Pengelolaan anestesi pada kasus subdural hematom disertai penyakit ginjal kronis dengan riwayat hemodialisis memberikan permasalahan bagi ahli anestesi Perubahan hemodinamik perioperatif serta ...perubahan farmakodinamik dan farmakokinetik obat membuat manajemen perioperatif dan pemilihan regimen anestesi serta cairan harus dipertimbangkan intraoperatif terhadap efek penurunan fungsi ekskresi ginjal pada pasien penyakit gagal ginjal kronik dengan riwayat hemodialisa. Pasien laki-laki, 56 tahun dibawa ke instalasi gawat darurat mengalami penurunan kesadaran setelah kecelakaan lalu lintas sejak 1 hari yang lalu. Pasien dengan riwayat penyakit gagal ginjal kronis serta rutin hemodialisis tiap seminggu sekali. Pada pemeriksaan CT Scan kepala didapatkan hematom subdural di regio temporoparietal sinistra. Pasien preoperatif dilakukan hemodialisa tanpa menggunakan heparin. Diputuskan untuk dilakukan kraniotomi evakuasi dengan induksi anestesi dengan propofol 1 mg/kgbb, fentanyl 2 µgr /kgbb, lidokain 1 mg/kgbb dan rocuronium 0.5 mg/kgbb. Pasien diintubasi dengan ETT 7,5 dilanjutkan rumatan anestesi dengan propofol 50 µgr /kgbb/menit, fentanyl 2 µgr/kg/jam dan rocuronium 5 µgr/kg/menit. Monitoring standar elektrokardiografi, SpO2, dan arteri line. Setelah operasi pasien dirawat diruang intensif selama 3 hari. Pasien post operatif diberikan sedasi analgetik dengan dexmedetomidine 0,2- 0,7 µgr /kg/jam
Objetivo: Describir las características clínicas del traumatismo encéfalo craneano en neonatos. Materiales y métodos: Se realizó una serie de casos de neonatos con traumatismo encéfalo craneano, ...todos con diagnóstico clínico y tomográfico atendidos por el Servicio de Neuropediatría y Neonatología del Hospital Cayetano Heredia del 2014 al 2019. Resultados: Se incluyeron 12 neonatos, 67% (8/12) fueron varones, 33% (4/12) menores de cuatro días de edad y 25% (3/12) hijos de madres añosas. La caída libre fue el mecanismo de lesión en todos los casos y tres de ellos se cayeron de coches de paseo para bebés. El lugar más frecuente de la caída fue el hospital, tres neonatos se encontraban en alojamiento conjunto, dos en la sala de espera de la consulta externa y uno en hospitalización. El 83% (10/12) de los casos cayó de ≥ 0.5 m de altura y 33% (4/12) cayó de ≥ 1m. El 58% (7/12) fue sintomático a la caída, cuatro casos con letargia y uno con irritabilidad. Además, se reportaron vómitos y dificultad respiratoria. Cuatro presentaron hematoma epidural y tres de ellos fractura craneal, dos de gravedad por hipertensión endocraneana descompensada que requirieron evacuación quirúrgica de emergencia. Conclusión: El traumatismo encéfalo craneano en neonatos es un problema potencialmente grave. El hematoma epidural fue la lesión intracraneal más frecuente. La letargia e irritabilidad fueron los síntomas más frecuentes en los neonatos que cayeron de ≥ 0.5m de altura.
Background. Postpartum haemorrhage from ruptured tissues can usually be diagnosed and managed properly. A problem exists with the occult haemorrhage without evident tissue trauma in which case a ...haematoma develops. Methods. After a normal delivery of the 41 years old secundipara after a previous caesarean in epidural analgesia a boy was born. Placenta was delivered spontaneously and perineal rupure sutured properly. About an hour after the delivery heavy pain was noted in the lower abdomen. Pelvic exam revealed a paravaginal haematoma and ultrasound scan coagulated and fresh blood behind the uterus. Rupture of the uterus was suspected and laparotomy revision performed. During the laparotomy there was no haemorrhage in the pelvic cavity, no uterine rupture but a large retroperitoneal haematoma extending to mesosigmoidal part of intestinum. Paravaginal heamatoma was evacuated vaginally and after half an hour the retroperitoneal haematoma diminished by 50 %. The patient received two blood transfusions. The blood loss was estimated as about 500 grams. The pulse and blood pressure were normal all the time. The laboratory values of haemoglobin was 96 g/l, haematocrit 0.30 before the operation and 93 g/l and 0.28 respectively 6 hours after. Beside anaemia the postoperative course was uneventful and the patient was dismissed from the hospital the 6th day postpartum. Conclusions. Although the laparotomy seems an excessive treatment it was the only way to exclude uterus rupture after a previous caesarean, heavy pain in the lower abdomen and blood behind the uterus noted on the ultrasound scan. In the non-urgent situation a CT scan could be performed to locate the blood accumulation and possibly exclude uterine rupture.
Araknoid kistler, meninkslerin intrakranial beyin parankimi dışında kalan konjenital malformasyonlarıdır. Birçoğu tesadüfen saptanırlar. Kafa travması sonrası subdural hematoma sebep olabilirler. ...Literatürde, araknoid kistler ile ilişkili subdural hematom tedavisinde çeşitli cerrahi yöntemler önerilmiştir. Bunlar; burr hole ya da kraniotomi ile subdural hematom boşaltılması, endoskopiyle kist fenestrasyonu ve subdural hematom boşaltılması, burr hole ya da kraniotomiyle subdural hematom boşaltılması sonrası kistoperitoneal şant takılmasıdır. En sık kullanılan uygulama burr hole ile subdural hematom boşaltılmasıdır. Diğer tedavi seçenekleri burr hole ile subdural hematom drenajının başarısız olduğu durumlarda önerilmektedir. Biz bu olgu sunumunda, burr hole ile subdural hematom drenajı yaparak tedavi ettiğimiz iki hastamızın sonuçlarını bildirmek istiyoruz.
Aim: Posterior fossa epidural hematoma (PFEDH) in the pediatric age group is a very rare condition and the treatment method is still a matter of debate. The aim of this study is to evaluate the ...observation results in the management of pediatric patients with PFEDH in our tertiary care hospital and to investigate the importance of the relationship of the hematoma with the cerebral venous sinuses, which has not been investigated before in the literature, in the treatment decision.
Materials and Methods: This is a retrospective study conducted at Selcuk University, Faculty of Medicine. All patients (≤ 17 years) diagnosed with PFEDH between January 2010 and May 2022 were included in this study. Demographic data, clinical signs, trauma type and symptoms at presentation, CT findings, type of treatment, and outcomes were collected. CT findings including hematoma thickness, hydrocephalus, presence of fourth ventricular compression, relation with cerebral venous sinuses and other associated brain injuries were evaluated.
Results: The patient group consists of two girl and six boy. The most common cause of PFEDH was a fall from a height resulting in a blow to the back of the head in four patients. Vomiting was the most frequent presenting symptom. Four patients had a relation between cerebral venous sinuses and hematoma, and two of these patients underwent surgical treatment
Conclusion: In addition to criteria such as hematoma thickness, GCS, hydrocephalus, and compression of the fourth ventricle, we determined that the relationship of hematoma with venous sinuses is a criterion to be evaluated.
Amaç: Pediatrik yaş grubunda posterior fossa epidural hematom (PFEDH) çok nadir görülen bir durumdur ve tedavi yöntemi halen tartışmalıdır. Bu çalışmanın amacı üçüncü basamak hastanemizde PFEDH'li çocuk hastaların yönetiminde gözlem sonuçlarını değerlendirmek ve literatürde daha önce araştırılmamış olan hematomun serebral venöz sinüslerle ilişkisinin önemini araştırmaktır. , tedavi kararında.
Gereç ve Yöntem: Bu, Selçuk Üniversitesi Tıp Fakültesi'nde yürütülen retrospektif bir çalışmadır. Ocak 2010 ile Mayıs 2022 arasında PFEDH tanısı alan tüm hastalar (≤ 17 yaş) bu çalışmaya dahil edildi. Demografik veriler, klinik belirtiler, travma tipi ve başvuru sırasındaki semptomlar, BT bulguları, tedavi tipi ve sonuçlar toplandı. Hematom kalınlığı, hidrosefali, dördüncü ventriküler kompresyon varlığı, serebral venöz sinüslerle ilişkisi ve diğer ilişkili beyin yaralanmalarını içeren BT bulguları değerlendirildi.
Bulgular: Hasta grubu iki kadın ve altı erkekten oluşmaktadır. PFEDH'nin en yaygın nedeni, dört hastada başın arkasına darbe ile sonuçlanan bir yükseklikten düşme idi. Kusma en sık başvuru semptomuydu. Dört hastada serebral venöz sinüsler ile hematom arasında ilişki vardı ve bu hastalardan ikisine cerrahi tedavi uygulandı.
Sonuç: Hematom kalınlığı, GKS, hidrosefali, dördüncü ventrikül basısı gibi kriterlere ek olarak hematomun venöz sinüslerle ilişkisinin değerlendirilmesi gereken bir kriter olduğunu belirledik.
Subdural hematoma in infants can be caused by abuse, and is thought to be more likely if subdural hematoma is associated with retinal hemorrhage and cerebral edema. In Japan, few doctors disagree ...that cases of subdural hematoma with retinal hemorrhage and cerebral edema with multiple findings on the body are more likely to have been caused by abuse rather than by household accident. On the other hand, in cases where there are no other significant physical findings, only subdural hematoma and retinal hemorrhage, there is a difference of opinion as to whether the injury was caused by an accident or abuse. The reason for this is that neurosurgeons in Japan promoted the concept that infants can develop subdural hematomas and retinal hemorrages due to minor trauma at home before the concept of abusive head trauma became known. In addition, the age distribution of subdural hematomas in Japan differs from that in other countries, with peaks at around 8 months, and the reason for this remains unclear. Therefore, the etiology of infant subdural hematoma in Japan needs to be investigated in greater detail.
Spinalni epiduralni hematom brez pomembne predhodne poškodbe je nujno stanje, s katerim se v pediatriji srečamo zelo redko. Diagnozo postavimo s kliničnim pregledom in slikovno preiskavo. Zdravljenje ...je večinoma kirurško. V prispevku predstavljamo spinalni epiduralni hematom pri enajstletnem, do tedaj zdravem dečku, ki je nenadoma začutil bolečino v predelu desne lopatice. Po kliničnem pregledu smo sum na patološko dogajanje v predelu hrbtenice potrdili z magnetnoresonančnim slikanjem. Po kirurški evakuaciji hematoma je deček popolnoma okreval.
En mann i 60-årene med brystsmerter og pareser Müller, Kai Ivar; Devik, Kristina; Vorren, Torgrim ...
Tidsskrift for den Norske Lægeforening,
2013, 2013-00-00, Letnik:
133, Številka:
12
Journal Article
PDF
