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Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Check all surgical anastomoses and cotton pledgets and pericardial or synthetic Dacron inserts before any organs are removed from the body. Remember that clumsy manipulation of a surgical suture line at autopsy can cause artefactual breakdown. Check the surgical site, drains and groins for significant haemorrhage. A certain amount of haemorrhage may occur after uncomplicated operations but a large collection of blood should be measured or weighed. Gelfoam at the operative site may be mistaken for blood clot or cotton swabs but will disintegrate in your hand and has a jelly-like consistency.
History of CSF rhinorrhea
Published in Jyotirmay S. Hegde, Hemanth Vamanshankar, CSF Rhinorrhea, 2020
Hemanth Vamanshankar, Jyotirmay S Hegde
For closure of CSF leaks, fascia lata was the primary choice, as described by Dandy. This was similarly described by others like Cushing (1927), McKinney (1932), Cairns (1937), Gissane and Rank (1940), Eden (1942), and Campbell, Howard, and Weary (1942).11–16 Echols and Holcombe (1941)17 described closure by using muscle. German (1944)18 described using flaps of dura covering the crista galli and falx to repair five cases. The use of a free periosteal graft over the cribriform plate was described by Ecker in 1947.19 The use of absorbable gelatin sponge (Gelfoam) was first mentioned by Cloward and Cunningham in 1947.20 The use of wax after stripping the dura on either side of the CSF leak and subsequent suturing was successfully described by Love and Gay.21 Coleman described the release of air and suturing dura over cribriform plate – which he successfully performed in a case of pneumatocele with CSF rhinorrhea following trauma.22
Management of lower gastrointestinal bleeding
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Colonic infarction has been reported more commonly (approximately 15%) with embolization due to the relatively sparse vascularity and poorer collateral pathways [16]. The process is, therefore, more technically demanding in that subselective catheterization is necessary. There is, however, no evidence of how distal the embolization should be to stop the bleeding and yet maintain tissue viability. The choice of agent for embolization is unclear, with some authors advocating a temporary agent such as gelatin sponge (Gelfoam), while others have used a permanently occlusive agent such as polyvinyl alcohol particles. Other agents such as collagen suspensions may cause distal thrombosis, while Gelfoam powder and absolute alcohol should be avoided as they may cause mucosal injury and necrosis. ‘Blind’ or prophylactic embolization in a patient with normal angiography is not recommended.
Complicated bleeding challenge and intraoperative safety strategies in a case of hemophilia a with rhabdomyosarcoma
Published in Pediatric Hematology and Oncology, 2022
Phumin Chaweephisal, Hansamon Poparn, Kanhatai Chiengthong, Panya Seksarn, Piti Techavichit, Supanun Lauhasurayotin, Darintr Sosothikul
Local control of bleeding is as important as systemic control. It can be employed with hemostatic agents (e.g. Gelfoam, Surgicel, Fibrin glue, Electrocautery and others). Antifibrinolytic agents such as oral tranexamic acid or epsilon-aminocaproic acid (EACA) are also important for controlling primary and secondary hemostatic disorders. A medication that is not used is Desmopressin acetate (DDAVP). It may have a role with minor procedures in mild hemophilia A cases but it has little role in this type of situation. Aspirin and non-steroidal anti-inflammatory drug (NSAIDs) for pain control should also be avoided. Continuous infusion of Factor VIII for this type of complex surgery has also been shown to be safe and efficacious,7 and could have been considered; however, it has been our institution’s preference to use intermittent infusions instead. With utmost caution and careful preparation, major surgery can be performed safely.
Preclinical characterization of the ADME properties of a surrogate anti-IL-36R monoclonal antibody antagonist in mouse serum and tissues
Published in mAbs, 2020
Kip P. Conner, Cinthia V. Pastuskovas, Marcus Soto, Veena A. Thomas, Mylo Wagner, Dan A. Rock
Surgical manipulation was similar to the 5/6 nephrectomy model described by Wang et al. with a few modifications.35 Aseptic surgical technique was used in all surgical procedures. Briefly, mice were anesthetized with 4–5% isoflurane (Abbott Laboratories, North Chicago, IL, USA). Two-thirds of renal mass was ablated by resection of 1/3 of the left kidney at the upper and lower poles. Gelfoam® (Pharmacia and Upjohn Co. Kalamazoo, MI, USA) was applied to renal tissue before the kidney was placed back into the abdomen. One week later the entire right kidney was removed, and the mice underwent an additional 1-week recovery period prior to being placed on study. An SC dose of buprenorphine (0.05 mg/kg) was given preoperatively and post-operatively twice a day for 48 h during each surgical session.
The efficacy of pelvic arterial embolisation for the treatment in massive vaginal haemorrhage in obstetric and gynaecological emergencies: a single-centre experience
Published in Journal of Obstetrics and Gynaecology, 2019
Several studies have described successful treatment of AVMs with embolisation alone (Yokomine et al. 2009; Vijayakumar et al. 2013). Transarterial embolisation protects the uterus should be preferred as a treatment option in cases of pregnancy expectancy. Preoperative embolisation can be used as a definitive treatment or to minimise intraoperative bleeding before surgery (Brown et al. 2008). Peitsidis et al. (2011) reported that 59% of their 100 cases were treated with UAE and 29% with total abdominal hysterectomy. Spontaneous resolution of AVM occurred in six (6%) patients, while recurrence was observed after treatment with UAE in 17 (17%). Those authors recommended the use of gelfoam, which resorbs within 10–14 days, over permanent particles as first-line embolic agents in women wishing to preserve fertility (Peitsidis et al. 2011). In fact, gelfoam sponge has been used as a safe and effective embolic agent for more than 30 years in UAE and other interventional procedures. It is also the most popular embolising agent for UAE in women with expectations of pregnancy (Delplanque et al. 2018). Although gelfoam particles are regarded as temporary embolising agents, embolisation has also been reported to induce permanent occlusion (Song et al. 2013). More recent studies have recommended polyvinyl alcohol particles or NBCA as agents of choice (Vijayakumar et al. 2013; Vilos et al. 2015).