Abdominal procedures are suggested to be done with cardiac surgery at the same time with laparoscopic technique to reduce mortality and morbidity in these patients.
The longer the SARS-CoV-2 pandemic takes, the greater the prothrombotic effects of the disease, which varies from venous thromboembolic events to limb arterial thrombosis and stroke. How we deal with the effects of the COVID-19 disease, is still unclear. In this study, researchers will report the clinical presentation, outcome and management of the patient with COVID-19 after coronary artery bypass graft (CABG) surgery, which led to rapid progression of arterial thrombosis. The COVID-19 positive patient underwent emergency CABG, due to developed coronary artery disease. Despite receiving high-dose preoperative Plavix and heparin and also postoperative aspirin, the patient developed progressive thrombosis in both lower extremities 4 days after surgery. It then spread to bilateral iliac arteries, aorta, abdominal and renal artery. Femoral endarterectomy was performed two times for atheromatous plaque removal which was unsuccessful and the patient died few days later due to multi-organ failure. COVID-19 is a risk factor for arterial thrombosis with high mortality and morbidity rate. If thrombosis happens, the prognosis will be poor. Comprehensive treatments have to be started immediately after diagnosis. In patients undergoing surgery for extensive arterial thrombosis due to poor prognosis, not only surgical revascularization is needed but also thrombolysis treatments may be considered as off-label use. As the pandemic continues, new approaches and interventions may be applied.
Introduction: Wilms tumor is the most common kidney cancer in children, but Wilms's tumors that extend by direct intravascular spread into the right side of the heart are rare and at this stage, they require the cardiac surgeons’ intervention. Case Presentation: The patient was a 2-year-old girl who was hospitalized due to fever and abdominal pain that had started 2 weeks before admission. Patient’s full abdominal exams revealed a large mass in the right kidney with a thrombus tumor in the entire inferior vena cava which was extended into the right atrium. Patient completed 8 weeks of neoadjuvant chemotherapy. After chemotherapy no changes was noted in renal mass and tumor thrombus. As, the thrombosis in the atrium was loose and there was a high risk of pulmonary embolism, emergency surgery was needed. Two pediatric and cardiac teams, simultaneously performed the surgery without cardiopulmonary bypass and cardiac arrest. Both kidney mass and the thrombus tumor were completely removed. Patient followed up for 5 years after surgery and no surgical complications, tumor recurrence, or metastasis were observed during that period. Conclusions: Although surgical intervention and tumor resection leads to good prognosis, multimodality management and multidisciplinary approach gives the best results.
Introduction: With the improvements in neoplasm treatments and the increased survival of patients with neoplastic diseases, we have entered a new era of having to deal with the complications of senile patients. The issue of bone fusion or the side effects of its delay, such as malunion or infections, are among the concerns for any surgery in patients whose bone marrow is affected by treatment or whose bone marrow blood flow is impaired. The left internal mammary artery (LIMA) is used for coronary artery bypass graft (CABG) surgery with its 2 - 3 times longer lifespan compared to saphenous vein grafts, but its harvest from the sternum affects the sternum blood flow and the outcome of its use is still not identified in patients undergoing bone marrow transplant. This case report is the first report on this issue. Case Presentation: A 60-year-old man with diffuse large B cell lymphoma who had undergone bone marrow transplant a year before had then developed chest pain, which was diagnosed as vessel disease; he was selected for CABG surgery. The LIMA was harvested during the surgery and the left anterior descending artery (LAD) was anastomosed. The saphenous vein graft was also anastomosed to the diagonal artery, obtuse marginatus (OM), posterior descending artery (PDA), and posterior left ventricle (PLV). After the surgery, the patient was followed up for six months, during which time no specific incidents occurred and no sternum-related complications were observed either. Conclusions: In this case report, the use of LIMA in a patient who had undergone a bone marrow transplant and CABG surgery was not associated with any increase in sternum-related complications.
Introduction: Misoprostol is a widely used prostaglandin to terminate pregnancy in the second trimester. The route of drug administration has a significant effect on the quality of treatment. Objectives: In this study, we aimed to compare efficacy and adverse effects of vaginal and intrauterine extra-amniotic administration of misoprostol in second-trimester termination. Patients and Methods: In a randomized clinical trial, 112 women with an intrauterine fetal death between 13– 24 weeks of gestation attended Akbarabadi hospital were enrolled during 2018-2019. Patients were randomly divided into two groups. In group A, 200 µg misoprostol was diluted in 10ml of normal saline and administered extra-amniotic every 4 hours. Group B received vaginal tablets (200 µg in each) according to FIGO protocol. The primary outcomes were the time needed to expel gestational products and hemoglobin level changes. Results: In group A, conception product expulsion occurred within an average of 7.52 ± 0.29 hours, significantly faster than group B (12.02 ± 0.42 hours; P<0.05). In group A, the Hemoglobin level decreased after intervention (-1.23 ± 1.20 g/dL), and the changes were more prominent than group B (-0.15 ± 0.51 g/dL; P<0.05). Conclusion: For pregnancy termination, intrauterine extra-amniotic administration of misoprostol is a more effective method than the vaginal route in the second trimester. However, regarding further hemoglobin decrease in this method, its safety is still unclear and needs to be approved by further clinical trials with a larger sample size. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trial (identifier: IRCT20190606043830N1; https://en.irct.ir/trial/40184, ethical code: IR.IUMS.FMD.REC1396.941129004).
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