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Background. Intracardiac thrombosis incidence during orthotopic liver transplantation is estimated at 0.36% to 6.2% with mortality up to 68%. We aimed to evaluate risk factors and outcomes related to intracardiac thrombosis during...
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Background. Intracardiac thrombosis incidence during orthotopic liver transplantation is estimated at 0.36% to 6.2% with mortality up to 68%. We aimed to evaluate risk factors and outcomes related to intracardiac thrombosis during orthotopic liver transplantation. Materials and Methods. A comprehensive retrospective data review of 388 patients who underwent orthotopic liver transplantation at an urban transplant center from January 2013 to October 2016 was obtained. Results. Six patients were found to have documented intracardiac thrombosis; 4 cases were recognized during the reperfusion stage and 1 during pre-anhepatic stage. All allografts were procured from decreased donors with a median donor age of 44 years (interquartile range, 35.25-49.75) and the cause of death was listed as cerebrovascular accident in 5 donors. Preoperative demographic, clinical, laboratory, and historical risk factors did not differ in patients with thrombosis. None had a prior history of transjugular intrahepatic portosystemic shunt or gastrointestinal bleeding. Three patients had renal injury, but no intraoperative hemodialysis was performed. Transesophageal echocardiographic findings included elevated pulmonary artery pressure (1/6), right ventricular strain (1/6), and pulmonary artery thrombus (1/6). Three patients died intraoperatively. Tissue plasminogen activator alone was given to 1 patient who did not survive, intravenous heparin only to 1 patient with resolution, and a combination of both was used in 2 patients with clot resolution achieved. Conclusion. Cardiac thrombosis should be considered in patients having hemodynamic compromise during liver transplantation. Transesophageal echocardiography is a useful diagnostic tool. Intracardiac thrombosis treatment remains challenging; however, using both thrombolytics and heparin could achieve better results.
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Abstract Objective To determine the incidence and risk factors for pregnancy‐associated venous thromboembolism (VTE). Methods An observational retrospective study was conducted using data from 452?176 live births between the year...
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Abstract Objective To determine the incidence and risk factors for pregnancy‐associated venous thromboembolism (VTE). Methods An observational retrospective study was conducted using data from 452?176 live births between the years 2010 and 2019. The study group consisted of women who were diagnosed with VTE during pregnancy or the postpartum period. The exclusion criteria included women who purchased anticoagulant drugs during pregnancy or postpartum. The hazard ratios (HRs) of VTE per week of each trimester and the postpartum period were calculated. Results A total of 421?125 live births were included in the study. Among the study population, 302 cases (0.71 cases/1000 pregnancies) were diagnosed with VTE during pregnancy and postpartum. The overall rates of diagnosis did not change significantly during the study period but followed a declining trend in the postpartum period. The highest risk of VTE was found to be during the third trimester (HR 0.002% per week, 95% confidence interval [CI] 0.0016–0.0023), while the lowest rate was during the postpartum period (HR 0.0007% per week, 95% CI 0.0004–0.0011). Conclusion Pregnancy and the puerperium are well‐established risk factors for VTE. The present study demonstrates a declining trend in the risk and incidence of VTE during the postpartum period, which can be explained by a liberal and effective VTE prevention policy.
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Thromboembolism represents the most significant complication and cause of non-surgical mortality in major urological surgery. The aim of the present study was to assess the association between the type of pharmacological thromboem...
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Thromboembolism represents the most significant complication and cause of non-surgical mortality in major urological surgery. The aim of the present study was to assess the association between the type of pharmacological thromboembolism prophylaxis and the postoperative complication rate in a cohort of patients undergoing major urological surgery. All consecutive patients treated with major urological surgery between December 2011 and March 2013 were evaluated. For each patient, clinical and demographic data, as well as information on the post-surgical complications and the type of pharmacological thromboembolism prophylaxis, were collected. In total, 453 patients (mean age, 63.36 +/- 12.05 years) were recruited (43.5% for prostate surgery, 33.1% for renal surgery, 12.1% for bladder surgery and 11.3% for other surgery). Postoperative blood transfusions were required in 50 cases (11.0%). A total of 32 patients (7.1%) underwent reinterven-tion due to the occurrence of grade >= 3 complications, with a readmission rate of 2.0%. According to the Clavien-Dindo Classification, the complications were grade 1 in 36.0% of the cases, grade 2 in 19.4%, grade 3 in 6.0%, grade 4 in 2.0% and grade 5 (mortality) in 0.7%. Only 1 case of deep venous thrombosis not associated with pulmonary thromboembolism was observed. Univariate analyses showed a significant negative association (higher risk of complications) between the use of >4,000 IU enoxaparin as the thromboembolism prophylaxis and postoperative blood transfusion rate (P=0.045), re-intervention rate (P=0.001) and the occurrence of grade >= 3 complications (P<0.001). Multivariate analysis confirmed the significant association between the use of >4,000 IU enoxaparin and both re-intervention rate (P=0.013) and occurrence of grade >= 3 complications (P=0.002). High doses of enoxaparin (>4,000 IU) may lead to an increased risk of re-intervention and severe postoperative complications following major urological surgery. Randomised, controlled trials comparing the effect of different types of pharmacological thromboembolism prophylaxis on postoperative complications following major urological surgery are required.
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A dissecting aneurysm of the anterior cerebral artery is a relatively rare disorder. A patient is presented with mild symptoms due to thrombo-embolic complications from a dissecting aneurysm of the pericallosal artery. The patient...
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A dissecting aneurysm of the anterior cerebral artery is a relatively rare disorder. A patient is presented with mild symptoms due to thrombo-embolic complications from a dissecting aneurysm of the pericallosal artery. The patient had a good outcome after conservative treatment. A review of the literature is presented.
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A statistical retrospective analysis of the results of treatment of patients undergoing inpatient treatment in the surgical clinic, proctology and urology departments for 5 years was conducted, total number of patients – 27771, o...
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A statistical retrospective analysis of the results of treatment of patients undergoing inpatient treatment in the surgical clinic, proctology and urology departments for 5 years was conducted, total number of patients – 27771, of them operated – 14849 (53.5%), postoperative mortality – 448 patients (3.0%), the overall mortality – 989 patients (3.6%). According to the analysis of the medical documentation, the total number of patients with pulmonary embolism (PE) was 98 (0.35%), the number of patients diagnosed during treatment – 56 (57.1%), at the time of pathoanatomical examination – 42 (42.9%); in 72 patients PE was directly responsible for death, 26 patients were cured by conservative methods. Of 98 patients with PE in 56 (56.1%), the main disease was oncological disease, in most cases in neglected form with distant metastases. A reduction in postoperative lethality by 40% was obtained, the reason for which, in our opinion, are: mandatory adherence to the recommended timing of the prevention of acute thromboembolic complications; prolongation of the prophylaxis term in patients who have undergone major surgical interventions or with postoperative complications that lead to a prolonged limitation of the patients' motor activity; a wider use of low molecular weight heparins.
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Background: As demand for outpatient procedures has increased, abdominoplasties are now judiciously being performed in accredited outpatient facilities. Previous reports on outpatient abdominoplasties are limited by small cohorts ...
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Background: As demand for outpatient procedures has increased, abdominoplasties are now judiciously being performed in accredited outpatient facilities. Previous reports on outpatient abdominoplasties are limited by small cohorts and have not distinguished among different types of body contouring procedures. Furthermore, these reports included patients who remained in the hospital overnight, rather than patients who were discharged within hours postoperatively. Objectives: The authors review a case series of patients who underwent full abdominoplasty procedures performed in an outpatient facility with same-day discharge. Methods: Charts were retrospectively reviewed for 319 consecutive patients who underwent full abdominoplasty with the senior author (CLM) between 1992 and 2010. The charts of 206 patients for whom complete electronic medical record data were available were analyzed as a separate cohort. Demographic, operative, and postoperative data were collected. Systemic and local complications were assessed, as were revision rates. Results: No patients in this series developed any systemic complications, including deep venous thrombosis or pulmonary embolism, blood transfusion, intra-abdominal perforation, or death. The most common local complication was seroma, at a rate of 19.4%. Conclusions: This report serves to add to the literature a large cohort of patients who underwent full abdominoplasty and were discharged within hours of surgery. The study shows that full abdominoplasty procedures can be safely performed without systemic complications in an outpatient setting. Based on these data, the ever-present sentiment that abdominoplasty is the plastic surgery procedure associated with the highest rate of venous thromboembolism should be carefully evaluated.
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Background: As demand for outpatient procedures has increased, abdominoplasties are now judiciously being performed in accredited outpatient facilities. Previous reports on outpatient abdominoplasties are limited by small cohorts ...
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Background: As demand for outpatient procedures has increased, abdominoplasties are now judiciously being performed in accredited outpatient facilities. Previous reports on outpatient abdominoplasties are limited by small cohorts and have not distinguished among different types of body contouring procedures. Furthermore, these reports included patients who remained in the hospital overnight, rather than patients who were discharged within hours postoperatively. Objectives: The authors review a case series of patients who underwent full abdominoplasty procedures performed in an outpatient facility with same-day discharge. Methods: Charts were retrospectively reviewed for 319 consecutive patients who underwent full abdominoplasty with the senior author (CLM) between 1992 and 2010. The charts of 206 patients for whom complete electronic medical record data were available were analyzed as a separate cohort. Demographic, operative, and postoperative data were collected. Systemic and local complications were assessed, as were revision rates. Results: No patients in this series developed any systemic complications, including deep venous thrombosis or pulmonary embolism, blood transfusion, intra-abdominal perforation, or death. The most common local complication was seroma, at a rate of 19.4%. Conclusions: This report serves to add to the literature a large cohort of patients who underwent full abdominoplasty and were discharged within hours of surgery. The study shows that full abdominoplasty procedures can be safely performed without systemic complications in an outpatient setting. Based on these data, the ever-present sentiment that abdominoplasty is the plastic surgery procedure associated with the highest rate of venous thromboembolism should be carefully evaluated.
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Objective: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is associated with the occurrence of venous thromboembolism (VTE) such as deep vein thrombosis (DVT) and pulmonary embolism (...
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Objective: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is associated with the occurrence of venous thromboembolism (VTE) such as deep vein thrombosis (DVT) and pulmonary embolism (PE). We aimed to assess the prevalence and associated risk factors for VTE in a large national cohort of IBD patients.Material and methods: Data from patients of the Swiss IBD Cohort Study (SIBDCS) enrolled between 2006 and 2013 were analyzed.Results: A total of 2284 IBD patients were analyzed of which 1324 suffered from CD and 960 from UC. VTE prevalence was 3.9% (90/2284) overall and 3.4% (45/1324) in CD patients (whereof 2.4% suffered from DVT and 1.5% from PE) and 4.7% (45/960) in UC patients (whereof 3.2% suffered from DVT and 2.4% from PE). Median disease duration in CD patients with VTE was 12 years [IQR 8-23] compared to eight years [3-16] in CD patients without VTE (p=0.001). Disease duration in UC patients with VTE was seven years [4-18] compared to six years [2-13] in UC patients without VTE (p=0.051). Age at CD diagnosis 40 years (OR 1.851, p=0.073) and disease duration >10 years (OR 1.771, p=0.088) showed a trend to be associated with VTE. In UC patients, IBD-related surgery (OR 3.396, p=0.004) and pancolitis (OR 1.927, p=0.050) were significantly associated with VTE.Conclusions: VTE are prevalent in CD and UC patients. Pancolitis and UC-related surgery are significantly associated with VTE in UC patients.
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Patients with coronary artery disease who undergo stent implantation and have concomitant indication for long-term oral anticoagulation represent a considerable proportion of the overall population. To date there is still no conse...
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Patients with coronary artery disease who undergo stent implantation and have concomitant indication for long-term oral anticoagulation represent a considerable proportion of the overall population. To date there is still no consensus about the optimal antithrombotic strategy to choose in this kind of patients, due to the difficult balance between an increased risk of bleeding and thromboembolic complications. Therefore, the aim of this study was to perform a meta-analysis to evaluate the risk and benefits of triple antithrombotic therapy versus dual antithrombotic therapy in patients undergoing coronary stent implantation, requiring long-term oral anticoagulation.
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