Vascular
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Jugular vein aneurysm is a rare morphologic entity. This report describes a case of an asymptomatic internal jugular vein aneurysm that presented as an enlarging mass in the neck. Diagnosis was established with duplex ultrasonography and venography. No thrombus was diagnosed in the aneurysm, but since the patient was uncomfortable with having a tumor in his neck, surgery was performed with resection of the aneurysm and lateral venorrhaphy of the jugular vein.
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The role of matrix metalloproteinases (MMPs) in abdominal aortic aneurysm (AAA) pathogenesis is well described. However, a clear role for the MMPs in disease prediction has not been established. The aim of this study was to determine if circulating levels of MMPs correlated with AAA diameter and with MMP concentrations within the aneurysm wall. ⋯ There were no correlations between the paired plasma and aneurysm wall concentrations for any MMP or TIMP. Correlation between MMP-9 levels in the aneurysm wall and aneurysm diameter was negative (r = -.42, p = .019). Other correlations between plasma and tissue levels with aneurysm diameter were nonsignificant.
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Graft migration and other device-related problems are more frequent in abdominal aortic aneurysm (AAA) patients with a complicated neck. We wanted to evaluate the performance of a balloon-expandable stent graft in these cases. Complicated aortic neck morphology was defined as a combination of short (<15 mm) and angulated (>45 degrees) necks with or without circumferential thrombus. ⋯ Scheduled CT scans did not show any graft migration or proximal neck dilatation. Neither neck dilatation nor endograft migration was observed with the balloon-expandable stent graft. In patients with complicated aortic neck morphology, balloon-expandable stent grafts such as the VI-Datascope graft provide more secure fixation and better long-term outcomes compared with the more commonly used self-expanding endografts.
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Intraoperative control of bleeding during any surgical procedure is vital for achieving a positive patient outcome. Hemostasis can be achieved through practical and effective systemic or topical approaches. A variety of hemostatic methods can be employed, ranging from simple manual pressure application with one finger to electrical tissue cauterization, systemic administration of blood products, and systemic administration or topical application of procoagulation agents. ⋯ As with the use of systemically delivered hemostatic agents, topical treatments also carry risks with their use, and their efficacy has not been extensively studied in large randomized, placebo-controlled prospective studies. The effective use of topical agents is highly dependent on the surgeon's experience or preference and their availability in the surgical setting. In this article, we review the currently available topical hemostatic agents, compare their efficacy, and give general recommendations for their use in the operating room.
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To effectively balance bleeding and clotting in surgical patients, the surgeon needs a fundamental knowledge of coagulation biology. The endothelium and activated platelets play crucial roles in coagulation. Activated platelets and damaged endothelial cells provide a platform of negatively charged phospholipids that not only bind coagulation factors and their complexes but also accelerate the conversion of inactive zymogens to active serine proteases. ⋯ Correctly diagnosing and appropriately treating perioperative bleeding in surgical patients require a basic understanding of the most common bleeding and clotting disorders. This article provides an overview of the characteristic features of common coagulopathic conditions and their treatment options. Given the challenge of balancing bleeding and clotting in surgical patients, hemostatic management must be tailored to each patient and should take into account the patient's genetic and acquired risk factors and the acute disturbances in bleeding and clotting caused by surgical intervention.