Autotransfusion of vaginally shed blood as a novel therapy in obstetric hemorrhage: A case series

AbstractPreviously, the simultaneous presence of endocarditis (IE) has been reported in 3–30% of spondylodiscitis cases. The specific implications on therapy and outcome of a simultaneous presence of both diseases are not yet fully evaluated. Therefore, the aim of this study was to investigate the influence of a simultaneously present endocarditis on the course of therapy and outcome of spondylodiscitis. A prospective database analysis of 328 patients diagnosed with spontaneous spondylodiscitis (S) using statistical analysis with propensity score matching was conducted. Thirty-six patients (11.0%) were diagnosed with concurrent endocarditis (SIE) by means of transoesophageal echocardiography. In our cohort, the average age was 65.82 ± 4.12 years and 64.9% of patients were male. The incidence of prior cardiac or renal disease was significantly higher in the SIE group (coronary heart disease SIE n = 13/36 vs. S n = 57/292, p < 0.05 and chronic heart failure n = 11/36 vs. S n = 41/292, p < 0.05, chronic renal failure SIE n = 14/36 vs. S n = 55/292, p < 0.05). Complex interdisciplinary coordination and diagnostics lead to a significant delay in surgical intervention (S = 4.5 ± 4.5 days vs. SIE = 8.9 ± 9.5 days, p < 0.05). Mortality did not show statistically significant differences: S (13.4%) and SIE (19.1%). Time to diagnosis and treatment is a key to efficient treatment and patient safety. In order to counteract delayed therapy, we developed a novel therapy algorithm based on the analysis of treatment processes of the SIE group. We propose a clear therapy pathway to avoid frequently observed pitfalls and delays in diagnosis to improve patient care and outcome.

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Dupilumab as a novel therapy for bullous pemphigoid: A multicenter case series

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2020.01.089 ◽

2020 ◽

Vol 83 (1) ◽

pp. 46-52 ◽

Cited By ~ 6

Author(s):

Rana Abdat ◽

Reid A. Waldman ◽

Valeria de Bedout ◽

Annette Czernik ◽

Michael Mcleod ◽

...

Keyword(s):

Bullous Pemphigoid ◽

Case Series ◽

Novel Therapy

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Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a multicenter international experience

Endoscopy ◽

10.1055/a-0596-7199 ◽

2018 ◽

Cited By ~ 11

Author(s):

Michel Kahaleh ◽

Jean-Michel Gonzalez ◽

Ming-ming Xu ◽

Iman Andalib ◽

Monica Gaidhane ◽

...

Keyword(s):

Gastric Emptying ◽

Hospital Stay ◽

Case Series ◽

Length Of Hospital Stay ◽

Novel Therapy ◽

Gastric Emptying Scintigraphy ◽

Post Procedure ◽

The Mean ◽

Procedure Duration

Abstract Background Gastroparesis is a difficult-to-treat motility disorder with a poor response to medical therapy. Gastric peroral endoscopic pyloromyotomy (G-POEM) has been offered as a novel therapy in the treatment of refractory gastroparesis. We present a multicenter case series of our experience with G-POEM. Methods This is an international multicenter case series of patients who underwent G-POEM for the treatment of gastroparesis. The severity of gastroparesis was assessed by delayed gastric emptying scintigraphy (GES) and an elevated gastroparesis cardinal symptoms index (GCSI). Patients then underwent G-POEM using the submucosal tunneling technique. The primary endpoint was improvement in the GCSI score and improvement in gastric emptying on repeat scintigraphy. Secondary endpoints were technical success, complication rate, procedure duration, and length of hospital stay post-procedure. Results G-POEM was technically successful in all 33 patients. Symptomatic improvement was seen in 28/33 patients (85 %), with a decrease in symptom score by GCSI from 3.3 to 0.8 at follow-up (P < 0.001). The mean procedure duration was 77.6 minutes (37 – 255 minutes). Mean GES improved significantly from 222.4 minutes to 143.16 minutes (P < 0.001). Complications were minimal and included bleeding (n = 1) and an ulcer (n = 1) treated conservatively. The mean length of hospital stay post-procedure was 5.4 days (1 – 14 days). The mean follow-up duration was 11.5 months (2 – 31 months). Conclusion G-POEM is a technically feasible, safe, and successful procedure for the treatment of refractory gastroparesis. A further multicenter comparative study should be performed to compare this technique to laparoscopic pyloromyotomy.

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Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia

Panamerican Journal of Trauma, Critical Care & Emergency Surgery ◽

10.5005/jp-journals-10030-1164 ◽

2017 ◽

Vol 6 (1) ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Carlos A Ordóñez ◽

Albaro J Nieto ◽

Javier A Carvajal ◽

Juan M Burgos ◽

Adriana Messa ◽

...

Keyword(s):

Damage Control ◽

Case Series ◽

Damage Control Surgery ◽

Descriptive Study ◽

Clinical Severity ◽

Damage Control Resuscitation ◽

Obstetric Hemorrhage ◽

Rapid Control ◽

Expected Mortality ◽

Overall Mortality

ABSTRACT Objective The aim of this case series is to describe the experience of implementing damage control resuscitation (DCR) in patients with major obstetric hemorrhage (MOH) between January 2005 and December 2015 in the Fundación Valle del Lili, Cali, Colombia. Materials and methods This is a prospective descriptive study of a case series from 108 patients with MOH who were subjected to DCR. All patients were operated on using a standardized surgical technique in accordance with the institutional protocol. Results The median age was 28 years, with a gestational age of 38 weeks. The principal associated diagnosis was severe preeclampsia (in 39% of cases). A total of 96 patients presented massive postpartum hemorrhage, and 75% of these cases presented after a cesarean section. In all patients, normal control of bleeding was achieved, 60% during the first surgical period. The Acute Physiology and Chronic Health Evaluation score was 14, with an overall mortality of 6.48%, far below the expected mortality according to the clinical severity of these patients. Conclusion This study includes the biggest series of pregnant women with MOH, in a critical condition, in whom DCR was used, during which rapid control of bleeding was achieved, associated with a significantly lower mortality than expected. How to cite this article Escobar MF, Carvajal JA, Burgos JM, Messa A, Ordoñez CA, García AF, Granados M, Forero AM, Casallas JD, Thomas LS, Nieto AJ. Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia. Panam J Trauma Crit Care Emerg Surg 2017;6(1):1-7.

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Resurgence of classical caesarean section in current obstetric practice- A case series

Indian Journal of Obstetrics and Gynecology Research ◽

10.18231/j.ijogr.2021.122 ◽

2021 ◽

Vol 8 (4) ◽

pp. 592-594

Author(s):

Priyanka Mathe ◽

Sanjana Narula Wadhwa ◽

Taru Gupta

Keyword(s):

Multidisciplinary Approach ◽

Placenta Accreta ◽

Case Series ◽

Cesarean Sections ◽

Obstetric Hemorrhage ◽

Maternal Morbidity And Mortality ◽

Life Threatening ◽

Placenta Accreta Spectrum ◽

High Index Of Suspicion ◽

Lower Segment Uterine

Although, the incidence of placenta accreta spectrum (PAS) and large fibroids is rare but still these cases contributes to a large number of maternal morbidity and mortality. Major obstetric hemorrhage is one the dreadful complication of these types of cases and thus early diagnosis and intervention in such cases helps the physician to minimize the risk to mother and the fetus. Also, current widespread use of ultrasound has helped us to manage these cases judiciously, predict and prevent life threatening obstetric hemorrhage. Here we present three complicated obstetric cases of placenta accreta, large lower segment uterine fibroid and large cervical fibroid which necessitated classical cesarean sections (CCS) thus emphasizing prowess in CCS in modern obstetric era. High index of suspicion, Multidisciplinary approach alongwith expert surgical personnel should be available in high risks cases like placenta accreta syndrome and large fibroids in pregnancy.

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