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Chang Gung Med J. 2002 Mar;25(3):183-9.
Unusual bleeding of aneurysmal bone cyst in the upper thoracic spine.
Chen SH, Huang TJ, Hsueh S, Lee YY, Hsu RW.
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Aneurysmal bone cyst (ABC) is a benign bone lesion and commonly affects young adolescents. It usually grows rapidly with hypervascularity. In the spine, it can cause extensive bone destruction and compress neural structures with eventual vertebral collapse. Operative management of such a lesion may be complicated by profuse hemorrhage. Herein, we report a 15-year-old boy who had an acute exacerbation of spinal cord compression because of an ABC in the upper thoracic region. With a two-staged operation that complicating with profuse intraoperative bleeding, decompressive curettage and stabilization of the vertebral column were assured. However, abrupt neurologic deterioration occurred because of rebleeding with spinal cord compression 1 month postoperatively. Secondary decompressive curettage and following local radiotherapy were undertaken to cure the disease. Neurological recovery and healing of spinal ABC could be expected if the lining of a cyst had been totally removed. At the 18-month follow-up examination, he was neurologically intact and without any backache, leg pain or gait disturbance.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12022739&dopt=Abstract hemorrhage
Ann Thorac Cardiovasc Surg. 2002 Aug;8(4):220-3.
Delayed sternal closure is a life saving decision.
Shalabi RI, Amin M, Ayed AK, Shuhiber H.
Department of Cardiothoracic Surgery, Chest Disease Hospital, Kuwait Univerisity.
Nineteen hundred and fifty open heart operations were performed between January 1995 and December 2000 at the cardiac surgery department of Chest Disease Hospital in Kuwait. Sternal closure was delayed in 40 patients (2%), because of hemodynamic instability limiting primary closure in 23 patients and uncontrollable bleeding in 17 patients. Four patients died in the immediate postoperative period while the chest was open, due to persistent low cardiac output secondary to myocardial failure. The sternum was closed in 36 patients on an average of 22 +/- 0.3 hours (range, 8 to 48 hours) postoperatively. Two patients died in the late postoperative period prior to hospital discharge after sternal closure. Wound infections occurred in 8 patients. The 34 survivors (85%) were discharged and followed up for a mean of 13.2 months. This study demonstrates that delayed sternal closure is an effective and life saving decision with unstable hemodynamics and uncontrollable hemorrhage.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12472386&dopt=Abstract hemorrhage
Shock. 2002 May;17(5):377-82.
Lower dose of hypertonic saline dextran reduces the risk of lethal rebleeding in uncontrolled hemorrhage.
Riddez L, Drobin D, Sjostrand F, Svensen C, Hahn RG.
Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
To challenge whether the recommended dose of 4 mL/kg of 7.5% sodium chloride in 6% Dextran (HSD) is optimal for fluid resuscitation in uncontrolled hemorrhage, 30 anesthetized pigs were randomized to receive a 5-min intravenous infusion of either 1, 2, or 4 mL/kg of HSD beginning 10 min after inducing a 5-mm laceration in the infrarenal aorta. In addition to conventional hemodynamic monitoring, the blood loss was calculated as the difference in blood flow rates between flow probes placed proximal and distal to the injury. The results show that the bleeding stopped between 3 and 4 min after the injury and amounted to 338+/-92 mL (mean +/- SEM), which corresponds to 28.5%+/-6.6% of the estimated blood volume. After treatment with HSD was started, six rebleeding events occurred in the 1-mL group, 11 in the 2-mL group, and 16 in the 4-mL group. The amount of blood lost due to rebleeding increased significantly with the dose of HSD and was also associated with a fatal outcome. The total blood loss was 408 mL in the survivors and 630 mL in the nonsurvivors (median, P < 0.007). The mortality in the three groups was 20%, 50%, and 50%, respectively. In conclusion, infusing 4 mL/kg of HSD after uncontrolled aortic hemorrhage promoted rebleeding and increased the mortality, while a dose of 1 mL/kg appeared to be more suitable.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12022757&dopt=Abstract hemorrhage
Shock. 2002 May;17(5):416-22.
Inducible nitric oxide synthase-deficient mice exhibit resistance to the acute pancreatitis induced by cerulein.
Cuzzocrea S, Mazzon E, Dugo L, Serraino I, Centorrino T, Ciccolo A, Van de Loo FA, Britti D, Caputi AP, Thiemermann C.
Institute of Pharmacology, School of Medicine, University of Messina, Torre Biologica, Gazzi, Italy.
Oxidative stress plays an important role in the early stage of acute pancreatitis as well as the associated multiple organ injury. Here we compare the degree of pancreatitis caused by cerulein in mice lacking the inducible (or type 2) nitric oxide synthase (iNOS) and in the corresponding wild-type mice. Intraperitoneal injection of cerulein resulted in wild-type mice in a severe, acute pancreatitis, which was characterized by edema, neutrophil infiltration, tissue hemorrhage and cell necrosis as well as increases in the serum levels of amylase and/or lipase. The infiltration of the pancreatic tissue of these animals with neutrophils (measured as increase in myeloperoxidase activity) was associated with up-regulation/expression of the adhesion molecules ICAM-1 and P-selectin as well as signs of enhanced lipid peroxidation (e.g., increased tissue levels of malondialdehyde). Immunohistochemical examination demonstrated a marked increase in the staining (immunoreactivity) for nitrotyrosine and poly (ADP-ribose) synthetase (PARS) in the pancreas of cerulein-treated iNOS wild-type mice. In contrast, the degree of pancreatic inflammation and tissue injury (histological score), upregulation/expression of P-selectin and ICAM-1, the staining for nitrotyrosine and PARS, and lipid peroxidation was markedly reduced in pancreatic tissue sections obtained from cerulein-treated iNOS-deficient mice. These findings support the view that iNOS plays an important, pro-inflammatory role in the acute pancreatitis caused by cerulein in mice.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12022764&dopt=Abstract hemorrhage
Surg Endosc. 2002 Aug;16(8):1242-3. Epub 2002 May 23.
Laparoscopic resection of an accessory spleen in a patient with chronic lower abdominal pain.
Wacha M, Danis J, Wayand W.
Second Surgical Department and Ludwig Boltzmann Institute for Surgical Laparoscopy at the General Hospital of Linz, Krankenhausstrasse 9, A-4020 Linz, Austria.
During a diagnostic laparoscopy in a patient with chronic lower abdominal pain we found a pediculated accessory spleen (AS) near the left adnex. The pedicle was dissected by ultrascision, it was cut by an Endo GIA, and the AS was extracted. AS occurs in 25-40% of the population. They are always situated on the left side: hilum of the spleen, splenic artery, pancreas, splenocolic ligament, greater omentum, mesenterium, adnexal region, and scrotum. In most cases they are asymptomatic. In hematological disorders they can take over the function of the original spleen after splenectomy. Sometimes, AS can mimic tumors in other organs, such as pancreas, kidney, or liver. Likewise, there are descriptions of AS in the scrotum, the spermatic cord, the adnexes, the uterus, the stomach, the small intestine, or the heart. In rare cases they can cause pain because of cysts, abscesses, hemorrhage, or spontaneous rupture. In acute pedicle torsion an infarction can be caused presenting as acute abdomen, which is most often seen in young patients. In our case the pain was caused by pedicle torsions or mechanical irritation of the adnex. The cause of the changing localization of the pain was the long pedicle. In describing this case, we point out the advantage of diagnostic laparoscopy in patients with chronic lower abdominal pain.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12023724&dopt=Abstract hemorrhage
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