The incidence of postpartum hemorrhage is around 5% and is continuously increasing worldwide due to increase in patients with advanced maternal age, multiple pregnancies, caesarean deliveries and previous caesarean sections with abnormal placentation [1–4]. Using intrauterine balloon to manage severe postpartum hemorrhage (PPH) is shown to be effective and can decrease the rate of hysterectomy [5– 8]. As a result, intrauterine balloon has been more and more commonly incorporated into severe PPH protocols. It has become an integral part of the “HEMOSTASIS” man- agement algorithm advocated in the United Kingdom . However, follow-up studies on the menstrual and repro- ductive outcomes after the use of balloon tamponade are minimal. There are only two studies in the literature that has specifically reviewed patients’ menses after the use of balloon tamponade, of which one was a case series that in- cluded only 5 patients  while the other included 33 women but was only published as electronic poster . For the reproductive outcomes, there are only five studies available that have reported a total of 14 patients’ subse- quent pregnancy and delivery after the use of balloon tam- ponade [11 – 14]. However, the details on subsequent pregnancy outcome such as the gestational age at delivery were not reported in at least half of the cases. Therefore this study aims at reviewing an unselected cohort of pa- tients who had been managed with intrauterine balloon for severe PPH in their index pregnancy over a period of 66 months. Using this larger sample size, we attempted to evaluate the details of the patients ’ menstrual func- tions, fertility and reproductive outcomes, in order to verify the long term impact of balloon tamponade on these patients with severe postpartum hemorrhage in their previous pregnancies.
In 2012, the World Health Organization (WHO) recommended use of the uterine balloon tamponade (UBT) for treatment of uterine atony when uterotonic drugs are unavailable or ineffective . UBT is a nonsurgi- cal intervention that can be administered by trained health care providers at the point of care. The balloon is inserted into the uterus and filled with clean water , and effect- ive tamponade occurs rapidly to stop hemorrhage. Pub- lished case series and systematic reviews have shown that UBT devices are safe and effective, with a success rate of 85% to 95% for treating PPH unresponsive to medical management [11–25]. Nonetheless, UBT is still widely underutilised and unavailable in low- and middle-income countries, largely because commercial devices are prohibi- tively expensive, ranging from $US125 to $350 for one- time use. Recent efforts to develop low-cost UBTs, which could cost approximately 10% of current prices, would provide opportunities to expand access to life- saving treatments [26, 27].
In conclusion our large, single centre series confirms that balloon tamponade is an effective means of control- ling severe PPH with success rates of approximately 87%. There should also be a low threshold for prophylactic balloon tamponade use in women at high risk of PPH, considering its ease of use, low complication rate and ability to retain fertility. This treatment is also cost effec- tive as it may avoid the need for hysterectomy and also hospital stay and convalescence are likely to be shorter compared to other invasive surgical procedures. Future prospective studies are warranted to determine the ideal fluid volume for balloon inflation, tamponade duration and duration of oxytocin infusion.
Background: PPH is responsible for quarter of maternal deaths occurring worldwide and its incidence is increasing in developed world. According to Confidential Enquiries into Maternal and Child Health (CEMACH) report obstetric hemorrhage occurs in around3.7 per 1000 births. The objective of the study is that it was a prospective randomized comparative study of misoprostol and balloon tamponade via condom catheter to prevent postpartum hemorrhage in normal delivered patients at MYH.
This study was approved by the Ethics Committee of Erzurum Regional Teaching Hospital, Turkey. We retrospectively reviewed the records of 50 patients treating for PPH by Bakri balloon tamponade who were managed between January 2013 and March 2016 in Nenehatun Hospital, Erzurum, Turkey. Women who developed massive PPH following a vaginal delivery or caesarean section in whom medical treatment had failed were included. Postpartum hemorrhage was defined as >500 ml estimated blood loss after vaginal delivery or >1000 ml after cesarean section . Patients with PPH due to uterine and cervical trauma or retained placental tissue were excluded. Patients who underwent Bakri balloon insertion to control PPH were analysed in terms of demo- graphic and clinical characteristics, treatment outcomes and the need for additional surgery and complications.
The patient was transferred to theatre and an halo- thane-based anaesthetic technique was performed. Com- plete reduction was finally achieved by manual replace- ment with Johnson maneuver (Figure 2) and the patient was thoroughly examined to ensure that no other injuries were sustained. At that point, the estimated blood loss was about 1500 ml. After confirming successful repla- cement of the uterus, which was now well contracted, prophylactic intravenous antibiotics were administered (1 gr ampiciline, 120 mg gentamicine and 500 mg me- thronidazol), so as the administration of fourty units of oxytocin and 0.250 mg of ergometrine maleate, in a 500 ml saline solution. Thirty minutes later, the patient beca- me haemodynamically unstable again, with a blood pre- ssure of 81/45 mmHg. At this time bleeding was poor and vaginal examination confirmed that uterus had re- inverted again showing fundus within vaginal cavity. Once again the patient was transferred to the treatre were previously described procedures were repeated. At this moment uterine fundus appeared atonic, and there was a suspicion of great propensity to invert again (Figure 3). As additional measure to prevent it a Surgical Obstetric Silicone (SOS) Bakri ® tamponade balloon catheter (Cook Medical Incorporated) was inserted into the uterus with
Over the past 7 years our team has designed, developed, implemented, and refined a PPH evidence-based package utilizing an ultra-low-cost condom-based uterine balloon called Every Second Matters for Mothers and Babies– UBT (ESM-UBT) [5 – 8]. When compared with commer- cially available devices, ESM-UBT utilizes readily available low cost materials (Fig. 1). Data have been collected dem- onstrating efficacy of the package in arresting PPH and averting emergency hysterectomy [5 – 8]. The ESM-UBT package has been successfully implemented across all levels of the health systems in South Sudan, Kenya, Tanzania, Si- erra Leone, Senegal, Zambia, Ghana and Nepal.
Methods: We performed desktop testing using a uterine model with pressure sensors to compare key design elements of the obstetrical prototype MSD (fundal pressure achieved, reduction in fluid loss, time to deploy, and time to remove) with alternativetechniques (uterine packing, balloon tamponade). To evaluate safety, we delivered the fetus of pregnant ewes by cesarean section and used the prototype to deliver the MSD into one uterine horn, and closed the hysterotomy. We followed the clinical recovery of animals ( n = 3) over 24 h, and then removed the reproductive tract for histologic evaluation. To evaluate late effects, we surgically removed the MSDs after 24 h, and followed the clinical recovery of animals ( n = 6) for an additional seven days before tissue removal.
FPH soundings by the Global Monitoring Division of NOAA ESRL often show intermittent water vapor measure- ment contamination during balloon ascent, especially when balloons are launched in cloudy conditions. Persistent as- cent measurement contamination starting ∼ 8 km above the tropopause is a typical feature of FPH humidity profiles be- cause temperature and solar irradiance increase with altitude above the tropopause, warming the balloon skin and intensi- fying outgassing (Fig. 3). In uncontaminated conditions the performance of the FPH during ascent and descent is simi- lar because the direction of sample flow through the instru- ment is irrelevant (i.e., the air intake and exhaust paths are identical). For these reasons FPH measurements made dur- ing controlled descent are preferable to ascent measurements in the UTLS. The high-resolution controlled descent data can be used to identify and flag ascent measurements affected by contamination, especially in the UTLS. In contrast, FPH measurements made after balloon burst, as the payload falls at > 20 m s −1 through the stratosphere, are of lower vertical resolution and typically poorer quality than the ascent data, making them less useful in identifying contaminated ascent measurements.
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feasible as screening tests for pericardial effusion at frontline physician such as general practitioners or primary care community health clinics. Furthermore, echocardiography requires a trained sonographer or cardiologist for interpretation. It is may not be practical and could be costly to send all patients for universal screening by echocardiography to rule out cardiac tamponade based on clinical suspicion alone. In contrast, 12-lead electrocardiography (ECG) is a non-invasive, cost effective, easy to perform, and readily available diagnostic tool in most of the health care settings. We will provide a brief background on the use of the 12-lead ECG for diagnosing cardiac tamponade. Spodick et al., had made a pivotal contribution to the research of ECG abnormalities in pericarditis. 1,2,5,6 In 1996, Eisenberg et al. applied a set of ECG
12. Fejka M, Dixon SR, Safian RD, O'Neill WW, Grines CL, Finta B, Mar- covitz PA, Kahn JK: Diagnosis, management, and clinical out- come of cardiac tamponade complicating percutaneous coronary intervention. Am J Cardiol 2002, 90(11):1183-1186. 13. Weinberg L, Kandasamy K, Evans SJ, Mathew J: Fatal cardiac rup-
Abstract: Despite treatment advances, rhegmatogenous retinal detachment (RD) can have poor visual outcomes even with prompt and appropriate therapy. Pars plana vitrectomy is a leading management modality for the treatment of RD. This procedure is generally accompanied by the use of internal tamponade. Various gases and silicone oils may yield beneficial outcomes. Heavy silicone oils have been approved in some European nations but are not available in the USA. Different tamponade agents have unique benefits and risks, and choice of the agent should be individualized according to the characteristics of the patient and RD, as well as perioperative and postoperative factors.
Balloon geometry and material properties gathered with experimental tests allowed to accurately design a computational model of the device. FE simulations were then able to successfully replicate the experimental data in both inflation scenarios (i.e., bal- loon alone and balloon within phantom). Such a good agreement was achieved partly due to the accurate design of the device in terms of geometry and material properties, and partly due to the adoption of the fluid cavity and fluid exchange algorithms, which allow to realistically simulating the entrance of a fluid with specified physical properties (i.e., density, bulk modulus) into a closed cavity. Indeed, in order for numerical mod- els to be translated into clinically relevant settings, they need to be robustly validated, which in this case was demonstrated by the good agreement between computational and experimental data. The observed discrepancy between simulated values of pres- sure and diameter is in fact within the precision characterising the same measurements in the clinical setting. In particular, during ballooning procedures balloon pressure is measured with a manometer incorporated in the inflation system, characterised by full scale range = 0 ÷ 5 atm and resolution = 0.2 atm, and balloon diameter is assessed with fluoroscopy images (isotropic image resolution = 0.5 mm/pixel). Our models exhibit maximum RMSE P = 161.98 mmHg, comparable to clinical manometer resolution, and
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Dog’s owner was provided consent form to approve the therapeutic procedure. Routine laboratory evaluations were performed included hematology, serum biochemistry and electrolyte levels analysis as shown in Table 1. Pericardiocentesis was performed and 400 ml of serosanguineous pericardial exudate was removed from the pericardial cavity to alleviate a sign of cardiac tamponade. After pericardiocentesis, no effusion fluid was observed in the pericardial sac. A full cardiac examination was performed as shown in Table 2, including Electrocardiography, 2- Dimensional, M-Mode and color flow Doppler echocardiography (vivid s5, USA). Echocardiography was performed in parasternal long, short axis views and apical four-chamber view in right and left parasternal position with
co-existing pleural effusion which was either left-sided or present bilaterally [24,25,27]. Co-existing pleuritis and/or pleural effusion has commonly featured in recent cases of aSLE presenting with tamponade and outside of SLE, bilateral pleural effusions in cardiac tamponade are distinctly rare [33,34]. Hematologic abnormalities were also frequently found including hemolytic anemia, thrombocytopenia and leukopenia [17,24,23,28]. Al- though not tested for in all cases, 5 patients had low serum complement [17,23,30,31]. This is significant as a low serum complement C4 level was found to be predictive of progression to cardiac tamponade in a series of aSLE patients [35,36]. However, we also note it has been reported that inherited complement defi- ciencies are a frequent comorbidity in cSLE [19,37]. Therefore the significance of low serum complement in these patients would benefit from further research.
A 61 year old man presented with diffuse large B cell lymphoma of the skin of the back of the shoulder which was excised and treated with chemotherapy (CHOP regime) in 1998. He was in complete remission till he presented in 2002 with extranodal marginal zone lymphoma of the parotid gland for which he underwent superficial parotidectomy and radiotherapy. He continued in remission till 2006 when he presented with recurrent pericardial effusion and tamponade. At median sternotomy, pericardial effusion was drained, an anterior pericardiectomy was done and a left posterior pericardial window made, and an enlarged hard paraaortic lymph node excised. Histology, immunocytochemistry and chromosome analysis revealed Burkitt lymphoma. Patient underwent chemotherapy with CODOX-M regime and continues in remission. This report is unusual on account of the highly atypical presentation of Burkitt lymphoma as cardiac tamponade, only a few cases having been reported previously, the occurrence of three lymphomas of different pathological and genomic profiles in one patient over a period of eight years and the relatively slow rate of growth of an otherwise fulminant tumour with high tumour doubling time. A review of literature with special emphasis on chromosomal diagnosis, transformation of other lymphomas into Burkitt lymphoma and mediastinal and cardiac involvement with Burkitt lymphoma is presented.
In case 1 balloon treatment failed because of the impossibility of passing a balloon through the narrow orifice of the fistula. In case 2 this kind of treatment was not attempted for the same reason. Standard coils were not used be- cause it was thought that GDCs would have better safety and efficacy.
On the postprocedural CT images, focal cortical hyperat- tenuation was noted following the endovascular treatment of 49 of 100 (49%) aneurysms (Figs 1 and 3– 6). This finding was seen in CT examinations of 40 of 74 (54%) aneurysms that were treated with balloon assistance (Figs 1, 3, 5, and 6) and 9 of 26 (34.6%) aneurysms that were treated without balloon assistance (Fig 4). Increased cortical attenuation was confined to the territory of the parent artery harboring the aneurysm, partially involving the territory in 44 cases and entirely, in 5. MR imaging examinations did not reveal any relevant lesions in any of the patients (Figs 1 and 5), and the cortical hyperat- tenuation resolved totally or partially in the CT scan that was repeated 4 – 6 hours later (Figs 1 and 3– 6). All patients were asymptomatic.
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Evaluation of the pericardial sac in cardiac tamponade should be performed carefully through all the echocardiographic windows in order to quantify pericardial fluid and to differentiate diffuse circumferential effusions from loculated regional ones. Excessive cardiac motion up to the so-called ‘swinging heart’ is frequently seen in severe pericardial effusion with chronically accumulated effusion and a minimum of adhesions (Tobias, 2010). This movement can be observed in malignancies, chronic tuberculous pericarditis and also benign viral pericarditis. An exaggerated inspiratory expansion of the right ventricle (RV) and simultaneous compression of the left ventricle is a nonspecific sign of increased direct
DOI: 10.4236/jcc.2018.611016 169 Journal of Computer and Communications lecting the appropriate surface coating of balloon decoy, thus basically eliminat- ing the various thermal effects that nuclear warhead may have on the balloon. For example, if the initial temperature of warhead is close to room temperature (300 K), the balloon surface can be coated with aluminum-silicon coating, mak- ing the balloon temperature change in a small range around 300 K. In this way, all infrared detectors of the ballistic missile defense system (including those on the LEO SBIRS satellite and interceptor) can be prevented from identifying bal- loon and balloon decoys with nuclear warhead.