Diffuse bleeding during neurosurgical operations is a major complication that can be difficult to control. In extreme circumstances, it may be necessary to clamp cerebral blood vessels or resect additional tissue. Both of these procedures can result in brain damage and, ultimately, in disability for the patient. We report on the use of recombinant activated blood coagulation Factor VII (rFVIIa) to control bleeding during neurosurgical procedures in three patients undergoing neurosurgery for brain tumors who received intravenous rFVIIa 4.8 mg (NovoSeven, NovoNordisk, Copenhagen, Denmark) for diffuse intracranial bleeding after conventional hemostatic techniques had been exhausted. All patients (one man and two women, age range 23-40 years) were otherwise somatically healthy with a mean weight of approximately 50 kg. Bleeding ceased 12 to 20 minutes after administration of rFVIIa. All three patients recovered with no further bleeding. In our initial experience, rFVIIa appears to be efficacious for terminating bleeding during neurosurgical procedures. The use of rFVIIa made it unnecessary to resort to procedures carrying a risk of long-term sequelae.

No abstract

Objective: We aimed to determine the safety and feasibility of general anaesthesia (GA) compared with local anaesthesia + Monitored Anaesthesia Care (LA+MAC) for One-Day Thyroid Surgery (ODTS); to assess patient and operator satisfaction with either of the anesthetic approaches. Material and Methods:We reviewed prospectively 130 patients who underwent ODTS from 2008 to 2011. 64 patients were operated on under GA and 62 -under LA+MAC. All variables of patient demographic characteristics, duration and type of operation, postoperative complications, difficulty in airway management and postoperative opiate consumption were recorded and analyzed.Results: There is no difference in respect to length of stay, discharge time and major/minor complications rate between two groups, but in the LA+MAC group, pain appears earlier and is more severe (56min; VAS 6, 5) than in GA patients (223 min; VAS 1, 5; p<0.001). Patient satisfaction was similar but the operator preference was greater for GA. Conclusion:In experienced hands LA with MAC for Thyroidectomy is a safe and wise choice, but GA is even more so!

No abstract

Aim To estimate the rate of hospital admissions for trauma and burns due to external causes (ICD-10) for a 1 year period in comparison with the overall number of admissions in a university hospital providing emergency services for a city with a population of 1.5 million. A secondary analysis involved identifying the types of external causes and assessing their preventability and cost. Methods Analysis of case notes from five wards (Ophtalmology; Orthopedics and Trauma; Ear, Nose and Throat; Intensive Care; Neurosurgery) for the period of 1 January 2011-1 January 2012. The trauma cases and burns due to external causes as well as suicide attempts were summarised. The ratio between trauma due to extraneous causes and overall number admissions was calculated, the percentage of cases leading to long-term disability, their financial cost and the estimated cost of their prevention. Results We found that preventable traumas due to external causes comprise a significant part of all admissions, with ophtalmology, hand trauma and suicide attempts in untreated psychiatric disorders contributing considerably. Our secondary analysis revealed a high percentage of long-term disability as a direct result of these preventable traumas. These data highlight the need to increase prevention efforts, as well as the need to register hospitalised patients under section 'External causes' of ICD-10 when appropriate. A166Inj Prev 2012;18(Suppl 1):A1-A246