Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.991
Filtrar
1.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1110-1114, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874524

RESUMO

Carbon dioxide embolization is a special complication of laparoscopic colorectal surgery. It is rarely reported in conventional laparoscopic colorectal surgery, and has not been well recognized by surgeons. Transanal total mesorectal excision (taTME) is an increasingly popular sphincter-preserving surgery for low rectal cancer in recent years. Although the number of cases worldwide is not large, carbon dioxide embolization after operation has been reported successively. Once serious carbon dioxide embolization occurs, the mortality is extremely high. The main related factors of carbon dioxide embolization in taTME include high pressure of pneumoperitoneum, narrow space, abundant blood supply of prostate and vaginal wall, Trendelenburg position, etc. The key of prevention and treatment is to pay attention to the control of related risk factors, identify the early signs of carbon dioxide embolism, and take active and effective symptomatic treatment. Reducing the pressure of pneumoperitoneum perfusion can reduce the occurrence of CO2 embolism. Transesophageal echocardiography is the most sensitive way to monitor intravenously CO2, but it is difficult to carry out in clinical practice. The sudden decrease of end expiratory CO2 partial pressure is an important sign of early detection of CO2 embolism. If there is a suspicious lacuna in the operation, it is possible to reduce or stop the pneumoperitoneum when it is unable to distinguish between normal tissue gap or vascular lumen. If the "bubble sign" is observed, CO2 may enter the vein. The risk of venous embolism should be considered.


Assuntos
Dióxido de Carbono/efeitos adversos , Embolia Aérea/prevenção & controle , Laparoscopia/efeitos adversos , Neoplasias Retais/cirurgia , Cirurgia Endoscópica Transanal/efeitos adversos , Canal Anal/cirurgia , Embolia Aérea/etiologia , Embolia Aérea/terapia , Feminino , Humanos , Masculino , Mesentério/cirurgia , Reto/cirurgia
2.
Undersea Hyperb Med ; 46(5): 633-634, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683361

RESUMO

A 54-year-old man suffered a leg cramp while diving in the ocean at a depth of 20 meters. He began to surface, with his ascent based on a decompression table. He lost consciousness at the surface and was rescued by a nearby boat. The boat staff judged him to be in cardiac arrest, so they performed chest compressions. When the boat reached port where an ambulance was waiting, emergency medical technicians confirmed that the patient was in cardiac arrest; his initial rhythm was asystole. Treated with basic life support, the patient was then transported to a rendezvous point, where a physician-staffed helicopter waited. The patient remained in cardiac arrest, so the staff of the helicopter performed tracheal intubation with mechanical ventilation, securing a venous route, infusion of adrenaline, and mechanical chest compression. On arrival at our hospital 100 minutes after collapse, he remained in cardiac arrest. Continued advanced cardiac life support failed to obtain spontaneous circulation. Whole-body computed tomography (CT) at 120 minutes after the collapse showed multiple gas bubbles in the heart, aorta, inferior vena cava, cerebral artery, coronary artery and portal vein with lung edema. This is the first case to show gas in the bilateral coronary arteries on CT. The present case clearly demonstrates that decompression sickness can also induce acute coronary syndrome.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Doença da Descompressão/complicações , Embolia Aérea/diagnóstico por imagem , Síndrome Coronariana Aguda/etiologia , Aorta/diagnóstico por imagem , Reanimação Cardiopulmonar/métodos , Mergulho/efeitos adversos , Embolia Aérea/etiologia , Evolução Fatal , Coração/diagnóstico por imagem , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
3.
Undersea Hyperb Med ; 46(5): 673-683, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683367

RESUMO

Gas can enter arteries (arterial gas embolism, AGE) due to alveolar-capillary disruption (caused by pulmonary over-pressurization, e.g. breath-hold ascent by divers) or veins (venous gas embolism, VGE) as a result of tissue bubble formation due to decompression (diving, altitude exposure) or during certain surgical procedures where capillary hydrostatic pressure at the incision site is subatmospheric. Both AGE and VGE can be caused by iatrogenic gas injection. AGE usually produces stroke-like manifestations, such as impaired consciousness, confusion, seizures and focal neurological deficits. Small amounts of VGE are often tolerated due to filtration by pulmonary capillaries; however VGE can cause pulmonary edema, cardiac "vapor lock" and AGE due to transpulmonary passage or right-to-left shunt through a patient foramen ovale. Intravascular gas can cause arterial obstruction or endothelial damage and secondary vasospasm and capillary leak. Vascular gas is frequently not visible with radiographic imaging, which should not be used to exclude the diagnosis of AGE. Isolated VGE usually requires no treatment; AGE treatment is similar to decompression sickness (DCS), with first aid oxygen then hyperbaric oxygen. Although cerebral AGE (CAGE) often causes intracranial hypertension, animal studies have failed to demonstrate a benefit of induced hypocapnia. An evidence based review of adjunctive therapies is presented.


Assuntos
Embolia Aérea/terapia , Oxigenação Hiperbárica/métodos , Algoritmos , Altitude , Artérias , Pressão Atmosférica , Descompressão/efeitos adversos , Doença da Descompressão/complicações , Mergulho/efeitos adversos , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Forame Oval Patente/complicações , Humanos , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Posicionamento do Paciente/métodos , Veias
4.
Medicine (Baltimore) ; 98(45): e17940, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702683

RESUMO

Venous air embolism (VAE) can be observed in the right heart system on contrast-enhanced computed tomography (CT), following injection of contrast media with a power injector system. Although most VAEs are mostly asymptomatic, they may result in paradoxical air embolism (PAE).To evaluate whether the incidence of VAE on coronary CT angiography is associated with the process of preparation of the intravenous access route.We retrospectively evaluated 692 coronary CT examinations at 3 institutions. Trained CT nurses placed an intravenous cannula in the forearm. Tubes connected to the cannula were prepared in the following ways: A, using an interposed three-way cock and a 20-mL syringe filled with normal saline to collect air contamination in the tube; B, through direct connection to the power injector system without the interposed 3-way cock; and C, using an interposed three-way cock and a 100-mL normal saline drip infusion bottle system to keep the tube patent. The incidence and location of VAE and preparation of intravenous injection were assessed.The overall incidence of VAE was 55.3% (383/692), most frequently observed in the right atrium (81.5%, 312/383). Its incidence varied significantly across the 3 techniques (A: 21.6% (35/162), B: 63.2% (237/375) and C: 71.6% (111/155); P < .001). No patient demonstrated any symptom associated with VAE.Using a 3-way cock with syringe demonstrated the lowest incidence of VAE on coronary CT angiography. It is thus recommended to reduce potential complication risks related to intravenous contrast media injection.


Assuntos
Angiografia por Tomografia Computadorizada/efeitos adversos , Embolia Aérea/etiologia , Embolia Paradoxal/etiologia , Átrios do Coração/diagnóstico por imagem , Idoso , Meios de Contraste/administração & dosagem , Embolia Aérea/complicações , Embolia Aérea/epidemiologia , Embolia Paradoxal/epidemiologia , Humanos , Injeções Intravenosas/efeitos adversos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Rev. neurol. (Ed. impr.) ; 69(3): 109-112, 1 ago., 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184023

RESUMO

Introducción. El embolismo arterial gaseoso se define como la presencia de aire en la circulación arterial. Se trata de una causa extremadamente rara de ictus que se ha descrito en multitud de escenarios clínicos, generalmente relacionados con procesos yatrógenos. Se aporta un caso clínico en el que el embolismo arterial gaseoso sucedió tras un traumatismo craneoencefálico, y se revisan los aspectos más relevantes del diagnóstico y la etiopatogenia. Caso clínico. Mujer de 52 años que presentaba herida incisa craneofacial tras una agresión con un hacha. La tomografía computarizada inicial objetivó fractura en los arcos cigomático, esfenoidal y maxilar izquierdos, así como neumoencéfalo en los senos cavernosos y el canal carotídeo derecho. Una hora más tarde, la paciente mostró un déficit neurológico hemisférico derecho, por lo que se solicitó de forma urgente una nueva tomografía computarizada craneal con estudio vascular multimodal, que objetivó la movilización del neumoencéfalo y descartó una oclusión arterial de gran vaso. Un estudio de shunt mediante Doppler transcraneal y ecocardiografía comprobó la presencia de un foramen oval permeable como causa de comunicación arteriovenosa que justificaba un embolismo arterial gaseoso. La tomografía computarizada de control a las 48 horas confirmó la aparición de una lesión isquémica parietal derecha. Conclusión. En este caso queda reflejada la presencia simultánea de aire en la circulación cerebral arterial y venosa y la comunicación periférica a través de un foramen oval permeable. Este mecanismo de producción está escasamente documentado en la bibliografía


Introduction. An arterial gas embolism is defined as the presence of air in the arterial circulation. This is an extremely rare cause of stroke that has been described in a multitude of clinical scenarios, generally related to iatrogenic processes. A clinical case is reported in which the arterial gas embolism occurred after a traumatic brain injury, and the most relevant aspects of diagnosis and aetiopathogenesis are reviewed. Case report. We report the case of a 52-year-old woman with an open craniofacial wound resulting from an attack with an axe. The initial CT scan found fractures in the left zygomatic, sphenoidal and maxillary arches, as well as pneumocephalus in the cavernous sinuses and the right carotid canal. One hour later, the patient showed a neurological deficit in the right hemisphere, and so a new cranial computed tomography scan with multimodal vascular study was urgently requested, which revealed the mobilisation of the pneumocephalus and ruled out a large vessel arterial occlusion. A shunt study using transcranial Doppler and echocardiography showed the presence of a patent foramen ovale to be the cause ofarteriovenous communication that justified an arterial gas embolism. The follow-up CT scan at 48 hours confirmed the appearance of a right parietal ischaemic lesion. Conclusion. This case reflects the simultaneous presence of air in the arterial and venous circulation of the brain, as well as the peripheral communication through a patent foramen ovale. This production mechanism is poorly documented in the literature


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Embolia Aérea/etiologia , Traumatismos Cranianos Penetrantes/complicações , Embolia Aérea/diagnóstico por imagem , Tomografia Computadorizada por Raios X
6.
Eur J Radiol ; 117: 26-32, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31307649

RESUMO

OBJECTIVES: To evaluate the incidence and risk factors of systemic air embolism (SAE) depicted on systematic whole thoracic CT performed after percutaneous lung biopsy. METHODS: A total of 559 CT-guided lung biopsies performed between April 2014 and May 2016 were retrospectively evaluated. SAE was defined by the presence of air in the aorta or left cardiac cavities seen on whole thorax CT images acquired after needle withdrawal. Analyzed data focused on patient (age, sex, spirometry data, emphysema on CT, therapeutics received), target lesion (location, depth, size and feature) and procedure (patient position, length of intrapulmonary needle path, number of pleural passes and of biopsy samples, operator's experience). A regression logistic model was used to identify risk factors of SAE. RESULTS: SAE was observed after 27 of the 559 lung biopsies, corresponding to a radiological incidence of 4.8% (95%CI: 3.3-7.0). Clinical incidence was 0.17% (n = 1). For 21/27 patients (78%), a targeted acquisition in the nodule area would not have included the cardiac cavities meaning SAE would have been missed. On multivariate analysis, the independent risk factors were needle path length through ventilated lung (OR: 1.13, 95%CI: 1.02-1.25, p = 0.024), number of samples (OR: 1.48, 95%CI: 1.01-2.17, p = 0.046) and prone position (OR: 3.12, 95%CI: 1.11-8.31, p = 0.031) or right-sided lateral decubitus (OR: 6.15, 95%CI: 1.66-22.85, p = 0.005). CONCLUSIONS: Asymptomatic systemic air embolism can be depicted in almost 5% of post biopsy CT examinations, when they are not limited to the targeted nodule area but include the entire thorax.


Assuntos
Biópsia por Agulha/efeitos adversos , Embolia Aérea/etiologia , Radiografia Torácica , Tomografia Computadorizada por Raios X , Idoso , Biópsia por Agulha/métodos , Embolia Aérea/terapia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
7.
Gen Thorac Cardiovasc Surg ; 67(10): 823-834, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31290000

RESUMO

Since the beginning of cardiac surgery, retained intracardiac air has been an important problem. While transesophageal echocardiography enabled to visualize the air and de-airing procedures have been routinely done, they appear to vary much among institutions not necessarily based on firm scientific evidence. Thus, "de-airing" was chosen as the theme of 2016 CVSAP (cardiovascular surgery and anesthesia and perfusion) symposium and a nation-wide questionnaire survey was carried out prior to it. This paper reports on its results and illustrate "the best of de-airing" based on literature review. The collection rate of the questionnaire survey was 77.9% (278/357) and 83.3% (85/102) from the major institutions of surgeons and anesthesiologists, respectively. More than 90% of both consider de-airing as important, since adverse events of air embolism were actually encountered including critical ones. Most routinely performed de-airing procedures are posture change, lung inflation and aspiration through the vent cannulae. Direct aspiration is performed in one-third of institutions. Carbon dioxide insufflation is performed in 82.5% of institutions (mostly 2-3 L/min). However, not a few surgeons are skeptical for its significance. While many surgeons are grateful for collaboration by anesthesiologists, some expect more information sharing between them. They also expect that clinical engineers understand "de-airing" better and operate the extracorporeal circulation system appropriately to avoid an occurrence of undesirable event. Some surgeons anticipated a convenient device for de-airing. Furthermore, some questions to be solved in the future were raised, including how meticulously the bubbles should be removed or how efficient carbon dioxide insufflation is.


Assuntos
Dióxido de Carbono/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Embolia Aérea/prevenção & controle , Insuflação/efeitos adversos , Embolia Aérea/etiologia , Humanos
8.
Intern Med ; 58(19): 2857-2859, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31178520

RESUMO

This manuscript describes the first known case of a patient with multiple system atrophy whose parasympathetic dominant disturbance might have been associated with the relative constriction of the superior mesenteric artery, leading to nonocclusive mesenteric ischemia and subsequent portomesenteric venous gas with pneumatosis intestinalis on abdominal computed tomography approaching death.


Assuntos
Embolia Aérea/diagnóstico , Atrofia de Múltiplos Sistemas/complicações , Pneumatose Cistoide Intestinal/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Idoso , Embolia Aérea/etiologia , Evolução Fatal , Humanos , Imagem por Ressonância Magnética , Masculino , Veias Mesentéricas , Atrofia de Múltiplos Sistemas/diagnóstico , Pneumatose Cistoide Intestinal/etiologia , Veia Porta
9.
Dis Colon Rectum ; 62(7): 794-801, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31188179

RESUMO

BACKGROUND: Carbon dioxide embolus has been reported as a rare but clinically important risk associated with transanal total mesorectal excision surgery. To date, there exists limited data describing the incidence, risk factors, and management of carbon dioxide embolus in transanal total mesorectal excision. OBJECTIVE: This study aimed to obtain data from the transanal total mesorectal excision registries to identify trends and potential risk factors for carbon dioxide embolus specific to this surgical technique. DESIGN: Contributors to both the LOREC and OSTRiCh transanal total mesorectal excision registries were invited to report their incidence of carbon dioxide embolus. Case report forms were collected detailing the patient-specific and technical factors of each event. SETTINGS: The study was conducted at the collaborating centers from the international transanal total mesorectal excision registries. MAIN OUTCOME MEASURES: Characteristics and outcomes of patients with carbon dioxide embolus associated with transanal mesorectal excision were measured. RESULTS: Twenty-five cases were reported. The incidence of carbon dioxide embolus during transanal total mesorectal excision is estimated to be ≈0.4% (25/6375 cases). A fall in end tidal carbon dioxide was noted as the initial feature in 22 cases, with 13 (52%) developing signs of hemodynamic compromise. All of the events occurred in the transanal component of dissection, with mean (range) insufflation pressures of 15 mm Hg (12-20 mm Hg). Patients were predominantly (68%) in a Trendelenburg position, between 30° and 45°. Venous bleeding was reported in 20 cases at the time of carbon dioxide embolus, with periprostatic veins documented as the most common site (40%). After carbon dioxide embolus, 84% of cases were completed after hemodynamic stabilization. Two patients required cardiopulmonary resuscitation because of cardiovascular collapse. There were no deaths. LIMITATIONS: This is a retrospective study surveying reported outcomes by surgeons and anesthetists. CONCLUSIONS: Surgeons undertaking transanal total mesorectal excision must be aware of the possibility of carbon dioxide embolus and its potential risk factors, including venous bleeding (wrong plane surgery), high insufflation pressures, and patient positioning. Prompt recognition and management can limit the clinical impact of such events. See Video Abstract at http://links.lww.com/DCR/A961.


Assuntos
Embolia Aérea/etiologia , Hemorragia/complicações , Insuflação/efeitos adversos , Complicações Intraoperatórias/etiologia , Reto/cirurgia , Cirurgia Endoscópica Transanal/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Dióxido de Carbono , Embolia Aérea/diagnóstico , Embolia Aérea/terapia , Feminino , Humanos , Insuflação/métodos , Internacionalidade , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/terapia , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Cuidados Pós-Operatórios , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Veias
10.
Diving Hyperb Med ; 49(2): 141-144, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31177521

RESUMO

Primary lung bullae have been reported to cause pulmonary barotrauma and lead to cerebral arterial gas embolism (CAGE) in the context of diving; however, a lack of symptoms and often minimal radiographic findings often preclude a diagnosis of lung bullae prior to undertaking diving activity. We present the case of a healthy 27-year-old Caucasian male who presented following the second of two introductory resort dives with neurological symptoms attributable to CAGE. Investigations revealed a previously undiagnosed large primary lung bulla. This case highlights the clinical sequelae of primary lung bullae in the context of pulmonary barotrauma related to recreational diving activity.


Assuntos
Barotrauma , Mergulho , Embolia Aérea , Lesão Pulmonar , Adulto , Barotrauma/etiologia , Vesícula , Mergulho/efeitos adversos , Embolia Aérea/etiologia , Humanos , Masculino
12.
Medicine (Baltimore) ; 98(18): e15437, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045810

RESUMO

RATIONALE: Cranial arterial air embolism is a rare but potentially fatal complication after computed tomography (CT)-guided pulmonary interventions. PATIENT CONCERNS: A 64-year-old man was diagnosed with a pulmonary nodule (diameter: approximately 1 cm) in the right lower lobe. The patient developed convulsions after CT-guided hook-wire localization. DIAGNOSIS: Cranial CT revealed arborizing/linearly distributed gas in the territory of the right middle cerebral artery. INTERVENTIONS: The patient was administered hyperbaric oxygen, antiplatelet aggregation therapy, and dehydration treatment. OUTCOMES: Clinical death occurred 55 hours after air embolism. LESSONS: Systemic air embolism is a serious complication of lung puncture. Clinicians should improve their understanding of this complication and remain vigilant against air embolism.


Assuntos
Doenças Arteriais Cerebrais/etiologia , Embolia Aérea/etiologia , Radiografia Intervencionista/efeitos adversos , Nódulo Pulmonar Solitário/cirurgia , Doenças Arteriais Cerebrais/terapia , Embolia Aérea/terapia , Humanos , Oxigenação Hiperbárica/métodos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Radiografia Intervencionista/métodos
13.
Undersea Hyperb Med ; 46(2): 197-202, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31051065

RESUMO

We present the case of a 42-year-old female who was critically ill due to an arterial gas embolism (AGE) she experienced while diving in Maui, Hawaii. She presented with shortness of breath and dizziness shortly after surfacing from a scuba dive and then rapidly lost consciousness. The diver then had a complicated hospital course: persistent hypoxemia (likely secondary to aspiration) requiring intubation; markedly elevated creatine kinase; atrial fibrillation requiring cardioversion; and slow neurologic improvement. She had encountered significant delay in treatment due to lack of availability of local hyperbaric oxygen (HBO2) therapy. Our case illustrates many of the complications that can occur when a patient suffers a severe AGE. These cases may occur even without a history of rapid ascent or risk factors for pulmonary barotrauma, and it is imperative that they be recognized and treated as quickly as possible with HBO2. Unfortunately, our case also highlights the challenges in treating critically ill divers, particularly with the growing shortage of 24/7 hyperbaric chambers able to treat these ICU-level patients.


Assuntos
Mergulho/efeitos adversos , Embolia Aérea/terapia , Oxigenação Hiperbárica , Tempo para o Tratamento , Adulto , Diagnóstico Tardio/efeitos adversos , Embolia Aérea/etiologia , Emergências , Feminino , Humanos , Hipóxia/etiologia , Hipóxia/terapia
14.
Aerosp Med Hum Perform ; 90(6): 524-530, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31101137

RESUMO

INTRODUCTION: The frequency of long-duration, high-altitude missions with fighter aircraft is increasing, which may increase the incidence of decompression sickness (DCS). The aim of the present study was to compare decompression stress during simulated sustained high-altitude flying vs. high-altitude flying interrupted by periods of moderate or marked cabin pressure increase.METHODS: The level of venous gas emboli (VGE) was assessed from cardiac ultrasound images using the 5-degree Eftedal-Brubakk scale. Nitrogen washout/uptake was measured using a closed-circuit rebreather. Eight men were investigated in three conditions: one 80-min continuous exposure to a simulated cabin altitude of A) 24,000 ft, or four 20-min exposures to 24,000 ft interspersed by three 20-min intervals at B) 20,000 ft or C) 900 ft.RESULTS: A and B induced marked and persistent VGE, with peak bubble scores of [median (range)]: A: 2.5 (1-3); B: 3.5 (2-4). Peak VGE score was less in C [1.0 (1-2), P < 0.01]. Condition A exhibited an initially high and exponentially decaying rate of nitrogen washout. In C the washout rate was similar in each period at 24,000 ft, and the nitrogen uptake rate was similar during each 900-ft exposure. B exhibited nitrogen washout during each period at 24,000 ft and the initial period at 20,000 ft, but on average no washout or uptake during the last period at 20,000 ft.DISCUSSION: Intermittent reductions of cabin altitude from 24,000 to 20,000 ft do not appear to alleviate the DCS risk, presumably because the pressure increase is not sufficient to eliminate VGE. The nitrogen washout/uptake rate did not reflect DCS risk in the present exposures.Ånell R, Grönkvist M, Eiken O, Gennser M. Nitrogen washout and venous gas emboli during sustained vs. discontinuous high-altitude exposures. Aerosp Med Hum Perform. 2019; 90(6):524-530.


Assuntos
Medicina Aeroespacial , Altitude , Doença da Descompressão/epidemiologia , Embolia Aérea/epidemiologia , Nitrogênio/sangue , Adulto , Gasometria , Doença da Descompressão/sangue , Doença da Descompressão/etiologia , Embolia Aérea/sangue , Embolia Aérea/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Militares , Pilotos , Fatores de Risco , Fatores de Tempo , Veias
15.
Ulus Travma Acil Cerrahi Derg ; 25(3): 311-315, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31135947

RESUMO

A venous air embolism can occur as a result of circumstances that include blunt head or chest trauma, thoracentesis, arterial catheterization, neurosurgery, cardiac surgery, and Caisson disease. The formation of a venous air embolism requires an air source, interaction between the air source and the vessel, and a pressure gradient supporting air migration into the vessel. Air enters through the impaired venous structure and travels to the right side of the heart and the pulmonary arteries, and depending on the amount of air, may occasionally be fatal. This report is the description of the case of a 3-year-old child who developed a fatal venous and cerebral embolism during neurosurgery for the treatment of skull fractures with epidural and subdural bleeding due to blunt head and chest trauma resulting from a television falling on her. The pathophysiology of death and notes regarding the medico-legal autopsy procedure in such cases are discussed. Meticulous autopsy techniques must be used to determine the presence of an air embolism in cases of blunt trauma, especially in patients with blunt trauma to the head who die during neurosurgery, and possible future malpractice claims should be kept in mind.


Assuntos
Embolia Aérea , Traumatismos Cranianos Fechados , Embolia Intracraniana , Procedimentos Neurocirúrgicos/efeitos adversos , Acidentes , Pré-Escolar , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Evolução Fatal , Feminino , Traumatismos Cranianos Fechados/complicações , Traumatismos Cranianos Fechados/cirurgia , Humanos
16.
Gen Thorac Cardiovasc Surg ; 67(10): 880-883, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30941696

RESUMO

OBJECTIVES: In this study, we aimed to determine conditions associated with the development of air bubbles in the pulmonary veins during lung resection. METHODS: A total of 28 patients who underwent lung resection at our institution between October 2016 and March 2018 were included in the study. An intraoperative transesophageal echocardiography was conducted, and the influx of air bubbles in the orifice of the pulmonary vein leading to the left atrium was observed during lung resection. RESULTS: The median age of all patients was 75 years. The study included 13 men and 15 women. Moreover, seven, 14, and seven patients underwent wedge resection, segmentectomy, and lobectomy, respectively. The presence of air bubbles was observed in 15 patients and was detected when the lung parenchyma was cut (13 patients) or compressed (3 patients) using staplers and when an energy device was used (1 patient). No postoperative organ infarction occurred in any patients. CONCLUSIONS: Although the presence of air bubbles was noted in the pulmonary vein during lung resection via transesophageal echocardiography, the clinical condition of the patients in our study did not deteriorate. The clinical significance of air bubbles is not clear. Therefore, more data about such events must be collected in future.


Assuntos
Ecocardiografia Transesofagiana/métodos , Embolia Aérea/etiologia , Cardiopatias/etiologia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Embolia Aérea/diagnóstico , Feminino , Átrios do Coração , Cardiopatias/diagnóstico , Humanos , Masculino , Tomografia Computadorizada por Raios X
18.
Tidsskr Nor Laegeforen ; 139(4)2019 02 26.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-30808098
19.
Cardiovasc Pathol ; 40: 12-18, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30769235

RESUMO

INTRODUCTION: Iatrogenic embolization following cardiac investigative procedures may result from hydrophilic polymer emboli (HPE) from catheter valve and vessel wall calcifications, and air embolism from open heart surgery. This retrospective clinical pathologic analysis was undertaken to ascertain the frequency and extent of these potentially fatal complications. METHODS: This retrospective clinical pathologic autopsy analysis with premortem diagnostic imaging correlation identified 110 individuals who had undergone endovascular procedures between 2010 and 2016 within 90 days of death and followed by hospital autopsy. Clinical outcomes, radiologic studies, and autopsy materials were reviewed. RESULTS: Iatrogenic emboli were assessed as causing death in 9/110 autopsy cases (8.2%) and 9/34 (26.5%) cases with proven iatrogenic emboli. Iatrogenic emboli caused strokes in 10/110 (9.1%) autopsy cases including calcified emboli (CE, n=6), HPE (n=2), cardiac valvular tissue (n=1), and air embolism (n=1). Seven cases of calcified emboli complicating endovascular procedures were identified: four of the CE were thought to be the cause of death due to fatal strokes (n=2) and fatal myocardial (n=1) and colonic infarction (n=1). The CE likely originated from calcified aortic valves and atherosclerotic aortic plaques. Histologic evidence of HPE was found in 23% (25/110) of cases; 54% (26/48) showed evidence of infarction in postprocedural imaging, with radiologic evidence of infarction in 32% (8/25) of cases with HPE histology. Endovascular aortic repair was associated with the greatest density/distribution of HPE. HPE material showed degradation with time and was often associated with an inflammatory response. HPE directly contributed to death in three cases. One fatal air embolism followed open heart surgery, and one cardiac tissue embolus resulted in a major stroke. CONCLUSIONS: We advocate for greater awareness of these underrecognized and occasionally fatal complications of endovascular procedures. Targeted postprocedural imaging has a role in the identification of iatrogenic embolic infarcts.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Embolia/etiologia , Procedimentos Endovasculares/efeitos adversos , Migração de Corpo Estranho/etiologia , Doença Iatrogênica , Polímeros/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/complicações , Autopsia , Calcinose/complicações , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/mortalidade , Causas de Morte , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Embolia/diagnóstico por imagem , Embolia/mortalidade , Embolia/patologia , Embolia Aérea/etiologia , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/mortalidade , Migração de Corpo Estranho/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
20.
Surg Technol Int ; 34: 340-350, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-30810216

RESUMO

Technological advances in the field of extracorporeal circulation (ECC) over the past decade have led to numerous methods for monitoring metabolism and coagulation during cardiopulmonary bypass (CPB), as well as materials with improved biocompatibility, which has reduced the risk associated with cardiopulmonary bypass. However, ECC is still predominantly based on a traditional design that involves the use of roller pumps. This exposes the patient to a variety of pathophysiological consequences, both intra- and postoperative, such as postoperative cognitive disorders, hemolysis and hemodilution, systemic inflammation and changes in coagulation. This article describes the advantages of an ECC circuit inspired by the Fibonacci Golden Ratio, which does not use a roller pump, in a prospective study on patients undergoing elective cardiac surgery, compared to conventional ECC. During CPB, echocardiography was used to estimate the quality of fluid dynamics in the extracorporeal circuit and the patient's arterial vessels, a DO2 management system was used to evaluate metabolism, and an electronic system was used to determine gaseous microemboli (GME) counts. Fibonacci ECC offered superior intraoperative fluid dynamics, reduced the production of and improved the elimination of GME, and improved intraoperative metabolism, particularly with regard to oxygen delivery and extraction. The improvements in fluid dynamics and metabolic variables were associated with a reduction in the incidence of pathophysiological events compared to the conventional system, particularly regarding transitory cognitive disorders, and a shorter stay in intensive care.


Assuntos
Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/métodos , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/prevenção & controle , Procedimentos Cirúrgicos Eletivos , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/etiologia , Embolia Aérea/prevenção & controle , Desenho de Equipamento , Hemodinâmica , Humanos , Oxigênio/metabolismo , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA