Retropharyngeal and Bowel Hematomas in an Anticoagulated Patient

ABSTRACT
As the indications for oral anticoagulation therapy increase, the number of patients being treated with anticoagulants and at risk for complications also will rise. Major bleeding episodes have been reported to occur in approximately 2–4% of patients being treated with oral anticoagulants. The case report of a patient with concurrent spontaneous retropharyngeal and small-bowel hematomas from overanticoagulation with warfarin is presented. The authors review the subtle presentation of retropharyngeal hematomas, common medications that may enhance warfarin anticoagulation, and therapy of potentially life-threatening hematomas. Airway management and possible surgical therapies to treat the complications of hematomas are discussed. Depending upon the indication for the initial anticoagulation, interim anticoagulation with heparin may be indicated.
Acad. Emerg. Med. 1994; 1:67–72.     

The anesthetic management of a patient with chromosome 10qter deletion syndrome

Terminal deletions of chromosome 10q are uncommon. The resulting syndrome includes cardiac and facial anomalies, urogenital abnormalities, limb defects, and mental retardation. Most affected infants require surgical correction of these anomalies. Presented are,features inherent in the syndrome that will aid the anesthesiologist in the perioperative management of such patients.     

Management of pregnancies beyond forty-one weeks'' gestation with an unfavorable cervix

Objective: Our purpose was to determine the optimal management of pregnancies beyond 41 weeks' gestation with a cervix unfavorable for induction. Study Design: All uncomplicated pregnancies that reached 41 weeks' gestation with a Bishop score of ≤4 were randomly assigned to one of three groups: (1) daily cervical examinations, (2) daily membrane stripping, or (3) daily placement of prostaglandin gel until 42 weeks. Results: In 105 pregnancies the Bishop score on admission to labor and delivery was significantly greater in the groups receiving prostaglandin or stripping of the membranes versus the control group, whereas the converse was time of gestational age at delivery (p = 0.0001). Fewer patients required induction in the two treatment groups (20%, 17%) versus the control (69%) patients (p < 0.0001). Conclusions: Daily membrane stripping or daily placement of prostaglandin gel is successful in reducing the number of inductions at 42 weeks for postdatism. (Am J Obstet Gynecol 1998;178:1279-87.)     

131I-metaiodobenzylguanidine and 125I-iodoamphetamine. Parameters of lung endothelial cell function and pulmonary vascular area

Radioiodinated metaiodobenzylguanidine (MIBG) has been shown to be extracted in the lung by an active, sodium-dependent, saturable transport system similar to that which extracts norepinephrine. Accordingly, first transit uptake of MIBG has been investigated as a method for in vivo evaluation of pulmonary biogenic amine metabolism. Issues that still must be resolved include the degree to which MIBG extraction is affected by simple loss of available vascular surface (in distinction to changes in amine metabolism). If MIBG lung extraction is altered by loss of pulmonary vascular surface alone, then a tracer must be found that can serve as a simultaneous monitor of vascular surface loss in order to allow normalization of the MIBG data. One tracer with such potential is radioiodinated iodoamphetamine (IMP). Accordingly, an experimental model of pulmonary vascular surface loss (lobar ligatures) was applied in an isolated-perfused lung model with simultaneous administration of MIBG and IMP. A linear relationship was found between MIBG extraction and percent lung surface loss by weight (n = 21, r = 0.75, P less than 0.05). Addition of IMP (1 or 10 microM) to media containing MIBG (1 microM) (n = 28) inhibited overall MIBG extraction, but decreases in MIBG uptake with vascular surface loss were otherwise parallel to those in experiments without IMP. IMP, however, did not adequately reflect vascular surface loss at the concentrations used in this study (extraction of IMP 1 microM = 31.2% +/- 12.9% in control vs 32.7% +/- 7.7% with greater than 50% lung surface loss, n = 18, P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)