STMO-07 Adverse events related to the glioblastoma surgery and their perioperative management in our hospital

Abstract Background: The standard treatment for glioblastoma is surgical resection following chemoradiation therapy. The rate of removal or the amount of residual tumor has some impact on the prognosis of patients with glioblastoma, but the highly invasive nature of this tumor makes complete removal limited to the contrast-enhanced lesions difficult due to its localization. Furthermore, when postoperative seizures and venous thrombosis are included in surgery-related complications, these perioperative adverse events can cause delays in the initiation of chemoradiotherapy and delay the return to work and home, such as prolonged hospitalization and rehabilitation time. Methods: We retrospectively reviewed the perioperative status of the recent 50 consecutive cases with histologically confirmed as glioblastoma at our hospital, the patient background, tumor localization, and perioperative treatment, and so on. Results: The major perioperative complications were ischemic or hemorrhagic complications, epileptic seizures, venous thrombosis, and pneumonia; CTCAE grade 2 or higher, grade 3 or higher, and grade 4 occurred in about 40%, 20%, and 10%, respectively, with some patients having multiple complications. Discussion: Although there was a tendency for ischemic changes around the cavity of the resection as the resection rate increased, most cases were asymptomatic and it seemed to be acceptable if residual brain function could be preserved. Residual tumors tended to show hemorrhagic changes and epileptic seizures because this is thought to be that the tumor was deliberately left in place to preserve function, based on the localization of the tumor. Postoperative FDP levels were useful in predicting the development of deep vein thrombosis and pulmonary artery thromboembolism. Conclusion: Because glioblastoma has short survival time and patient PS before and after surgery varies greatly depending on tumor localization, it is important to consider risk-benefit strategies for each case and to establish a scheme for a seamless transition from perioperative management to the introduction of postoperative therapy and maintenance therapy.

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PREVENTION AND TREATMENT OF VENOUS THROMBOSIS AND THROMBOEMBOLISM IN SURGICAL TREATMENT PELVIC NEOPLASMS

Kharkiv Surgical School ◽

10.37699/2308-7005.3.2020.15 ◽

2020 ◽

pp. 74-80

Author(s):

A. V. Chikin

Keyword(s):

Surgical Treatment ◽

Venous Thrombosis ◽

Vena Cava ◽

Fold Increase ◽

Initial State ◽

Pelvic Neoplasms ◽

Surgical Interventions ◽

Vein Thrombosis ◽

Prevention And Treatment ◽

Before And After

Summary. Venous thromboembolic complications — a collective concept that combines thrombosis of the saphenous and deep veins, as well as pulmonary thromboembolism. In the clinical practice of a doctor of any specialty, especially surgical, the possibility of timely diagnosis, treatment and preventive measures for deep vein thrombosis and pulmonary embolism are extremely important. Purpose. To study the most informative measures for the prevention and treatment of venous thrombosis and thromboembolism in the surgical treatment of pelvic neoplasms. Materials and methods. The analysis of the results of the examination and treatment of 112 patients observed for tumors of the pelvic organs and tumors of the retroperitoneal space is presented. Results and discussion. When studying the initial state of the hemostasis system in 48 patients, a significant shortening of activated partial thromboplastin time (APTT), a 1.5-fold increase in the concentration of fibrinogen, which indicates activation of the procoagulant link, as well as an increase in platelet aggregation by 20.0 %, were established. Studies of the hemostatic system showed that surgical interventions and injuries contribute to increased hypercoagulation. Conclusions. The most informative methods for determining thrombosis in the system of the inferior vena cava and the optimal examination algorithm are: ultrasonic dynamic angioscanning, determination of the amount of D-dimer, computer, magnetic resonance bolus venography and retrograde ileocavagography. The use of unfractionated and low molecular weight heparins effectively prevents the development of thrombosis and thromboembolism before and after surgery and does not cause bleeding. Nonspecific and specific prophylaxis of venous thrombosis and embolism allowed a 2.8-fold reduction in their number in patients of the main group.

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Frequency of Myocardial Infarction, Pulmonary Embolism, Deep Venous Thrombosis, and Death following Primary Hip or Knee Arthroplasty

Anesthesiology ◽

10.1097/00000542-200205000-00017 ◽

2002 ◽

Vol 96 (5) ◽

pp. 1140-1146 ◽

Cited By ~ 237

Author(s):

Margaret Wood ◽

Carlos B. Mantilla ◽

Terese T. Horlocker ◽

Darrell R. Schroeder ◽

Daniel J. Berry ◽

...

Keyword(s):

Myocardial Infarction ◽

Pulmonary Embolism ◽

Adverse Events ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Knee Arthroplasty ◽

Perioperative Complications ◽

Total Hip ◽

Diagnostic Certainty ◽

Contemporary Practice

Background There is limited information about the frequency of perioperative complications after elective primary orthopedic total hip and knee arthroplasty in contemporary practice. The purpose of this study was to determine the frequency of clinically relevant myocardial infarction, pulmonary embolism, deep venous thrombosis, and death within 30 days after elective primary hip or knee arthroplasty treated according to contemporary perioperative management. Methods The authors examined the medical records of consecutive patients undergoing hip or knee arthroplasty at their institution in a 10-yr period. Prospectively collected databases were used to identify patients with the diagnosis of myocardial infarction, pulmonary embolism, deep venous thrombosis, or death using strict validation criteria and diagnostic-certainty categories. Results A total of 10,244 patients underwent primary total hip or knee arthroplasty in the period of study. Of these, 224 patients had one or more adverse events (overall event rate: 2.2%; myocardial infarction: 0.4%; pulmonary embolism: 0.7%; deep venous thrombosis: 1.5%; death: 0.5%). Most adverse events (myocardial infarction, pulmonary embolism, and death) increased in frequency with older age, particularly for patients aged 70 yr or older. Myocardial infarction occurred more frequently in male patients. There were no differences in the overall event frequency between types of procedure. However, pulmonary embolism was highest in patients undergoing bilateral knee operations. Conclusions The overall frequency of serious complications within 30 days after primary total hip or knee arthroplasty with contemporary practice was 2.2%. Accurate knowledge of the perioperative risks associated with widely performed elective operations can be used to implement management strategies that may further improve patient outcomes and decrease cost.

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Antiplasmin Levels After Surgery: The Failure of α2 Antiplasmin Rise in Patients With Venous Thrombosis

10.1055/s-0039-1684850 ◽

1979 ◽

Author(s):

D.A. Taberner ◽

L. Poller

Keyword(s):

Deep Vein Thrombosis ◽

Venous Thrombosis ◽

Low Dose ◽

Vein Thrombosis ◽

Dose Heparin ◽

Α2 Macroglobulin ◽

Specific Antisera ◽

Before And After ◽

Deep Vein ◽

Low Dose Heparin

Levels of antiproteases have been determined before and after surgery in twenty-five gynaecological patients by rocket immunoelectrophoresis using specific antisera. The patients who developed deep vein thrombosis during the first post - operative week were identified by screening all patients with the 125I fibrinogen scan. α2 antiplasmin rose post-operatively in all fifteen patients who did not develop thrombosis. This rise was not modified patients receiving low-dose heparin. In the patients who developed positive fibrinogen scans no rise in α2 antiplasmin occurred and on the second post-operative day levels in these patients were significantly lower than in the fifteen patients whose scans remained negative in contrast, α2 macroglobulin tended to fall post-operatively but this change was only significant in the thrombotic group. α1 antitrypsin levels rose significantly in both thrombotic and non-thrombotic groups after operation. Plasmin-α2 antiplasmin complexes were not found in the thrombotic patients so that consumption of α2 antiplasmin does not explain tne lower levels observed.

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Proximal deep venous thrombosis following PTA of the superficial femoral artery – an obligation to disclose a complication that is rarely taken into account

VASA ◽

10.1024/0301-1526.35.1.41 ◽

2006 ◽

Vol 35 (1) ◽

pp. 41-44 ◽

Cited By ~ 5

Author(s):

Klein-Weigel ◽

Pillokat ◽

Klemens ◽

Köning ◽

Wolbergs ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Femoral Artery ◽

Superficial Femoral Artery ◽

Rare Complication ◽

Femoral Vein ◽

Vein Thrombosis ◽

Explicit Information ◽

Life Threatening ◽

Legal Consequences

We report two cases of femoral vein thrombosis after arterial PTA and subsequent pressure stasis. We discuss the legal consequences of these complications for information policies. Because venous thrombembolism following an arterial PTA might cause serious sequel or life threatening complications, there is a clear obligation for explicit information of the patients about this rare complication.

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A Plasma Clot Lysis Assay Based on the Release of Fibrin Degradation Products: Application to the Diagnosis of Hypofibrinolytic States

Thrombosis and Haemostasis ◽

10.1055/s-0038-1645690 ◽

1990 ◽

Vol 63 (01) ◽

pp. 076-081 ◽

Cited By ~ 2

Author(s):

Pascale Gaussem ◽

Sophie Gandrille ◽

Pascale Molho-Sabatier ◽

Loïc Capron ◽

Jean-Noël Fiessinger ◽

...

Keyword(s):

Degradation Products ◽

Venous Occlusion ◽

Lower Limbs ◽

Clot Lysis ◽

Plasma Clot ◽

Vein Thrombosis ◽

Fibrin Degradation Products ◽

Before And After ◽

Euglobulin Clot Lysis Time ◽

Pai 1

SummaryUsing a monoclonal antibody-based assay, we measured the fibrin degradation product release in the supernatant of plasma clots obtained before and after venous occlusion (VO) in 30 patients with definite or suspected vascular thrombosis (19 definite and 2 suspected deep vein thrombosis, 6 recurrent superficial thrombophlebitis, 3 arterial occlusions of lower limbs). tPA and PAI-1 concentrations were determined using ELISA assays; the post-occlusion values were corrected for haemoconcentration. The increase in tPA during VO was correlated with haemoconcentration (r = 0.74), but 3 patients had ineffective VO (<2% increase in proteins). The fibrinolytic response to VO was evaluated using the shortening of the time necessary for the release of 200 μg of fibrin degradation products per mg of fibrinogen (Δ T 200). Two among the 27 patients with effective VO were bad responders with a Δ T 200 <3 h (whereas all the others had Δ T 200 >10 h). These patients had respectively a deficient tPA release (Δ tPA = 1 ng/ml) and an elevated PAI-1 level at rest (33 ng/ml). Several other patients were bad responders in terms of tPA release or of shortening of the euglobulin clot lysis time but they had a normal Δ T 200. This plasma clot test reflects the ability of free tPA to bind to fibrin (the amount of which depends on the level of tPA and PAI-1), and may be useful in the diagnosis of a hypofibrinolytic state.

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Platelet Coagulant Activities and Retinal Vein Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1651475 ◽

1977 ◽

Vol 38 (02) ◽

pp. 0399-0406 ◽

Cited By ~ 10

Author(s):

Peter N. Walsh ◽

Richard E. Goldberg ◽

Richard L. Tax ◽

Larry E. Magargal

Keyword(s):

Platelet Aggregation ◽

Venous Thrombosis ◽

Retinal Vein Occlusion ◽

Serotonin Release ◽

Platelet Factor ◽

Trigger Mechanism ◽

Local Conditions ◽

Plasma Coagulation ◽

Vein Thrombosis ◽

Vein Occlusion

SummaryTo determine whether platelets play a role in the pathogenesis of retinal vein occlusion (RVO), platelets and coagulation were evaluated in 28 patients with RVO. Platelet coagulant activities concerned with the initiation and early stages of intrinsic coagulation were 2–4 fold increased in 9 patients with acute primary RVO but not in patients with acute secondary (10 patients) or chronic (9 patients) RVO. Platelet factor 3 activity, platelet aggregation, serotonin release by platelets and plasma coagulation were normal in all patients. Platelets may provide a trigger mechanism for venous thrombosis in the eye when local conditions permit.

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Cerebellar venous thrombosis mimicking a cerebellar tumor due to polycythemia vera: a case report

BMC Neurology ◽

10.1186/s12883-021-02261-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hongfeng Wen ◽

Di Jin ◽

Yu Chen ◽

Bin Cui ◽

Tianyi Xiao

Keyword(s):

Venous Thrombosis ◽

Polycythemia Vera ◽

Delayed Diagnosis ◽

Janus Kinase ◽

Cerebellar Hemisphere ◽

Cerebellar Tumor ◽

Cortical Vein ◽

Vein Thrombosis ◽

Cortical Vein Thrombosis ◽

V617f Mutation

Abstract Background Cerebral venous thrombosis (CVT) occurs rarely in the general population and is frequently associated with confused clinical findings and delayed diagnosis. Isolated cerebellar cortical vein thrombosis is a very rare phenomenon. Case presentation This report describes a case with CVT, which is manifested as space-occupying lesions of the cerebellar hemisphere and mimics a cerebellar tumor at the beginning. The diagnosis of CVT was finalized given the laboratory and brain biopsy findings. The etiology may be related to polycythemia vera with Janus Kinase 2 V617F mutation. Conclusion Isolated cerebellar vein thrombosis should be considered when swelling and enhancing cerebellar lesions are detected. Polycythemia vera, especially with a positive JAK2 V617F mutation, may be a rare risk factor for CVT.

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Algorithmic prediction of failure modes in healthcare

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzaa151 ◽

2020 ◽

Author(s):

Ayala Kobo-Greenhut ◽

Ortal Sharlin ◽

Yael Adler ◽

Nitza Peer ◽

Vered H Eisenberg ◽

...

Keyword(s):

Adverse Events ◽

Failure Modes ◽

Medical Center ◽

Hazard Analysis ◽

Working Hours ◽

Hazard Identification ◽

Patient Identification ◽

Complete Identification ◽

Before And After ◽

Fmea Method

Abstract Background Preventing medical errors is crucial, especially during crises like the COVID-19 pandemic. Failure Modes and Effects Analysis (FMEA) is the most widely used prospective hazard analysis in healthcare. FMEA relies on brainstorming by multi-disciplinary teams to identify hazards. This approach has two major weaknesses: significant time and human resource investments, and lack of complete and error-free results. Objectives To introduce the algorithmic prediction of failure modes in healthcare (APFMH) and to examine whether APFMH is leaner in resource allocation in comparison to the traditional FMEA and whether it ensures the complete identification of hazards. Methods The patient identification during imaging process at the emergency department of Sheba Medical Center was analyzed by FMEA and APFMH, independently and separately. We compared between the hazards predicted by APFMH method and the hazards predicted by FMEA method; the total participants’ working hours invested in each process and the adverse events, categorized as ‘patient identification’, before and after the recommendations resulted from the above processes were implemented. Results APFMH is more effective in identifying hazards (P < 0.0001) and is leaner in resources than the traditional FMEA: the former used 21 h whereas the latter required 63 h. Following the implementation of the recommendations, the adverse events decreased by 44% annually (P = 0.0026). Most adverse events were preventable, had all recommendations been fully implemented. Conclusion In light of our initial and limited-size study, APFMH is more effective in identifying hazards (P < 0.0001) and is leaner in resources than the traditional FMEA. APFMH is suggested as an alternative to FMEA since it is leaner in time and human resources, ensures more complete hazard identification and is especially valuable during crisis time, when new protocols are often adopted, such as in the current days of the COVID-19 pandemic.

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Outcome of Anticoagulation in Isolated Distal Deep Vein Thrombosis Compared to Proximal Deep Venous Thrombosis

Journal of Thrombosis and Haemostasis ◽

10.1111/jth.15416 ◽

2021 ◽

Author(s):

Danielle T Vlazny ◽

Ahmed K Pasha ◽

Wiktoria Kuczmik ◽

Waldemar E Wysokinski ◽

Matthew Bartlett ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Vein Thrombosis ◽

Distal Deep Vein Thrombosis ◽

Deep Vein

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En Plaque Sphenoid Wing Meningiomas: Recurrence Factors and Surgical Strategy in a Series of 71 Patients

Operative Neurosurgery ◽

10.1227/01.neu.0000345652.19200.d5 ◽

2009 ◽

Vol 65 (suppl_6) ◽

pp. ons100-ons109 ◽

Cited By ~ 6

Author(s):

Giuseppe Mirone ◽

Salvatore Chibbaro ◽

Luigi Schiabello ◽

Serena Tola ◽

Bernard George

Keyword(s):

Cavernous Sinus ◽

Residual Tumor ◽

Complete Removal ◽

Subtotal Resection ◽

Presenting Symptoms ◽

Time To Recurrence ◽

Clinical Records ◽

Mean Time ◽

Case Basis

Abstract Objective: En plaque sphenoid wing meningiomas are complex tumors involving the sphenoid wing, the orbit, and sometimes the cavernous sinus. Complete removal is difficult, so these tumors have high rates of recurrence and postoperative morbidity. The authors report a series of 71 patients with sphenoid wing meningiomas that were managed surgically. Methods: The clinical records of 71 consecutive patients undergoing surgery for sphenoid wing meningiomas at Lariboisière Hospital, Paris, were prospectively collected in a database during a 20-year period and analyzed for presenting symptoms, surgical technique, clinical outcome, and follow-up. Results: Among the 71 patients (mean age, 52. 7 years; range, 12–79 years), 62 were females and 9 were males. The most typical symptoms recorded were proptosis in 61 patients (85.9%), visual impairment in 41 patients (57.7%), and oculomotor paresis in 9 patients (12.7%). Complete removal was achieved in 59 patients (83%). At 6 months of follow-up, magnetic resonance imaging scans revealed residual tumor in 12 patients (9 in the cavernous sinus and 3 around the superior orbital fissure). Mean follow-up was 76.8 months (range, 12–168 months). Tumor recurrence was recorded in 3 of 59 patients (5%) with total macroscopic removal. Among the patients with subtotal resection, tumor progression was observed in 3 of 12 patients (25%; 2 patients with grade III and 1 patient with grade IV resection). Mean time to recurrence was 43.3 months (range, 32–53 months). Conclusion: Surgical management of patients with sphenoid wing meningiomas cannot be uniform; it must be tailored on a case-by-case basis. Successful resection requires extensive intra- and extradural surgery. We recommend optic canal decompression in all patients to ameliorate and/or preserve visual function.

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