in the group of 69 patients with gastrointestinal bleeding (there is no comparative data based on relevant cases in the literature), and 58.8% in the group with ruptured abdominal aneurysm. The difference in those values was caused by prolonged time (i.e. days), which elapsed from the onset of symptoms of pathology and commencing surgery and intensive therapy. In the group with ruptured aneurysm, the dramatic onset of symptoms reduced the time between commencing of pathology and the intensive treatment and procedure.
Subject(s)
Abdomen, Acute/complications , Aortic Aneurysm, Abdominal/complications , Aortic Rupture/complications , Gastrointestinal Hemorrhage/complications , Shock, Hemorrhagic/mortality , Shock, Hemorrhagic/therapy , APACHE , Abdomen, Acute/etiology , Abdomen, Acute/mortality , Abdomen, Acute/therapy , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/surgery , Female , Gastrointestinal Hemorrhage/surgery , Humans , Intensive Care Units , Length of Stay , Male , Retrospective Studies , Shock, Hemorrhagic/etiology , Treatment OutcomeABSTRACT
The main indication for recombinant activated factor VII (rFVIIa) is the treatment of patients with hemophilia or other hemostatic disturbances. Additionally, rFVIIa has been considered as a universal hemostatic agent prompting its use in the management of severe uncontrolled bleeding in patients without pre-existing coagulopathies. Authors report their own experience in the beneficial effect of rFVIIa (NovoSeven, NovoNordisk, Denmark) administration in a patient with severe bleeding from the nasopharyngeal region after extensive fronto-basal injuries. After one dose of NovoSeven (2.4 mg - 40 microg/kg of body weight) reduction in bleeding, normalization of hemostasis parameters and hemodynamic stabilization of the patient were achieved.
Subject(s)
Factor VIIa/therapeutic use , Hemorrhage/drug therapy , Nasopharyngeal Diseases/drug therapy , Adult , Facial Injuries/complications , Hemorrhage/etiology , Humans , Male , Nasopharyngeal Diseases/etiology , Skull Fractures/complicationsABSTRACT
Presented is material of 277 patients, who were treated due to acute abdomen illness in Intensive Therapy Unit at 2nd Department General Surgery Collegium Medicum Jagiellonian University during the time: from 01.07.1997 till 30.06.2002. This material regards only geriatric patients (patients > 65 years old). Patients analysis was divided into two main groups: patients with haemorrhagic shock caused by gastrointestinal bleeding (49 patients--group A) and by ruptured abdominal aneurysm (16 patients--group B), patients with hypovolemic and/or septic shock owing to diffuse peritonitis (150 patients--group C), and intestinal obstruction (62 patients--group D). The other principles of therapeutic procedures were described for every main group. In every illness group was showed: multiorgan dysfunction (acute myocardial ischemia with enzymatic and/or electrocardiographic changes, pulmonary oedema as acute left ventricular failure, respiratory and renal failure and metabolic dysfunction), actual punctuation into two scoring systems: APACHE II (28.8 points) and TISS-28 (44.5 points), time of hospitalization in the intensive therapy unit (mean 7.1 days), hospital's time of treatment (mean 17.5 days), mortality (for all patients 57.8%). These dates compared with dates from publications.
