Efficacy of intravascular embolization in profuse hemorrhage from complicated duodenal ulcers

Objective. To estimate the efficacy of intravascular embolization in profuse hemorrhage from complicated duodenal ulcers. Materials and methods. Into the investigation 80 patients were included, operated for the profuse hemorrhage complication of duodenal ulcers, penetrating into pancreatic head. The patients were distributed into two groups: the control - 40 patients, in whom the standard methods of the hemorrhage arrest were applied, and the main - 40 patients, in whom the method elaborated was used. Results. In the main group in postoperative period the complications have had occur in 1 (2.5±0.2%) patients (p<0.001) only - the duodenal fistula development. There was verified, that the best results of hemostasis in hemorrhage from penetrating duodenal ulcers were obtained in the patients of the main group, in whom іntraoperative endovascular arrest of the hemorrhage together with the ulcer suturing was applied, because in 100% of patients of this group the definite hemostasis was achieved. Conclusion. The proposed method of intraoperative endovascular arrest of hemorrhage from penetrating duodenal ulcer guarantees a qualitative hemostasis, lowers the rate of the hemorrhage early recurrence and the need for relaparotomy performance, and raises the surgical treatment quality.

Acute Renal Failure and Laminitis Following Cesarean Section in a Friesian Mare. A Case Report

The term dystocia refers to an abnormal birth and the most common cause is an abnormal alignment of the head or forelimbs in the birth canal. Usually in adult horses, acute renal failure occurs as a complication of another disease process that causes hypovolemia . Diarrhea and severe laminitis may develop in more serious cases. The aim of this case report was to present a cesarean section in the mare that evolved with renal failure and subsequent with laminitis. A nine year old Friesian mare was referred to the Veterinary teaching hospital FMV Cluj-Napoca, after a dystocia that could not be resolved conservatively.During surgery, profuse hemorrhage was noticed during the incision and suture of the uterine wall. Hypovolemia was corrected and recovery was uneventful. Two days after surgery, the mare developed acute hyposthenuric renal failure. After 3 days of intensive therapy, kidney function started to improve but the mare developed laminitis. The mare improved over a few weeks and was discharged after orthopedic shoeing. According to the author’s knowledge, this is the first case report of a cesarean section in the mare that evolved into this cascade of sequelae.

Preduodenal portal vein – a cause of antenatally diagnosed duodenal obstruction

Preduodenal portal vein (PDPV) is a rare congenital vascular anomaly in which the portal vein passesanterior to the duodenum rather than posteriorly. Generally asymptomatic, PDPV may rarely cause aduodenal obstruction in the newborn. It is usually associated with gastrointestinal tract, cardiac,pancreatic, as well as biliary tract anomalies or may, occur as a single isolated malformation. Tillnow, only a few cases have been reported with duodenal obstruction and associated anomalies. Thepresent study report one such case of PDPV with multiple congenital anomalies. A full-term, one-day-old baby who had an antenatal history of polyhydramnios, presented to us with abdominaldistension and non-bilious vomitings soon after birth. Surgical exploration revealed a hugely dilatedstomach, multiple Ladd bands, malrotation of the small intestine, preduodenal portal vein, and anannular pancreas causing external duodenal compression. Intraoperative recognition of PDPV isimportant because iatrogenic injury during surgery can cause profuse hemorrhage from the vein andmay cause damage to the biliary tract or duodenal wall. Prompt evaluation of associated cardiacanomalies is important before surgery. Duodenostomy anterior to the portal vein is the definitivetreatment. Studies in animal models (AKR/J mice) have shown an autosomal recessive mode ofinheritance.

Penetrating Orbitocranial Injury

Penetrating orbitocranial trauma is an infrequent episode, which may be caused by penetration of the most diverse foreign bodies such as knife, pencil and scissors that tend to take a direction into the orbital apex, with access to the cranial cavity and potential risk of cerebral lesion and mortality. It is essential to evaluate the tomographic images in order to establish the exact location of the foreign body, making it possible to check the entire trajectory of the object; also the possibility of performing an angiography should be considered for the initial analysis. The attempt to remove penetrating objects outside the operating room compromises patient’s safety; it may cause profuse hemorrhage since in most cases the object itself stops the hemorrhage. if there is no intracranial emergency, the orbital injury must be prioritized. This article reports the case of a patient submitted to facial injury by a motorcycle handlebar, in which the foreign body penetrated the orbital region into the cranial middle fossa.

MANAGEMENT OF ACUTE SEVERE ULCERATIVE COLITIS: A CLINICAL UPDATE

ABSTRACT Introduction: Acute severe colitis is a potentially lethal medical emergency and, even today, its treatment remains a challenge for clinicians and surgeons. Intravenous corticoid therapy, which was introduced into the therapeutic arsenal in the 1950s, continues to be the first-line treatment and, for patients who are refractory to this, the rescue therapy may consist of clinical measures or emergency colectomy. Objective: To evaluate the indications for and results from drug rescue therapy (cyclosporine, infliximab and tacrolimus), and to suggest a practical guide for clinical approaches. Methods: The literature was reviewed using the Medline/PubMed, Cochrane library and SciELO databases, and additional information from institutional websites of interest, by cross-correlating the following keywords: acute severe colitis, fulminating colitis and treatment. Results: Treatments for acute severe colitis have avoided colectomy in 60-70% of the cases, provided that they have been started early on, with multidisciplinary follow-up. Despite the adverse effects of intravenous cyclosporine, this drug has been indicated in cases of greater severity with an imminent risk of colectomy, because of its fast action, short half-life and absence of increased risk of surgical complications. Therapy using infliximab has been reserved for less severe cases and those in which immunosuppressants are being or have been used (AZA/6-MP). Indication of biological agents has recently been favored because of their ease of therapeutic use, their good short and medium-term results, the possibility of maintenance therapy and also their action as a "bridge" for immunosuppressant action (AZA/6-MP). Colectomy has been reserved for cases in which there is still no response five to seven days after rescue therapy and in cases of complications (toxic megacolon, profuse hemorrhage and perforation). Conclusion: Patients with a good response to rescue therapy who do not undergo emergency operations should be considered for maintenance therapy using azathioprine. A surgical procedure is indicated for selected cases.

CAESAREAN SCAR PREGNANCY;

Caesarean Scar pregnancy (CSP) is a rare form of Ectopic pregnancy where the gestation sac is surrounded bymyometrium and the fibrous tissue of the scar from the previous caesarean section. It is often misdiagnosed as Molar pregnancy orInevitable Abortion and can be associated with massive hemorrhage and pervaginal bleeding leading to uterine rupture. Here we reporteda case of Caesarean scar pregnancy who presented with history of cesarean section and pervaginal bleeding. Dilatation and curettagewas planned but during the operative procedure there was profuse hemorrhage leading to hypovolumic shock which was managed byBlood and venesection then emergency laparotomy followed by Total Abdominal Hysterectomy done as life saving procedure,th postoperative period was uneventful and the patient was discharged on 10 postoperative day. Diagnosis is important as caesarean scarpregnancy is associated with life threatening complications such as uterine rupture, massive hemorrhage and the need for Hysterectomywith subsequent loss of fertility.