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1.
J Trauma Acute Care Surg ; 88(2): 249-257, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31804414

RESUMO

BACKGROUND: The efficacy of surgical stabilization of rib fracture (SSRF) in patients without flail chest has not been studied specifically. We hypothesized that SSRF improves outcomes among patients with displaced rib fractures in the absence of flail chest. METHODS: Multicenter, prospective, controlled, clinical trial (12 centers) comparing SSRF within 72 hours to medical management. Inclusion criteria were three or more ipsilateral, severely displaced rib fractures without flail chest. The trial involved both randomized and observational arms at patient discretion. The primary outcome was the numeric pain score (NPS) at 2-week follow-up. Narcotic consumption, spirometry, pulmonary function tests, pleural space complications (tube thoracostomy or surgery for retained hemothorax or empyema >24 hours from admission) and both overall and respiratory disability-related quality of life (RD-QoL) were also compared. RESULTS: One hundred ten subjects were enrolled. There were no significant differences between subjects who selected randomization (n = 23) versus observation (n = 87); these groups were combined for all analyses. Of the 110 subjects, 51 (46.4%) underwent SSRF. There were no significant baseline differences between the operative and nonoperative groups. At 2-week follow-up, the NPS was significantly lower in the operative, as compared with the nonoperative group (2.9 vs. 4.5, p < 0.01), and RD-QoL was significantly improved (disability score, 21 vs. 25, p = 0.03). Narcotic consumption also trended toward being lower in the operative, as compared with the nonoperative group (0.5 vs. 1.2 narcotic equivalents, p = 0.05). During the index admission, pleural space complications were significantly lower in the operative, as compared with the nonoperative group (0% vs. 10.2%, p = 0.02). CONCLUSION: In this clinical trial, SSRF performed within 72 hours improved the primary outcome of NPS at 2-week follow-up among patients with three or more displaced fractures in the absence of flail chest. These data support the role of SSRF in patients without flail chest. LEVEL OF EVIDENCE: Therapeutic, level II.


Assuntos
Fixação de Fratura/métodos , Fraturas Múltiplas/cirurgia , Hemotórax/epidemiologia , Dor Pós-Operatória/diagnóstico , Fraturas das Costelas/cirurgia , Adolescente , Adulto , Idoso , Feminino , Fraturas Múltiplas/complicações , Fraturas Múltiplas/diagnóstico , Hemotórax/etiologia , Hemotórax/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/terapia , Estudos Prospectivos , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico , Índices de Gravidade do Trauma , Resultado do Tratamento , Adulto Jovem
2.
Diagn Interv Radiol ; 25(4): 328-330, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31295145

RESUMO

Aortic arch pseudoaneurysms are rare but quite fatal when ruptured. Owing to its less morbidity and mortality compared with the surgical approach, endovascular and hybrid treatment methods are increasingly preferred. In this report, we present a 58-year-old male patient who has a ruptured saccular aortic arch pseudoaneurysm treated by endovascular approach using parallel grafts.


Assuntos
Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Procedimentos Endovasculares/métodos , Falso Aneurisma/complicações , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Aorta Torácica/transplante , Ruptura Aórtica/diagnóstico por imagem , Prótese Vascular , Angiografia por Tomografia Computadorizada/métodos , Hemotórax/diagnóstico por imagem , Hemotórax/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
3.
World Neurosurg ; 130: 157-159, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295587

RESUMO

BACKGROUND: Although vascular abnormality is an uncommon comorbidity of neurofibromatosis type 1 (NF1), it is potentially fatal. We present spontaneous hemothorax caused by rupture of a vertebral artery (VA) aneurysm in a patient with NF1. CASE DESCRIPTION: A 36-year-old man with a history of NF1 was transferred to the emergency department with dyspnea. Chest computed tomography scan revealed hemothorax in the left lung field with mediastinal shifting and aneurysmal dilatation of the left VA at the C6 vertebra level. Immediate drainage of the hematoma by chest tube insertion was performed. Diagnostic angiogram showed a 3- to 4-cm fusiform aneurysm of the VA. After the angiogram, cardiopulmonary arrest occurred after a rebleed of the VA aneurysm. The aneurysmal segment of the VA was urgently occluded with detachable coils. Postoperatively, the patient was in intensive care for 1 month because of fulminant pneumonia. After the patient regained consciousness, he was found to have right hemiparesis from a small infarction at the pons. The patient's function improved to near normal after 1 year of recovery. CONCLUSIONS: Hemothorax caused by VA rupture in a patient with NF1 is an extremely rare condition that can be fatal. Careful examination with suspicion for early detection and treatment is required for this urgent condition. Endovascular coiling was safe even for an unstable patient with massive bleeding.


Assuntos
Aneurisma Roto/complicações , Hemotórax/etiologia , Hemotórax/cirurgia , Neurofibromatose 1/cirurgia , Adulto , Aneurisma Roto/diagnóstico , Aneurisma Roto/cirurgia , Embolização Terapêutica/métodos , Hemotórax/diagnóstico , Humanos , Masculino , Neurofibromatose 1/complicações , Neurofibromatose 1/diagnóstico , Ruptura Espontânea/complicações , Ruptura Espontânea/cirurgia , Artéria Vertebral/cirurgia
4.
J Surg Res ; 244: 225-230, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31301478

RESUMO

BACKGROUND: Chest tube (CT) placement is among the most common procedures performed by trauma surgeons; evidence guiding CT management is limited and tends toward thoracic surgery patients. The study goal was to identify current CT management practices among trauma providers. MATERIALS AND METHODS: We designed a Web-based multiple-choice survey to assess CT management practices of trauma providers who were active, senior, or provisional members (n = 1890) of the Eastern Association for the Surgery of Trauma and distributed via e-mail. Descriptive statistics were used. RESULTS: The response rate was 39% (n = 734). Ninety-one percent of respondents were attending surgeons, the remainder fellows or residents. Regarding experience, 36% of respondents had five or fewer years of practice, 54% 10 y or fewer, and 79% 20 y or fewer. Attendings were more likely than trainees to place pigtail catheters for stable patients with pneumothorax (PTX). Attendings with experience of <5 y were more likely to choose a pigtail than more experienced surgeons for elderly patients with PTX. Respondents preferred standard size CTs for hemothorax and unstable patients with PTX, and larger tubes for unstable patients with hemothorax. Most respondents (53%) perceived the quality of evidence for trauma CT management to be low and cited personal experience and training as the main factors driving their practice. CONCLUSIONS: Trauma CT management is variable and nonstandardized, depending mostly on clinician training and personal experience. Few surgeons identify their practice as evidence based. We offer compelling justification for the need for trauma CT management research to determine best practices.


Assuntos
Tubos Torácicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Toracostomia/instrumentação , Ferimentos e Lesões/cirurgia , Adulto , Fatores Etários , Idoso , Competência Clínica/estatística & dados numéricos , Hemotórax/etiologia , Hemotórax/cirurgia , Humanos , Pneumotórax/etiologia , Pneumotórax/cirurgia , Padrões de Prática Médica/normas , Inquéritos e Questionários/estatística & dados numéricos , Toracostomia/normas , Toracostomia/estatística & dados numéricos , Ferimentos e Lesões/complicações
8.
Monaldi Arch Chest Dis ; 89(2)2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31162485

RESUMO

Neurofibromatosis type 1 (NF1), also known as Von Recklinghausen's disease is an autosomal dominant genetic disorder. It is the most common of phacomatoses. Pulmonary complications have been rarely described in the literature. It is generally a benign disease, but has the potential for rare and fatal complications, such as spontaneous hemothorax. We reported two cases of patients with a history of von Recklinghausen's disease. Both of them suffered sudden chest pain. Chest-X ray revealed a hemi-thoracic opacity. Enhanced chest computed tomography showed massive hemothorax, but no evidence of tumors or an obvious bleeding point in the thorax. After we had ensured a stable hemodynamic condition, we performed video-assisted thoracic surgery to remove the hematoma. No evidence of bleeding was noticed in the first patient whereas an active bleeding was observed in the second patient. We could not determine which vessel was responsible of the hemorrhage. Electrocoagulation and clot removal were performed.  Evolution was favorable for both patients. Spontaneous hemothorax is a rare and potentially life threatening NF1's complication. A tumor like neurofibroma or more rarely vascular involvement of large or small caliber arteries may be at hemothorax's origin.


Assuntos
Hemotórax/etiologia , Neurofibromatose 1/complicações , Tomografia Computadorizada por Raios X , Adulto , Dor no Peito/etiologia , Eletrocoagulação/métodos , Feminino , Hemotórax/diagnóstico por imagem , Hemotórax/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
9.
Rozhl Chir ; 98(5): 223-226, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31159545

RESUMO

Varicose veins of lower extremities represent a common medical condition with minimally invasive percutaneous endovenous ablation techniques as a treatment of choice. A very rare complication is a catheter migration in the deep venous system. In the literature only 7 cases have been published so far, with only 2 cases with migration to the systemic circulation and heart involvement. In this paper we present an interesting case report from the perspective of a thoracic surgeon with the finding of a laser ablation catheter remnant in the left pleural cavity during thoracoscopic exploration for a spontaneous hemothorax in a 47-year old male patient after collapse. A similar complication affecting the pleural cavity has not been published before. In this paper we discuss possible routes of the cathether migration into the left pleural cavity, impending complications when a part of the catheter is left behind in the body and the means of prevention of these serious potentially fatal complications even after many years following the initial treatment.


Assuntos
Ablação por Cateter , Migração de Corpo Estranho , Hemotórax , Terapia a Laser , Varizes , Migração de Corpo Estranho/complicações , Hemotórax/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pelve , Veia Safena , Varizes/terapia
10.
BMC Med Imaging ; 19(1): 31, 2019 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-31029094

RESUMO

BACKGROUND: A pseudoaneurysm occurs as the result of a contained rupture of an arterial wall, yielding a perfused sac that communicates with the arterial lumen. Pseudoaneurysm of an intercostal artery is an extremely rare event but it carries with it a significant risk of rupture and subsequent hemothorax. It must be considered as a potential complication of thoracentesis. CASE PRESENTATION: Here, we report a rare case of an intercostal artery pseudoaneurysm following thoracentesis in an 82-year old male. The patient presented with respiratory distress 1 day after a therapeutic thoracentesis had been performed. Computed tomography (CT) with contrast revealed a left intercostal pseudoaneurysm with hemothorax and adjacent compressive atelectasis. Doppler ultrasound revealed bidirectional blood flow in the pseudoaneurysm sac. An intercostal arteriogram and thoracic aortogram aided in confirmation of the pseudoaneurysm and successful treatment with coil embolization. CONCLUSIONS: An intercostal pseudoaneurysm complication following thoracentesis is very rare but important to rule out as a possible cause of hemothorax after the procedure. Capturing this finding with the aid of multiple imaging modalities allowed for diagnostic certainty and rapid treatment with coil embolization, leading to a successful patient recovery.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Hemotórax/diagnóstico por imagem , Toracentese/efeitos adversos , Idoso de 80 Anos ou mais , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Angiografia , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/terapia , Aortografia , Meios de Contraste/administração & dosagem , Embolização Terapêutica , Hemotórax/etiologia , Hemotórax/terapia , Humanos , Masculino , Imagem Multimodal , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia Doppler
11.
J Surg Res ; 239: 98-102, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30825758

RESUMO

BACKGROUND: The insertion of a chest tube is a common procedure in trauma care, and the Advanced Trauma Life Support program teaches the insertion of chest tubes as an essential and life-saving skill. It is also recognized that the insertion of chest tubes is not without risks or complications. The purpose of this study was to evaluate complications of chest tube placement in a level 1 trauma center compared with those placed in surrounding referral hospitals. METHODS: A retrospective matched cohort study of trauma patients was performed between those who underwent chest tube placement at the level 1 trauma center and those with a chest tube placed before transfer to the level 1 center between 2004 and 2013. Conditional logistic regression was used to compare the likelihood of complications and death between chest tube placement groups. RESULTS: Four thousand two hundred and sixteen trauma patients had a chest tube placed at the level 1 center, and 364 patients had a chest tube placed at an outside hospital before transfer. Two hundred and eighty-one patients were matched. Patients with a chest tube placed outside the trauma center had an increased likelihood of malposition (OR 7.2, 95% CI 3.6-14.6), residual hemothorax (OR 6.3, 95% CI 3.4-11.6), residual pneumothorax (OR 6.7, 95% CI 3.9-11.4), and having a second chest tube placed (OR 3.77, 95% CI 2.37-6.01). However, the patients with a chest tube placed outside of the trauma center were also less likely to develop pneumonia (OR 0.32, 95% CI 0.14-0.73). There were no differences in the odds of developing an empyema, the need for video-assisted thoracoscopic surgery, thoracotomy, or death. CONCLUSIONS: There are opportunities for improving the care of patients who require chest tubes at both referring hospitals and the receiving trauma center. Improving the care of patients who require intercostal drainage requires a systems-based approach, focusing on training and quality improvement.


Assuntos
Tubos Torácicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/cirurgia , Adulto , Feminino , Hemotórax/epidemiologia , Hemotórax/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Transferência de Pacientes , Pneumonia/epidemiologia , Pneumonia/etiologia , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Complicações Pós-Operatórias/etiologia , Melhoria de Qualidade , Estudos Retrospectivos , Adulto Jovem
12.
Kyobu Geka ; 72(2): 128-131, 2019 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-30772878

RESUMO

A 32-year-old man leaping down from the 3rd floor of his house got injured and was transferred to our center. Pseudoaneurysm at the aortic isthmus as well as pelvic and lower limb fractures were observed by computed tomography (CT) scan. Thoracic endovascular aortic repair(TEVAR)of the thoracic aorta was performed from zone 2, followed by external skeletal fixation. Postoperative chest X-ray revealed right hemothorax, and CT scan showed active bleeding from the right subclavian artery in addition to splenic artery pseudoaneurysm. A 10×60 mm covered stent was deployed at the right subclavian artery and coiling of the splenic artery was performed. He was discharged without complication. The timing and procedures of surgery are difficult to decide in treatment of aortic injury with multiple trauma, TEVAR makes quick control of bleeding possible by less invasive approach. Moreover, endovascular approach to the subclavian artery avoides median sternotomy.


Assuntos
Falso Aneurisma/cirurgia , Aorta Torácica/lesões , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/métodos , Artéria Subclávia/lesões , Adulto , Falso Aneurisma/etiologia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/etiologia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Hemotórax/diagnóstico por imagem , Hemotórax/etiologia , Humanos , Masculino , Ossos Pélvicos/lesões , Stents , Artéria Subclávia/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
BMC Pulm Med ; 19(1): 26, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709387

RESUMO

BACKGROUND: Immunoglobulin G4-related disease (IgG4-RD) encompasses a group of immune-mediated disorders that are gaining increasing recognition. Pulmonary presentations are common, with four types of patterns been described on radiography, including solid nodular, bronchovascular, ground glass opacities, and alveolar interstitial. Pleural thickening and pleural effusion have also been reported. However, there have been no reports of IgG4-RD that presents as spontaneous hemothorax. CASE PRESENTATION: A 61-year-old Chinese woman experienced recurrent right-sided chest pain and transient syncope. A significant decrease in her hemoglobin level and thick bloody pleural fluid demonstrated spontaneous hemothorax. The elevated serum IgG4 and histopathological analysis of the right pleura and intercostal lymph node specimens all supported the diagnosis of IgG4-RD in this patient. Further diagnostic evaluation did not reveal other causes for spontaneous hemothorax. She received steroids and no recurrent bleeding event occurred during a follow-up period of more than 1 year. CONCLUSION: Recurrent spontaneous hemothorax can be a rare manifestation of IgG4-RD, with pleural involvement as the most probable mechanism.


Assuntos
Hemotórax/etiologia , Doença Relacionada a Imunoglobulina G4/diagnóstico , Imunoglobulina G/sangue , Pleura/patologia , Feminino , Humanos , Doença Relacionada a Imunoglobulina G4/patologia , Doença Relacionada a Imunoglobulina G4/fisiopatologia , Linfonodos/patologia , Pessoa de Meia-Idade , Recidiva , Tomografia Computadorizada por Raios X
14.
Mymensingh Med J ; 28(1): 200-205, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30755570

RESUMO

We examined the hypothesis that the cross mattress for chest drain insertion site security is better than that of polypropylene horizontal mattress in chest trauma patient required tube thoracostomy at the Department of Casualty Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2016 to June 2016. Accordingly we prospectively studied 50 consecutive patients who needed chest tube insertion. In 25 consecutive cases chest drain insertion site was secured with polypropylene horizontal mattress technique (Control- Group A) and another 25 consecutive patients had a cross-mattress with non-absorbable suture materials (Experimental- Group B). All chest tubes were inserted into the triangle of safety to following the BTS guideline. A baseline x-ray chest was compared with post-procedure chest x-ray. Male preponderance and young adults were comprised in both the groups; mean age in Group A and Group B was 38.7±15.5 and 37.3±14.1 respectively. Haemo-pneumothorax was the most common cause of tube thoracostomy among the trauma victims. This study shows that, polypropylene horizontal mattress results in increased chest tube site infection 52% in Control Group vs. 12% in Experimental Group (p=0.002). Although there was similar incidence of blood loss between the groups, the length of Hospital stay was significantly higher in Control Group. We conclude that cross mattress for chest drain insertion site security showed a better clinical outcome, less wound complications and less hospitalization.


Assuntos
Tubos Torácicos , Hemotórax/cirurgia , Pneumotórax/cirurgia , Sucção/métodos , Traumatismos Torácicos/cirurgia , Toracostomia/métodos , Bangladesh , Hemotórax/etiologia , Humanos , Masculino , Pneumotórax/etiologia , Estudos Prospectivos , Sucção/instrumentação , Traumatismos Torácicos/complicações , Toracostomia/instrumentação , Adulto Jovem
15.
Orv Hetil ; 160(5): 172-178, 2019 Feb.
Artigo em Húngaro | MEDLINE | ID: mdl-30686031

RESUMO

INTRODUCTION: Chest injuries cause a significant number of pneumothorax (PTX) and hemothorax (HTX). The most commonly used treatment is chest-tube drainage. The position of the tube is a prime necessity to achieve adequate drainage. AIM: To analyze the duration of chest drainage at the occurrence of PTX and HTX. To find what the underlying cause of drainage insufficiency is and whether there is any relation between the surgical qualification needed to the procedure. METHOD: Clinical data of 110 injured patients from 2011 to 2015 were collected and retrospectively analyzed. In the case of tube breaking or drainage insufficiency it was investigated if repositioning, usage of new tubes or insertion of additional tubes resolved the drainage insufficiency. Authors investigated the location of the tube on x-ray and CT, and the connection between the drainage insufficiency and the surgical qualifications needed to the procedure. RESULTS: The average duration of chest drainage was 6.5 days. The duration of drainage was shorter by 1.9 days regarding the tube inserted in the middle section of the chest compared to the upper one and shorter by 1.2 days regarding the tube inserted in the lower section of the chest compared to the upper one. In the case of HTX, the duration of drainage was shorter by 2.8 days regarding the lower and by 3.6 days regarding the middle section compared to the upper position. Drainage insufficiency occurred in 30% of all cases. The duration of chest drainage was shorter after application of new tubes (9.5 days) than after reposition (10.2 days), but there was no significant difference. CONCLUSION: Chest injury is a wide entity, thus one standard protocol cannot be developed on the management of these injuries. Authors concluded that drainage duration decreases significantly if the position of the tube is in the middle or lower section of the chest. The high occurrence of drainage insufficiency was caused by inadequate tube positioning and tube breaking. The practical qualification of trauma surgeons did not play a significant role regarding the prevalence of drainage insufficiency rather if the tube positioning was appropriate. Orv Hetil. 2019; 160(5): 172-178.


Assuntos
Tubos Torácicos , Drenagem/métodos , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/terapia , Adulto , Feminino , Hemotórax/diagnóstico por imagem , Hemotórax/etiologia , Hemotórax/terapia , Humanos , Hungria , Masculino , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/terapia , Estudos Retrospectivos , Traumatismos Torácicos/complicações , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X
16.
Forensic Sci Med Pathol ; 15(2): 272-275, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30649692

RESUMO

Cardiac injury following blunt chest trauma is common in motor vehicle accidents due to a crush or blast injury. Severe cardiac trauma is associated with a very high mortality. If a cardiac injury develops several weeks after non-penetrating chest trauma, establishing a causal link between the traumatic event and the cardiac injury becomes complicated. This article reports a case of fatal delayed hemopericardium and hemothorax following a motor vehicle accident including blunt chest trauma 34 days prior to death. The cardiac injury was caused by displacement of a sharp irregular fragment of one of the decedents fractured ribs and the primary defect was sealed by blood clots. Subsequent bleeding occurred when the thrombus was displaced. Since the incidence of blunt high-energy chest injuries is relatively high, heart and large vessel injuries must be taken into account and a comprehensive examination needs to be done in order to prevent the delayed development of fatal complications.


Assuntos
Hemotórax/etiologia , Derrame Pericárdico/etiologia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Feminino , Ventrículos do Coração/lesões , Ventrículos do Coração/patologia , Hemotórax/patologia , Humanos , Pessoa de Meia-Idade , Pedestres , Derrame Pericárdico/patologia , Fraturas das Costelas/complicações , Fraturas das Costelas/patologia , Choque Hemorrágico/etiologia , Trombose/patologia , Fatores de Tempo
18.
Medicine (Baltimore) ; 98(3): e14119, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30653138

RESUMO

RATIONALE: Acquired hemophilia A is a rare hemorrhagic disease in which the body produces specific antibodies that attack factor VIII, resulting in bleeding that is mainly mucocutaneous and associated with soft tissue and the gastrointestinal system. Approximately 50% of this disease derives from basic diseases, such as autoimmune diseases, cancer, and pregnancy. PATIENT CONCERNS: We report a 35-year-old postpartum female with acquired hemophilia A who initially presented with pleural hemorrhage. DIAGNOSES: In this patient activated prothrombin time (PT) and activated partial thromboplastin time (APTT) were found, and the factor VIII activity was 12.6%, furthermore Bethesda assay showed a FVIII antibody titer of 7.4 Bethesda units (BUs). INTERVENTIONS: The treatment requires a 2-pronged approach: treatment of the bleeding and elimination of the inhibitor. OUTCOMES: After hemostatic agents were used and inhibitors were eradicated, the patient achieved complete remission without relapse. LESSONS: It is essential to recognize the development of disease earlier in pregnant woman.


Assuntos
Hemofilia A/complicações , Hemotórax/etiologia , Complicações Hematológicas na Gravidez/etiologia , Adulto , Feminino , Humanos , Gravidez
19.
Cardiovasc Interv Ther ; 34(4): 358-363, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30656612

RESUMO

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a powerful device for treatment of patients with life-threatening heart failure. Although bleeding is often associated with VA ECMO and sometimes results in a fatal outcome, its precise causes remain unknown. On the other hand, excessive high shear stress in the cardiovascular system causes acquired von Willebrand syndrome (aVWS), characterized by loss of von Willebrand factor (vWF) large multimers. vWF large multimers of five consecutive patients treated with VA ECMO were quantitatively evaluated using the vWF large multimer indices, defined as the ratio of the large multimer ratio of a patient to that of a healthy subject analyzed simultaneously. All 5 patients exhibited oozing type of bleeding at the skin insertion sites under treatment with PCPS at flow rates of 2.5-3.0 l/min/m2, including two severe cases of bleeding; one patient had massive gastrointestinal bleeding and another had hemothorax. Their vWF large multimer indices were 20.8, 28.8, 27.6, 51.0, and 31.0% (means 31.8 ± 11.4%). Surprisingly, these values are much lower than those observed in severe aortic stenosis reported previously by us (Tamura et al. in J Atheroscler Thromb 22:1115-1123, 2015), where vWF multimer indices in 31 severe aortic stenosis patients with peak pressure gradient through the aortic valves of 85.1 ± 29.4 mmHg were 75.0 ± 21.7% (p < 0.0001), indicating that much higher grade of aVWS occurred in patients with VA ECMO than severe aortic stenosis patients. All the 5 patients treated with VA ECMO developed aVWS that was much more severe than in patients with severe aortic stenosis.


Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Doenças de von Willebrand/etiologia , Adulto , Idoso , Feminino , Hemorragia Gastrointestinal/etiologia , Hemotórax/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/terapia , Miocardite/terapia , Embolia Pulmonar/terapia
20.
Chest ; 155(4): 805-815, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30664856

RESUMO

BACKGROUND: Intrapleural lytic therapy has been established as an important modality of treatment for many pleural disorders, including hemothorax and empyema. Retained traumatic hemothorax is a common and understudied subset of pleural disease. The current standard of care for retained traumatic hemothorax is operative management. The use of lytic therapy for avoidance of operative intervention in the trauma population has not been well established. METHODS: Randomized controlled trials (RCTs) and non-RCTs reporting operative intervention following the use of intrapleural lytic treatment for retained traumatic hemothorax were identified in the literature. The primary outcome was avoidance of surgery following treatment with any lytic agent. Meta-analysis was performed to pool the results of those studies. Subgroup analysis by type of lytic therapy and analysis of length of stay were also performed. RESULTS: One RCT and nine non-RCTs including 162 patients were pooled in the analysis. Avoidance of surgery following treatment with any lytic agent was found to be 87% (95% CI, 81%-92%). Tissue plasminogen activator resulted in 83% operative avoidance (95% CI, 71%-94%), and other, non-tissue plasminogen activator lytic agents resulted in 87% operative avoidance (95% CI, 82%-93%). The average length of stay for patients undergoing lytic therapy was 14.88 days (95% CI, 12.88-16.88). CONCLUSIONS: Lytic therapy could reduce the need for operative intervention in trauma patients with retained traumatic hemothorax. RCTs are indicated to definitively evaluate the benefit of this approach.


Assuntos
Hemotórax/terapia , Traumatismos Torácicos/complicações , Cirurgia Torácica Vídeoassistida/métodos , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/administração & dosagem , Fibrinolíticos/administração & dosagem , Hemotórax/etiologia , Humanos , Injeções , Cavidade Pleural , Resultado do Tratamento
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