The Use of Spray Electrocautery to Control Presacral Bleeding: A Report of Four Cases

2007 ◽  
Vol 73 (4) ◽  
pp. 410-413 ◽  
Author(s):  
George M. Filippakis ◽  
Manolis Leandros ◽  
Kostas Albanopoulos ◽  
Michael Genetzakis ◽  
Emmanuel Lagoudianakis ◽  
...  
Keyword(s):  
High Frequency ◽  
Low Anterior Resection ◽  
Electrical Current ◽  
Venous Plexus ◽  
Novel Technique ◽  
Presacral Bleeding ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Rectal Mobilization ◽  
Presacral Fascia

Bleeding originating from the presacral venous plexus during pelvic operations is difficult to control, constituting a potentially life-threatening complication. Although suture ligatures, packing, and placement of tacks are established hemostatic techniques, they are often proved to be ineffective. We report a simple novel technique using spray diathermy for managing this severe complication. We have applied our method in four patients, two undergoing low anterior resection, and the others undergoing abdominoperineal resection for rectal cancer, that manifested severe presacral bleeding during rectal mobilization. Electrocautery at spray setting was applied slightly above the target bleeders at the presacral fascia, delivering a high-frequency electrical current in combination with drainage suction. In all cases, the method resulted in successful hemostasis. Applying spray electrocautery is a simple and effective method for controlling pre-sacral bleeding. The advantages of using such a method instead of conventional hemostatic techniques include the option of varying the degree of haemostatic effect by altering the frequency and the volume of electric current.

scholarly journals Surgical management of presacral bleeding

2014 ◽  
Vol 96 (4) ◽  
pp. 261-265 ◽  
Author(s):  
V Celentano ◽  
JR Ausobsky ◽  
P Vowden
Keyword(s):  
Rectal Surgery ◽  
Alternative Methods ◽  
Primary Data ◽  
Venous Plexus ◽  
Presacral Bleeding ◽  
Creative Solutions ◽  
Life Threatening ◽  
Venous Bleeding ◽  
Comprehensive Classification

Introduction Presacral venous bleeding is an uncommon but potentially life threatening complication of rectal surgery. During the posterior rectal dissection, it is recommended to proceed into the plane between the fascia propria of the rectum and the presacral fascia. Incorrect mobilisation of the rectum outside the Waldeyer’s fascia can tear out the lower presacral venous plexus or the sacral basivertebral veins, causing what may prove to be uncontrollable bleeding. Methods A systematic search of the MEDLINE® and Embase™ databases was performed to obtain primary data published in the period between 1 January 1960 and 31 July 2013. Each article describing variables such as incidence of presacral venous bleeding, surgical approach, number of cases treated and success rate was included in the analysis. Results A number of creative solutions have been described that attempt to provide good tamponade of the presacral haemorrhage, eliminating the need for second operation. However, few cases are reported in the literature. Conclusions As conventional haemostatic measures often fail to control this type of haemorrhage, several alternative methods to control bleeding definitively have been described. We propose a practical comprehensive classification of the available techniques for the management of presacral bleeding.

Presentation of Gall Stone Ileus as Gut Obstruction

JMS SKIMS ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. 117-119
Author(s):  
Munir Ahmad Wani ◽  
Mubarak Ahmad Shan ◽  
Syed Muzamil Andrabi ◽  
Ajaz Ahmad Malik
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Ct Scan ◽  
Bowel Obstruction ◽  
Emergency Surgery ◽  
Gallstone Ileus ◽  
Gall Stone ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Gall Stone Ileus

Gallstone ileus is an uncommon and often life-threatening complication of cholelithiasis. In this case report, we discuss a difficult diagnostic case of gallstone ileus presenting as small gut obstruction with ischemia. A 56-year-old female presented with abdominal pain and vomiting. A CT scan was performed and showed an evolving bowel obstruction with features of gut ischemia with pneumobilia although no frank hyper density suggestive of a gallstone was noted. The patient underwent emergency surgery and a 60 mm obstructing calculus was removed from the patient's jejunum, with a formal tube cholecystostomy. JMS 2018: 21 (2):117-119

scholarly journals 187 Improving Awareness of Managing Post-Operative Haemorrhage in Patients Undergoing Thyroid and Parathyroid Surgery: The SCOOP Protocol

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Bhattacharya ◽  
J Jegadeeson ◽  
J Ramsingh ◽  
P Truran
Keyword(s):  
Nursing Staff ◽  
Simulation Training ◽  
Clinical Signs ◽  
Skin Wound ◽  
Junior Doctors ◽  
Parathyroid Surgery ◽  
Surgical Department ◽  
Life Threatening ◽  
Clinical Questions ◽  
Life Threatening Complication

Abstract Introduction Post-operative haemorrhage is a rare but potentially life-threatening complication of thyroid surgery and occurs in 1 in 100 patients. Our aim was to assess current levels of awareness of post-operative haemorrhage in the surgical department and to improve confidence in managing this. Method Questionnaires with a combination of clinical questions were distributed amongst nurses, foundation doctors, senior house officers and registrars in the surgical department. Results There was a clear gap in awareness in all grades. The British Association of Endocrine and Thyroid surgeons (BAETS) have guidance on the management of these patients and in particular the acronym SCOOP (Steristrips removed, Cut subcuticular sutures, Open skin wound, Open strap muscles, Pack wound). 18/24 of participants had not heard of the SCOOP protocol. Most nurses (6/12) all junior doctors (8/8) showed lack of confidence in managing patients with suspected bleeding. Conclusions An informative poster was created for relevant clinical areas as per the BAETS recommendation. These posters outlined the steps in the SCOOP acronymas well as the main clinical signs of haemorrhage. BAETS recommend that all first responders, including nursing staff, junior doctors and the crash team should be aware of the SCOOP protocol. Simulation training sessions are in progress for these members of staff.

scholarly journals Optimizing the Frequency Capping: A Robust and Reliable Methodology to Define the Number of Ads to Maximize ROAS

2021 ◽  
Vol 11 (15) ◽  
pp. 6688
Author(s):  
Jesús Romero Leguina ◽  
Ángel Cuevas Rumin ◽  
Rubén Cuevas Rumin
Keyword(s):  
High Frequency ◽  
Large Scale ◽  
Low Frequency ◽  
Digital Marketing ◽  
Optimal Frequency ◽  
Novel Technique ◽  
Maximum Threshold

The goal of digital marketing is to connect advertisers with users that are interested in their products. This means serving ads to users, and it could lead to a user receiving hundreds of impressions of the same ad. Consequently, advertisers can define a maximum threshold to the number of impressions a user can receive, referred to as Frequency Cap. However, low frequency caps mean many users are not engaging with the advertiser. By contrast, with high frequency caps, users may receive many ads leading to annoyance and wasting budget. We build a robust and reliable methodology to define the number of ads that should be delivered to different users to maximize the ROAS and reduce the possibility that users get annoyed with the ads’ brand. The methodology uses a novel technique to find the optimal frequency capping based on the number of non-clicked impressions rather than the traditional number of received impressions. This methodology is validated using simulations and large-scale datasets obtained from real ad campaigns data. To sum up, our work proves that it is feasible to address the frequency capping optimization as a business problem, and we provide a framework that can be used to configure efficient frequency capping values.

scholarly journals Rivaroxaban-Induced Nontraumatic Spinal Subdural Hematoma: An Uncommon Yet Life-Threatening Complication

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mazen Zaarour ◽  
Samer Hassan ◽  
Nishitha Thumallapally ◽  
Qun Dai
Keyword(s):  
Subdural Hematoma ◽  
Lower Risk ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
Bleeding Events ◽  
Spinal Hematoma ◽  
The Third ◽  
Spinal Subdural Hematoma ◽  
Life Threatening ◽  
Life Threatening Complication

In the last decade, the desire for safer oral anticoagulants (OACs) led to the emergence of newer drugs. Available clinical trials demonstrated a lower risk of OACs-associated life-threatening bleeding events, including intracranial hemorrhage, compared to warfarin. Nontraumatic spinal hematoma is an uncommon yet life-threatening neurosurgical emergency that can be associated with the use of these agents. Rivaroxaban, one of the newly approved OACs, is a direct factor Xa inhibitor. To the best of our knowledge, to date, only two published cases report the incidence of rivaroxaban-induced nontraumatic spinal subdural hematoma (SSDH). Our case is the third one described and the first one to involve the cervicothoracic spine.

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