ABSTRACT
INTRODUCTION: Massive haemothorax is a relatively rare complication of thoracocentesis or the placement of tube thoracostomy. It is principally caused by intercostal vessel injury. The therapeutic approach consists in pleural drainage and sometimes thoracotomy for haemostasis. CASE REPORT: We describe a frail 72 year old patient, who developed a massive haemothorax occurring after a tube thoracostomy placing, persisting despite second pleural drainage, and complicated by deep haemodynamic shock. He was considered to have a very high risk of mortality if surgery was undertaken. Haemorrhage was totally stopped after intercostal instillation of lidocaïne-adrenaline. CONCLUSION: This case report suggests a role for pleural vasoconstrictor injection as initial treatment in case of persistent pleural haemorrhage caused by intercostal vessel injury.
Subject(s)
Chest Tubes , Epinephrine/administration & dosage , Hemothorax/drug therapy , Iatrogenic Disease , Lidocaine/administration & dosage , Postoperative Complications/drug therapy , Thoracotomy , Vasoconstrictor Agents/administration & dosage , Aged , Hemothorax/diagnostic imaging , Humans , Injections, Intramuscular , Intercostal Muscles/drug effects , Male , Postoperative Complications/diagnostic imaging , Resuscitation/methods , Tomography, X-Ray ComputedABSTRACT
A prospective comparison of peritoneal dialysis to hemodialysis was undertaken to identify advantages and disadvantages of either treatment relative to the other. Hematologic, biochemical, lipid, and neurobehavioral parameters were followed. Careful controls were imposed to assure that the treatment groups were comparable. Patients on peritoneal dialysis proved to have more normal concentrations of BUN, hemoglobin, potassium, bicarbonate, and high-density lipoproteins. Hemodialysis patients had more normal concentrations of albumin, total protein, and calcium. Hypertriglyceridemia was only minimally greater in peritoneal patients. Neurobehavioral results documented multiple abnormalities in both. The profile of results obtained provides preliminary criteria for selecting either form of dialysis for a particular patient.
Subject(s)
Kidney Diseases/therapy , Peritoneal Dialysis , Renal Dialysis , Adult , Aged , Female , Humans , Male , Middle Aged , Peritoneal Dialysis/adverse effects , Prospective Studies , Renal Dialysis/adverse effectsABSTRACT
Three patients with dialysis ascites improved markedly after treatment with isolated ultrafiltrations. This simple, noninvasive technique should be applied first to patients with dialysis ascites before resorting to more drastic therapeutic measures.
