RESUMEN
Anastomotic leakage and subsequent pelvic sepsis are serious complications after surgery for pelvic malignancies, particularly challenging due to the large pelvic cavity dead space post-exenteration. We report a 47-year-old man treated for a severely infected pelvic hematoma and sepsis following anastomotic leakage after anterior pelvic exenteration. Post robot-assisted exenteration for locally advanced sigmoid colon cancer treated with neoadjuvant chemotherapy, a pelvic abscess from anastomotic dehiscence was identified. Initial CT-guided drainage and subsequent laparoscopic drainage were performed. On postoperative day 22, a bleeding left internal iliac pseudoaneurysm required embolization. Despite these efforts, the sepsis worsened due to an enlarged, infected hematoma. Endoscopic lavage, in collaboration with skilled endoscopists, successfully removed the hematoma, leading to an improved inflammatory response, and the patient was discharged. Endoscopic lavage proved to be the safest and most effective treatment for pelvic sepsis with an infected hematoma after various attempted interventions.
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Hematoma , Exenteración Pélvica , Sepsis , Humanos , Masculino , Persona de Mediana Edad , Exenteración Pélvica/efectos adversos , Hematoma/etiología , Hematoma/cirugía , Sepsis/etiología , Fuga Anastomótica/cirugía , Fuga Anastomótica/etiología , Fuga Anastomótica/terapia , Irrigación Terapéutica , Drenaje , Complicaciones Posoperatorias/etiologíaRESUMEN
Background: Bleeding is a serious cause of hypotension and tachycardia after childbirth and should always be considered. Case presentation: A healthy woman in her thirties who had previously undergone caesarean section, underwent induction and operative vaginal delivery. Postpartum, she experienced chest pain, hypotension and tachycardia, and had signs of ischaemia on electrocardiogram. A CT scan showed a large intraperitoneal haematoma. The patient underwent immediate laparotomy and received a massive blood transfusion. However, no large haematoma was found. The chest pain was attributed to a myocardial infarction caused by hypovolaemic shock. After discharge, the patient experienced significant vaginal bleeding and was transferred to a different university hospital. A CT scan revealed a large retroperitoneal haematoma. Emergency surgery was performed based on the suspicion of active bleeding, but only an older haematoma was found. Re-evaluation of the initial CT scan revealed that the haematoma was in fact located retroperitoneally and was thereby not found in the first operation. Interpretation: This case highlights the importance of bleeding as an important cause in unstable postpartum patients. Additionally, it is a reminder that retroperitoneal haematomas can occur in obstetric patients and can mask typical symptoms of uterine rupture such as abdominal pain. also hindering perioperative diagnosis.
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Dolor en el Pecho , Hematoma , Choque , Humanos , Femenino , Adulto , Hematoma/diagnóstico por imagen , Hematoma/etiología , Hematoma/diagnóstico , Dolor en el Pecho/etiología , Choque/etiología , Choque/diagnóstico , Tomografía Computarizada por Rayos X , Embarazo , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/etiología , Trastornos Puerperales/diagnóstico por imagen , Espacio Retroperitoneal/diagnóstico por imagen , Cesárea/efectos adversos , Electrocardiografía , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/complicaciones , Hemorragia Posparto/etiología , Hemorragia Posparto/diagnósticoRESUMEN
Bone marrow biopsy (BMB) is a routinely performed procedure, with the preferred site being the posterior superior iliac crest. Uncommonly, it may be complicated by haemorrhagic complications, especially in patients with coagulopathy. Here, we present a case of pelvic haematoma following a BMB due to the injury of the right internal iliac artery. Endovascular embolisation was performed on an urgent basis to manage this complication. The bleeding stopped following the embolisation.
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Aneurisma Falso , Embolización Terapéutica , Hematoma , Enfermedad Iatrogénica , Arteria Ilíaca , Humanos , Aneurisma Falso/etiología , Aneurisma Falso/terapia , Aneurisma Falso/diagnóstico por imagen , Embolización Terapéutica/efectos adversos , Hematoma/etiología , Arteria Ilíaca/lesiones , Arteria Ilíaca/diagnóstico por imagen , Biopsia/efectos adversos , Femenino , Procedimientos Endovasculares , Masculino , Médula Ósea/patología , Persona de Mediana EdadRESUMEN
INTRODUCTION: Current guidelines recommend that the International Normalized Ratio (INR) be less than 1.5 prior to spine intervention. Recent studies have shown that an INR > 1.25 is associated worse outcomes following anterior cervical surgery. We sought to determine the risk of complications associated with an INR > 1.25 following elective posterior cervical surgery. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried. Patients undergoing elective posterior cervical surgery from 2012 to 2016 with an INR level within 24 h of surgery were included. Primary outcomes were hematoma requiring surgery, 30-day mortality, and transfusions within 72-hours. There were 815 patients in the INR ≤ 1 cohort (Cohort A), 410 patients in the 1 < INR ≤ 1.25 cohort (Cohort B), and 33 patients in the 1.25 < INR ≤ 1.5 cohort (Cohort C). RESULTS: Cohort C had a higher rate of transfusion (4% Cohort A; 6% Cohort B; 12% Cohort C; p = 0.028) and the rate of mortality within 30 days postoperatively trended toward significance (0.4% Cohort A; 0.5% Cohort B; 3% Cohort C; p = 0.094). There was no significant difference in the rate of postoperative hematoma formation requiring surgery (0.2% Cohort A; 0% Cohort B; 0% Cohort C; p = 0.58). On multivariate analysis, increasing INR was not associated with an increased risk of developing a major complication. CONCLUSION: An INR > 1.25 but ≤ 1.5 may be safe for posterior cervical surgery. An INR > 1.25 but ≤ 1.5 was associated with a significantly higher rate of transfusions. However, increasing INR was not significantly associated with increased risk of any of the major complications.
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Vértebras Cervicales , Relación Normalizada Internacional , Complicaciones Posoperatorias , Humanos , Femenino , Vértebras Cervicales/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Anciano , Resultado del Tratamiento , Estudios de Cohortes , Transfusión Sanguínea/estadística & datos numéricos , Hematoma/etiología , Hematoma/epidemiología , Adulto , Estudios Retrospectivos , Periodo Preoperatorio , Procedimientos Quirúrgicos Electivos/efectos adversosRESUMEN
Presenting this video tutorial, we want to demonstrate a step-by-step surgical approach to acute intramural haematoma of the thoracic aorta without a definite entry tear. Limited by the aortic valve proximally, the intramural haematoma involved the aortic root, ascending aorta, aortic arch, including adjacent parts of supra-aortic branches, and descending aorta extending to the diaphragmatic level. The operative strategy involved urgent total aortic arch replacement with the frozen elephant trunk technique and anatomical reimplantation of the three supra-aortic vessels. The direct open over-the-wire technique was used to cannulate the right axillary artery, and standard venous cannulation was performed while brain protection was achieved with bilateral selective antegrade cerebral perfusion.
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Aorta Torácica , Implantación de Prótesis Vascular , Hematoma , Humanos , Aorta Torácica/cirugía , Hematoma/cirugía , Hematoma/etiología , Hematoma/diagnóstico , Implantación de Prótesis Vascular/métodos , Masculino , Prótesis Vascular , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/diagnóstico , Femenino , Persona de Mediana Edad , Anciano , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnósticoRESUMEN
This was the case of a male patient in his 60s, who suddenly collapsed. When the ambulance team arrived, the initial waveform was pulseless electrical activity; accordingly, a supraglottic airway device was inserted, and the patient was immediately transported to a referring hospital. On arrival, the patient resumed spontaneous circulation, the patient was diagnosed with Stanford type B acute aortic dissection and was referred to the author's hospital, where diffuse swelling of the anterior cervical region was revealed. CT performed by the previous hospital revealed compression of the trachea. The cause of cardiac arrest was considered to be severe airway stenosis secondary to a retropharyngeal haematoma associated with Stanford type B acute aortic dissection. Stanford type B acute aortic dissection can be complicated by retropharyngeal haematomas, which can lead to airway obstruction and even cardiac arrest. This condition also requires careful airway examination.
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Obstrucción de las Vías Aéreas , Disección Aórtica , Paro Cardíaco , Hematoma , Humanos , Masculino , Paro Cardíaco/etiología , Hematoma/diagnóstico por imagen , Hematoma/complicaciones , Hematoma/etiología , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/diagnóstico por imagen , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/diagnóstico , Persona de Mediana Edad , Enfermedades Faríngeas/complicaciones , Enfermedades Faríngeas/diagnóstico por imagen , Enfermedades Faríngeas/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
RATIONALE: Large extremity hematoma can rarely happen after contrast extravasation during a contrast-enhanced computed tomography scan. Some hematomas need prompt surgical managements. PATIENT CONCERNS: A 77-year-old man had acute ischemic stroke and received the thrombolytic and antiplatelet therapies. He had a contrast extravasation during the computed tomography scan and developed a large hematoma in the right forearm, despite without evidence of compartment syndrome. DIAGNOSIS: Right forearm hematoma, status post contrast extravasation. INTERVENTIONS: The patient responded poorly to the routine care with arm elevation, cold pack, and wet dressing, and was finally treated by the surgical debridement, vacuum sealing drainage, fascioplasty, and skin flap repair. OUTCOMES: Right forearm wound healed with a scar. LESSONS: Large extremity hematoma can happen after contrast extravasation during computed tomography scan, which may require surgical treatments. Careful preparation, close monitor, and prompt managements should be applied in high-risk patients.
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Extravasación de Materiales Terapéuticos y Diagnósticos , Antebrazo , Hematoma , Humanos , Masculino , Anciano , Extravasación de Materiales Terapéuticos y Diagnósticos/cirugía , Hematoma/cirugía , Hematoma/etiología , Antebrazo/cirugía , Tomografía Computarizada por Rayos X , Medios de Contraste/efectos adversosRESUMEN
BACKGROUND Classical hemophilia A, an X-linked recessive disorder, is characterized by an inability to produce factor VIII in normal quantities. This condition, also leading to factor IX deficiency, underpins the bleeding disorder known as hemophilia A. Among the complications of this illness, spontaneous retroperitoneal hematoma is rare but can be associated with congenital coagulopathies such as von Willebrand disease or hemophilia A. This type of spontaneous internal bleeding has been the subject of a limited number of studies. CASE REPORT A 38-year-old man with a known diagnosis of hemophilia A presented to the Emergency Department exhibiting acute pain in the right lower abdomen. A computed tomography scan of the abdomen identified a right-sided retroperitoneal mass, suspected to be a hematoma. Within 7 h after admission, the patient experienced significant drops in the hemoglobin level and platelet count. He was administered packed red blood cells, fresh frozen plasma, and platelet transfusions prior to transfer to the Intensive Care Unit. There, he was treated with factor VIII and recombinant factor VIIa, coupled with stringent monitoring. Following clinical and laboratory findings and stabilization, he was discharged with specific medications, and a follow-up appointment was scheduled. CONCLUSIONS Spontaneous retroperitoneal hematoma in patients with hemophilia A is a rare and grave emergency. This case underscores the need for precise diagnostic approaches, tailored management strategies, and vigilant surveillance to prevent and mitigate the potentially life-threatening complications associated with spontaneous hemorrhage in this population.
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Hematoma , Hemofilia A , Humanos , Masculino , Hemofilia A/complicaciones , Adulto , Hematoma/etiología , Espacio Retroperitoneal , Abdomen Agudo/etiología , Factor VIII , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Ligamentum flavum haematoma (LFH) is an extremely rare entity, found mostly in the lumbar and thoracic ligamentum flavum and seldom in the cervical ligamentum flavum. Cervical LFH can cause paralysis in patients. We describe a case of LFH in the cervical spine that accepted surgical treatment. CASE PRESENTATION: A 70-year-old man with incomplete spinal cord injury presented with sudden paralysis of his left limbs for 10 days and hemi-hypaesthesia below the level of the right clavicle. Magnetic resonance imaging (MRI) showed a space-occupying lesion in the left ligamentum flavum between the C4 and C5 laminae. The preliminary diagnoses were concluded to be incomplete spinal cord injury, spinal epidural lesions, and cervical spinal stenosis. After a posterior C3-C6 laminectomy with lateral mass screw instrumentation, the muscle strength and sensation recovered partially. The lesion was greyish black and located in the ligamentum flavum. A pathological examination identified it as a haematoma of the ligamentum flavum. The patient was discharged 15 days after the operation and commenced rehabilitation. DISCUSSION: The LFH was mainly caused by slight trauma during gentle activities and contributed by many factors. MRI is an essential tool but pathological diagnosis is the gold standard. Most LFH patients can be treated surgically.
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Vértebras Cervicales , Hematoma , Ligamento Amarillo , Anciano , Humanos , Masculino , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Hematoma/diagnóstico por imagen , Hematoma/etiología , Hematoma/cirugía , Laminectomía/métodos , Ligamento Amarillo/patología , Ligamento Amarillo/diagnóstico por imagen , Ligamento Amarillo/cirugía , Imagen por Resonancia Magnética , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/diagnóstico por imagen , Traumatismos de la Médula Espinal/cirugíaRESUMEN
BACKGROUND: Decompressive craniectomy (DC) can alleviate increased intracranial pressure in aneurysmal subarachnoid hemorrhage patients with concomitant space-occupying intracerebral hemorrhage, but also carries a high risk for complications. We studied outcomes and complications of DC at time of ruptured aneurysm repair. METHODS: Of 47 patients treated between 2010 and 2020, 30 underwent DC during aneurysm repair and hematoma evacuation and 17 did not. We calculated odds ratios (OR) for delayed cerebral ischemia (DCI), angiographic vasospasm, DCI-related infarction, and unfavorable functional outcome (extended Glasgow Outcome Scale 1-5) at three months. Complication rates after DC and cranioplasty in the aneurysmal subarachnoid hemorrhage patients were compared to those of all 107 patients undergoing DC for malignant cerebral infarction during the same period. RESULTS: In DC versus no DC patients, proportions were for clinical DCI 37% versus 53% (OR = 0.5;95%CI:0.2-1.8), angiographic vasospasm 37% versus 47% (OR = 0.7;95%CI:0.2-2.2), DCI-related infarctions 17% versus 47% (OR = 0.2;95%CI:0.1-0.7) and unfavorable outcome 80% versus 88% (OR = 0.5;95%CI:0.1-3.0). ORs were similar after adjustment for baseline predictors for outcome. Complications related to DC and cranioplasty occurred in 18 (51%) of subarachnoid hemorrhage patients and 41 (38%) of cerebral infarction patients (OR = 1.7;95%CI:0.8-3.7). CONCLUSIONS: In patients with aneurysmal subarachnoid hemorrhage and concomitant space-occupying intracerebral hemorrhage, early DC was not associated with improved functional outcomes, but with a reduced rate of DCI-related infarctions. This potential benefit has to be weighed against high complication rates of DC in subarachnoid hemorrhage patients.
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Craniectomía Descompresiva , Hemorragia Subaracnoidea , Humanos , Craniectomía Descompresiva/métodos , Craniectomía Descompresiva/efectos adversos , Hemorragia Subaracnoidea/cirugía , Hemorragia Subaracnoidea/complicaciones , Masculino , Persona de Mediana Edad , Femenino , Anciano , Adulto , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Hemorragia Cerebral/cirugía , Hemorragia Cerebral/etiología , Hematoma/cirugía , Hematoma/etiología , Aneurisma Roto/cirugía , Aneurisma Roto/complicaciones , Estudios Retrospectivos , Aneurisma Intracraneal/cirugía , Aneurisma Intracraneal/complicacionesRESUMEN
We present a case of atraumatic splenic rupture secondary to Epstein-Barr virus (EBV) infection in a woman in her early 50s. The patient initially presented with sepsis secondary to pneumonia but then developed abdominal pain and distension. CT revealed splenic rupture with a significant perisplenic hematoma. Laboratory tests confirmed an EBV infection. Owing to frailty, she underwent fluoroscopy-guided splenic artery embolisation. This case highlights the rare risk of splenic rupture following EBV infection, even in the absence of typical symptoms of infectious mononucleosis.
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Embolización Terapéutica , Infecciones por Virus de Epstein-Barr , Rotura del Bazo , Humanos , Femenino , Rotura del Bazo/etiología , Rotura del Bazo/diagnóstico por imagen , Rotura del Bazo/virología , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/diagnóstico , Persona de Mediana Edad , Rotura Espontánea , Embolización Terapéutica/métodos , Tomografía Computarizada por Rayos X , Hematoma/diagnóstico por imagen , Hematoma/etiología , Hematoma/virología , Arteria Esplénica/diagnóstico por imagen , Dolor Abdominal/etiologíaRESUMEN
BACKGROUND: Pocket hematoma is the most prevalent complication with cardiac implantable electronic devices (CIEDs), especially in patients who are undergoing oral anticoagulation and/or antiplatelet therapy. OBJECTIVE: To evaluate the efficacy of hypothermic compression bandaging versus conventional compression bandaging for the prevention of surgical wound hematoma of CIEDs in patients who are undergoing chronic anticoagulant drug use and/or antiplatelet therapy. METHODS: This was a single-center randomized prospective study. The intervention group received a hypothermic compression bandage, and the control group received a conventional compression bandage. The primary endpoint was the appearance of hematoma 10 days after the intervention. RESULTS: A total of 310 patients participated in the study. The mean age of the participants was 73.77 ± 10.68 years, and 74.8% were men. In the intervention group, 5.88% (n = 18) of patients developed ecchymosis, and 1.3% (n = 4) developed mild hematoma. In the control group, 5.88% (n = 18) of patients developed ecchymosis, and 2.9% (n = 9) developed mild hematoma. No patient in either group had a severe hematoma. No significant differences were observed between the two types of dressing in any of the three degrees of hematoma. CONCLUSIONS: This study demonstrated that compression bandaging with or without hypothermic therapy effectively prevents pocket hematoma of CIEDs in patients at high risk of bleeding.
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Vendajes de Compresión , Humanos , Masculino , Femenino , Anciano , Estudios Prospectivos , Persona de Mediana Edad , Hematoma/prevención & control , Hematoma/etiología , Anciano de 80 o más Años , Herida Quirúrgica/terapia , Herida Quirúrgica/complicaciones , Hipotermia Inducida/métodos , Hipotermia Inducida/instrumentación , Hipotermia Inducida/efectos adversos , Desfibriladores Implantables/efectos adversos , Marcapaso Artificial/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: In this article we describe an underexposed cause of subgaleal hematoma in the older child. Subgaleal hematomas are well-known in the context of trauma or blood clotting disorders. International literature acknowledges excessive force during hair styling as a possible cause. Here, we present two cases to illustrate the importance of a complete patient work-up. CASE DESCRIPTION: Recently, two patients presented themselves at Juliana Children's Hospital, the Hague, the Netherlands, with a swelling on the head and headache with no obvious cause. Radiological imaging showed subgaleal hematomas. Upon questioning, both patients mentioned using extensive traction while styling their hair. CONCLUSION: In conclusion, when analysing an older child with a swelling on the head with no obvious cause, consider the diagnoses subgaleal hematoma due to hair traction. It might be helpful to observe them styling their hair. A proper clinical review can therefore prevent over-testing and overtreatment.
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Cabello , Hematoma , Humanos , Hematoma/etiología , Hematoma/diagnóstico , Masculino , Niño , Femenino , Tracción/efectos adversos , Cuero CabelludoRESUMEN
RATIONALE: Complications associated with breast implants pose a significant obstacle to improving the quality of life for patients undergoing implant-based breast reconstruction. Due to the intricate nature of their presentation, diagnosis often becomes challenging and perplexing. Herein, we present a case report detailing the diagnostic and therapeutic processes employed in managing implant-related complications in a patient with multiple malignancies who underwent immediate breast reconstruction following mastectomy. PATENT CONCERNS: The patient, a 48-year-old woman, presented with severe pain and hardening in her left breast. She had previously undergone nipple-sparing mastectomy followed by immediate implant-based breast reconstruction 3 years ago. DIAGNOSES: Upon admission, we suspected a simple diagnosis of capsular contracture. However, upon investigation, she had a medical history of colon cancer, breast cancer, and acute B-lymphoblastic leukemia. Furthermore, she recently experienced nipple hemorrhage. INTERVENTIONS: Considering her clinical manifestations, we postulated the possibility of tumor recurrence along with potential presence of breast implant-associated anaplastic large cell lymphoma. The situation took a new turn, as diagnostic imaging techniques including breast MRI, and ultrasound revealed indications of potential prosthesis rupture and periprosthetic infection. OUTCOMES: Ultimately, en bloc capsulectomy with implant removal was performed, revealing no evidence of implant rupture or infection but rather indicating delayed hematoma formation. LESSONS: An accurate diagnosis of complications associated with breast prosthesis reconstruction is crucial for effective treatment. The examination and treatment processes employed in this case offer valuable insights toward achieving a more precise diagnosis of prosthesis-related complications, particularly in patients with complex medical histories.
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Implantes de Mama , Neoplasias de la Mama , Hematoma , Recurrencia Local de Neoplasia , Humanos , Femenino , Persona de Mediana Edad , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/cirugía , Implantes de Mama/efectos adversos , Hematoma/etiología , Hematoma/cirugía , Mastectomía/efectos adversos , Contractura Capsular en Implantes/etiología , Contractura Capsular en Implantes/cirugía , Mamoplastia/efectos adversos , Mamoplastia/métodosRESUMEN
OBJECTIVE: Hematomas of the liver graft, that is, postintervention, subcapsular or intrahepatic are rare yet potentially fatal complications following liver transplantation (LT), necessitating immediate diagnosis and management to avert devastating outcomes. This study was aimed to introduce our approach to manage graft hematoma subsequent to LT. METHODS: Among 131 orthotopic liver transplantations (OLT) conducted at our institution between January 2017 and May 2023, 3 cases of intrahepatic (n = 2) and extrahepatic (n = 1) hematoma were confirmed through computed tomography (CT) within 10 days after LT. The clinical outcomes of various treatment modalities for these three cases were analyzed. RESULTS: Three out of 131 (2.3%) LT recipients developed graft hematoma. Patient 1 developed a spontaneous intrahepatic hematoma, without evident predisposing factors, while patient 2 developed an intrahepatic hematoma following endoscopic retrograde cholangiopancreatography (ERCP). The third case that is extrahepatic hematoma was speculated to be a result of minor hepatic parenchymal injury stemming from compressive and volume-reducing manipulation of a large graft, or secondary to focal ischemic necrosis of the liver. Our management protocol was summarized as follows: (1). Immediate ultrasound and CT, particularly enhanced CT; (2). Puncture and percutaneous drainage (PD) of the hematoma; (3). Arterial embolization if the origin could be identified as a ruptured vessel; (4). Surgical evacuation of the hematoma in the presence of bile leakage, to avoid a compartment respectably secondary infection. All three patients responded favorably to treatment and remained alive to date. CONCLUSION: Prompt diagnosis and sequential individualized management can successfully deal with intra-/extrahepatic graft hematoma after LT. Our results underscored that an individualized management considering potential future complications into account.
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Hematoma , Trasplante de Hígado , Humanos , Trasplante de Hígado/efectos adversos , Hematoma/etiología , Hematoma/terapia , Masculino , Persona de Mediana Edad , Femenino , Tomografía Computarizada por Rayos X , Complicaciones Posoperatorias/terapia , Adulto , Hepatopatías/cirugía , Embolización TerapéuticaRESUMEN
OBJECTIVES: To analyze our patient's complication profile and rate after removal of hardware (ROH) surgery, and survey our patients to ask their overall status and improvement in symptomatology post-operatively. DESIGN: Retrospective chart review and survey. SETTING: Academic, tertiary referral center. PATIENTS/PARTICIPANTS: 173 patients with 314 pieces of hardware. Seventy-six patients (43.9%) responded to our survey. INTERVENTION: ROH surgery. MAIN OUTCOME MEASUREMENTS: Patient demographics and complications were recorded. All patients were sent a brief 3-question survey which asked: (1) Why did you get your hardware removed? (2) How did your overall status change after ROH? (3) How did the ROH affect your stiffness, pain, swelling, and mobility? RESULTS: There were 10 complications (5.5%): 5 infections, 2 with unresolved pain, 1 hematoma, 1 chronic regional pain syndrome exacerbation, and 1 recurrent deformity. All infections were treated with oral antibiotics and improved. All other complications resolved with treatment except for the patient who developed recurrent deformity. Patients underwent ROH surgery because their doctor suggested it (76.3%) and to improve mobility (39.5%). 86.9% reported their overall status improved after ROH. They improved regarding stiffness (73.7%), pain (73.6%), swelling (61.8%), and mobility (76.3%). Similar results were seen among different implants removed. CONCLUSIONS: The majority of patients who underwent percutaneous ROH were satisfied. They reported improvement in stiffness, pain, swelling and mobility (greatest improvement). The complication rate was low (5.5%). ROH can be a meaningful operation to patients allowing them to improve their quality of life with a low complication rate. LEVEL OF EVIDENCE: Level IV.
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Remoción de Dispositivos , Humanos , Remoción de Dispositivos/efectos adversos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Complicaciones Posoperatorias/etiología , Hematoma/etiología , Satisfacción del Paciente , Anciano de 80 o más Años , Adulto JovenRESUMEN
BACKGROUND: Trans-radial (TRA) access has become increasingly prevalent in neurointervention. Nonetheless, mediastinal hematoma after TRA is an infrequent yet grave complication associated with a notably elevated mortality rate. While our review found no reported mediastinal hematoma cases managed conservatively within neuro-interventional literature, similar complications are documented in cardiac and vascular interventional radiology, indicating its potential occurrence across disciplines. CASE PRESENTATION: Carotid computed tomography angiography (CTA) showed calcified plaques with stenosis (Left: Severe, Right: Moderate) in the bilateral internal carotid arteries (ICAs) of an 81-year-old male presented with paroxysmal weakness in the right upper limb. Dual antiplatelet therapy with aspirin and clopidogrel was administered. On day 7, DSA of the bilateral ICAs was performed via TRA. Post-DSA, the patient experienced transient loss of consciousness, chest tightness, and other symptoms without ECG or MRI abnormalities. Hemoglobin level decreased from 110 g/L to 92 g/L. Iodinated contrast-induced laryngeal edema was suspected, and the patient was treated with intravenous methylprednisolone. Neck CT indicated a possible mediastinal hemorrhage, which chest CTA confirmed. The patient's treatment plan involved discontinuing antiplatelet medication as a precautionary measure against the potential occurrence of an ischemic stroke instead of the utilization of a covered stent graft and surgical intervention. Serial CTs revealed hematoma absorption. Discharge CT showed a reduced hematoma volume of 35 × 45 mm. CONCLUSIONS: This case underscores the need for timely identification and precise manipulation of guidewires and guide-catheters through trans-radial access. The critical components of successful neuro-interventional techniques include timely examination, rapid identification, proper therapy, and diligent monitoring.
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Hematoma , Humanos , Masculino , Anciano de 80 o más Años , Hematoma/diagnóstico por imagen , Hematoma/etiología , Angiografía Cerebral/efectos adversos , Angiografía Cerebral/métodos , Enfermedades del Mediastino/diagnóstico por imagen , Enfermedades del Mediastino/etiología , Arteria Radial/diagnóstico por imagen , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Estenosis Carotídea/diagnóstico por imagenRESUMEN
BACKGROUND: Radial artery access for coronary angiography or percutaneous coronary intervention (PCI) reduces the risk of death, bleeding, and vascular complications and is preferred over femoral artery access, leading to a class 1 indication by clinical practice guidelines. However, alternate upper extremity access such as distal radial and ulnar access are not mentioned in the guidelines despite randomized trials. We aimed to evaluate procedural outcomes with femoral, radial, distal radial, and ulnar access sites in patients undergoing coronary angiography or PCI. METHODS: PubMed, EMBASE, and clinicaltrials.gov databases were searched for randomized clinical trials that compared at least 2 of the 4 access sites in patients undergoing PCI or angiography. Primary outcomes were major bleeding and access site hematoma. Intention-to-treat mixed treatment comparison meta-analysis was performed. RESULTS: From 47 randomized clinical trials that randomized 38â 924 patients undergoing coronary angiography or PCI, when compared with femoral access, there was a lower risk of major bleeding with radial access (odds ratio [OR], 0.46 [95% CI, 0.35-0.59]) and lower risk of access site hematoma with radial (OR, 0.34 [95% CI, 0.24-0.48]), distal radial (OR, 0.33 [95% CI, 0.20-0.56]), and ulnar (OR, 0.50 [95% CI, 0.31-0.83]) access. However, when compared with radial access, there was higher risk of hematoma with ulnar access (OR, 1.48 [95% CI, 1.03-2.14]). CONCLUSIONS: Data from randomized trials support guideline recommendation of class 1 for the preference of radial access over femoral access in patients undergoing coronary angiography or PCI. Moreover, distal radial and ulnar access can be considered as a default secondary access site before considering femoral access. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: 42024512365.
Asunto(s)
Cateterismo Periférico , Angiografía Coronaria , Arteria Femoral , Hemorragia , Intervención Coronaria Percutánea , Arteria Radial , Ensayos Clínicos Controlados Aleatorios como Asunto , Arteria Cubital , Humanos , Arteria Radial/diagnóstico por imagen , Angiografía Coronaria/efectos adversos , Arteria Femoral/diagnóstico por imagen , Cateterismo Periférico/efectos adversos , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Arteria Cubital/diagnóstico por imagen , Resultado del Tratamiento , Factores de Riesgo , Punciones , Hematoma/etiología , Masculino , Femenino , Metaanálisis en Red , Persona de Mediana Edad , Anciano , Oportunidad Relativa , Medición de Riesgo , Cateterismo Cardíaco/efectos adversosRESUMEN
OBJECTIVE: To compare different types of genioplasty techniques (chin advancement, rotation and advancement, setback, and reduction) in terms of neurosensory deficit and haematoma formation. STUDY DESIGN: Comparative analytical study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from January 2022 to April 2023. METHODOLOGY: Patients requiring genioplasty and fulfilling the inclusion criteria i.e. both genders aged 16-60 years were included and divided into 4 groups according to the type of genioplasty performed. Genioplasty was planned as per the ortho treatment plan and performed under general anaesthesia. Setback genioplasty was performed on 8 patients, advancement genioplasty on 11 patients, reduction genioplasty on 3, and advancement with rotation genioplasty on 16 patients. Postoperatively neurosensory deficit was recorded on follow-up after 1 month by subjective and objective assessments, and haematoma formation was assessed clinically on the 7th day after the procedure. RESULTS: Advancement with rotation genioplasty showed the highest frequency of neurosensory deficit (almost 50%) and reduction type genioplasty showed the least frequency of neurosensory deficit (<1%, p = 0.49). The frequency of haematoma formation was maximum in the advancement with rotation genioplasty (62.5%) and minimum in equal setback genioplasty (25%, p = 0.61). CONCLUSION: Advancement with rotation genioplasty had the highest rate of postoperative neurosensory deficit and haematoma formation when compared with other techniques of genioplasty. KEY WORDS: Genioplasty, Neurosensory deficit, Haematoma, Advancement with rotation genioplasty, Setback genioplasty.