Injured spleens have been successfully managed without operation in a number of children; however, splenectomy or splenic-conserving surgery may not be avoided because of exsanguinating hemorrhage. This study was performed to evaluate the efficacy of splenic arterial embolization (SAE) to control hemorrhage from injured spleens in children. We compared the outcomes of two groups of children with splenic injury. The first group (G1) consisted of eighteen children who were managed with conventional selective nonoperative treatment between 1993 and 1994. The second group (G2) consisted of 23 children prospectively studied from 1996 to 1997 after SAE was added in the management protocol of splenic injury. The criteria for SAE were grade III or IV injury, extravasation of contrast material revealed by CT, or unstable vital signs without evidence of associated injuries. Laparotomy was performed in 6 patients of G1 (33.3%), 2 of whom had associated injuries. Five underwent splenectomy and the overall salvage rate in G1 was 72.2% (13/18). In G2, eight patients (34.8%) had SAE, which stopped bleeding successfully in all patients. Two of G2 (8.7%) had laparotomy because of associated injuries. Only one patient underwent splenectomy and the salvage rate was 95.6% (22/23). No patients required transfusion after SAE. In conclusion, the SAE effectively controlled hemorrhage from injured spleens. More spleens were salvaged with a reduced laparotomy rate after application of SAE in splenic injury.
Child* ; Exsanguination ; Hemorrhage ; Humans ; Laparotomy ; Prospective Studies ; Spleen* ; Splenectomy ; Vital Signs

This study aimed to investigate the mechanism of action of baclofen on the detrusor muscle isolated from rat. Rats (Sprague-Dawley) were sacrificed by decapitation and exsanguination. Horizontal muscle strips of 2 mm x 15mm were prepared for isometric myography in isolated muscle chamber bubbled with 95% / 5%-OZ / CO2 at 371C, and the pH was maintained at 7.4 Detrusor strips. contracted responding to the.. electrical field stimulation (EFS) by 2 Hz, 2U msec, monophasic square wave of 60 VDC. The initial peak of EFS-Induced contraction was tended to be suppresed by a,p-methylene-adenosine 5'-triphosphate (mATP), a partial agonist of purinergic receptor, and baclofen, a GABAB receptor agonist (statistically nonsignificant). The late sustained contraction by EFS was suppressed significantly (p < 0.05) by additions of atropione, a cholinergic muscarinic receptor antagonist and baclofen. The adenosine 5'-triphosphate-induced contraction was completely abolished by mA TP but not by baclofen. In the presence of atropine, the subsequent addition of acetylcholine could not contract the muscle strips: but the addition of acetylcholine in the presence of baclofen evoked a contraction to a remarkable extent.
Acetylcholine ; Adenosine ; Animals ; Atropine ; Baclofen* ; Decapitation ; Exsanguination ; Hydrogen-Ion Concentration ; Myography ; Rats* ; Receptors, Muscarinic

Pulmonary artery rupture with a flow-directed balloon tipped pulmonary artery catheter (Swan-Ganz catheter)is a rare complication with high mortality. This report concerns a case of this complication with hemothorax leading to fatal exsanguination. Emphasis is placed on the safety guidelines to prevent this. Also, possible causes and managements are presented. A high index of suspicion is necessary whenever a patient with the catheter has hemoptysis or unexplained hemodynamic or respiratory changes.
Arteries* ; Catheters* ; Exsanguination ; Hemodynamics ; Hemoptysis ; Hemothorax ; Humans ; Mortality ; Pulmonary Artery ; Rupture*

Pulmonary artery rupture with a flow-directed balloon tipped pulmonary artery catheter (Swan-Ganz catheter)is a rare complication with high mortality. This report concerns a case of this complication with hemothorax leading to fatal exsanguination. Emphasis is placed on the safety guidelines to prevent this. Also, possible causes and managements are presented. A high index of suspicion is necessary whenever a patient with the catheter has hemoptysis or unexplained hemodynamic or respiratory changes.
Arteries* ; Catheters* ; Exsanguination ; Hemodynamics ; Hemoptysis ; Hemothorax ; Humans ; Mortality ; Pulmonary Artery ; Rupture*

Upper gastrointestinal bleeding occurs so rapidly that emergency measures are required to avoid exsanguination. Many diseases cause bleeding from the gastrointestinal tract. Patients with upper gastrointestinal bleeding must be quickly assessed and resuscitated. An endoscopy is the diagnostic procedure of choice because of its high rate of accuracy and immediate therapeutic potential. An endoscopy however, must be performed only following adequate resuscitation and clinical assessment of the patient. Recently, reports have described the usefulness of endoscopic O-ring band ligation in the management of upper gastrointestinal bleeding. Endoscopic O-ring band ligation is mucosal ligation using intraluminal negative pressure with an elastic O-ring. We performed an emergency endoscopy in 3 patients who had massive or recurrent episodes of upper gastrointestinal bleeding, identified as having resulted from Dieulafoy lesion and Anisakiasis. We tried to perform an endoscopic ligation using an O-ring band, and were successful in achieving hemostasis. Our conclusion is that endoscopic ligation using an O-ring band can be used effectively to control active upper gastrointestinal bleeding resulting from Anisakiasis and a Dieulafoy lesion.
Anisakiasis ; Emergencies ; Endoscopy ; Exsanguination ; Gastrointestinal Tract ; Hemorrhage* ; Hemostasis ; Humans ; Ligation* ; Resuscitation

Cardiac electromechanical dissociation is a cause of cardiac arrest and this is characterized by regularly recurring QRS complexes and T waves- P waves may even be present. without an obtainable blood pressure and pulse. Such findings in man are almost invariably associated with a fatal outcome although one can observe this phenomenon in potentially treatable disorders. Recognition of these disorders on the basis of certain clinical and electrocardiographic findings may be of clinical importance. This experimental study on rabbits was performed to observe electromechanical dissociation (E.M.D.) and to recognize its clinical importance, in exsanguinating hemorrhage with the cutting of the right femoral artery. The results were as follows: 1) The incidence of E.M.D. was 100 percent. 2) In the all cases except two cardiac rhythm showed sinus rhythm but in two cases it was difficult to distinguish it from nodal rhythm. 3) Heart rate at the time of E.M.D showed a significant increase of 13,8 percent as compared with the control. 4) The voltage of the P wave and QRS complex at the time of E.M.D. showed a significant decreases of the former, 34.7%, and the latter, 30%, as compared with the control. and the QRS complex at the time of E.M.D showed severe axis deviation. 5) In seven cases in all, the voltage of the T wave at the time of E.M.D, showed a significant decrease of 61. 3 percent (one case showed T wave inversion) and the others showed. conversely a significant increase of 271 percent. 6) Regarding change of interval, the QRS interval showed no changes and P-R and Q-T intervals showed shortening of 14, 7% and 2.4%. 7) We consider that devices for heart sound, pulse or blood pressure monitoring should be: combined with ECG monitoring.
Blood Pressure ; Blood Pressure Monitors ; Electrocardiography ; Exsanguination* ; Fatal Outcome ; Femoral Artery ; Heart Arrest ; Heart Rate ; Heart Sounds ; Incidence ; Rabbits*

Vasa previa is said to occur when fetal vessels, unsupported by placenta or umbilical cord, transverse the menbranes over the cervix, below the presenting part. It is typically caused by velamentous insertion of the umbilical cord with fetal vessels between the cervix and presenting part. Bilobed or succenturiate placentas also can be associated with aberrant vasculature over the internal cervical os. Vasa previa has an incidence of approximately one per 2,000-5,000 deliveries. It has a high fetal mortality due to fetal exsanguination resulting from fetal vessels tearing when the menbranes rupture. So Prenatal detection of vasa previa is very important. We believe transvaginal ultrasound in combination with color Doppler is the most effective tool in the antenatal diagnosis of vasa previa. Recently, we experienced one case of vasa previa accompanied by succenturiate placenta diagnosed prenatally by color Doppler and transvaginal sonography. Here we report our experience with a literature review.
Cervix Uteri ; Exsanguination ; Female ; Fetal Mortality ; Incidence ; Placenta ; Prenatal Diagnosis ; Rupture ; Ultrasonography, Prenatal ; Umbilical Cord ; Vasa Previa

A tracheo-innominate artery fistula is a highly lethal complication following tracheostomy; therefore, it's early recognition and prompt treatment is mandatory. A 37-years-old man who had undergone a tracheostomy several days earlier, following brain surgery, was found to have a tracheo-innominate artery fistula with an exsanguinating hemorrhage from his tracheostomy site. After temporary control of the bleeding with ballooning, a stent graft was implanted through the femoral artery into the innominate artery. The patient experienced rebleeding from the mouth 50 days later. Aortoinnominate interposition grafting and patch closure of the trachea were performed for the permanent control of bleeding and to maintain the airway. This delayed operation is easier and safer than an emergency operation; therefore, we could expect better operative results under such circumstances. 12 months after surgery, the patient is in a state of well being.
Arteries* ; Blood Vessel Prosthesis* ; Brachiocephalic Trunk ; Brain ; Emergencies ; Exsanguination ; Femoral Artery ; Fistula* ; Hemorrhage ; Humans ; Mouth ; Stents* ; Trachea ; Tracheostomy ; Transplants

OBJECTIVE: To investigate the roles of ET in the regulation of peripheral vascular tone, we studied the effect of hyperlipidemia on vascular responsiveness in femoral arteries from rabbits with control groups of rabbits and test groups receiving a hyperlipidemic diet. MATERIALS AND METHODS: New Zealand Whites were anesthetized with pentobabital and killed by exsanguination from the femoral arteries. Arteries which were suspended on muscle chambers at their optimal length for contractile properties, were examined. RESULTS: 1. After 14-16 weeks of cholesterol-rich diet, plasma cholestrol and HDL levels were significantly higher in the hyperlipidemic rabbits than in the control rabbits. There was no significant difference in the triglyceride levels between the two groups. 2. The contractions caused by 60 mM KCI in the femoral arterial strips were significantly augmented (P<0.01). The contractile responses to phenylephrine or angiotensin II were also augmented, whereas 5-hydroxytryptamine or U46619- induced contraction was not affected by the hyperlipidemic diet. 3. In control rabbits, ET-1 and ET- 2 contracted femoral arteries in a concentraction-dependent manner, whereas sarafotoxin S6c and IRL 1620 had no effect. 4. Contractions caused by ET-1 and ET-2 were significantly diminished by hyperlipidemia. 5. ET-1-induced concentration-response curves were inhibited by BQ-610, but not affected by BQ-788 in the femoral arterial strips from control and hyperlipidemic rabbits. CONCLUSIONS: These results suggest that ET is involved in the regulation of vascular tone in peripheral arteries and ETA receptor subtypes are mainly present in rabbit femoral arteries. Further more, ET-induced contraction is attenuated in hyperlipidemic rabbit, and the attenuated responses might be caused at least in part by the alteration of ET receptors (e.g. desensitization).
Angiotensin II ; Arteries ; Diet ; Endothelin-2 ; Endothelins* ; Exsanguination ; Femoral Artery* ; Hyperlipidemias ; New Zealand ; Phenylephrine ; Plasma ; Rabbits* ; Receptors, Endothelin ; Serotonin ; Triglycerides

Subjects should not have any factors affecting neuromuscular transmission. Anestheisa was induced by a sleep dose of 2.5% thiopental sodium, and oxygen, nitrous oxide and lower concentration of enflurane were used for maintenance. When the patients were stabilized, the arm with electrode attached and an indwelling needle inserted into a vein on the back of the wrist, was elevated for 30 seconds to partially drain the blood from it and then pneumatic tourniquet inflated 30 to 40 mmHg above the systolic blood pressure around the upper arm, so that a small dose of relaxants (1/60 or 1/30 of the clinical dose; succinylcholine 1mg/kg, vecuronium 0.08 mg/kg, atracurium 0.2 mg/kg, pancuronium 0.08 mg/kg and alpha-tubocurarine 0.2 mg/kg) could be injected into the arm isolated from the systemic circulation. Thereafter, ischemia was maintained for 4 minutes to allow retrograde spread of some of the drugs into the capillary bed where neuromuscular block was established. At the end of 4 minutes after tourniquet applied, the tourniquet was released. Neuromuscular conduction was recorded using ABM monitor of the Datex Co. for neuromuscular transmssion by 40 mA 2Hz stimulaton to ulnar nerve 20 seconds interval. We confirmed the marked rundown of amplitude of muscle action potensial (MAP) in group injected very small doses throughout the isolated limb but no affect the evoked MAP in group injected into systemic circulation. Conclusively, even there are various factors affecting extent of block by the tournique; ischemic acidosis, concentration volume of drugs, amovnt of exsanguination and the state of vasculare bed, these were not thought to be a source of error for study. Therefore small doses of relaxants required wih this technique exclude the possibility of unwanted systemic side effects and can be reliable and effective for clinical study for neuromuscular transmission.
Acidosis ; Arm* ; Atracurium ; Blood Pressure ; Capillaries ; Electrodes ; Enflurane ; Exsanguination ; Extremities ; Humans ; Ischemia ; Needles ; Neuromuscular Blockade* ; Nitrous Oxide ; Oxygen ; Pancuronium ; Succinylcholine ; Thiopental ; Tourniquets ; Ulnar Nerve ; Vecuronium Bromide ; Veins ; Wrist