Aneurysm rupture from blunt abdominal trauma after endovascular repair.

We present a case of aneurysm rupture from severe blunt abdominal trauma due to fight in a patient who had endovascular aneurysm repair. The patient presented to the emergency service with computed tomography evidence of an endoleak and a large retroperitoneal hematoma. The contrast abdominal computed tomography demonstrated a type Ib endoleak, increase in the aneurysm diameter and hematoma in the retroperitoneum. The patient has been taken under interventional procedure for endovascular aneurysm repair revision under urgent condition. Type Ib endoleak was treated by placement of a covered iliac extension limb, but a second leakage from graft body was found in control computed tomography images and open surgical conversion was necessary. Operative findings included a type III endoleak from graft body, defect on fabric. It was seen that the aneurysm sac anterior and posterior parts were ruptured. Upon reviewing the literature, we found that it was an interesting case as the first rupture case which had been developed after severe blunt abdominal trauma during the follow-up period of a patient on which endovascular aneurysm repair procedure had been performed and progressed in this manner.

Effect of combined dopamine and diltiazem on renal function after cardiac surgery.

BACKGROUND: In order to evaluate the effect of the combined use of dopamine and diltiazem on renal function in patients undergoing coronary artery bypass grafting (CABG), we conducted a prospective randomized study. MATERIAL/METHODS: Sixty patients (8F, 52M) with normal preoperative renal function undergoing CABG were divided randomly into four groups, including control (n=15), use of dopamine-only (n=15), use of diltiazem-only (n=15), and combined use of dopamine and diltiazem (n=15). The patients ranged in age from 38 to 74 years (mean 59.3). Drug administration (diltiazem: intravenous infusion of 2 microg x kg(-1) x min(-1), dopamine: 2 microg x kg(-1) x min(-1)) was initiated 24 hours before surgery and was continued for 72 hours. RESULTS: Creatinine and osmotic clearances were found to be significantly higher in the combined group compared with the other groups 24 hours after surgery (p<0.05). There was no significant difference in respect to creatinine clearance, osmotic clearance, and free water clearance in the dopamine-only and diltiazem-only groups compared to the control group. The free water clearance at 24 and 72 hours after surgery were significantly higher in the combined group compared with the other groups (p<0.05). In the control group, dopamine-only, and diltiazem-only groups beta(2)-microglobulin was statistically higher 72 hours postoperative than preoperatively (p<0.05). There were no significant changes in beta(2)-microglobulin levels in the combined group. CONCLUSIONS: The combined use of dopamine and diltiazem may provide a positive contribution and sufficient protection for early postoperative renal function in patients undergoing CABG.