• Title/Summary/Keyword: Posterior bleeding

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THE HEMOSTASIS IN INTRACTABLE POSTERIOR NASAL BLEEDING WITH ANGIOGRAPHIC EMBOLIZATION;A CASE REPORT (혈관조영색전술을 이용한 비조절성 후비강부 출현의 처치;증례 보고)

  • Nam, Ki-Young;Kwon, Tae-Geon;Kim, Jong-Bae
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.22 no.4
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    • pp.454-457
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    • 2000
  • The posterior nasal bleeding sometimes develope a life threatening situation because of its limited access and the profuse vascular network of the bleeding area. There are various methods of hemostasis including packing, cautery, and arterial ligation those vary in effectiveness. But sometimes patients cannot tolerate these methods or show rebleeding sign. So, if all of these methods are not successful, we should consider the further treatment. The selective angiographic embolization has various advantages such as rapidness, repetition, good visualization, and being performed under local anesthesia, therefore it can provide useful way in patients with massive, intractable posterior nasal bleeding. We report a case of angiographic embolization for intractable posterior nasal bleeding patient and review the effectiveness of the this treatment.

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Cervical Spinal Epidural Hematoma Following Cervical Posterior Laminoforaminotomy

  • Choi, Jeong Hoon;Kim, Jin-Sung;Lee, Sang-Ho
    • Journal of Korean Neurosurgical Society
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    • v.53 no.2
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    • pp.125-128
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    • 2013
  • A 65-year-old man who had lateral cervical disc herniation underwent cervical posterior laminoforaminotomy at C5-6 and C6-7 level right side. During the operation, there was no serious surgical bleeding event. After operation, he complained persistent right shoulder pain and neck pain. Repeated magnetic resonance image (MRI) showed diffuse cervical epidural hematoma (EDH) extending from C5 to T1 level right side and spinal cord compression at C5-6-7 level. He underwent exploration. There was active bleeding at muscular layer. Muscular active bleeding was controlled and intramuscular hematoma was removed. The patient's symptom was reduced after second operation. Symptomatic postoperative spinal EDH requiring reoperation is rare. Meticulous bleeding control is important before wound closure. In addition, if patient presents persistent or aggravated pain after operation, rapid evaluation using MRI and second look operation is needed as soon as possible.

CONTINUOUS POSTOPDRATIVE BLEEDING AFTER PRIMARY PALATORRHAPHY;A CASE REPORT (일차 구개성형술 후 발생된 지속적인 술후출혈;증례보고)

  • Shim, Cheong-Hwan;Kim, Young-Kyun;Chae, Byung-Kuk
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.23 no.5
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    • pp.458-460
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    • 2001
  • A 11-month-old infancy was referred for treatment of cleft palate. The patient's congenital deformities had included oronasal fistula on the soft palate and bifid uvula. Furrow double-opposing Z-plasty was performed under general anesthesia. However, postoperative bleeding developed at ward. Despite the pressure of operative wound, venous oozing continued and hemoglobin concentration and RBC were decreased (Hb: 5.5g/dL, RBC: $1.98{\times}10^6/mm^3$). The patient was pale and confused and transferred to Surgical Intensive Care Unit(SICU) We could not keep the peripheral venous line and there was a high risk of hypovolemic shock. Emergency transfusion was performed through the central femoral venous line and emergency operation for bleeding control was carried out. We explored the operation site and found bleeding point from the posterior pharyngeal wall. Electrocoagulation and surgicel packing were carried out and bleeding was stopped.

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Effect of the Mixture of Thrombin Powder and Gelfoam Powder on Control of Exposed Cancellous Bone Bleeding (Thrombin Powder와 Gelfoam Powder의 혼합물을 이용한 노출된 망상골면 출혈의 지혈효과)

  • Park, Sung Wan;Cho, Ha Young;Lee, Seung Myoung;Jeong, Seong Hun;Song, Jin Kyu;Jang, Suk Jung;Shin, Ho
    • Journal of Korean Neurosurgical Society
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    • v.29 no.5
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    • pp.664-667
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    • 2000
  • Objective : Excessive bleeding from the exposed cancellous bone surface may cause serious problem such as hematoma formation, infection, transfusion reaction during operation and postoperative period. There are several kinds of bleeding control agent on the cancellous bone surface including bone wax, gelatin sponge ($Gelfoam^{(R)}$), oxidized cellulose($Oxycel^{(R)}$, $Surgicel^{(R)}$), thrombin, microfibrillar collagen($Avitene^{(R)}$) etc. In the past, bone wax was used to control bone bleeding but it is associated with increased infection rate and fusion failure. Recently, gelfoam paste has been used to control cancellous bone bleeding. We controlled the cancellous bone bleeding with the mixture of gelfoam powder and thrombin powder. Material and Methods : Seventeen patients of posterior fusion on the 4 motion segments of thoracolumbar spine were selected to compare the result of bone bleeding control. In the test group of 9 patients, the cancellous bone bleeding was controlled with the mixture of Gelfoam and thrombin powder during operation. In the control group of 8 cases, no chemical hemostatic agent was used to manage the bone bleeding during operation. We calculated the total amount of bleeding from cancellous bone surface during and after operation in the two groups and compared their statistic significance of the result which was judged by student t-test. Results : The average amount of intraoperative bleeding was 1825ml in control group, 811ml in test group(p<0.01). The amount of postoperative bleeding was 943ml in control group and 812ml in test group, there were no significant difference in the amount of bleeding during postoperative period between two groups(p>0.5). Total amount of blood was decreased in as much as 1150ml in test group(p<0.01). Conclusion : We concluded that the application of the mixture of thrombin and gelfoam powder on the cancellous bone surface is the effective control method of cancellous bone bleeding for multilevel posterior spinal fusion.

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EMERGENCY BLEEDING CONTROL BY RAPID ENTIRE OROPHARYNGEAL PACKING IN A PATIENT WITH ACTIVE OROPHARYNGEAL BLEEDING FOLLOWING BASAL SKULL FRACTURE: REPORT OF A CASE (뇌기저부 골절후 발생된 과도한 구인두 출혈의 구인두 전체 신속압박에 의한 응급지혈: 증례보고)

  • Mo, Dong-Yub;Yoo, Jae-Ha;Choi, Byung-Ho;Kim, Ha-Rang;Lee, Chun-Ui;Ryu, Mi-Heon
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.32 no.2
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    • pp.189-195
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    • 2010
  • Excessive oral and maxillofacial bleeding causes upper airway obstruction, bronchotracheal & gastric aspiration and hypovolemic shock. Therefore, the rapid & correct bleeding control is very important for life-saving in the medical emergency room. In spite of the bleeding control methods of the wound suture & direct pressure, the postoperative bleeding can be occurred, because of the presence of various bleeding disorders & postoperative delayed wound infections. The proper care of bleeding disorders & wound infections are very important for the control of the delayed postoperative rebleeding. In spite of these methods, active oral bleeding can be presented by the other causes of head injury. A rare but particularly dangerous sort of bleeding that may have an especial importance to the patient with severe basal skull fracture that damage large vessels and even the cavernous sinus. The occurrence of profuse nasal or oropharyngeal bleeding may arise from damage to the anterior and posterior ethmoidal vessels, but when mixed with brain tissue it is evidence of mortal damage. In this condition, rapid entire oropharyngeal packing is essential for the control of active oral bleeding. This is a case report of rapid rational bleeding control method by much amount of wet gauze packings, in a 44-years-old male patient with active oropharyngeal bleeding by basal skull fractures.

Hemorrhagic Moyamoya Disease : A Recent Update

  • Fujimura, Miki;Tominaga, Teiji
    • Journal of Korean Neurosurgical Society
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    • v.62 no.2
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    • pp.136-143
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    • 2019
  • Moyamoya disease (MMD) is a progressive cerebrovascular disease with unknown etiology, characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network formation at the base of the brain. MMD has an intrinsic nature to convert the vascular supply for the brain from internal carotid (IC) system to the external carotid (EC) system, as indicated by Suzuki's angiographic staging. Insufficiency of this 'IC-EC conversion system' could result not only in cerebral ischemia, but also in intracranial hemorrhage from inadequate collateral anastomosis, both of which represent the clinical manifestation of MMD. Surgical revascularization prevents cerebral ischemic attack by improving cerebral blood flow, and recent evidence further suggests that extracranial-intracranial bypass could powerfully reduce the risk of re-bleeding in MMD patients with posterior hemorrhage, who were known to have extremely high re-bleeding risk. Although the exact mechanism underlying the hemorrhagic presentation in MMD is undetermined, most recent angiographic analysis revealed the characteristic angio-architecture related to high re-bleeding risk, such as the extension and dilatation of choroidal collaterals and posterior cerebral artery involvement. We sought to update the current management strategy for hemorrhagic MMD, including the outcome of surgical revascularization for hemorrhagic MMD in our institute. Further investigations will clarify the optimal surgical strategy to prevent hemorrhagic manifestation in patients with MMD.

A Comparative Study to Evaluate a Simple Method for the Management of Postoperative Bleeding Following Palatoplasty

  • Rossell-Perry, Percy;Schneider, William J.;Gavino-Gutierrez, Arquimedes M.
    • Archives of Plastic Surgery
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    • v.40 no.3
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    • pp.263-266
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    • 2013
  • Bleeding, is one of the most common postoperative complications after palatoplasty in patients with cleft palate. The purpose of this article is to present our experience using a Foley catheter balloon for perioperative palatoplasty bleeding management. A retrospective data analysis was performed for all cases of palatoplasty performed by the author from 1999 to 2012 that experienced postoperative hemorrhage. These patients were managed by utilizing posterior nasal compression with a Foley catheter balloon for the period 2006 to 2012. We have compared two methods (we use before 2006 the reoperative method) with regards to the later development of palatal fistulae and cases with reoperative hemostasis. The study found no statistically significant differences between the conventional and proposed method in relation to the development of palatal fistulae (P=0.7). These findings suggest that nasal packing using a Foley balloon is a safe and effective method for postoperative bleeding control after palatoplasty in patients with cleft palate.

The Dissecting Aneurysm of the Posterior Inferior Cerebellar Artery with Unusual Clinical Course

  • Lee, Hyoung-Soo;Lee, Sang-Youl;Rhee, Woo-Tack;Jang, Yeon-Gyu
    • Journal of Korean Neurosurgical Society
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    • v.40 no.5
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    • pp.369-372
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    • 2006
  • The dissecting aneurysms of the posterior cerebral circulation arise most commonly from the vertebral artery and occasionally extend to the posterior inferior cerebellar artery[PICA]. The dissecting aneurysm localized in the PICA without involving the vertebral artery is rare. We present a PICA dissecting aneurysm that had kaleidoscopic clinical course of bleeding, occlusion, and recanalization before the surgery. The patient had serial follow-up angiograms based on significant changes of clinical status. The patient successfully underwent microsurgical trapping with clips for the dissecting aneurysm and showed neurological improvement.

Efficacy of Endoscopic Electrocauterization for Recurrent Posterior Epistaxis (반복되는 후방 비출혈에서 내시경 지혈술의 효과)

  • Lee, Jung Joo;Lee, Eunkyu;Ryu, Gwanghui;Seo, Min Young;Hong, Sang Duk;Kim, Hyo Yeol;Dhong, Hun-Jong;Chung, Seung-Kyu
    • Journal of Rhinology
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    • v.25 no.2
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    • pp.75-79
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    • 2018
  • Background and Objectives: To investigate the common site of recurrent epistaxis after initial intervention such as packing and cauterization had failed and to evaluate the efficacy of surgical endoscopic electrocautery. Subjects and Method: Retrospective review of 47 patients with recurrent and uncontrolled idiopathic epistaxis between October 1995 and March 2016. All patients underwent endoscopic examination in the operating room after hospitalization. We performed electrocautery when a bleeding site was found. Results: The most common sites of bleeding were the inferior meatus (28%), sphenoethmoid recess (23%), superior septum around the olfactory cleft (13%), and the posterior end of the middle turbinate (15%). There was no serious complication during the one week after surgery. In 46 (98%) patients, refractory epistaxis was successfully controlled. One patient had recurrent epistaxis after electrocautery and underwent endoscopic sphenopalatine artery ligation. Conclusion: In patients with refractory idiopathic epistaxis after failure of first-line treatment, endoscopic examination through a surgical approach and electrocautery for suspected bleeding are effective.