A & A case reports
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Case Reports
Needle Migration to the Heart: An Unusual Association of Hemodialysis and Cardiovascular Morbidity.
In this report, we present a unique complication of hemodialysis: the hemodialysis access needle was lost into an arteriovenous fistula. The event went unnoticed for several months. ⋯ Loss of the needle was likely unrecognized because of the use of a retracting safety cannula that conceals the needle within a sheath after removal. This case highlights a rare and potentially serious complication of hemodialysis access, demonstrates a possible hazard of retracting safety needles, and reviews the management of foreign bodies that have migrated into the heart.
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Mechanical valve thrombosis is a severe complication of valve replacement associated with significant patient morbidity and mortality. The main factors that predispose patients to thrombus formation include endothelial injury or dysfunction, hypercoagulability, and hemodynamic changes. ⋯ Early diagnosis of thrombus could prevent adverse patient outcomes. We describe the use of transesophageal echocardiography in the diagnosis of acute thrombus in a patient with a recently replaced single atrioventricular valve.
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A 65-year-old man was admitted for acute coronary syndrome with depressed left ventricular function and moderate aortic regurgitation. He was managed with an intraaortic balloon pump for circulatory support before coronary artery bypass grafting and subsequently developed flash pulmonary edema with an associated rare finding of diastolic pulmonary venous flow reversal. In this report, we provide a review of intraaortic balloon pump use in current clinical practice and elaborate on the pathophysiology of an uncommon pulmonary venous flow pattern found in our patient.
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Improvement of living and socioeconomic conditions, developments, and innovations in medicine and technology has prolonged of life expectancy. We provided spinal anesthesia for a 111-year-old woman requiring internal fixation of a fractured femur. ⋯ The patient was discharged from the intensive care unit after 24-hour monitoring without any complications. She was discharged from the hospital on postoperative day 2.
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Effective multimodal analgesia and sedation reduce the postoperative morbidity and mortality associated with newborn bladder exstrophy repair. Epidural analgesia is safe and effective for major surgery in neonates and infants, reducing the need for muscle relaxants, opioids, and ventilator support postoperatively. ⋯ In this report, we describe the postoperative analgesic management of an infant undergoing bladder exstrophy repair using a directly placed tunneled epidural catheter with ropivacaine 0.1% infusion. Because of the prolonged infusion, we also monitored plasma ropivacaine levels to preclude systemic toxicity from local anesthetic overdose.