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Treatment of Variceal Bleeding in Cirrhotic Patients
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Temporizing measures as a bridge to definitive therapy include balloon tamponade and esophageal stent placement. Balloon tamponade is useful at controlling hemorrhage; however, severe complications such as re-bleeding upon balloon deflation and esophageal rupture can occur. Esophageal stents, self-expanding metal stents placed endoscopically, show no differences in survival when compared to balloon tamponade; however, control of bleeding was superior and side effects were significantly lower [7].
Primary Postpartum Haemorrhage
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
Formerly, uterine tamponade was achieved by packing the uterus with wide, rolled gauze. This has been superseded by the use of balloon tamponade. Balloon tamponade was first attempted with the Sengstaken-Blakemore oesophageal catheter or the Rusch urological balloon. Subsequently, the Bakri balloon was specifically designed for the purpose of uterine tamponade. Balloon tamponade is a simple and relatively noninvasive procedure that can be performed in the labour room, and it does not require anaesthesia. It will often immediately reduce or stop the bleeding and avert the need for laparotomy. The principle of balloon tamponade is to apply direct pressure on the uteroplacental vessels that are exposed after placental separation so that, once the bleeding stops, blood can clot and form a permanent seal. Therefore, the pressure applied should be greater than the pressure of blood flow in the uteroplacental vessels. The uterine cavity should be empty of blood clots or placental tissue in order for balloon tamponade to be effective.
Complications of percutaneous intervention for femoral, popliteal, and infrapopliteal artery occlusive disease
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Renganaden Sooppan, Christopher J. Abularrage
It is best to take the necessary precautions to avoid perforating an artery during a procedure. Road mapping should be used when attempting to cross any lesion, and any deviation from the normal course of the blood vessel should be treated as a perforation or side branch cannulation. Once the stenosis or occlusion is crossed, a catheter is advanced over the wire and angiography is performed to confirm that the wire and catheter combination is intraluminal and not in the extravascular space. If a perforation has occurred, the catheter should be pulled back into the true lumen and repeat angiography should be used to confirm the cessation of extravasation prior to proceeding with the intervention. Balloon tamponade and cessation of anticoagulation may be required.
Experience of Bakri balloon tamponade at a single tertiary centre: a retrospective case series
Published in Journal of Obstetrics and Gynaecology, 2021
Mariana C. Dorkham, Mathias J. Epee-Bekima, Hannah C. Sylvester, Scott W. White
Fifty-seven (21%) women in our case series had a duration of balloon tamponade 24 hours or longer, for which there is no evidence of benefit and some suggestion of harm, including the manufacturers recommendation that tamponade time should be 24 hours or less due to theoretical concerns about infection and tissue necrosis (Bakri and Arulkumaran, 2016). Our case series did not demonstrate greater infectious morbidity in the group with prolonged balloon tamponade, based on the patient records that exist within our institution. Duration of balloon tamponade in the three cases identified as developing endometritis ranged from 11 to 22 hours, reducing the likelihood that this complication was related to IUBT. The cause for delay in balloon removal is often related to the time of day and availability of senior staff should an emergency occur at the time of removal, with removal being deferred to daylight hours.
Massive hemorrhage from a unique old cesarean scar ectopic pregnancy with negative urine and serum β-HCG: a rare case report
Published in Postgraduate Medicine, 2018
Xiao Yang, Xiao-Qing Wei, Dan Feng, Wei He, Yuan Chen, Ping Hua
A 41-year-old gravida 4 para 1 female with no significant medical history presented to our gynecological clinic on 5 December 2014 with a chief complaint of ‘more than 50 days’ vaginal spotting’. The patient reported having regular menstrual periods, with the ‘last one’ on 14 October 2014, and vaginal spotting persisting for more than 1 month up to 14 November 2014. She reported no lower abdominal pain, nausea, or vomiting. She had undergone lower segment transverse cesarean section delivery 10 years prior and had a history of three early miscarriages. Urine hCG was not detected on 1 December 2014 and the serum β-HCG titer on 4 December 2014 was 2.7 mIU/ml (laboratory negative standard, <10 mIU/ml). TVUS performed on 1 December 2014 demonstrated a 3.7 × 2.5 cm intrauterine mixed and heterogeneous mass that was well-perfused and attached to the cesarean scar in the lower segment of the uterus (Figure 1). The gynecologist considered the diagnosis of intrauterine mass and suggested diagnostic dilation and curettage (D&C); during the procedure, the patient lost approximately 500 ml of blood, and the D&C was stopped immediately. A Foley catheter (FC) balloon tamponade in the uterine cavity stopped the bleeding after intracervical injection of oxytocin was ineffective; the patient was referred to the inpatient department immediately. The tissue curetted from the uterine cavity was sent for simultaneous pathologic examination.
Managing coronary artery perforation after percutaneous coronary intervention
Published in Expert Review of Cardiovascular Therapy, 2022
Type I CAP can often be managed successfully by watchful waiting, and rarely require reversal of anticoagulation and/or balloon inflation at the perforation site. In rare cases, an occlusion strategy is needed to control the bleeding and stop the ttamponade(Fischell, 2006 #34). Type II–III CAP nearly always lead to an emergency, with cardiac tamponade, rapid hemodynamic collapse, myocardial infarction, and death if not treated aggressively [1,2]. In those cases balloon tamponade might not be enough to resolve the bleeding, and other measures may be necessary depending on CAP location and vessel size. In many instances, one must either seal the perforation (e.g. covered stent) or close the vessel [1]