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ICU Issues with Abdominal and Pelvic Trauma
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Allison J. Tompeck, Ara J. Feinstein
Adults (n = 1488) with blunt splenic injury from 27 level I and II trauma centers were studied retrospectively. In this multi-institutional study, 38.5% of adults with blunt splenic injury went directly to laparotomy; 61.5% were admitted with planned observation. Angiography/embolization was rarely utilized in this study. Ultimately, 55% of patients were successfully managed nonoperatively. The failure rate of observation was 10.8%; increasing with grade of injury and quantity of hemoperitoneum. Sixty-one percent of failures occurred in the first 24 hours. Successful nonoperative management was associated with higher blood pressure and hematocrit on admission, less severe injury based on ISS, Glasgow Coma Scale, grade of splenic injury, and quantity of hemoperitoneum.
Abdominal Ectopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
The symptoms range from amenorrhea, abdominal pain, and vaginal bleeding to hemorrhagic shock. The most common clinical presentation of ectopic pregnancy is early trimester vaginal bleeding and/or abdominal pain [8]. The hidden nature of ectopic pregnancy lesions may lead to clinical emergencies. Acute clinical manifestations include acute pelvic, right or left upper abdominal, or diffuse abdominal pain. Abdominal tenderness, sickness, and hypovolemic shock occur during the phases of amenorrhea. Nonspecific symptoms, such as epigastric pain, dyspepsia, or irregular vaginal bleeding, sometimes anticipate the acute clinical evolution [6]. Rupture and hemoperitoneum must be considered in case of hypotension, tachycardia, abdominal tenderness with abdominal guarding, and low-grade fever [1].
Ethylmalonic encephalopathy
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
Dilated tortuous retinal vessels (Figures 102.11 and 102.12) may be seen as early as three to four months of life. Hematuria may be observed and erythrocytes were reported in the cerebrospinal fluid (CSF) [5, 7, 11]. An association with nephrotic syndrome has been previously reported [12], and we have encountered a case with an episode of nephrosis which was responsive to conventional steroid treatment. One patient had a terminal hemoperitoneum [7]. Biopsies of the skin lesions showed nothing but hemorrhage [7]. There was no evidence for an immunologic abnormality, nor were there abnormalities of bleeding, clotting, or platelets. A markedly elevated level of plasminogen activator inhibitor-1 has been encountered [9]. Terminal events in two patients appeared to be pulmonary edema and one had cerebral edema.
Spontaneous splenic rupture associated with Escherichia coli bacteremia and dual antiplatelet therapy
Published in Baylor University Medical Center Proceedings, 2020
Carlos A. Perez, Alexander Bastidas, Saranya Rajasekar, Nawal Nasser, Victor O. Garcia-Rodriguez
A 60-year-old woman with a past medical history of hypertension, type 2 diabetes mellitus, coronary artery disease, and heart failure presented to the emergency department complaining of acute-onset left upper-quadrant pain. Vital signs at initial presentation were a blood pressure of 85/63 mm Hg, heart rate of 120 beats per minute, and temperature of 37.2°C. She reported having a fever and low back pain for the past week and frequent urinary tract infections. Her home medications included aspirin and prasugrel, both started 1 month earlier, after undergoing percutaneous coronary intervention for an inferior wall myocardial infarction. Her white blood cell count was 4000/mm3; hemoglobin, 11.8 g/dL; hematocrit, 36.2%; and platelets, 348/mm3. Computed tomography of the abdomen and pelvis showed a large subcapsular hematoma with frank hemoperitoneum, as well as evident extravasation from the spleen (Figure 1). The patient was found to be in hemorrhagic shock and was resuscitated appropriately with intravenous fluids.
Computed tomography-guided percutaneous microwave ablation with artificial ascites for problematic hepatocellular tumors
Published in International Journal of Hyperthermia, 2020
Yongzheng Wang, Lili Zhang, Yuliang Li, Wujie Wang
The success rate of artificial ascites induction was 100%. The volume of the introduced solution was 503 ± 249.2 ml (range, 150–1200 ml). Microwave ablation with artificial ascites was successfully performed in all 61 tumors. The technical effectiveness rate was 100% with contrast-enhanced CT immediately after ablation. Complete ablation was achieved in all cases. Mild and moderate pain was reported in 25 (52%) patients, including four (8.3%) patients with pain in the right shoulder. Fever at 37.5–38.5 °C lasted for 1–7 days in 21 (43.7%) patients. These symptoms were alleviated with supportive treatment. No disabling events or deaths related to the procedure occurred. No severe complications, such as hemoperitoneum or infection, were observed after the procedure. Table 2 summarizes the adverse events related to the procedure. Local tumor progression occurred in three (6.3%) patients with tumor diameters larger than 4 cm during the follow-up period (mean, 15 months; range, 6–24 months). Remote intrahepatic tumors were found in ten (20.8%) patients. No electrode needle track seeding was found during the follow-up period.
From β-hCG values to counseling in tubal pregnancy: what do women want?
Published in Gynecological Endocrinology, 2019
Lorenzo Sabbioni, Emanuela Carossino, Filiberto Maria Severi, Stefano Luisi
In addition, it is suggested to mandatory observe the adnexa systematically, looking for a mass typically swelling separate to the ovary, as previously mentioned. Then, to complete the exam, signs of hemoperitoneum must be assessed. Going back to the tubal pregnancy, how to measure it depends on the morphological aspect. Three common forms are identified:Solid swelling: the mass should be measured on the three orthogonal planes taking into account the outer to outer margins of the trophoblastic tissue.Mass with a gestational sac: the celomic cavity should be measured within the inner to inner margins, meanwhile the trophoblastic ring should be recorded in its largest orthogonal measures (outside to outside)In women with evidence of hematosalpinx measurements were taken between the inner margins of the tube (inside to inside)