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Hemothorax after chest tube insertion for pneumothorax as a complication of clopidogrel

100%
Ohara G., Kagohashi K., Kurishima K., Miyazaki K., Satoh H.
Open Medicine
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2013
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vol. 8
|
issue 4
406-409
EN
Hemorrhagic complications are recognized when anti-platelet agents are used during or after surgical procedures. We present a 69-year-old male patient who developed hemothorax after chest tube insertion for pneumothorax as a complication of clopidogrel and aspirin following ischemic heart disease. Hemothorax associated clopidogrel has rarely been reported and this is the first academic publication of this complication type following chest tube insertion shortly after the cessation of clopidogrel. Our case demonstrates the possibility of hemothorax when chest tube insertion is indicated under such conditions.
2
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Complications during pregnancy, labor and puerperium in women with increased BMI at pregnancy term

100%
Mamula O., Severinski N., Mamula M., Severinski S.
Open Medicine
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2009
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vol. 4
|
issue 1
71-75
EN
The aim of this study was to analyse perinatal complications in woman with increased BMI at pregnancy term. Study included 23190 women who gave singleton birth during a 10-year period in our institution. Maternal databases were reviewed for pregnancy, labor and delivery complications and early maternal postpartum morbidity. Women with increased BMI at pregnancy term had a significantly higer incidence of postterm pregnancy, gestational diabetes, pregnancy-induced hypertension and third trimester hemorrhage, compared to normal weight women (p 0.000). Women with increased BMI had significantly more labor induction with prostaglandins (p 0.001 and 0.000) and elective caesarean (p 0.025 and 0.000). Also, overweight and obese women had higher incidence of operative delivery: caesarean section (p 0.000) and vacuum extraction (p 0.000). The incidences of postpartum febrility (p 0.057, 0.000, 0.002) and trombophlebits (p 0.013) were also significantly higher. We can conclude that prepregnancy normal weight women with increased BMI during pregnancy need special follow-up and counseling in pregnancy and delivery.
3
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Removal and successful re-implantation of a customized interpositional knee device following an early postoperative infection: A case report

100%
Koeck F., Rath B., Springorum H.-R., Tingart M., Grifka J., Beckmann J.
Open Medicine
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2010
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vol. 5
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issue 4
442-446
EN
We report the first case of early postoperative infection after a medial hemiarthroplasty of the knee with a customized ConforMIS iForma™ interpositional device. The infection was treated successfully by revision surgery with implant removal and antibiotic therapy. Despite the additional diagnosis of rheumatoid arthritis that did not affect the treated knee, the preservation of bony and ligamentous structures enabled a successful re-implantation of another iForma™ implant 9 months later with good clinical results at follow-up examination 1 year postoperatively. This is very much in contrast to the extensive and complex revision surgery, with significant bone loss, in patients with infected unicompartmental or total knee arthroplasties. The iForma™ device may be an alternative treatment option in early and moderate unicompartmental arthritis of the knee, with easy revision with the same type of implant in the rare case of infection.
4
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Total vs. partial aponeurectomy for Dupuytren’s contracture - A literature review

88%
Högemann A., Kendoff D., Wolfhard U., O’Loughlin P., Olivier L.
Open Medicine
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2010
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vol. 5
|
issue 1
1-5
EN
The etiology of Dupuytren’s disease is controversial and thus the disease can only be treated when it presents with symptoms to warrant intervention. Surgical treatment is the method of choice to preserve hand dexterity and function. It is advisable to perform surgery at an early stage of disease progression, but various surgical techniques have been advocated. A partial fasciectomy is recommend by many authors, whereas a total aponeurectomy, where all palmar tissue is removed, might reduce the risk of recurrent disease due to the widespread removal of aponeurosis. The total aponeurectomy is performed less frequently due to the potential complications of this technique. In order to achieve an objective comparison of both surgical options we performed a literature meta-analysis, involving a comparison of surgical indications, results and complications following partial and total aponeurectomy, which are described in detail within this review article.
5
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Late onset of pulmonary cement embolism after a regular vertebroplasy. A clinical documentation

75%
Falkenstern-Ge R., Husemann K., Kohlhäufl M.
Open Medicine
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2013
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vol. 8
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issue 5
662-664
EN
Vertebroplasty is a new minimal-invasive procedure for the treatment of painful vertebral fractures. The risk of a pulmonary embolism ranges from 3.5 to 23% for osteoporotic fractures. However, data about the incidence and treatment strategies of pulmonary cement embolisms (PCE) are limited. We report a case of a patient with symptomatic pulmonary cement embolism after the vertebroplasty. The diagnosis was confirmed by means of CT- scan. In cases of asymptomatic patients with peripheral PCE we recommend no treatment besides clinical follow-up. In our case of symptomatic embolisms, we recommend to proceed according to the guidelines regarding the treatment of thrombotic pulmonary embolisms, which includes initial heparinization and a following 6-month coumarin therapy.
6
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Quality assurance of sphincterotomy: A prospective single-centre survey

75%
Sulz M., Sagmeister M., Schelling M., Binek J., Borovicka J., Ulmer H., Meyenberger C.
Open Medicine
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2012
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vol. 7
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issue 1
9-19
EN
Quality assurance becomes an increasingly important part of clinical medicine and of the field of endoscopy. Endoscopic sphincterotomy is associated with a fairly high complication rate. We aimed to assess our quality of sphincterotomy for benchmarking by using a prospective electronic database registry, and to identify potential risk factors for post-interventional complications. Over 2 years, 471 sphincterotomies were performed in a single tertiary referral centre. Patient- and procedure-related variables were prospectively recorded with the support of a multi-centre international sphincterotomy registry. Multivariate analysis was performed. The overall post-interventional complication rate was 9.3%. Pancreatitis happened in 5.5%, bleeding in 2.1%, perforation in 1.3%, and cholangitis in 0.4%. In the multivariate analysis following variables remained highly significant and predictive for complications: ‘papilla only in lateral view’ (p=0.001), antiplatelet therapy (p=0.024), and opacification with contrast up to the pancreatic tail (p=0.001). The primary success rate of sphincterotomy was 95.1%. The rate of post-interventional pancreatitis did not differ significantly regardless of the presence of prophylactic pancreatic stent (p=0.56). The outcome of sphincterotomy in our centre matches with literature data. The extent of pancreatic duct opacification has an influence on the pancreatitis rate. Prevention of pancreatitis by inserting pancreatic stents is not confirmed.
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