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5 results

  • Chapter 44 - Eclampsia and pre-eclampsia

  • from Section III: - Organ dysfunction and management
  • Edited by Fang Gao Smith, University of Warwick
  • Edited in association with Joyce Yeung
  • Book:
    Core Topics in Critical Care Medicine
    Published online:
    06 July 2010
    Print publication:
    22 April 2010, pp 342-348

  • Summary

    The three common forms of presentation for acute gastrointestinal (GI) bleeds are: haematemesis, melaena, and haematochezia. This chapter discusses the complications associated with GI bleeding and management of GI bleeding. It lists the commonest causes of upper GI bleeding, and explains management of non-variceal upper GI bleeding and upper GI bleeding indications for surgery. Gastro-oesophageal varices are dilated submucosal veins which occur in approximately 40-60% of patients with cirrhosis. Control of active variceal bleeding has been shown to be achievable with sclerotherapy (80%) or band ligation (94%). The chapter discusses the incidence of upper GI perforation and lower GI perforation. Approximately 15% of patients with diverticulitis develop bowel perforation. The mortality rate is high (20-40%) as patients may suffer from sepsis and multiorgan failure. The chapter discusses initial management, specific management and post-operative complications of bowel perforation. Endoscopic treatment achieves haemostasis in the majority of patients with non-variceal bleeding.

  • Alcohol sclerotherapy of human immunodeficiency virus related parotid lymphoepithelial cysts

  • E Meyer, D E Lubbe, J J Fagan
  • Journal:
    The Journal of Laryngology & Otology / Volume 123 / Issue 4 / April 2009
    Published online by Cambridge University Press:
    01 July 2008, pp. 422-425
    Print publication:
    April 2009
  • Objective:

    The aim of the study was to determine the effectiveness of alcohol sclerotherapy in patients with human immunodeficiency virus related salivary gland disease.

    Study design:

    Prospective study investigating the effectiveness of alcohol as a sclerosing agent.

    Setting:

    Tertiary referral hospital.

    Patients:

    Eleven human immunodeficiency virus positive patients with benign lymphoepithelial cysts were included in the study, from July 2005 to September 2006.

    Interventions:

    Alcohol sclerotherapy was performed under local anaesthesia, with alcohol infiltrated into the benign lymphoepithelial cysts.

    Results:

    Alcohol injection sclerotherapy proved to be an effective, simple, cheap, ambulatory procedure for patients who did not qualify for antiretroviral treatment.

  • Chronic facial pain following injection of sodium tetradecyl sulphate into an intraparotid haemolymphangioma

  • D P Crampsey, L Cochrane, D Roebuck, B E Hartley
  • Journal:
    The Journal of Laryngology & Otology / Volume 122 / Issue 9 / September 2008
    Published online by Cambridge University Press:
    12 July 2007, pp. 1002-1004
    Print publication:
    September 2008
  • Objective:

    We report a rare case of chronic facial pain following sclerotherapy for intraparotid haemolymphangioma, thereby highlighting an important clinical consideration when advising this treatment option as an alternative to surgery in the head and neck.

    Method:

    Case report, with a review of relevant literature.

    Results:

    Sclerotherapy of lymphangiomata is well reported in the literature. Unusually, our young patient with an intraparotid haemolymphangioma experienced severe, chronic pain following intralesional injection of sodium tetradecyl sulphate, which required management by a specialist pain service. We discuss the technique of sclerotherapy for such lesions, and also discuss the potential side effects of two agents commonly used in our centre: OK 432 and sodium tetradecyl sulphate.

    Conclusion:

    Non-surgical treatments of lymphangiomata and venous vascular malformations are not without complication. Both patient and clinician should be aware of this, and of the other potential side effects of sclerotherapy, prior to its use in the head and neck.

  • Cervico-thoracic teratoma masquerading as lymphatic malformation

  • M F Bhutta, H-Y Ching, B E J Hartley
  • Journal:
    The Journal of Laryngology & Otology / Volume 120 / Issue 11 / November 2006
    Published online by Cambridge University Press:
    26 July 2006, pp. 955-958
    Print publication:
    November 2006

  • A case is presented of a nine-month-old male infant who presented acutely with an anterior neck and mediastinum mass compressing the trachea. Radiological assessment by ultrasound, magnetic resonance imaging and computed tomography suggested the nature of the mass to be a lymphatic malformation (cystic hygroma). The excised specimen was revealed as a mature teratoma. The inability to distinguish between lymphatic malformation and teratoma on multi-imaging modalities confers a risk of mismanaging these lesions with the use of sclerotherapy; surgical excision is the necessary treatment. The potential consequences are discussed.