Axillary, Chest Wall and Abdominal Hematoma as a Rare Complication of Radial Artery Catheterization.

BACKGROUND Radial artery access during coronary angiography has gained popularity as there are fewer associated complications when compared with femoral artery access. However sporadic complications can occur following radial artery catheterization. A rare case of axillary, chest wall and abdominal hematoma is presented following radial artery catheterization. CASE REPORT A 58-year-old man with hypertension, type 2 diabetes, with a history of smoking, underwent elective coronary artery angiography via the right radial artery route. He was discharged from care without event, before returning 24 hours later with a large hematoma of the right axilla, extending to the anterior chest wall and abdomen. One year previously, he underwent coronary artery angiography with catheterization of the femoral artery, which was without complications. On this occasion, after resolution of the hematoma, he underwent coronary artery bypass graft (CABG) surgery. CONCLUSIONS This case has reported a rare complication of radial artery catheterization that involved extensive hematoma involving the chest, abdominal wall, and axilla. Although such complications may be rare, a high level of vigilance should be maintained for rare complications in patients undergoing radial artery catheterization.

Evaluation and management of patients with aortic valve disorders in Trinidad and Tobago: summary report

On October 3, 2010, the Trinidad and Tobago Medical Association in association with the Trinidad and Tobago Heath Science Initiative and John Hopkins Cardiology sponsored a day-long symposium addressing the evaluation and management of patients with aortic stenosis and regurgitation in Trinidad and Tobago. The topic was chosen because aortic disease is the most common valve disorder, if not treated is associated with significant impairment of quality of life and mortality, and because its assessment and management is complex. There were three presentations reviewing some of the current international recommendation, guidelines and published literature, concerning the evaluation and medical management of aortic regurgitation, aortic stenosis, and the timing and type of surgical intervention. The group of approximately 70 health care providers then assembled in four workshops to address four critical issues in the management of this condition: (1) the initial diagnosis and evaluation, (2) medical management, (3) aortic valve surgery, and (4) post surgery follow-up and care. The workshop goals were to identify and prioritize targeted areas for improvement in each of these areas and were led by well-known and respected experts. The participants were asked to review a list of targets for improvement; to discuss, comment, add, and/or delete any; and to suggest how improvements might be implemented.

Can tissue adhesives and glues significantly reduce the incidence and length of postoperative air leaks in patients having lung resections?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether the intraoperative use of surgical adhesives in patients undergoing lung resection would reduce the incidence and length of postoperative air leaks. The reported search strategy identified 261 papers of which 12 were considered to represent the best evidence available. The author, journal, publication date, patient groups studied, study types, relevant outcomes, results and study weaknesses were tabulated. We conclude that six of the identified randomised trials found a significant reduction in air leak duration, but five found no significant difference. In contrast to significant reductions in air leak, only two studies identified a reduction in time to chest drain removal. Also, only two studies found a significant reduction in length of stay. There are multiple issues surrounding these studies ranging from identifying the optimal glue and delivery system, dealing with the learning curve of surgeons and robust protocols for chest drain removal to selection of patients suitable for surgical adhesive usage. Thus, routine usage of surgical adhesive for all operations cannot yet be recommended, although there is a wide range of adhesives available to surgeons which may be useful in selected situations.