Vascular
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Multicenter Study
Approach to the vascular complications of lumbar disc surgery.
The objective of this study was to demonstrate the role of major surgery on patients presenting with vascular complications after lumbar disc surgery. A retrospective analysis of seven cases treated surgically in two tertiary care centers between August 2001 and June 2010 was carried out. The average age of patients (three women and four men) was 35.8 ± 7.2. ⋯ Vascular injury occurring at lumbar discus surgery has a considerable potential for morbidity and mortality. A high index of suspicion is necessary for early diagnosis. In hemodynamically instable patients, the transperitoneal approach provides better exposure and more effective control of hemorrhage, while minimal angiography and endovascular intervention should be preserved for hemodynamically stable cases.
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Comparative Study
Effects of anesthesia versus regional nerve block on major leg amputation mortality rate.
There are greater than 120,000 above-knee amputations (AKA) and below-knee amputations (BKA) performed in the USA each year. Traditionally, general anesthesia (GA) was the preferred modality of anesthesia. The use of regional nerve blocks has recently gained popularity, however, without the supporting evidence of any mortality benefits. ⋯ The overall 30-day mortality was 17.1% (27 patients) consisting of 15.2% for regional nerve analgesia versus 17.9% for GA/spinal blocks (P = 0.867). Age did not affect mortality outcome in either groups of anesthesia modality. Our analysis did not reveal any mortality benefit of utilizing regional nerve block over GA or spinal blocks.
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We report three cases of aortoesophageal fistula (AEF), in which the patients remained free from catastrophic bleeding after endovascular stent-grafting. The three patients, who were not candidates for surgical repair because of their poor general condition and prognosis, underwent endovascular stent-grafting following the administration of antibiotics and were successfully managed; hemostasis was maintained for several months until their death. Although we did not find any conclusive evidence to support this strategy, our experiences suggest that endovascular stent-grafting of AEF is useful for maintaining hemodynamic stability.
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Case Reports
Limb salvage in a child with severely injured mangled lower extremity and muscle rigor.
Most surgeons make their decision to amputate or perform limb salvage of a mangled extremity based on scoring systems and grading of acute ischemic limb. We report on a child in whom limb salvage was achieved in spite of a clinical picture of irreversible ischemia with high mangled severity scores. Attempts to revascularize the mangled extremity of children are recommended, regardless of their severity scores and condition of the foot.