Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021843 (bowel obstruction)
 9,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nonoperative management of splenic and hepatic injuries in children is safe, and the majority of those with isolated injuries do not require blood transfusion. Thirty-seven children were treated for blunt splenic or hepatic trauma from November 1983 to September 1989. There was one death in a patient with a lethal head injury. No operations were performed on those with isolated splenic or hepatic injuries. Three of those with multiple injuries underwent delayed laparotomy. Two had perirenal and retroperitoneal hematomas without active bleeding, and one had a bowel obstruction secondary to an intramural jejunal hematoma. There were no late complications related to the splenic or hepatic injuries. Eight children (22%) required surgery for other injuries. Twelve children were not transfused, including the majority (8/11) of those with isolated splenic or hepatic injury. The hematocrit of four of these children fell to below 28% and this anemia was well-tolerated. Two children with bleeding disorders (factor VIII [antihemophilic factor] and factor XII [Hageman factor] deficiency) did not require packed red blood cells transfusion. Two clinically distinct groups of children received blood transfusions: (1) eight patients with multiple injuries were transfused during initial resuscitation when unstable or during early operation for other system trauma (mean, 62.0 mL blood/kg body weight); and (2) three hemodynamically stable patients with isolated injuries and 14 stable patients with multiple injuries were transfused empirically after initial resuscitation solely because of decreasing blood counts. They received an average of 16.5 and 21.1 mL blood/kg body weight, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Transfusion requirements in conservative nonoperative management of blunt splenic and hepatic injuries during childhood. 221 46

Case I: A 9-year-old boy, diagnosed as having hemophilia A at 8 months, was admitted complaining of slight headache and nausea one day after a minor head trauma. Neurological deficits were absent but CT scan revealed an epidural hematoma in the posterior fossa. Shortly afterwards, he lapsed into coma with apnea and dilated pupils. Following resuscitation, emergency suboccipital craniectomy and total removal of the bilateral supra- and infratentorial extradural hematoma was performed under AHG administration. The patient gradually regained consciousness, but during the subsequent nine weeks he underwent three major operations (laparotomy): the first two for hemostasis of gastrointestinal bleeding, and the last one for strangulated intestinal obstruction. Although this patient necessitated 16 weeks of AHG administration, he was discharged without any side effects after 4 months of hospitalization. Case II: A 10-year-old boy, diagnosed earlier as having hemophilia A, experienced a minor head trauma and was admitted because of headaches and nausea. CT scan revealed an epidural hematoma in the posterior fossa. Removal of the hematoma was successfully completed under AHG administration. The patient was discharged without any neurological deficits. In the above hemophilic cases, we used a high concentrated AHG and maintained at 70% of the plasma concentration of the VIII factor during the first 14 postoperative days. The high concentrated AHG was safe for long term administration, so one should not hesitate operation even in the case of intracranial hemorrhage of hemophilic patients. CT scan should be recommended to the patient of hemophilia A even in minor head trauma.
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PMID:[Acute epidural hematoma in the posterior fossa in patients with hemophilia A--report of two surgically treated cases]. 641 74