Int Surg
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Transesophageal echocardiography (TEE) has been established as a very valuable asset for patient monitoring during cardiac surgery. The value of perioperative TEE for patients undergoing noncardiac surgery is less clear. ⋯ However, certain requirements for the use of the technique are necessary, most important the development of sufficient echocardiographic skills by the anesthesiologists. Indications, skill requirements, and possible complications of the technique are reviewed.
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Blood conservation is based on the principle of avoiding allogeneic blood transfusion with the aim of improving outcome and protecting patients' rights. Surgical patients receive a significant proportion of the allogeneic blood transfused in the hospital. Blood conservation in surgery greatly reduces overall allogeneic blood use, thereby reducing costs, hazards, and adverse outcomes. ⋯ Bloodless medicine and surgery programs represent the gold standard in blood conservation. Blood conservation is evidence based, and it results in faster recovery, lower morbidity, lower mortality, shorter hospital stay, lower cost, and better patient (and physician) satisfaction while avoiding the hazards of allogeneic blood transfusion. Blood conservation is thus the current standard of care.
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Review Case Reports
Extra-adrenal nonfunctional retroperitoneal paraganglioma: case report and review of the literature.
An extra-adrenal paraganglioma is a rare tumor derived from the chromaffin cells of sympathetic ganglia. This report documents a rare case of nonfunctional extra-adrenal paraganglioma in a 20-year-old woman with persistent flank pain. Ultrasonography and computed tomography revealed a solid mass with calcification in center, measuring 7 x 6 x 6 cm, and localized in the left upper para-aortal retroperitoneal region. ⋯ Tumor was successfully removed through a midline laparotomy incision, and pathological analysis of the surgical specimen revealed a paraganglioma. After 12 months, the patient is still in a good health, asymptomatic, and without evidence of tumor recurrence. This case emphasizes the necessity to include extra-adrenal paraganglioma in the differential diagnosis and management of retroperitoneal tumors, despite its rarity.
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Review Case Reports
Gunshot wound of the heart with embolism to the right axillary artery.
The rarity of bullet emboli leads to frequent delays in diagnosis and inadequate early management. A case report of a bullet entering the right ventricle and embolization to the right axillary artery is presented. Our recent experience with this entity is described, and 160 cases reported in the English literature are reviewed and summarized.
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Review Case Reports
Acute colonic intramural hematoma due to blunt abdominal trauma.
Trauma to the colon is uncommon and accounts for only 3-5% of all blunt abdominal injuries. Among them, intramural hematoma of the colon is a rare complication and the acute form is rarer than the chronic form. We report a 37-year-old man who presented with abdominal pain followed by intestinal obstruction due to a blunt trauma. ⋯ We conclude that acute colonic hematoma can be diagnosed by sonography and/or CT in contrast to the early reported cases, in the pre-CT era, when they could only be diagnosed at laparotomy. Endoscopy may also be helpful for diagnosis in some cases. Although expectant therapy may be successful in some cases, the majority of the cases may need operation.