No abstract

Introduction. Warfarin is one of the most frequently used anticoagulant agents in the clinic. The most important adverse effect of warfarin is hemorrhage of vital organs, such as lung and brain. Diffuse Alveolar Hemorrhage (DAH) is a rare clinical condition which occurs due to variety of medical disorders. Although it’s rarely reported, DAH can be a result of coagulopathy prompted by warfarin therapy. In this study we present a case of DAH, caused by warfarin toxicity which referred to the hospital with non-specific respiratory symptoms.Case presentation. A 41-year-old female patient referred to the hospital complaining of shortness of breath, cough and dizziness. She had been taking warfarin due to mitral valve replacement for the past 10 years. Her recent symptoms began shortly after taking amoxicillin, a few days before admission. Early clinical examination and paraclinical studies reveal DAH as the cause of respiratory symptoms. The patient was then intubated and received fresh frozen plasma, packed cells and oral vitamin K. Laboratory findings apart from increased INR, PT, ESR and CRP were all within normal range. After the initiation of treatment patient’s INR decreased and her clinical condition improved. Follow-up CT-Scan and bronchoscopy also confirmed resolving DAH.Conclusions. The usage of warfarin in anticoagulation should be closely monitored due to its narrow therapeutic window and other factors, including its interaction with other medications such as antibiotics. Warfarin toxicity can lead to DAH, a life-threatening condition which can be presented with non-specific symptoms and deteriorate patient’s clinical condition in a short time. Therefore, it is of utmost importance to watch closely for primary symptoms of such rare incident in patients under warfarin therapy and initiate treatment as soon as possible, to prevent mortality.

Right heart cement embolization is a rare but potentially life‐threatening complication of vertebroplasty surgeries. Transthoracic echocardiography is the first‐line imaging modality for detecting cement particles in cardiac chambers. Anticoagulation treatments or surgical interventions are necessary, depending on the patient's condition.

Cite this article as: Mahmoodzadeh H, Omranipour R, Borjian A, Borjian MA. Study of therapeutic results, lymph node ratio, short-term and long-term complications of lateral lymph node dissection in rectal cancer patients.

Background and aimDespite improvements in the imaging modalities, the optimal protocol for extracranial facial nerve imaging using 1.5 T MRI is still debatable. Pre-operative mapping of the facial nerve could provide valuable information for surgeons. The current study aimed to evaluate and choose proper 1.5 T MRI protocols for the extracranial segment of facial nerve pre-op imaging.Patients and methodsExtracranial facial nerves on the tumoral and normal side of 19 patients (38 nerves) were imaged by 1.5 T MRI, using five sequences including T1-weighted, T2-weighted, T1-weighted-fat-saturated with contrast, Three-dimensional (3D) T1-weighted and 3D T2-weighted. The visibility of each of the three segments of the extracranial facial nerve (the main trunk, cervicofacial and temporofacial divisions and terminal branches) in each sequence was assessed.ResultsOn the normal side, segments 1 and 2 of the nerve were identifiable in all patients and segment 3 was identifiable in 89.5% of patients in both 3D T1-weighted and 3D T2-weighted sequences. On the tumoral side, segments 1, 2 and 3 were identifiable in 89.5, 84.2 and 68.4% of patients, respectively, in 3D T1-weighted and T2-weighted sequences. 3D sequences showed significant improvement in visualizing extracranial facial nerve and its branches compared to routine T1-weighted and T2-weighted sequences.ConclusionsOur protocol showed favourable results in visualizing the extracranial facial nerve and its branches. We believe the protocol used in this study could be used as a pre-operative facial nerve mapping method using 1.5 T MRI.