Subject(s)
Thromboangiitis Obliterans/genetics , Thrombophilia/genetics , Female , Humans , Risk FactorsSubject(s)
Aneurysm, Ruptured/therapy , Aortic Aneurysm, Abdominal/therapy , Factor VIIa/therapeutic use , Aged , Aneurysm, Ruptured/diagnosis , Aortic Aneurysm, Abdominal/diagnosis , Combined Modality Therapy , Emergency Service, Hospital , Female , Hemostasis, Surgical/methods , Humans , Intraoperative Care/methods , Male , Sampling Studies , Sensitivity and Specificity , Severity of Illness Index , Treatment Outcome , Vascular Surgical Procedures/methodsABSTRACT
BACKGROUND: New recommendations concerning the use of prophylactic anticoagulation for medically ill patients have been in use for some time now. This study aims at assessing how much house-staff in a tertiary care setting are implementing these new recommendations in the hope that through quantitative analysis of the deficiency we would be able to identify areas of weakness. METHODS: About 250 patients were randomly selected from all patients admitted to the American University of Beirut Medical Center (AUBMC) during the year 2005 and stayed more than 48 h. The risk factor profiles, contraindications to thromboprophylaxis, if present, and whether these patients received the appropriate VTE pharmacologic prophylaxis during their stay in hospital were recorded. RESULTS: About 139 patients were found to have two or more risk factors, with no absolute contraindications. About 37 patients (26.6%) received VTE prophylaxis. Upon reviewing the risk factors profile, the majority of patients (71.3%) were found to have 2-4 risk factors. Among risk factors studied, age > 40 years, admission to ICU, prior VTE, chronic lung disease, infection, respiratory failure, and central venous catheter were significantly associated with receiving prophylaxis. CONCLUSIONS: VTE prophylaxis is underutilized at AUBMC, a tertiary care teaching hospital in the Middle East. Critical care patients were being acceptably anti-coagulated, whereas cancer patients are doing the worst.
Subject(s)
Anticoagulants/therapeutic use , Drug Utilization , Hospitals, Teaching , Inpatients , Practice Patterns, Physicians' , Venous Thromboembolism/prevention & control , Adolescent , Adult , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Female , Guideline Adherence , Humans , Lebanon , Male , Middle Aged , Practice Guidelines as Topic , Retrospective Studies , Risk Assessment , Risk Factors , Venous Thromboembolism/etiology , Young AdultABSTRACT
BACKGROUND: Surgical treatment of aneurysmal bone cysts of the cervical spine, frequently affecting pediatric patients, is a challenge to operating surgeons. Complete tumor resection offers the best chance for cure. CASE DESCRIPTION: We present the case of a child with an expansile aneurysmal bone cyst of the cervical spine that involves all 3 spinal columns. The advantages of combining a posterolateral followed by anterior approach after a preoperative angiography and vertebral artery balloon occlusion testing provided the added safety to maximize the extent of tumor resection. Spinal stabilization was successfully achieved in both approaches. CONCLUSION: The challenge of surgically resecting aneurysmal bone cysts of the cervical spine in children enabled us to achieve a total resection with the help of preoperative angiography and vertebral artery balloon occlusion testing. Spinal instability should be addressed with reconstruction and stabilization techniques.
