Introduction:Paragangliomas (PGs) or extra-adrenal pheochromocytomas are rare neuroendocrine neoplasms of ubiquitous distribution. Those that produce excess catecholamine are categorized as functional, and those that do not are categorized as nonfunctional. Although modern medical technology is becoming more widespread, there are still substantial risks of misdiagnosis or missed diagnosis of PGs.Case presentation:A 38-year-old woman who lived in an autonomous region of inner Mongolia presented complaining of having experienced coughing for approximately the past month. Chest computed tomography (CT) and magnetic resonance imaging (MRI) revealed a lesion on the right side of thoracic vertebra 5–8 of approximately 66 mm × 54 mm, and it was deemed to be a mediastinal tumor that required surgical treatment. The patient exhibited severe hemodynamic instability during the operation, resulting in substantial challenges and risks with regard to anesthesia management.Conclusion:When a patient is suspected having PG, whether the surgery should be continued or not depends on their overall condition and whether hemodynamic fluctuation can be controlled to within the normal range. Both are factors that should be considered during intraoperative management. Communication between the surgeon and anesthesiologist is necessary, in order to accurately assess the risks associated with the operation. The combination of central venous pressure and the Flotrac/Vigileo system may provide precise guidance for complementary liquid therapy and reduce cardiopulmonary complications. After the operation, hemodynamic changes should be monitored continuously in the intensive care unit, and vasoactive drugs are required to avoid postoperative hypotension. Dramatic hemodynamic changes are certainly a challenge for patients and anesthesiologists, regardless of their origin, and sufficient attention should be paid to avoid serious consequences.
Background: Spontaneous co-occurrence of acute myocardial infarction (AMI) and acute lower extremity arterial embolism (ALEAE) has rarely been reported.Case presentation: A 44-year-old male with a history of 4 years of type1 diabetes was admitted to hospital when he suddenly experienced severe pain in his right lower limb and felt tightness in the left anterior chest area. Ultrasonography revealed distal occlusion of the right superficial femoral artery. ECG showed acute anterior interstitial myocardial infarction. After conservative treatment for 2 days, the patient had severe necrosis of lower limbs and secondary injury of multiple organs. Hemodialysis and heparin anticoagulant therapy were performed before amputation. Twelve days after the operation, the patient's condition was stable and he was transferred out of ICU.Conclusions: Emergency amputation and multidisciplinary approaches may offer a chance for survival if patents lost the opportunity for early treatment.
Introduction The objective of this single-center study it to retrospectively analyze the relationship between transfusion and 30-day postoperative outcomes in patients undergoing isolated off-pump coronary artery bypass grafting. Methods Perioperative data of 2,178 patients who underwent isolated off-pump coronary artery bypass grafting from 2018 to 2019 were collected. A 1:1 propensity score matching was performed to control for potential biases between patients who received blood transfusion and those who did not. After propensity score matching, we analyzed the clinical outcomes of transfusion and non-transfusion patients. Postoperative complications and the survival of patients within 30 days after surgery in both groups were analyzed. Kaplan-Meier survival curve and log-rank test were used for survival analysis. Results The total blood transfusion rate of all patients was 29%, including red blood cell (27.6%), plasma (7.3%), and platelet (1.9%). Four hundred and forty patients in each group were compared after propensity score matching. There were no significant differences in the incidence of stroke, myocardial infarction, atrial fibrillation, acute kidney function injury, and sternal wound infection of both groups (P>0.05). However, higher incidence of postoperative pulmonary infection and more mechanical ventilation time and days of stay in the intensive care unit and postoperative in-hospital stay were associated with blood transfusion (P<0.05). The 30-day cumulative survival rate of the transfusion group was lower than that of the control group (P<0.05). Conclusion Perioperative blood transfusion increases the risks of postoperative pulmonary infection and short-term mortality in off-pump coronary artery bypass grafting patients.
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