ABSTRACT
Klippel-Trénaunay syndrome is a congenital malformation characterized by the triad of flat red hemangiomas, soft tissue and bony hypertrophy and varicose veins. In addition, venous malformations or hemangiomas may also be found in the lung, gastrointestinal tract, liver, kidney and bladder, which may result in recurrent hemor-rhage and compromise the affected organs. Involvement of the cerebrum, cerebellum or spinal cord may lead to intracerebral bleeding and compression of neurological structures. Venous thrombosis and pulmonary thromboembolism are both common and may cause pulmonary hypertension and right ventricle failure. In some patients, in addition to flat hemangiomas, cavernous hemangiomas can be seen with a rapid growth rate in the first year of the patient's lifespan, producing high-output congestive heart failure and consumptive coagulopathy (Kasabach-Merritt syndrome). We report the case of a 35-year-old male patient diagnosed with Klippel-Trénaunay syndrome who was scheduled for right hemicolectomy for relapsing gastrointestinal hemorrhage unmanageable with conservative treatment. We also discuss the pathophysiologic and clinical aspects of the Klippel-Trénaunay syndrome. Nowadays, the anesthetic management of these patients remains a matter of controversy.
Subject(s)
Anesthesia , Gastrointestinal Hemorrhage/surgery , Klippel-Trenaunay-Weber Syndrome/surgery , Adult , Cellulitis/etiology , Colectomy , Gastrointestinal Hemorrhage/etiology , Humans , Hypertrophy/etiology , MaleABSTRACT
OBJECTIVE: To measure the correctness of decisions concerning counter-indications to vaccination (CV), taken by Primary Care professionals involved with the vaccination programme; to identify their associations with personal or organisational variables; and to sound out professionals' views on the source of false counter-indications and training for the programme. DESIGN: A crossover study. SETTING: Primary care centres in the city of Málaga and its metropolitan area. PARTICIPANTS: 173 nurses and 68 doctors from these centres. INTERVENTIONS: A questionnaire to professionals about their clinical decisions and views of CV. RESULTS: The worse average score was that recorded in the clinical situation involving live virus vaccines (634 points out of 1,000) and whooping cough vaccination (791 points). General counter-indicative items reached a higher score (865). CONCLUSIONS: Professional criteria on CV must be brought up to date and unified.
