ABSTRACT
We report the case of a 79-year-old Caucasian male, who underwent anterior resection of the rectum for treatment of a colorectal carcinoma. Two days after the surgery, the patient had mild but persistent haemorrhage from all drains and around the wounds which eventually required blood transfusion (18 units of erythrocyte concentrate and 8 units of fresh-frozen plasma). Endoscopy revealed no surgical bleeding source, and standard coagulation tests were inconspicuous. Based on suspicion of factor XIII deficiency, the patient was treated with factor XIII concentrate (1250 I.U. injections twice daily), starting on day 4 of bleeding. The bleeding stopped after the second dose of factor XIII. Laboratory testing retrospectively revealed the lack of factor XIII (43 % at the first day of dosing). Factor XIII concentrate was administered for 10 days. Withdrawal of factor XIII after 9 days of treatment led to a bleeding recurrence. After resuming treatment for one more day, the therapy could be stopped without further bleeding. Thus, factor XIII deficiency should be considered in patients with unexplained postoperative bleeding and appropriate diagnostic measures be taken early. In cases of medical emergency, probative administration of factor XIII may be justified.
Subject(s)
Colectomy/adverse effects , Factor VIII/therapeutic use , Hemophilia A/drug therapy , Hemophilia A/etiology , Postoperative Hemorrhage/drug therapy , Postoperative Hemorrhage/etiology , Aged , Blood Coagulation Tests , Coagulants/therapeutic use , Colectomy/methods , Hemophilia A/diagnosis , Humans , Male , Treatment OutcomeABSTRACT
Computerized EEG was performed in 20 patients with renal failure before and after haemodialysis (HD), applying spectral analysis and Hjorth's EEG descriptors in EEG quantification, correlation and factor analysis as statistical procedures to analyse the connections of EEG, blood variables and psychological performance. The main results were: (1) Moderate uraemic encephalopathy -- according to Kiley's (1971) standards -- was present in most of our patients, before and after HD. (2) Before HD, EEG slowing was most strongly connected with the creatinine level and EEG acceleration with hyperkalaemia, which in most cases accompanied a high urea level. (3) Significant EEG changes after HD were: decrease of percentage delta activity, increase of Hjorth's 'mobility', decrease of Hjorth's 'complexity'. (4) The theta/alpha ratio (Matousek 1968) was significantly correlated with the patient's general clinical state after HD. (5) Visual discrimination, memory and maximal tapping speed improved significantly after HD. Only Hjorth's EEG parameters were correlated with test performance in that patients with low voltage and fast EEGs did worse in visual discrimination.
