The HELLP syndrome: clinical issues and surgical management. A Case Experience.

AIM: This study aims to challenge the current know-how in patients with spontaneous rupture of a liver hematoma, to differentiate amongst patients requiring such specific surgical therapy and avoiding mistakes during surgical operations, in order to terminate pregnancy with beneficial effects on the mother and fetus. MATERIALS AND METHODS: In a emergency scenario we admitted a 37-year-old woman at 35+4 weeks of gestation for emergency cesarean section after the onset of right hypochondrium pain. A diagnosis of hemoperitoneum and severe preeclampsia with liver and splenic bleeding was done and managed with packing of hepatic and splenic hematomas and according to her haemo-dynamic clinical conditions, done in different time. RESULTS: A diagnosis of hemoperitoneum and severe pre-eclampsia with liver and splenic bleeding was done and managed it with 3 xypho-pubic-laparatomy in different time with haemostatic packing. DISCUSSION: In this case report, the patient underwent an emergency caesarean section and was managed with packing of hepatic and splenic hematomas and according to her haemodynamic clinical conditions was operated in different time. The choice of laparotomy and hepatic packing has proved to be a viable option in patients with unstable vital signs and is feasible even in limited resource settings. CONCLUSION: Short interval between diagnosis and management may enhance the feto-maternal survival rate and prevent further morbidity or mortality. The choice of laparotomy and hepatic packing has proved to be a viable option in patients with unstable vital signs and is feasible even in limited resource settings. KEY WORDS: HELLP syndrome, Liver hematoma rupture, Packing.

Intermittent pneumatic compression in laparoscopic surgery for prevention of deep vein thrombosis and cellular damage from iatrogenic compartment syndrome.

AIM: This study is aimed to evaluate the incidence of the postoperative deep vein thrombosis (DVT) and the cell damage from compartment iatrogenic syndrome, analyzing two groups of patients operated laparoscopically, one of which assisted with a Sequential Compression Device (SCD). MATERIAL OF STUDY: A patients' series submitted to laparoscopic surgery over a period at least 90 minutes. The venous flow in the lower limbs was detected with the Echo Colour Doppler method, and only one of the two groups was assisted with the SCD. RESULTS: Between November 2006 and October 2007, 35 patients were evaluated, 21 of them wew assisted with SDC and the remaining 14 patients were the control group. All patients had a follow-up was extended for 5 years at the interval of 7 days, 14 days, 30 days, 3 and 5 years. DISCUSSION: The results were confirmed that the application of SCD is able to neutralize the negative effect of the PNP reducing the possible risk of thromboembolic venous stasis and the improvement of lactic acid and of myoglobinemia are attributable to a reduction of preload. With the use of IPC, it decreases venous stasis, improves venous return and cardiac output increases, preventing cell damage by hypoperfusion. CONCLUSIONS: The use of a SCD applied to the lower limbs allows an increase in venous return from the lower limbs so reducing the risk of DVT. KEY WORDS: Cellular damage, DVT, Pneumoperitoneum.