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Sample records for acute bleeding arterioenteric

  1. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered

  2. Endovascular management of acute bleeding arterioenteric fistulas

    Leonhardt, H.; Mellander, S.; Snygg, J.;

    2008-01-01

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed...

  3. Volcano-like intermittent bleeding activity for seven years from an arterio-enteric fistula on a kidney graft site after pancreas-kidney transplantation: a case report

    Schölmerich Jürgen

    2010-11-01

    Full Text Available Abstract Introduction We report the first case of a patient who underwent simultaneous kidney and pancreas transplantation and who then suffered from repeated episodes of severe gastrointestinal bleeding over a period of seven years. Locating the site of gastrointestinal bleeding is a challenging task. This case illustrates that detection of an arterio-enteric fistula can be very difficult, especially in technically-challenging situations such as cases of severe intra-abdominal adhesions. It is important to consider the possibility of arterio-enteric fistulas in cases of intermittent bleeding episodes, especially in transplant patients. Case presentation A 40-year-old Caucasian man received a combined pancreas-kidney transplantation as a result of complications from diabetes mellitus type I. Thereafter, he suffered from intermittent clinically-relevant episodes of gastrointestinal bleeding. Repeat endoscopic, surgical, scintigraphic, and angiographic investigations during his episodes of acute bleeding could not locate the bleeding site. He finally died in hemorrhagic shock due to arterio-enteric bleeding at the kidney graft site, which was diagnosed post-mortem. Conclusions In accordance with the literature, we suggest considering the removal of any rejected transplant organs in situations where arterio-enteric fistulas seem likely but cannot be excluded by repeat conventional or computed tomography-angiographic methods. Arterio-enteric fistulas may intermittently bleed over many years.

  4. [Acute gastrointestinal bleeding].

    Baumbach, Robert; Faiss, Siegbert; Cordruwisch, Wolfgang; Schrader, Carsten

    2016-04-01

    Acute gastrointestinal bleeding is a common major emergency (Internal medical or gastroenterological or medical), approximately 85 % of which occur in the upper GI tract. It is estimated that about a half of upper GI bleeds are caused by peptic ulcers. Upper GI bleeds are associated with more severe bleeding and poorer outcomes when compared to middle or lower GI bleeds. Prognostic determinants include bleeding intensity, patient age, comorbid conditions and the concomitant use of anticoagulants. A focused medical history can offer insight into the bleeding intensity, location and potential cause (along with early risk stratification). Initial measures should focus on rapid assessment and resuscitation of unstable patients. The oesophagogastroduodenoscopy (OGD) is the gold standard method for localizing the source of bleeding and for interventional therapy. Bleeding as a result of peptic ulcers is treated endoscopically with mechanical and / or thermal techniques in combination with proton pump inhibitor (PPI) therapy. When variceal bleeding is suspected, pre-interventional use of vasopressin analogues and antibiotic therapies are recommended. Endoscopically, the first line treatment of esophageal varices is endoscopic ligature therapy, whereas that for gastric varices is the use of Histoacryl injection sclerotherapy. When persistent and continued massive hemorrhage occurs in a patient with known or suspected aortic disease the possibility of an aorto-enteric fistula must be considered. PMID:27078246

  5. Secondary arterio-enteric fistula: case report and review of the literature.

    Budimir, Ivan; Nikolić, Marko; Supanc, Vladimir; Ljubicić, Neven; Krpan, Tomislav; Zovak, Mario; Sabol, Mateja

    2012-03-01

    Arterio-enteric fistula is a rare, but potentially deadly cause of gastrointestinal bleeding. The disease occurs in two forms: primary as a result of atherosclerotic aortic aneurysm, aortitis, trauma, radiation, tumor invasion or penetrating ulcer, and secondary as a consequence of surgical aortal reconstruction. The clinical manifestation is mostly gastrointestinal bleeding, rarely back pain, fever and sepsis. Computed tomography with contrast medium is the most suitable diagnostic test, however, the diagnosis frequently requires explorative laparotomy. A case is presented of secondary arterio-enteric fistula, found two years after surgical treatment of chronic pancreatitis with pseudocystojejunostomy, which clinically manifested with gastrointestinal bleeding. Although there was strong suspicion of arterio-enteric fistula, the diagnosis was not verified by routine workup, but only on explorative laparotomy. PMID:22920006

  6. Treatment of acute variceal bleeding

    Bendtsen, Flemming; Krag, Aleksander Ahm; Møller, Søren

    2008-01-01

    The management of variceal bleeding remains a clinical challenge with a high mortality. Standardisation in supportive and new therapeutic treatments seems to have improved survival within the last 25 years. Although overall survival has improved in recent years, mortality is still closely related...... to failure to control initial bleeding or early re-bleeding occurring in up to 30-40% of patients. Initial procedures are to secure and protect the airway, and administer volume replacement to stabilize the patient. Treatment with vasoactive drugs should be started as soon as possible, since a...... adhesives should be used. In conclusion: Improvements in resuscitation and prevention of complications have together with introduction of vasoactive drugs and refinement of endoscopic therapy majorily changed the prognosis of the patient presenting with variceal bleeding....

  7. Somatostatin analogues for acute bleeding oesophageal varices

    Gøtzsche, Peter C.; Hrobjartsson, A.

    2008-01-01

    BACKGROUND: Somatostatin and its derivatives are sometimes used for emergency treatment of bleeding oesophageal varices in patients with cirrhosis of the liver. OBJECTIVES: To study whether somatostatin or its analogues improve survival or reduce the need for blood transfusions in patients with...... bleeding oesophageal varices. SEARCH STRATEGY: PubMed and The Cochrane Library were searched (November 2007). Reference lists of publications, contacts with authors. SELECTION CRITERIA: All randomised trials comparing somatostatin or analogues with placebo or no treatment in patients suspected of acute or...

  8. Porcine survival model to simulate acute upper gastrointestinal bleedings.

    Prosst, Ruediger L; Schurr, Marc O; Schostek, Sebastian; Krautwald, Martina; Gottwald, Thomas

    2016-06-01

    The existing animal models used for the simulation of acute gastrointestinal bleedings are usually non-survival models. We developed and evaluated a new porcine model (domestic pig, German Landrace) in which the animal remains alive and survives the artificial bleeding without any cardiovascular impairment. This consists of a bleeding catheter which is implanted into the stomach, then subcutaneously tunnelled from the abdomen to the neck where it is exteriorized and fixed with sutures. Using the injection of porcine blood, controllable and reproducible acute upper gastrointestinal bleeding can be simulated while maintaining normal gastrointestinal motility and physiology. Depending on the volume of blood applied through the gastric catheter, the bleeding intensity can be varied from traces of blood to a massive haemorrhage. This porcine model could be valuable, e.g. for testing the efficacy of new bleeding diagnostics in large animals before human use. PMID:26306615

  9. Interventional angiography in the diagnosis of acute lower gastrointestinal bleeding

    Interventional angiography with the use of indwelling arterial catheters, anticoagulants, vasodilators and fibrinolytic agents, complements conventional angiography in the diagnosis of acute lower gastrointestinal bleeding. These interventional techniques prolong, augment or reactive bleeding and, by enabling better timing of examinations, they increase the diagnostic efficacy of angiography. In the reported series of 63 patients with acute lower gastrointestinal hemorrhage, interventions increased the diagnostic yield of angiography for demonstration of extravasation from 32% to 65% and decreased the percentage of negative angiograms from 27% to 16%. Indications, techniques and risks of interventional angiography in the diagnosis of acute lower gastrointestinal bleeding are discussed. (orig.)

  10. Sandostatin therapy of acute oesophageal variceal bleeding.

    McKee, R F

    1993-01-01

    This communication deals with the emergency control of variceal bleeding rather than the prevention of rebleeding. The current main options of oesophageal tamponade, emergency sclerotherapy and drug therapy are discussed, with particular reference to the use of somatostatin. Sandostatin (Sandoz, Basel), a synthetic long-acting somatostatin analogue, was found to reduce transhepatic venous gradient by 30% with no effect on systemic haemodynamics in a study of 16 stable cirrhotic patients. In a trial comparing intravenous infusion of Sandostatin (SMS) to oesophageal tamponade (OT) in active variceal bleeding, 18 of 20 bleeds in the SMS group and 19 of 20 bleeds in the OT group were controlled at 4 h. Ten in the SMS group and 14 in the OT group had no further bleeding during the 48-hour study period. Thus SMS may be useful in the temporary control of active variceal bleeding. PMID:8359565

  11. Multidetector computed tomography in acute lower gastrointestinal bleeding

    John Palma

    2010-11-01

    Full Text Available John Palma, Marius Mihaila, Frank PilleulDépartement de Radiologie Digestive et des Urgences, Hôpital Edouard Herriot, Hospices Civils de Lyon, CHU, Lyon, FranceBackground: The aim of this study is to evaluate multidetector computed tomography (MDCT in acute massive lower gastrointestinal bleeding, with endoscopy and surgery as reference examinations.Methods: A single-center retrospective study involving 34 patients with acute massive lower gastrointestinal bleeding was carried out. All patients were evaluated by MDCT scan then endoscopic or surgical examinations. Sensitivity, specificity, and positive and negative predictive values of MDCT scan were calculated using the extravasation of the contrast agent as the main criterion.Results: Extravasation of the contrast agent was found in 30 of 34 patients (88%. The bleeding site seen on CT was always the same as on endoscopic or surgical examinations (100%. Sensitivity of MDCT scan was 94%, specificity 100%, positive predictive value 100%, and negative predictive value 50% (P < 0.001. Twelve diverticulum bleedings were seen on MDCT scan compared with 13 (92% on endoscopic or surgical examinations. Angiodysplasia was overestimated by MDCT scan.Conclusion: MDCT scan appears to be an excellent tool to find and localize the bleeding site in cases of acute massive lower gastrointestinal disease.Keywords: MDCT, acute lower gastrointestinal bleeding, extravasation, contrast agent

  12. Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding

    Full text: The aim of the study was to carry out a systematic review determining the accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding. A search of published work in Medline and manual searching of reference lists of articles was conducted. Studies were included if they compared CT angiography to a reference standard of upper gastrointestinal endoscopy, colonoscopy, angiography or surgery in the diagnosis of acute gastrointestinal bleeding. Eight published studies evaluating 129 patients were included. Data were used to form 2x2 tables. Computed tomography angiography showed pooled sensitivity of 86% (95% confidence interval 78-92%) and specificity of 95% (95% confidence interval 76-100%), without showing significant heterogeneity (x2 = 3.5, P=0.6) and (x2 - 5.4, P = 0.6), respectively. Summary receiver operating characteristic analysis showed an area under the curve of 0.93. Computed tomography angiography is accurate in the diagnosis of acute gastrointestinal bleeding and can show the precise location and aetiology of bleeding, thereby directing further management. Strong recommendations for use of CT cannot be made from this review because of the methodological limitations and further large prospective studies are needed to define the role of CT in acute gastrointestinal bleeding.

  13. Transcatheter embolization for treatment of acute lower gastrointestinal bleeding

    Treatment of lower gastrointestinal bleeding was attempted in 13 patients by selective embolization of branches of the mesenteric arteries with Gelfoam. Bleeding was adequately controlled in 11 patients with active bleeding during the examination. One patient improved after embolization but bleeding recurred within 24 hours and in another patient the catheterization was unsuccessful. Five patients with diverticular hemorrhage were embolized in the right colic artery four times, and once in the middle colic artery. Three patients had embolization of the ileocolic artery because of hemorrhage from cecal angiodysplasia, post appendectomy, and leukemia infiltration. Three patients had the superior hemorrhoidal artery embolized because of bleeding from unspecific proctitis, infiltration of the rectum from a carcinoma of the bladder, and transendoscopic polypectomy. One patient was septic and bled from jejunal ulcers. Ischemic changes with infarction of the large bowel developed in two patients and were treated by partial semi-elective colectomy, three and four days after embolization. Four other patients developed pain and fever after embolization. Transcatheter embolization of branches of mesenteric arteries in an effective way to control acute lower gastrointestinal bleeding, but still has a significant rate of complications that must be seriously weighed against the advantages of operation. (orig.)

  14. N-butyl cyanoacrylate embolotherapy for acute gastroduodenal ulcer bleeding

    Various embolic agents have been used for embolization of acute gastrointestinal (GI) arterial bleeding. N-butyl cyanoacrylate (NBCA) is not easy to handle, but it is a useful embolic agent. In this retrospective study, we describe our experience with NBCA embolization of acute gastroduodenal ulcer bleeding. NBCA embolization was performed in seven patients with acute upper GI arterial bleeding; they had five gastric ulcers and two duodenal ulcers. NBCA embolization was done in the left gastric artery (n = 3), right gastric artery (n = 2), gastroduodenal artery (n = 1) and pancreaticoduodenal artery (n = 1). Coil was used along with NBCA in a gastric bleeding patient because of difficulty in selecting a feeding artery. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:2. The blood pressure and heart rate around the time of embolization, the serial hemoglobin and hematocrit levels and the transfusion requirements were reviewed to evaluate hemostasis and rebleeding. Technical success was achieved in all the cases. Two procedure-related complications happened; embolism of the NBCA mixture to the common hepatic artery occurred in a case with embolization of the left gastric artery, and reflux of the NBCA mixture occurred into the adjacent gastric tissue, but these did not cause any clinical problems. Four of seven patients did not present with rebleeding, but two had rebleeding 10 and 16 days, respectively, after embolization and they died of cardiac arrest at 2 months and 37 days, respectively. One other patient died of sepsis and respiratory failure within 24 hours without rebleeding. NBCA embolization with or without other embolic agents could be safe and effective for treating acute gastroduodenal ulcer bleeding

  15. N-butyl cyanoacrylate embolotherapy for acute gastroduodenal ulcer bleeding

    Choi, Young Ho; Kim, Ji Hoon; Koh, Young Hwan; Han, Dae Hee; Cha, Joo Hee; Seong, Chang Kyu; Song, Chi Sung [Seoul National University Boramae Hospital, Seoul (Korea, Republic of)

    2007-01-15

    Various embolic agents have been used for embolization of acute gastrointestinal (GI) arterial bleeding. N-butyl cyanoacrylate (NBCA) is not easy to handle, but it is a useful embolic agent. In this retrospective study, we describe our experience with NBCA embolization of acute gastroduodenal ulcer bleeding. NBCA embolization was performed in seven patients with acute upper GI arterial bleeding; they had five gastric ulcers and two duodenal ulcers. NBCA embolization was done in the left gastric artery (n = 3), right gastric artery (n = 2), gastroduodenal artery (n = 1) and pancreaticoduodenal artery (n = 1). Coil was used along with NBCA in a gastric bleeding patient because of difficulty in selecting a feeding artery. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:2. The blood pressure and heart rate around the time of embolization, the serial hemoglobin and hematocrit levels and the transfusion requirements were reviewed to evaluate hemostasis and rebleeding. Technical success was achieved in all the cases. Two procedure-related complications happened; embolism of the NBCA mixture to the common hepatic artery occurred in a case with embolization of the left gastric artery, and reflux of the NBCA mixture occurred into the adjacent gastric tissue, but these did not cause any clinical problems. Four of seven patients did not present with rebleeding, but two had rebleeding 10 and 16 days, respectively, after embolization and they died of cardiac arrest at 2 months and 37 days, respectively. One other patient died of sepsis and respiratory failure within 24 hours without rebleeding. NBCA embolization with or without other embolic agents could be safe and effective for treating acute gastroduodenal ulcer bleeding.

  16. Factors affecting hospital mortality in acute upper gastrointestinal bleeding

    Alam Mohammed

    2000-01-01

    Full Text Available This retrospective analysis studied the records of 564 consecutive patients admitted to Gastrointestinal Bleeding Unit of Riyadh Medical Complex with acute upper gastrointestinal bleeding over a 2-year period (May 1996-April 1998. The purpose of the study was to analyze the mortality with an aim to identify the risk factors affecting mortality in these patients. Majority of patients were men (82% and Saudis (54%. Their mean age was 52.46 + 17.8 years. Esophageal varices (45% were the main causes of bleeding followed by duodenal ulcers (24%. Overall mortality in this series was 15.8% (89 patients. Comorbid diseases were responsible for death in 68 (76% patients, whereas, bleeding was considered to be directly responsible for death in 21 (24% patients. On analysis of data from this study, old age (>60 years, systolic pressure < 90 mm Hg on admission, comorbid disease, variceal bleeding and Child′s grade C in patients with chronic liver disease were associated with adverse outcome.

  17. Acute Gastric Bleeding Due to Giant Hyperplastic Polyp

    Bulent Aksel

    2013-04-01

    Full Text Available Hyperplastic gastric polyps account for the majority of benign gastric polyps. The vast majority of these lesions are small, asymptomatic and found incidentally on radiologic or endoscopic examination. Giant hyperplastic gastric polyps are uncommon and most of them are asymptomatic. We report a case of a 66-year-old woman who admitted because of acute gastric bleeding. The gastrin levels were within normal ranges. Esophagogastroduodenoscopy showed 12 cm pedunculated and multiple lobulated hyperplastic polyps arising from antrum with signs of diffuse oozing. The patient is treated by subtotal gastrectomy with Roux-Y gastrojejunostomy. Histological examination showed the presence of ulcers and regeneration findings with the contemporary occurrence of hyperplastic polyp. Giant hyperplastic gastric polyp should be kept in mind in the differential diagnosis of acute upper gastrointestinal bleeding.

  18. Acute gingival bleeding as a complication of dengue hemorrhagic fever

    Saif Khan; Gupta, N. D.; Sandhya Maheshwari

    2013-01-01

    Dengue fever is mosquito borne disease caused by dengue virus (DENV) of Flaviviridae family. The clinical manifestations range from fever to severe hemorrhage, shock and death. Here, we report a case of 20-year-old male patient undergoing orthodontic treatment presenting with acute gingival bleeding with a history of fever, weakness, backache, retro orbital pain and ecchymosis over his right arm. The hematological investigations revealed anemia, thrombocytopenia and positive dengue non-struct...

  19. Application of cyanoacrylate in difficult-to-arrest acute non-variceal gastrointestinal bleeding

    Kurek, Krzysztof; Baniukiewicz, Andrzej; Świdnicka-Siergiejko, Agnieszka; Dąbrowski, Andrzej

    2014-01-01

    Gastrointestinal bleeding is a common medical emergency. Although endoscopic treatment is effective in controlling non-variceal upper gastrointestinal bleeding, in cases of persistent bleeding radiological or surgical interventions are required. Application of cyanoacrylate for treatment of difficult-to-arrest non-variceal upper gastrointestinal bleeding is poorly investigated. We describe patients in whom cyanoacrylate for acute non-variceal gastrointestinal bleeding was used to stop the ble...

  20. Angiographically Negative Acute Arterial Upper and Lower Gastrointestinal Bleeding: Incidence, Predictive Factors, and Clinical Outcomes

    Kim, Jin Hyoung; Shin, Ji Hoon; Yoon, Hyun Ki; Chae, Eun Young; Myung, Seung Jae; Ko, Gi Young; Gwon, Dong Il; Sung, Kyu Bo [Asan Medical Center, Seoul (Korea, Republic of)

    2009-08-15

    To evaluate the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal (GI) bleeding. From 2001 to 2008, 143 consecutive patients who underwent an angiography for acute arterial upper or lower GI bleeding were examined. The angiographies revealed a negative bleeding focus in 75 of 143 (52%) patients. The incidence of an angiographically negative outcome was significantly higher in patients with a stable hemodynamic status (p < 0.001), or in patients with lower GI bleeding (p = 0.032). A follow-up of the 75 patients (range: 0-72 months, mean: 8 {+-} 14 months) revealed that 60 of the 75 (80%) patients with a negative bleeding focus underwent conservative management only, and acute bleeding was controlled without rebleeding. Three of the 75 (4%) patients underwent exploratory surgery due to prolonged bleeding; however, no bleeding focus was detected. Rebleeding occurred in 12 of 75 (16%) patients. Of these, six patients experienced massive rebleeding and died of disseminated intravascular coagulation within four to nine hours after the rebleeding episode. Four of the 16 patients underwent a repeat angiography and the two remaining patients underwent a surgical intervention to control the bleeding. Angiographically negative results are relatively common in patients with acute GI bleeding, especially in patients with a stable hemodynamic status or lower GI bleeding. Most patients with a negative bleeding focus have experienced spontaneous resolution of their condition.

  1. Acute gingival bleeding as a complication of dengue hemorrhagic fever

    Saif Khan

    2013-01-01

    Full Text Available Dengue fever is mosquito borne disease caused by dengue virus (DENV of Flaviviridae family. The clinical manifestations range from fever to severe hemorrhage, shock and death. Here, we report a case of 20-year-old male patient undergoing orthodontic treatment presenting with acute gingival bleeding with a history of fever, weakness, backache, retro orbital pain and ecchymosis over his right arm. The hematological investigations revealed anemia, thrombocytopenia and positive dengue non-structural protein-1 antigen and also positive immunoglobulin M and immunoglobulin G antibodies for DENV. Patient was diagnosed as a case of dengue hemorrhagic fever and was immediately referred for appropriate management. This case report emphasizes the importance of taking correct and thorough medical history.

  2. Acute gingival bleeding as a complication of dengue hemorrhagic fever.

    Khan, Saif; Gupta, N D; Maheshwari, Sandhya

    2013-07-01

    Dengue fever is mosquito borne disease caused by dengue virus (DENV) of Flaviviridae family. The clinical manifestations range from fever to severe hemorrhage, shock and death. Here, we report a case of 20-year-old male patient undergoing orthodontic treatment presenting with acute gingival bleeding with a history of fever, weakness, backache, retro orbital pain and ecchymosis over his right arm. The hematological investigations revealed anemia, thrombocytopenia and positive dengue non-structural protein-1 antigen and also positive immunoglobulin M and immunoglobulin G antibodies for DENV. Patient was diagnosed as a case of dengue hemorrhagic fever and was immediately referred for appropriate management. This case report emphasizes the importance of taking correct and thorough medical history. PMID:24174736

  3. Acute gastrointestinal bleeding: detection of source and etiology with multi-detector-row CT

    Scheffel, Hans; Pfammatter, Thomas; Marincek, Borut; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Wildi, Stefan [University Hospital Zurich, Department of Visceral and Transplant Surgery, Zurich (Switzerland); Bauerfeind, Peter [University Hospital Zurich, Division of Gastroenterology, Zurich (Switzerland)

    2007-06-15

    This study was conducted to determine the ability of multi-detector-row computed tomography (CT) to identify the source and etiology of acute gastrointestinal bleeding. Eighteen patients with acute upper (n = 10) and lower (n = 8) gastrointestinal bleeding underwent 4-detector-row CT (n = 6), 16-detector-row CT (n = 11), and 64-slice CT (n = 1) with an arterial and portal venous phase of contrast enhancement. Unenhanced scans were performed in nine patients. CT scans were reviewed to determine conspicuity of bleeding source, underlying etiology, and for potential causes of false-negative prospective interpretations. Bleeding sources were prospectively identified with CT in 15 (83%) patients, and three (17%) bleeding sources were visualized in retrospect, allowing the characterization of all sources of bleeding with CT. Contrast extravasation was demonstrated with CT in all 11 patients with severe bleeding, but only in 1 of 7 patients with mild bleeding. The etiology could not be identified on unenhanced CT scans in any patient, whereas arterial-phase and portal venous-phase CT depicted etiology in 15 (83%) patients. Underlying etiology was correctly identified in all eight patients with mild GI bleeding. Multi-detector-row CT enables the identification of bleeding source and precise etiology in patients with acute gastrointestinal bleeding. (orig.)

  4. Superselective transarterial embolization for the management of acute gastrointestinal bleeding

    Lee, In Kyoung; Kim, Young Min; Kim, Jeong; Shin, Sang Soo; Yoon Woong; Kim, Jae Kyu; Park, Jin Gyoon [Chonnam National University Hospital, Gwangju (Korea, Republic of); Cho, Chol Kyoon; Kang, Heoung Keun [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

    2006-03-15

    We wanted to evaluate the safety and effectiveness of superselective transarterial embolization for the management of gastrointestinal bleeding. We evaluated 97 of 115 patients who had undergone diagnostic angiography and transarterial embolization for gastrointestinal bleeding from February 2001 to July 2004, and they subsequently underwent superselective transarterial embolization. Their ages ranged from 17 to 88 years (mean age: 58.5 years), and 73 were men and 24 were women. The etiologies were a postoperative condition (n=31), ulcer (n=23), Mallory-Weiss syndrome (n=3), trauma (n=3), pseudoaneurysm from pancreatitis (n=3), diverticula (n=2), inflammatory bowel disease (n=2), tumor (n=2), Behcet's disease (n=2), hemobilia (n=1), and unknown origin (n=25). The regions of bleeding were the esophagus (n=3), stomach and duodenum (n=41), small bowel (n=38) and colon (n=15). All the patients underwent superselective transarterial embolization using microcoils, gelfoam or a combination of microcoils and gelfoam. Technical success was defined as devascularization of targeted vascular lesion or the disappearance of extravasation of the contrast media, as noted on the angiography after embolization. Clinical success was defined as the disappearance of clinical symptoms and the reestablishment of normal cardiovascular hemodynamics after transarterial embolization without any operation or endoscopic management. The technical success rate was 100%. The primary clinical success rate was 67% (65 of 97 patients). Of the 32 primary failures, fourteen patients underwent repeat embolization; of these, clinical success was achieved in all the patients and so the secondary clinical success rate was 81% (79 of 97 patients). Of the 18 patients with primary failures, five patients underwent operation, one patient underwent endoscopic management and the others died during the observation period due to disseminated coagulopathy or complications of their underlying diseases. During

  5. The role of nuclear medicine in acute gastrointestinal bleeding

    Robinson, P. (Saint James' s Hospital, Leeds (United Kingdom). Dept. of Radiology)

    1993-10-01

    In most patients with upper gastrointestinal (GI) bleeding, endoscopy will locate the site and cause of bleeding, and also provide an opportunity for local therapy. The cause of lower GI bleeding is often difficult to attribute, even when pathology is found by colonoscopy or barium enema. Nuclear medicine techniques can be used to identify the site of bleeding in those patients in whom the initial diagnostic procedures are negative or inconclusive. Methods using transient labelling of blood (e.g. [sup 99]Tc[sup m]-sulphur colloid) produce a high target-to-background ratio in positive cases, give quick results and localize bleeding sites accurately, but depend upon bleeding being active at the time of injection. Techniques using stable blood labelling (e.g. [sup 99]Tc[sup m]-labelled red blood cells) may be positive even with intermittent bleeding but may take several hours to produce a result and are less precise in localization. The most useful application is in patients with recurrent or prolonged bleeding, those with inconclusive endoscopy or barium studies, and those who are high-risk surgical candidates. (author).

  6. Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding:A meta-analysis

    2010-01-01

    AIM: To analyze the accuracy of computed tomography (CT) angiography in the diagnosis of acute gastrointestinal (GI) bleeding. METHODS: The MEDLINE, EMBASE, Cancerlit, Cochrane Library database, Sciencedirect, Springerlink and Scopus, from January 1995 to December 2009, were searched for studies evaluating the accuracy of CT angiography in diagnosing acute GI bleeding. Studies were included if the ycompared CT angiography to a reference standard of upper GI endoscopy, colonoscopy, angiography or surgery in ...

  7. Acute Upper Gastro-Intestinal Bleeding in Morocco: What Have Changed?

    Timraz, A.; Khannoussi, W.; Ajana, F. Z.; W. Essamri; Benelbarhdadi, I.; Afifi, R.; M. Benazzouz; Essaid, A.

    2011-01-01

    Objective. In the present study, we aimed to investigate epidemiological, clinical, and etiological characteristics of acute upper gastro-intestinal bleeding. Materials and Methods. This retrospective study was conducted between January 2003 and December 2008. It concerned all cases of acute upper gastroduodenal bleeding benefited from an urgent gastro-intestinal endoscopy in our department in Morocco. Characteristics of patients were evaluated in terms of age, gender, medical history, presen...

  8. Endovascular treatment of nonvariceal acute arterial upper gastrointestinal bleeding

    Andersen, Poul Erik; Duvnjak, Stevo

    2010-01-01

    Transcatheter arterial embolization as treatment of upper nonvariceal gastrointestinal bleeding is increasingly being used after failed primary endoscopic treatment. The results after embolization have become better and surgery still has a high mortality. Embolization is a safe and effective...... procedure, but its use is has been limited because of relatively high rates of rebleeding and high mortality, both of which are associated with gastrointestinal bleeding and non-gastrointestinal related mortality causes. Transcatheter arterial embolization is a valuable minimal invasive method in the...

  9. Acute Uterine Bleeding Unrelated to Pregnancy: A Southern California Permanente Medical Group Practice Guideline

    Munro, Malcolm G.

    2013-01-01

    Acute uterine bleeding unrelated to pregnancy has been defined as bleeding “sufficient in volume as to, in the opinion of the treating clinician, require urgent or emergent intervention.” The Southern California Permanente Medical Group updated its guidelines for the management of this condition on the basis of the best available evidence, as identified in a systematic review of the available literature. Given the paucity of studies evaluating this condition, the guidelines, by necessity, inc...

  10. Management of Adult Jehovah's Witness Patients with Acute Bleeding

    K. Berend; M. Levi

    2009-01-01

    Because of the firm refusal of transfusion of blood and blood components by Jehovah's Witnesses, the management of Jehovah's Witness patients with severe bleeding is often complicated by medical, ethical, and legal concerns. Because of a rapidly growing and worldwide membership, physicians working i

  11. Endovascular control of the acute bleeding in patients with advanced neoplasms of the neck

    Full text: Introduction: Advanced neoplastic processes in the neck can cause acute life-threatening bleeding. Source of the bleeding can be vessels from a tumor mass or invasion of the main cervical arterial vessels. Poor general condition of the patients and accompanying complications create additional difficulties in getting these situations under control. What you will learn: Endovascular embolization of acute bleeding from advanced cervical neoplasms requires detailed knowledge of anatomical structures in this area and precision equipment with the possibility of super selective catheterization of small caliber vessels. The presentation discusses the various embolization materials and possibilities for their application in the neck. The experience of 5 embolization sessions in 4 patients is presented. An important point is discussion of the possible complications and how to avoid them. Discussion: Acute bleeding from large tumor formation is often a real risk to the life of the patient. Getting these conditions under control usually postpones the poor prognosis of the main disease. Postembolization syndrome and postembolization tissue necrosis define the basic cares in the early and late period after such a procedure. Conclusion: Acute bleeding from advanced neoplastic processes in the neck offers a real challenge. For their successful mastery it is required certain technical skills, unconventional solutions and a wide range of materials for embolization. A multidisciplinary approach is required to view the specific care these patients need and the possible complications

  12. Effect of Transfusion Strategy in Acute Non-variceal Upper Gastrointestinal Bleeding

    Fabricius, Rasmus; Svenningsen, Peter; Hillingsø, Jens; Svendsen, Lars Bo; Sillesen, Martin

    2016-01-01

    BACKGROUND: Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is a common cause of admissions as well as aggressive transfusion of blood products. Whether the transfusion strategy in NVUGIB impacts on hemostasis is unknown and constitutes the focus of this study. METHOD: Retrospective...

  13. The Impact of Vascular Access for In-Hospital Major Bleeding in Patients with Acute Coronary Syndrome at Moderate- to Very High-Bleeding Risk

    Park, Keun-Ho; Jeong, Myung Ho; Ahn, Youngkeun; Jung, Sang Sik; Kim, Moo Hyun; Yang, Hyoung-Mo; Yoon, Junghan; Rha, Seung Woon; Park, Keum Soo; Han, Kyoo Rok; Cho, Byung Ryul; Cha, Kwang Soo; Kim, Byung Ok; Hyon, Min Soo; Shin, Won-Yong

    2013-01-01

    The aim of our study was to determine the impact of vascular access on in-hospital major bleeding (IHMB) in acute coronary syndrome (ACS). We analyzed 995 patients with non-ST elevation myocardial infarction and unstable angina at the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) moderate- to very high-bleeding risk scores in trans-radial intervention (TRI) retrospective registry from 16 center...

  14. Hepatic artery stent-grafts for the emergency treatment of acute bleeding

    Bellemann, Nadine, E-mail: nadine.bellemann@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Sommer, Christof-Matthias; Mokry, Theresa; Kortes, Nikolas; Gnutzmann, Daniel; Gockner, Theresa; Schmitz, Anne [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Weitz, Jürgen [Department of Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Department for Visceral, Thoracic and Vascular Surgery at the University Hospital, Technical University Dresden (Germany); Kauczor, Hans-Ulrich; Radeleff, Boris; Stampfl, Ulrike [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany)

    2014-10-15

    Highlights: • We report our experiences with stent-grafts for the treatment of acute hemorrhage from the hepatic artery or the stump of the gastroduodenal artery. • The technical success of stent-graft implantation was 88%. • The bleeding ceased immediately after stent-graft implantation in 88%. • The complication rate was 21%. - Abstract: Purpose: We evaluated the technical success and clinical efficacy of stent-graft implantation for the emergency management of acute hepatic artery bleeding. Methods: Between January 2010 and July 2013, 24 patients with hemorrhage from the hepatic artery were scheduled for emergency implantation of balloon expandable stent-grafts. The primary study endpoints were technical and clinical success, which were defined as successful stent-graft implantation with sealing of the bleeding site at the end of the procedure, and cessation of clinical signs of hemorrhage. The secondary study endpoints were complications during the procedure or at follow-up and 30-day mortality rate. Results: In 23 patients, hemorrhage occurred after surgery, and in one patient hemorrhage occurred after trauma. Eight patients had sentinel bleeding. In most patients (n = 16), one stent-graft was implanted. In six patients, two overlapping stent-grafts were implanted. The stent-grafts had a target diameter between 4 mm and 7 mm. Overall technical success was 88%. The bleeding ceased after stent-graft implantation in 21 patients (88%). The mean follow-up was 137 ± 383 days. In two patients, re-bleeding from the hepatic artery occurred during follow-up after 4 and 29 days, respectively, which could be successfully treated by endovascular therapy. The complication rate was 21% (minor complication rate 4%, major complication rate 17%). The 30-day mortality rate was 21%. Conclusions: Implantation of stent-grafts in the hepatic artery is an effective emergency therapy and has a good technical success rate for patients with acute arterial hemorrhage.

  15. Hepatic artery stent-grafts for the emergency treatment of acute bleeding

    Highlights: • We report our experiences with stent-grafts for the treatment of acute hemorrhage from the hepatic artery or the stump of the gastroduodenal artery. • The technical success of stent-graft implantation was 88%. • The bleeding ceased immediately after stent-graft implantation in 88%. • The complication rate was 21%. - Abstract: Purpose: We evaluated the technical success and clinical efficacy of stent-graft implantation for the emergency management of acute hepatic artery bleeding. Methods: Between January 2010 and July 2013, 24 patients with hemorrhage from the hepatic artery were scheduled for emergency implantation of balloon expandable stent-grafts. The primary study endpoints were technical and clinical success, which were defined as successful stent-graft implantation with sealing of the bleeding site at the end of the procedure, and cessation of clinical signs of hemorrhage. The secondary study endpoints were complications during the procedure or at follow-up and 30-day mortality rate. Results: In 23 patients, hemorrhage occurred after surgery, and in one patient hemorrhage occurred after trauma. Eight patients had sentinel bleeding. In most patients (n = 16), one stent-graft was implanted. In six patients, two overlapping stent-grafts were implanted. The stent-grafts had a target diameter between 4 mm and 7 mm. Overall technical success was 88%. The bleeding ceased after stent-graft implantation in 21 patients (88%). The mean follow-up was 137 ± 383 days. In two patients, re-bleeding from the hepatic artery occurred during follow-up after 4 and 29 days, respectively, which could be successfully treated by endovascular therapy. The complication rate was 21% (minor complication rate 4%, major complication rate 17%). The 30-day mortality rate was 21%. Conclusions: Implantation of stent-grafts in the hepatic artery is an effective emergency therapy and has a good technical success rate for patients with acute arterial hemorrhage

  16. Comparison of ACUITY and CRUSADE Scores in Predicting Major Bleeding during Acute Coronary Syndrome

    Luis C. L. Correia

    2015-07-01

    Full Text Available Background:The ACUITY and CRUSADE scores are validated models for prediction of major bleeding events in acute coronary syndrome (ACS. However, the comparative performances of these scores are not known.Objective:To compare the accuracy of ACUITY and CRUSADE in predicting major bleeding events during ACS.Methods:This study included 519 patients consecutively admitted for unstable angina, non-ST-elevation or ST-elevation myocardial infarction. The scores were calculated based on admission data. We considered major bleeding events during hospitalization and not related to cardiac surgery, according to the Bleeding Academic Research Consortium (BARC criteria (type 3 or 5: hemodynamic instability, need for transfusion, drop in hemoglobin ≥ 3 g, and intracranial, intraocular or fatal bleeding.Results:Major bleeding was observed in 31 patients (23 caused by femoral puncture, 5 digestive, 3 in other sites, an incidence of 6%. While both scores were associated with bleeding, ACUITY demonstrated better C-statistics (0.73, 95% CI = 0.63 - 0.82 as compared with CRUSADE (0.62, 95% CI = 0.53 - 0.71; p = 0.04. The best performance of ACUITY was also reflected by a net reclassification improvement of + 0.19 (p = 0.02 over CRUSADE’s definition of low or high risk. Exploratory analysis suggested that the presence of the variables ‘age’ and ‘type of ACS’ in ACUITY was the main reason for its superiority.Conclusion:The ACUITY Score is a better predictor of major bleeding when compared with the CRUSADE Score in patients hospitalized for ACS.

  17. [Antisecretory therapy as a component of hemostasis in acute gastroduodenal ulcer bleedings].

    Gostishchev, V K; Evseev, M A

    2005-01-01

    Results of antisecretory therapy (pyrenzepin, H(2)-blockers, inhibitors of proton pump, octreotid) in 962 patients with acute gastroduodenal ulcer bleedings (AGDUB) were analyzed over 14-years period. Antisecretory treatment in AGDUB has principally different goals and potential depending on risk of bleeding's recurrence and morphological changes in tissue of gastroduodenal ulcer. Antisecretory therapy is the main treatment in high risk of AGDUB recurrence or before urgent surgery. Intravenous infusion of omeprazol has demonstrated the highest clinical efficacy due to maximal inhibition of gastric secretion and absence of negative influences on oxygen regimen in tissue of ulcer. PMID:16091681

  18. Experience in Diagnosis and Treatment of Bleeding Complications in Severe Acute Pancreatitis by TAE

    2005-01-01

    The experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis (SAP) by transcatheter arterial embolization was summarized. The clinical data of 19 SAP patients complicated with intra-abdominal bleeding in our hospital from Jan. 2000 to Jan. 2003 were analyzed retrospectively and the therapeutic outcome of TAE was evaluated statistically. The results showed that the short-term successful rate of hemostasis by TAE was 89.5 % (17/19), the incidence of re-bleeding after TAE was 36.8 % (7/19) and the successful rate of hemostatis by second TAE was 71.4 % (5/7). It was concluded that the intra-abdominal bleeding in SAP was mainly caused by the rupture of erosive/infected pseudoaneurysm. Mostly, the broken vessels were splenic artery and gastroduodenal artery. In terms of emergence hemostatis, TAE is the most effective method. Surgical hemostasis is necessary if hemostasis by TAE is failed or re-bleeding occurs after TAE.

  19. Detection of acute gastrointestinal bleeding by intra-arterial scintigraphy: an experimental study and preliminary clinical experience

    The purpose of this animal and clinical study was to compare intra-arterial (IA) scintigraphy with angiography in the localization of gastrointestinal (GI) bleeding. After sedation with intramuscularly administered ketamine, lower GI bleeding was induced in ten rabbits. Using inguinal cut-down, an arterial femoral 3F catheter was placed in the proximal mesenteric artery. Following abdominal incision to expose the bowel, lower GI bleeding was caused by incising the antimesenteric border of the small bowel wall. Initial angiography was performed, and this was followede by Tc-99m pertechnetate IA scintigarphy. Tc-99m RBC IA scintigraphy involved two patients who had undergone selective mesenteric arterial catheterizaion for the evaluation of acute lower GI bleeding. Ten rabbits, bleeding at a mean rate of 0.7g/min, were studied. IA scintigraphy was superior to angiography in four cases and equal in six. The sensitivity of angiography was 40%(4/10), and IA scintigraphy 80%(8/10). In one patient, Tc-99m RBC was administered directly into the superior mesenteric artery and ulcer bleeding in the transverse colon was identified. PRior to conventional angiography, the bleeding had been occult. In a second patient, in whom angiography had revealed a hypervascular mass, selective injection of Tc-99m RBC into the superior mesenteric artery revealed tumor(leiomyoma) bleeding in the jejunum. Selective IA scintigraphy was valuable for detecting intestinal bleeding, occult during conventional studies and may be useful for detecting acute bleeding at the time of negative angiography.=20

  20. Huge bilateral polycystic kidneys with suspicion of malignancy, recurrent bleeding in cysts, and acute abdomen

    Bhatty, TAN; Moazin, MS; Haque, R.

    2012-01-01

    We present a case of huge bilateral polycystic kidneys, with suspicion of malignancy and repeated admissions with acute abdomen, secondary to bleeding in cysts, and anaemia, requiring affected side nephrectomy. Key message Autosomal dominant polycystic kidney disease (ADPKD) mostly ends up with end stage renal disease (ESRD), requiring haemodialysis, with increased risk of malignancy and enlargement of kidneys with its associated complications, mostly dealt with conservatively, except maligna...

  1. Detection and localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi-detector row helical CT

    Jaeckle, T.; Stuber, G.; Hoffmann, M.H.K.; Jeltsch, M.; Schmitz, B.L.; Aschoff, A.J. [University Hospital of Ulm, Diagnostic and Interventional Radiology, Ulm (Germany)

    2008-07-15

    The purpose of this study was to evaluate the accuracy of multi-detector row helical CT (MDCT) for detection and localization of acute upper and lower gastrointestinal (GI) hemorrhage or intraperitoneal bleeding. Thirty-six consecutive patients with clinical signs of acute bleeding underwent biphasic (16- or 40-channel) MDCT. MDCT findings were correlated with endoscopy, angiography or surgery. Among the 36 patients evaluated, 26 were examined for GI bleeding and 10 for intraperitoneal hemorrhage. Confirmed sites of GI bleeding were the stomach (n = 5), duodenum (n = 5), small bowel (n = 6), large bowel (n = 8) and rectum (n = 2). The correct site of bleeding was identifiable on MDCT in 24/26 patients with GI bleeding. In 20 of these 24 patients, active CM extravasation was apparent during the exam. Among the ten patients with intraperitoneal hemorrhage, MDCT correctly identified the bleeding source in nine patients. Our findings suggest that fast and accurate localization of acute gastrointestinal and intraperitoneal bleeding is achievable on MDCT. (orig.)

  2. Detection and localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi-detector row helical CT

    The purpose of this study was to evaluate the accuracy of multi-detector row helical CT (MDCT) for detection and localization of acute upper and lower gastrointestinal (GI) hemorrhage or intraperitoneal bleeding. Thirty-six consecutive patients with clinical signs of acute bleeding underwent biphasic (16- or 40-channel) MDCT. MDCT findings were correlated with endoscopy, angiography or surgery. Among the 36 patients evaluated, 26 were examined for GI bleeding and 10 for intraperitoneal hemorrhage. Confirmed sites of GI bleeding were the stomach (n = 5), duodenum (n = 5), small bowel (n = 6), large bowel (n = 8) and rectum (n = 2). The correct site of bleeding was identifiable on MDCT in 24/26 patients with GI bleeding. In 20 of these 24 patients, active CM extravasation was apparent during the exam. Among the ten patients with intraperitoneal hemorrhage, MDCT correctly identified the bleeding source in nine patients. Our findings suggest that fast and accurate localization of acute gastrointestinal and intraperitoneal bleeding is achievable on MDCT. (orig.)

  3. Detection of acute gastrointestinal bleeding by means of technetium-99m in vivo labelled red blood cells

    Prognosis of gastrointestinal (GI) bleeding depends on the timely and accurate detection of the source of bleeding and sequential surgical or endoscopy therapy. Scintigraphy with red blood cells (RBCs) in vivo labelled by means of technetium-99m hastened detection of source of GI bleeding and improved management of the particular disease. Gastrointestinal endoscopy is the method of choice for the diagnostics of bleeding from upper tract and large bowel. For diagnostics of bleeding from the small bowel we can use scintigraphy with in vivo labelled autological red blood cells if pushenteroscopy, intra-operative enteroscopy or angiography are not available. 31 patients (13 men, 18 women, aged 20-91, mean 56 years) underwent this investigation from 1998 till 2001 at the Department of Nuclear Medicine. All patients had melaena or enterorrhagia associated with acute anaemia. Gastroscopy, colonoscopy, enteroclysis or X-ray angiography did not detect the source of bleeding. Twenty-one patients had positive scintigraphy with in vivo labelled RBCs - 9 patients were already positive on dynamic scintigraphy, and 12 patients were positive on static images. Scintigraphy with in vivo labelled RBCs was negative in 10 patients. GI bleeding stopped spontaneously in these 10 patients with negative scintigraphy. These patients did not undergo intra-operative enteroscopy or surgery. The final diagnosis of the 21 patients with positive scintigraphy was determined in 16 patients by push-enteroscopy (6 patients), intra-operative enteroscopy (6 patients) or by surgery (4 patients). Of these 16 patients the correct place of bleeding was determined by scintigraphy with labelled RBCs in 11 (69%) patients. Final diagnoses of our 16 patients with positive scintigraphy with autological labelled RBCs were: bleeding small bowel arteriovenous malformation (6 patients), uraemic enteritis with bleeding erosions in ileum and jejunum (2 patients), Osler-Rendu- Weber disease (1 patient), pseudocyst of

  4. The Management of Acute Upper Gastrointestinal Bleeding: A Comparison of Current Clinical Guidelines and Best Practice

    Alison A. Taylor

    2014-12-01

    Full Text Available Acute upper gastrointestinal bleeding (AUGIB is the most common GI emergency, responsible for up to 70,000 hospital admissions in the UK and around 4,000 deaths. The latest UK national audit highlighted inconsistencies in both the management and service provision. Several national and international professional bodies have produced evidence-based recommendations on the management of AUGIB. We carried out a review of the guidance documentation published by four expert bodies including the National Institute of Clinical Excellence, the Scottish Intercollegiate Guidelines Network, the American College of Gastroenterology, and those published in the Annals of Internal Medicine. Consensus is still yet to be reached for initiating blood products in the emergency situation, with some evidence suggesting that liberal transfusion could exacerbate bleeding severity, although there is a lack of large randomised trials. It is widely agreed that prompt endoscopy within 24 hours improves outcomes, but evidence suggests that lowering this threshold confers no additional benefit. Use of proton pump inhibitors both pre and post-endoscopy for non-variceal bleeds is also advocated by professional bodies, with substantial evidence that it reduces the risk of re-bleeding. For patients with suspected oesophageal or gastric variceal bleeding, prophylactic antibiotics and vasopressin analogues are recommended, although guidelines vary on specific regimens. Recent UK and international guidelines provide a useful framework to guide management of patients who present to the emergency department with suspected AUGIB; however, their advice varies in some key areas due to a lack of large randomised trials as supporting evidence.

  5. Onyx (ethylene-vinyl-alcohol-copolymer). A novel approach to the endovascular treatment of acute bleeding

    Purpose: The purpose of our retrospective study was to determine the feasibility and efficacy of the endovascular embolization of peripheral acute arterial hemorrhage using Onyx. Materials and Methods: Between October 2003 and February 2007, 14 patients with acute arterial bleeding underwent percutaneous arterial embolization using Onyx. Bleeding was caused by iatrogenic vessel injury (6 patients), malignancy/inflammation (5 patients) and trauma (3 patients). Hematomas were located in the pelvis (5 patients), followed by liver (3 patients), retroperitoneal space (2 patients), thorax (2 patients), pancreas (1 patient), and thigh (1 patient). The number of embolized arteries, the volume and viscosity of embolic agent (Onyx), the number of additionally used coils, the embolization time, and the technical and clinical outcome were documented. Procedure-related complications, recurrent bleeding during hospital stay and outcome were recorded. Results: In 14 patients selective endovascular embolization of 15 arteries was performed. The average volume of injected Onyx was 1.3 ± 0.8 ml. In 6 cases (42.9%) Onyx was used in conjunction with coils. The average time between the correct placement of microcatheter and complete embolization was 24.9 ± 12.6 minutes. In 13 of 14 patients (92.8%), embolization was technically successful. In one case, procedure-related complications occurred and embolization was performed in a second session a day later. After technically successful embolization, no recurrent bleeding occurred during hospitalization. Out of 14 patients, six (42.9%) died 1 - 38 days after technically successful embolization due to multiple organ failure (2 patients), hypoxic brain injury (2 patients), septic shock (1 patient) or malignancy-associated death (1 patient). (orig.)

  6. Spontaneous intra-peritoneal bleeding secondary to warfarin, presenting as an acute appendicitis: a case report and review of literature

    Shah Dharmendra K; Kumar Vikas; Sagar Jayesh; Bhatnagar Ashok

    2006-01-01

    Abstract Background Warfarin is a coumarin anti-coagulant, used widely for the therapeutic and prophylactic anticoagulation. Although, it is considered as a life saving medicine, it is associated with the significant adverse effects including intra-abdominal bleeding, which have been very well documented in literature. However, the presentation of warfarin induced intra-peritoneal bleeding as an acute appendicitis has not been reported in English literature. We report this rare, spontaneous i...

  7. Clinical outcomes of patients with major bleeding after primary coronary intervention for acute ST-segment elevation myocardial infarction

    Objective: To evaluate the clinical outcomes of patients complicated with major bleeding after primary coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods: During the period of January 2004-January 2008, primary PCI was performed in 412 consecutive patients with acute STEMI at Shanghai Ruijin Hospital. The clinical data were retrospectively analyzed. Major adverse cardiac events (MACE), including death, reoccurrence of myocardial infarction and target vessel revascularization, in patients with major bleeding were compared with that in patients without major bleeding. Results: Compared to patients without bleeding, the patients with bleeding were older (70.0 ± 8.9 years vs 64.9 ± 12.7 years, P=0.04), mainly the females (51.9% vs 23.1%, P=0.001) and treated more often with glycoprotein (GP) IIb / IIIa receptor inhibitor (88.9% vs 69.4%, P=0.03) or intra-aortic balloon pump (7.4% vs 1.3%, P=0.02). In-hospital and one-year MACE rate in the patients with bleeding was 18.5% and 37.0% respectively,which were significantly higher than that in the patients without bleeding (5.7% and 14.3%, with P=0.008 and P=0.002, respectively). Multivariate analysis indicated that patient aged over 70 years, feminine gender and use of GP IIb/IIIa receptor inhibitor were independent predictors for the occurrence of major bleeding. The occurrence of major bleeding after primary PCI was significantly correlated with MACE occurred within one year after the procedure (OR 2.79, 95% CI: 2.21-5.90, P<0.001). Conclusion: In patients with acute STEMI, the occurrence of major bleeding after primary PCI is closely linked to the increased MACE rate within one year after the treatment.Feminine gender, aged patient and use of GPIIb/IIIa receptor inhibitor are independent predictors to increase the danger of major bleeding. (authors)

  8. Use of /sup 99m/Tc-DTPA for detection and localization of site of acute gastrointestinal bleeding

    Abdel-Dayem, H.; Owuwanne, A.; Nawaz, K.; Kouris, K.; Higazy, E.; Mahajan, K.; Ericsson, S.; Awdeh, M.

    1988-05-01

    Intravenously injected /sup 99m/Tc-DTPA was evaluated in 64 patients for its efficiency in detecting and localizing sites of acute upper and lower gastrointestinal (G.I.) bleeding. These studies were correlated with endoscopic and surgical findings. There were 34 bleeders and 30 non bleeders giving a sensitivity of 90%, specificity of 82% and accuracy of 86%. Of these, 49 were upper G.I. studies (stomach 21 and duodenum 28) and 15 were lower G.I. studies (small intestine 8, large bowel 7). Of the 49 upper G.I. studies, 27 showed active bleeding while 22 showed no bleeding at the time of the study resulting in a sensitivity of 87.5%, specificity of 76% and accuracy of 82%. Of the 15 lower G.I. studies, 7 were bleeders while 8 were non bleeders. All the lower G.I. bleeding sites were accurately localized with the /sup 99m/Tc-DTPA. An incidental finding of these studies was the localization of /sup 99m/Tc-DTPA in the site of inflammatory and malignant lesions of the G.I. tract. Of the 64 studies, 18 inflammatory and malignant lesions were detected with the IV injected /sup 99m/Tc-DTPA; 10 were bleeders while 8 were non bleeders. Image subtraction of early from delayed images was helpful to differentiate bleeding from non bleeding cases in this last group of studies.

  9. The use of 99mTc-DTPA for detection and localization of site of acute gastrointestinal bleeding

    Intravenously injected 99mTc-DTPA was evaluated in 64 patients for its efficiency in detecting and localizing sites of acute upper and lower gastrointestinal (G.I.) bleeding. These studies were correlated with endoscopic and surgical findings. There were 34 bleeders and 30 non bleeders giving a sensitivity of 90%, specificity of 82% and accuracy of 86%. Of these, 49 were upper G.I. studies (stomach 21 and duodenum 28) and 15 were lower G.I. studies (small intestine 8, large bowel 7). Of the 49 upper G.I. studies, 27 showed active bleeding while 22 showed no bleeding at the time of the study resulting in a sensitivity of 87.5%, specificity of 76% and accuracy of 82%. Of the 15 lower G.I. studies, 7 were bleeders while 8 were non bleeders. All the lower G.I. bleeding sites were accurately localized with the 99mTc-DTPA. An incidental finding of these studies was the localization of 99mTc-DTPA in the site of inflammatory and malignant lesions of the G.I. tract. Of the 64 studies, 18 inflammatory and malignant lesions were detected with the IV injected 99mTc-DTPA; 10 were bleeders while 8 were non bleeders. Image subtraction of early from delayed images was helpful to differentiate bleeding from non bleeding cases in this last group of studies. (orig.)

  10. Coagulation factors and recurrence of ischemic and bleeding adverse events in patients with acute coronary syndromes.

    Campo, Gianluca; Pavasini, Rita; Pollina, Alberto; Tebaldi, Matteo; Ferrari, Roberto

    2013-08-01

    In the last years, management and prognosis of patients with acute coronary syndromes (ACS) are significantly improved. Nowadays antithrombotic (antiplatelet plus anticoagulant drugs) therapy represents the main treatment of ACS patients. Anticoagulant drugs are particularly helpful in the acute phase of ACS, whereas in the chronic phase are maintained only in selected cases. Many studies demonstrate that exists a significant variability in the coagulation factor levels between patients affected by ACS. This variation on coagulation factors levels is due to environmental (smoking, inflammation, sex, oral contraceptive, triglycerides, diabetes mellitus) and genetic determinants. Particularly several gene polymorphisms have been selected and clearly associated with significant variations in the coagulation factors values. The heightened levels of tissue factor, factor VII and fibrinogen are related with a "hypercoagulable status" and with a higher occurrence of ischemic complications after ACS and/or PCI. On the contrary, less data are available regarding the relationship between coagulation factors levels (or their gene polymorphisms) and bleeding complications. Recently, new anticoagulant drugs have been developed. They show less side effects and a better tolerability and, probably, their selected use in patients with a "hypercoagulable status" may improve the clinical outcome after ACS. In this review we analyze the current available data and we discuss how this finding may be useful for planning future studies to optimize the treatment of ACS patients. PMID:23827698

  11. Acute upper gastrointestinal bleeding in octogenarians: Clinical outcome and factors related to mortality

    George J Theocharis; Vassiliki Arvaniti; Stelios F Assimakopoulos; Konstantinos C Thomopoulos; Vassilis Xourgias; Irini Mylonakou; Vassiliki N Nikolopoulou

    2008-01-01

    AIM: To evaluate the aetiology, clinical outcome and factors related to mortality of acute upper gastrointestinal bleeding (AUGIB) in octogenarians.METHODS: We reviewed the records of all patients over 65 years old who were hospitalised with AUGIB in two hospitals from January 2006 to December of 2006. Patients were divided into two groups: Group A (65-80 years old) and Group B (>80 years old).RESULTS: Four hundred and sixteen patients over 65 years of age were hospitalized because of AUGIB. Group A included 269 patients and Group B147 patients. Co-morbidity was more common in octogenarians (P=0.04). The main cause of bleeding was peptic ulcer in both groups. Rebleeding and emergency surgery were uncommon in octogenarians and not different from those in younger patients. In-hospital complications were more common in octogenarians (P=0.05) and more patients died in the group of octogenarians compared to the younger age group (P=0.02). Inability to perform endoscopic examination (P=0.002), presence of high risk for rebleeding stigmata (P=0.004), urea on admission (P=0.036), rebleeding (P=0.004) and presence of severe co-morbidity (P<0.0001) were related to mortality. In multivariate analysis, only the presence of severe co-morbidity was independently related to mortality (P=0.032).CONCLUSION: While rebleeding and emergency surgery rates are relatively low in octogenarians with AUGIB, the presence of severe co-morbidity is the main factor of adverse outcome.

  12. Endoscopic management of acute gastrointestinal bleeding in children: Time for a radical rethink.

    Thomson, Mike; Belsha, Dalia

    2016-02-01

    Currently we are no nearer than 10 or 20years ago providing a safe, adequate, and effective round-the-clock endoscopic services for acute life-threatening gastrointestinal bleeding in children. Preventable deaths are occurring still, and it is a tragedy. This is owing to a number of factors which require urgent attention. Skill-mix and the ability of available endoscopists in the UK are woeful. Manpower is spread too thinly and not concentrated in centers of excellence, which is necessary given the relative rarity of the presentation. Adult gastroenterologists are increasingly reticent regarding their help in increasingly litigious times. Recent work on identification of those children likely to require urgent endoscopic intervention has mirrored scoring systems that have been present in adult circles for many years and may allow appropriate and timely intervention. Recent technical developments such as that of Hemospray® may lower the threshold of competency in dealing with this problem endoscopically, thus allowing lives to be saved. Educational courses, mannequin and animal model training are important but so will be appropriate credentialing of individuals for this skill-set. Assessment of competency will become the norm and guidelines on a national level in each country mandatory if we are to move this problem from the "too difficult" to the "achieved". It is an urgent problem and is one of the last emergencies in pediatrics that is conducted poorly. This cannot and should not be allowed to continue unchallenged. PMID:26703435

  13. PROPOSAL OF A CLINICAL CARE PATHWAY FOR THE MANAGEMENT OF ACUTE UPPER GASTROINTESTINAL BLEEDING

    Matheus Cavalcante FRANCO

    2015-12-01

    Full Text Available Background - Upper gastrointestinal bleeding implies significant clinical and economic repercussions. The correct establishment of the latest therapies for the upper gastrointestinal bleeding is associated with reduced in-hospital mortality. The use of clinical pathways for the upper gastrointestinal bleeding is associated with shorter hospital stay and lower hospital costs. Objective - The primary objective is the development of a clinical care pathway for the management of patients with upper gastrointestinal bleeding, to be used in tertiary hospital. Methods - It was conducted an extensive literature review on the management of upper gastrointestinal bleeding, contained in the primary and secondary information sources. Results - The result is a clinical care pathway for the upper gastrointestinal bleeding in patients with evidence of recent bleeding, diagnosed by melena or hematemesis in the last 12 hours, who are admitted in the emergency rooms and intensive care units of tertiary hospitals. In this compact and understandable pathway, it is well demonstrated the management since the admission, with definition of the inclusion and exclusion criteria, passing through the initial clinical treatment, posterior guidance for endoscopic therapy, and referral to rescue therapies in cases of persistent or rebleeding. It was also included the care that must be taken before hospital discharge for all patients who recover from an episode of bleeding. Conclusion - The introduction of a clinical care pathway for patients with upper gastrointestinal bleeding may contribute to standardization of medical practices, decrease in waiting time for medications and services, length of hospital stay and costs.

  14. Balancing Potency of Platelet Inhibition with Bleeding Risk in the Early Treatment of Acute Coronary Syndrome

    Slattery, David E

    2009-08-01

    Full Text Available Objective: To review available evidence and examine issues surrounding the use of advanced antiplatelet therapy in an effort to provide a practical guide for emergency physicians caring for patients with acute coronary syndromes (ACS.Data Sources: American College of Cardiology/American Heart Association (ACC/AHA 2007 guidelines for the management of patients with unstable angina (UA and non-ST-segment elevation myocardial infarction (NSTEMI, AHA/ACC 2007 focused update for the management of patients with STEMI, selected clinical articles identified through the PubMed database (1965-February 2008, and manual searches for relevant articles identified from those retrieved.Study Selection: English-language controlled studies and randomized clinical trials that assessed the efficacy and safety of antiplatelet therapy in treating patients with all ACS manifestations.Data Extraction and Synthesis: Clinical data, including treatment regimens and patient demographics and outcomes, were extracted and critically analyzed from the selected studies and clinical trials. Pertinent data from relevant patient registries were also evaluated to assess current clinical practice.Conclusions: As platelet activation and aggregation are central to ACS pathology, antiplatelet agents are critical to early treatment. A widely accepted first-line treatment is aspirin, which acts to decrease platelet activation via inhibition of thromboxane A2 synthesis. Thienopyridines, which inhibit ADP-induced platelet activation, and glycoprotein (GP receptor antagonists, which bind to platelet GP IIb/IIIa receptors and hinder their role in platelet aggregation and thrombus formation, provide complementary mechanisms of platelet inhibition and are often employed in combination with aspirin. While the higher levels of platelet inhibition that accompany combination therapy improve protection against ischemic and peri-procedural events, the risk of bleeding is also increased. Thus, the

  15. The value of multidetector-row computed tomography for localization of obscure acute gastrointestinal bleeding

    Purpose: There are no simple guidelines on when to perform multidetector-row computed tomography (MDCT) for diagnosis of obscure acute gastrointestinal bleeding (AGIB). We used a risk scoring system to evaluate the diagnostic power of MDCT for patients with obscure AGIB. Materials and methods: Ninety-two patients with obscure AGIB who were referred for an MDCT scan after unsuccessful endoscopic treatment at presentation were studied. We recorded clinical data and calculated Blatchford score for each patient. Patients who required transfusion more than 500 mL of blood to maintain the vital signs were classified as high-risk patients. Two radiologists independently reviewed and categorized MDCT signs of obscure AGIB. Discordant findings were resolved by consensus. One-way ANOVA was used to compare clinical data between two groups; kappa statistics were used to estimate agreement on MDCT findings between radiologists. Results: Of the 92 patients, 62 (67.4%) were classified as high-risk patients. Blatchford scores of high-risk patients were significantly greater than those of low-risk patients. Sensitivity for MDCT diagnosing obscure AGIB was 81% in high-risk patients, as compared with 50% in the low-risk. When used in conjunction with selection of the cut-off value of 13 in Blatchford scoring system, the sensitivity and specificity of MDCT were 70.9% and 73.7%, respectively. Contrast extravasation was the most specific sign of AGIB (k = .87), recognition of which would have improved diagnostic accuracy. Conclusions: With the aid of Blatchford scoring system for evaluating the disease severity, MDCT can localize the bleeders of obscure AGIB more efficiently.

  16. Bleeding rates necessary for detecting acute gastrointestinal bleeding with technetium-99m-labeled red blood cells in an experimental model

    Proponents of [/sup 99m/Tc]sulfur colloid for GI bleeding studies argue that, although labeled red blood cells are useful for intermittent bleeding, they are not capable of detecting low bleeding rates. Studies of dogs with experimental GI bleeding have indicated bleeding rates of 0.05 ml/min can be detected with [/sup 99m/Tc]sulfur colloid. Since similar data in the dog model were unavailable for /sup 99m/Tc-labeled red blood cells, we undertook this study. To simulate lower GI bleeding, catheters were inserted into the bowel lumen. Each dog's blood was labeled with /sup 99m/Tc using an in vitro technique. Venous blood was then withdrawn and re-infused into the lumen of the bowel using a Harvard pump. Fourteen dogs were studied, ten receiving a bleeding rate from 4.6-0.02 ml/min in the descending colon and four with proximal jejunal bleeds of 0.20-0.02 ml/min. Bleeding rates of 4.6-0.2 ml/min were detected within 10 min in the colon and bleeding rates as low as 0.04 ml/min were seen by 55 min. Slower bleeding rates were not detected. Similar findings were noted for proximal jejunal bleeds. Based on the time of appearance, a minimum volume of approximately 2-3 ml labeled blood was necessary to detect bleeding. We conclude that /sup 99m/Tc-labeled RBCs are sensitive for low bleeding rates in the dog model. The rates are comparable to those described for [/sup 99m/Tc]sulfur colloid in this experimental setting. The time of appearance of activity is related to the bleeding rate

  17. Relation Between Red Blood Cell Omega-3 Fatty Acid Index and Bleeding During Acute Myocardial Infarction

    Salisbury, Adam C.; Harris, William S.; Amin, Amit P.; Reid, Kimberly J.; O’Keefe, James H; Spertus, John A.

    2011-01-01

    Omega-3 fatty acids have multiple cardiovascular benefits, but may also inhibit platelet aggregation and increase bleeding risk. If this platelet inhibition is clinically meaningful, patients with the highest omega-3 indices (red blood cell eicosapentaenoic [EPA] plus docosahexaenoic acid [DHA]), which reflect long-term omega-3 fatty acid intake, should be at the greatest bleeding risk. We studied 1,523 patients from 24 US centers who had their omega-3 index assessed at the time of AMI. The r...

  18. Localization of bleeding using 4-row detector-CT in patients with clinical signs of acute gastrointestinal hemorrhage

    Purpose: There is no gold-standard regarding the diagnostic work-up and therapy of an acute gastrointestinal (GI) hemorrhage. In most cases endoscopy provides the diagnosis but in a low percentage this modality is not feasible or negative. Purpose of this study was to evaluate the role of multi-phase Multi-Slice-Computertomography (MSCT) as a modality to diagnose and locate the site of acute GI hemorrhage in case of unfeasible or technically difficult endoscopy. Materials and methods: 58 patients, presenting with clinical signs of lower GI hemorrhage, were examined through a 24-month period. Preliminary endoscopy was either negative or unfeasible. Images were obtained with a four-detector row CT with an arterial (4 x 1 mm collimation, 0.8 mm increment, 1.25 mm slice width, 120 kV, 165 mAs) and portal venous series (4 x 2,5 mm collimation, 2 mm increment, 3 mm slice width, 120 kV, 165 mAs). Time interval between endoscopy and CT varied between 30 minutes and 3 hours. The results of the MSCT were correlated with clinical course and surgical or endoscopical treatment. Results: 20 of the 58 patients (34%) undergoing MSCT had a bleeding site identified, thus providing decisive information for the following intervention. In case of a following therapeutic intervention there was 100% correlation regarding the bleeding site. In 38 of the 58 patients (66%), a bleeding site was not identified by MSCT. Twenty of these 38 patients (53%) were stable and required no further treatment. In 18 of these 38 patients further interventional therapy was required due to continuing hemorrhage and in all of those patients the bleeding site was detected by intervention. (orig.)

  19. Mortality associated with gastrointestinal bleeding events: Comparing short-term clinical outcomes of patients hospitalized for upper GI bleeding and acute myocardial infarction in a US managed care setting

    C Mel Wilcox

    2009-03-01

    Full Text Available C Mel Wilcox1, Byron L Cryer2, Henry J Henk3, Victoria Zarotsky3, Gergana Zlateva41University of Alabama, Birmingham, AL, USA; 2University of Texas Southwestern Medical School, Dallas, TX; 3i3 Innovus, Eden Prairie, MN, USA; 4Pfizer, Inc., New York, NY, USA Objectives: To compare the short-term mortality rates of gastrointestinal (GI bleeding to those of acute myocardial infarction (AMI by estimating the 30-, 60-, and 90-day mortality among hospitalized patients.Methods: United States national health plan claims data (1999–2003 were used to identify patients hospitalized with a GI bleeding event. Patients were propensity-matched to AMI patients with no evidence of GI bleed from the same US health plan.Results: 12,437 upper GI-bleed patients and 22,847 AMI patients were identified. Propensity score matching yielded 6,923 matched pairs. Matched cohorts were found to have a similar Charlson Comorbidity Index score and to be similar on nearly all utilization and cost measures (excepting emergency room costs. A comparison of outcomes among the matched cohorts found that AMI patients had higher rates of 30-day mortality (4.35% vs 2.54%; p < 0.0001 and rehospitalization (2.56% vs 1.79%; p = 0.002, while GI bleed patients were more likely to have a repeat procedure (72.38% vs 44.95%; p < 0.001 following their initial hospitalization. The majority of the difference in overall 30-day mortality between GI bleed and AMI patients was accounted for by mortality during the initial hospitalization (1.91% vs 3.58%.Conclusions: GI bleeding events result in significant mortality similar to that of an AMI after adjusting for the initial hospitalization.Keywords: gastrointestinal, bleeding, mortality, acute myocardial infarction, claims analysis

  20. Acute respiratory failure and active bleeding are the important fatality predictive factors for severe dengue viral infection.

    Kamolwish Laoprasopwattana

    Full Text Available To determine the outcome of severe dengue viral infection (DVI and the main dengue fatality risk factors.The medical records of patients aged <15 years admitted to Songklanagarind Hospital in southern Thailand during 1989-2011 were reviewed. Patients who had dengue hemorrhagic fever (DHF grades III-IV, organ failure (cardiovascular, respiratory, liver, renal or hematologic, impaired consciousness, or aspartate aminotransferase more than 1,000 units/L, were classified as having severe DVI. To determine the fatality risk factors of severe DVI, the classification trees were constructed based on manual recursive partitioning.Of the 238 children with severe DVI, 30 (12.6% died. Compared to the non-fatal DVI cases, the fatal cases had higher rates of DHF grade IV (96.7% vs 24.5%, repeated shock (93.3% vs 27.9%, acute respiratory failure (ARF (100% vs 6.7%, acute liver failure (ALF (96.6% vs 6.3%, acute kidney injury (AKI (79.3% vs 4.5%, and active bleeding requiring blood transfusion (93.3% vs 5.4%, all p<0.01. The combined risk factors of ARF and active bleeding considered together predicted fatal outcome with sensitivity, specificity, and negative and positive predictive values of 0.93 (0.78-0.99, 0.97 (0.93-0.99, 0.99 (0.97-1.00, and 0.82 (0.65-0.93, respectively. The likelihood ratios for a fatal outcome in the patients who had and did not have this risk combination were 32.4 (14.6-71.7 and 0.07 (0.02-0.26, respectively.Severe DVI patients who have ARF and active bleeding are at a high risk of death, while patients without these things together should survive.

  1. Effect of recombinant Factor VIIa on outcome of acute variceal bleeding

    Bendtsen, Flemming; D'Amico, Gennaro; Rusch, Ea; de Franchis, Roberto; Andersen, Per Kragh; Lebrec, Didier; Thabut, Dominique; Bosch, Jaime

    2014-01-01

    BACKGROUND & AIMS: Two randomized controlled studies have evaluated the effect of recombinant Factor VIIa (rFVIIa) on variceal bleeding in cirrhosis without showing significant benefit. The aim of the present study was to perform a meta-analysis of the two trials on individual patient data with s...

  2. The secondary prophylactic efficacy of beta-blocker after endoscopic gastric variceal obturation for first acute episode of gastric variceal bleeding

    Choi, Moon Han; Kim, Young Seok; Kim, Sang Gyune; Lee, Yun Nah; Seo, Yu Ri; Kim, Min Jin; Lee, Sae Hwan; Jeong, Soung Won; Jang, Jae Young; Kim, Hong Soo; Kim, Boo Sung

    2013-01-01

    Background/Aims The most appropriate treatment for acute gastric variceal bleeding (GVB) is currently endoscopic gastric variceal obturation (GVO) using Histoacryl®. However, the secondary prophylactic efficacy of beta-blocker (BB) after GVO for the first acute episode of GVB has not yet been established. The secondary prophylactic efficacy of BB after GVO for the first acute episode of GVB was evaluated in this study. Methods Ninety-three patients at Soonchunhyang University Hospital with ac...

  3. Pharmaco-induced vasospasm therapy for acute lower gastrointestinal bleeding: A preliminary report

    Liang, Huei-Lung, E-mail: hlliang@vghks.gov.tw [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); National Yang-Ming University, Taipei, Taiwan (China); Chiang, Chia-Ling [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); Chen, Matt Chiung-Yu [Department of Radiology, Yuan' s General Hospital, Kaohsiung. Taiwan (China); Lin, Yih-Huie; Huang, Jer-Shyung; Pan, Huay-Ben [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); National Yang-Ming University, Taipei, Taiwan (China)

    2014-10-15

    Purpose: To report a novel technique and preliminary clinical outcomes in managing lower gastrointestinal bleeding (LGIB). Materials and methods: Eighteen LGIB patients (11 men and 7 women, mean age: 66.2 years) were treated with artificially induced vasospasm therapy by semi-selective catheterization technique. Epinephrine bolus injection was used to initiate the vascular spasm, and followed by a small dose vasopressin infusion (3–5 units/h) for 3 h. The technical success, clinical success, recurrent bleeding and major complications of this study were evaluated and reported. Results: Sixteen bleeders were in the superior mesenteric artery and 2 in the inferior mesenteric artery. All patients achieved successful immediate hemostasis. Early recurrent bleeding (<30 days) was found in 4 patients with local and new-foci re-bleeding in 2 (11.1%) each. Repeated vasospasm therapy was given to 3 patients, with clinical success in 2. Technical success for the 21 bleeding episodes was 100%. Lesion-based and patient-based primary and overall clinical successes were achieved in 89.4% (17/19) and 77.7% (14/18), and 94.7% (18/19) and 88.8% (16/18), respectively. None of our patients had complications of bowel ischemia or other major procedure-related complications. The one year survival of our patients was 72.2 ± 10.6%. Conclusions: Pharmaco-induced vasospasm therapy seems to be a safe and effective method to treat LGIB from our small patient-cohort study. Further evaluation with large series study is warranted. Considering the advanced age and complex medical problems of these patients, this treatment may be considered as an alternative approach for interventional radiologists in management of LGIB.

  4. Bleeding time

    Bleeding time is a medical test that measures how fast small blood vessels in the skin stop bleeding. ... until the bleeding stops. The provider records the time it takes for the cuts to stop bleeding.

  5. X-ray diagnostic features of acute bleeding ulcers of the stomach and duodenum

    The paper is based on the analysis of clinical, X-ray, and morphological studies in 74 patients with massive gastrointestinal hemorrhage. The paper presents the specific features of X-ray studies of patients with bleeding gastroduodenal ulcers. X-ray studies shout be twice performed in these patients. The first study is conducted if gastroscopic findings are unclear, the repeated one is carried out while assessing changes in disease regression. X-ray diagnosis of bleeding ulcers is determined by their sites and the nature of an ulcerous process. The X-ray diagnosis of chronic callous gastric ulcers accompanied by hemorrhage was based on the detection of two direct symptoms of a niche on the gastric outlines and configuration and an inflammatory mound on the gastric outline and configuration. That of chronic bleeding ulcers of the duodenal bulb is based not only on searches niche, but other signs of the disease - the deformed organ, and the magnitude of a periprocess. 10 refs., 5 figs

  6. Hemorragia digestiva baja masiva en pacientes con enfermedad de Crohn Major acute bleeding in patients with Crohn's disease

    M. Barreiro de Acosta

    2007-07-01

    Full Text Available Objetivo: analizar la frecuencia de las hemorragias masivas en la EC e intentar determinar sus potenciales factores de riesgo (ambientales, propios de la enfermedad y genéticos. Material y métodos: se estudió de manera retrospectiva una cohorte de 174 pacientes -103 mujeres (59% y 71 hombres (41%, edad media de 37 años- con EC, analizándose las hemorragias digestivas masivas que se habían producido en relación con su enfermedad. Se revisaron asimismo potenciales factores de riesgo como hábito tabáquico, localización de la enfermedad y presencia de mutaciones genéticas en CARD15, RTL-4 y CD14, entre otros. Resultados: tres pacientes (1,7% presentaron una hemorragia digestiva masiva que precisó intervención quirúrgica para su resolución. Esta indicación de cirugía supone el 3,4% de las cirugías en relación con la EC. Todos los pacientes eran jóvenes y su enfermedad seguía un patrón inflamatorio y estaba localizada en el íleon. No se ha evidenciado asociación estadísticamente significativa entre las hemorragias digestivas masivas y los potenciales factores de riesgo analizados. Conclusiones: la hemorragia digestiva baja masiva es una complicación poco común, aunque grave de la EC. Se trata habitualmente de pacientes con patrón inflamatorio de la enfermedad y afectación ileal. Para su diagnóstico resulta clave la asociación de endoscopia y arteriografía, y su resolución suele ser quirúrgica.Objective: we aimed at evaluating the frequency of acute severe bleeding in CD and its potential association to some risk factors, including clinical features of CD, environmental factors, and genetic alterations. Material and methods: 174 consecutive patients with CD (103 female (59% and 71 men (41%, with a mean age of 37 years were included. We analyzed all major acute lower gastrointestinal (GI hemorrhage related to CD. Potential risk factors like smoking, site of disease, and presence of gene mutations in CARD15, TLR-4, and

  7. State-of-the-art management of acute bleeding peptic ulcer disease

    Hisham Al Dhahab

    2013-01-01

    Full Text Available The management of patients with non variceal upper gastrointestinal bleeding has evolved, as have its causes and prognosis, over the past 20 years. The addition of high-quality data coupled to the publication of authoritative national and international guidelines have helped define current-day standards of care. This review highlights the relevant clinical evidence and consensus recommendations that will hopefully result in promoting the effective dissemination and knowledge translation of important information in the management of patients afflicted with this common entity.

  8. Hypertension and Life-Threatening Bleeding in Children with Relapsed Acute Myeloblastic Leukemia Treated with FLT3 Inhibitors.

    Yılmaz Karapınar, Deniz; Karadaş, Nihal; Önder Siviş, Zühal; Balkan, Can; Kavaklı, Kaan; Aydınok, Yeşim

    2015-09-01

    Experiences with new multikinase inhibitors are limited, especially in children. In this report we summarize our experience with 2 patients with relapsed acute myeloblastic leukemia (AML), one with FMS-like tyrosine kinase-3-internal tandem duplication mutation and the other with a single base mutation (D835Y). Both patients received sorafenib, one for 19 days and the other for 42 days, with clofarabine-including chemotherapy. One additionally received sunitinib for a total of 20 days. Both patients developed severe pancytopenia, hypertension, life-threatening bleedings from the gastrointestinal system, and, finally, intrapulmonary hemorrhage. Although both reached severe aplasia of the bone marrow without blastic infiltration, death occurred with neutropenic sepsis. PMID:25912283

  9. Hypertension and Life-Threatening Bleeding in Children with Relapsed Acute Myeloblastic Leukemia Treated with FLT3 Inhibitors

    Deniz Yılmaz Karapınar

    2015-09-01

    Full Text Available Experiences with new multikinase inhibitors are limited, especially in children. In this report we summarize our experience with 2 patients with relapsed acute myeloblastic leukemia (AML, one with FMS-like tyrosine kinase-3-internal tandem duplication mutation and the other with a single base mutation (D835Y. Both patients received sorafenib, one for 19 days and the other for 42 days, with clofarabine-including chemotherapy. One additionally received sunitinib for a total of 20 days. Both patients developed severe pancytopenia, hypertension, life-threatening bleedings from the gastrointestinal system, and, finally, intrapulmonary hemorrhage. Although both reached severe aplasia of the bone marrow without blastic infiltration, death occurred with neutropenic sepsis.

  10. Impact of chronic kidney disease on long-term ischemic and bleeding outcomes in medically managed patients with acute coronary syndromes

    Melloni, Chiara; Cornel, Jan H; Hafley, Gail;

    2016-01-01

    AIMS: We aimed to study the relationship of chronic kidney disease stages with long-term ischemic and bleeding outcomes in medically managed acute coronary syndrome patients and the influence of more potent antiplatelet therapies on platelet reactivity by chronic kidney disease stage. METHODS AND...... RESULTS: We estimated creatinine clearance for 8953 medically managed acute coronary syndrome patients enrolled in the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes trial. Patients were classified by chronic kidney disease stage: normal renal...... of Strategies to Open Occluded Coronary Arteries and Thrombolysis In Myocardial Infarction bleeding) outcomes by chronic kidney disease stage and treatment allocation (prasugrel vs. clopidogrel) within each stage. Adjusted hazard ratios (95% confidence intervals) for moderate and for severe chronic...

  11. Intracerebral Hemorrhage; towards physiological imaging of hemorrhage risk in acute and chronic bleeding.

    Raphael eJakubovic

    2012-05-01

    Full Text Available Despite improvements in management and prevention of intracerebral hemorrhage (ICH, there has been little improvement in mortality over the last 30 years. Hematoma expansion, primarily during the first few hours is highly predictive of neurological deterioration, poor functional outcome and mortality. For each 10% increase in ICH size, there is a 5% increase in mortality and an additional 16% chance of poorer functional outcome. As such, both the identification and prevention of hematoma expansion are attractive therapeutic targets in ICH. Previous studies suggest that contrast extravasation seen on CT Angiography (CTA, MRI, and digital subtraction angiography correlates with hematoma growth, indicating ongoing bleeding. Contrast extravasation on the arterial phase of a CTA has been coined the CTA Spot Sign. These easily identifiable foci of contrast enhancement have been identified as independent predictors of hematoma growth, mortality and clinical outcome in primary ICH. The Spot Sign score, developed to stratify risk of hematoma expansion, has shown high inter-observer agreement. Post-contrast leakage or delayed CTA Spot Sign, on post contrast CT following CTA or delayed CTA respectively are seen in an additional ~8% of patients and explain apparently false negative observations on early CTA imaging in patients subsequently undergoing hematoma expansion. CT perfusion provides an opportunity to acquire dynamic imaging and has been shown to quantify rates of contrast extravasation. Intravenous recombinant factor VIIa(rFVIIa within 4 hours of ICH onset has been shown to significantly reduce hematoma growth. However, clinical efficacy has yet to be proven. There is compelling evidence that cerebral amyloid angiopathy (CAA may precede the radiographic evidence of vascular disease and as such contribute to microbleeding. The interplay between microbleeding, CAA,CTA Spot Sign and genetic composition (ApoE genotype may be crucial in developing a

  12. Intra-Arterial Treatment in Patients with Acute Massive Gastrointestinal Bleeding after Endoscopic Failure: Comparisons between Positive versus Negative Contrast Extravasation Groups

    Chang, Wei Chou; Liu, Chang Hsien; Hsu, Hsian He; Huang, Guo Shu; Hsieh, Tasi Yuan; Tsai, Shin Hung; Hsieh, Chung Bao; Yu, Chin Yung [Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (China); Tung, Ho Jui [Asia University, Taichung, Taiwan (CN)

    2011-10-15

    To determine whether treatment outcome is associated with visualization of contrast extravasation in patients with acute massive gastrointestinal bleeding after endoscopic failure. From January 2007 to December 2009, patients that experienced a first attack of acute gastrointestinal bleeding after failure of initial endoscopy were referred to our interventional department for intra-arterial treatment. We enrolled 79 patients and divided them into two groups: positive and negative extravasation. For positive extravasation, patients were treated by coil embolization; and in negative extravasation, patients were treated with intra-arterial vasopressin infusion. The two groups were compared for clinical parameters, hemodynamics, laboratory findings, endoscopic characteristics, and mortality rates. Forty-eight patients had detectable contrast extravasation (positive extravasation), while 31 patients did not (negative extravasation). Fifty-six patients survived from this bleeding episode (overall clinical success rate, 71%). An elevation of hemoglobin level was observed in the both two groups; significantly greater in the positive extravasation group compared to the negative extravasation group. Although these patients were all at high risk of dying, the 90-day mortality rate was significantly lower in the positive extravasation than in the negative extravasation (20% versus 42%, p < 0.05). A multivariate analysis suggested that successful hemo stasis (odds ratio [OR] = 28.66) is the most important predictor affecting the mortality in the two groups of patients. Visualization of contrast extravasation on angiography usually can target the bleeding artery directly, resulting in a higher success rate to control of hemorrhage.

  13. Additive effect of in-hospital TIMI bleeding and chronic kidney disease on 1-year cardiovascular events in patients with acute coronary syndrome

    Lin, Tsung-Hsien; Lai, Wen-Ter; Kuo, Chi-Tai; Hwang, Juey-Jen; Chiang, Fu-Tien; Chang, Shu-Chen; Chang, Chee-Jen

    2014-01-01

    In-hospital bleeding (IHB) is associated with the risk of subsequent cardiovascular events (CVE) in acute coronary syndrome (ACS). We investigated whether increased risk of CVE by IHB is influenced by chronic kidney disease (CKD) or both have detrimental effects on CVE. In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of

  14. Effects of Clopidogrel on Mortality, Cardiovascular and Bleeding Outcomes in Patients with Chronic Kidney Disease - Data from Taiwan Acute Coronary Syndrome Full Spectrum Registry

    Lin, Tsung-Hsien; Lai, Wen-Ter; Hsin, Ho-Tsung; Li, Ai-Hsien; Wang, Chun-Li; Kuo, Chi-Tai; Hwang, Juey-Jen; Chiang, Fu-Tien; Chang, Shu-Chen; ,

    2013-01-01

    Background The efficacy of clopidogrel is inconclusive in the chronic kidney disease (CKD) population with acute coronary syndrome (ACS). Furthermore, CKD patients are prone to bleeding with antiplatelet therapy. We investigated the efficacy and safety of clopidogrel in patients with ACS and CKD. Methods In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of less than 60 ml/min per 1.73 m2. The primary endpoints are th...

  15. The emergency treatment and nursing of acute upper gastrointestinal bleeding%急性上消化道出血的急救与护理体会

    朱承菊

    2011-01-01

    目的 探讨急性上消化道大出血的临床特点和护理对策.方法 总结分析186例急性上消道大出血的临床资料.结果 186例急性上消化道大出血,通过护理干预,痊愈157例,好转22例,死亡2例.结论 急性上消化道大出血临床常见,加强临床护理,预防各种并发症的发生,将大大降低病死率.%Objective To investigate the clinical features and nursing of acute upper gastrointestinal bleeding. Methods 168 patients with acute upper gastrointestinal bleeding were involved in our study, the clinical data was investigated With strict analysis. Results Among all the 168 patients, 157 patients recovered, 22 patients improved, 5 were sent to surgical treatment and 2 patients died. Conclusions Acute upper gastrointestinal bleeding is one of the most common medical emergencies. Intensive clinical nursing can prevent complications reduce the rate of fatality greatly.

  16. Bleeding Disorders

    ... as clotting factors. If you have a bleeding disorder, you either do not have enough platelets or ... don't work the way they should. Bleeding disorders can be the result of other diseases, such ...

  17. Acute Middle Gastrointestinal Bleeding Risk Associated with NSAIDs, Antithrombotic Drugs, and PPIs: A Multicenter Case-Control Study

    Nagata, Naoyoshi; Niikura, Ryota; Yamada, Atsuo; Sakurai, Toshiyuki; Shimbo, Takuro; Kobayashi, Yuka; Okamoto, Makoto; Mitsuno, Yuzo; Ogura, Keiji; Hirata, Yoshihiro; Fujimoto, Kazuma; Akiyama, Junichi; Uemura, Naomi; Koike, Kazuhiko

    2016-01-01

    Background Middle gastrointestinal bleeding (MGIB) risk has not been fully investigated due to its extremely rare occurrence and the need for multiple endoscopies to exclude upper and lower gastrointestinal bleeding. This study investigated whether MGIB is associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin (LDA), thienopyridines, anticoagulants, and proton-pump inhibitors (PPIs), and whether PPI use affects the interactions between MGIB and antithrombo...

  18. Trouble with bleeding: risk factors for acute hepatitis C among HIV-positive gay men from Germany--a case-control study.

    Axel J Schmidt

    Full Text Available OBJECTIVES: To identify risk factors for hepatitis C among HIV-positive men who have sex with men (MSM, focusing on potential sexual, nosocomial, and other non-sexual determinants. BACKGROUND: Outbreaks of hepatitis C virus (HCV infections among HIV-positive MSM have been reported by clinicians in post-industrialized countries since 2000. The sexual acquisition of HCV by gay men who are HIV positive is not, however, fully understood. METHODS: Between 2006 and 2008, a case-control study was embedded into a behavioural survey of MSM in Germany. Cases were HIV-positive and acutely HCV-co-infected, with no history of injection drug use. HIV-positive MSM without known HCV infection, matched for age group, served as controls. The HCV-serostatus of controls was assessed by serological testing of dried blood specimens. Univariable and multivariable regression analyses were used to identify factors independently associated with HCV-co-infection. RESULTS: 34 cases and 67 controls were included. Sex-associated rectal bleeding, receptive fisting and snorting cocaine/amphetamines, combined with group sex, were independently associated with case status. Among cases, surgical interventions overlapped with sex-associated rectal bleeding. CONCLUSIONS: Sexual practices leading to rectal bleeding, and snorting drugs in settings of increased HCV-prevalence are risk factors for acute hepatitis C. We suggest that sharing snorting equipment as well as sharing sexual partners might be modes of sexual transmission. Condoms and gloves may not provide adequate protection if they are contaminated with blood. Public health interventions for HIV-positive gay men should address the role of blood in sexual risk behaviour. Further research is needed into the interplay of proctosurgery and sex-associated rectal bleeding.

  19. Bleeding in the Digestive Tract

    ... lining of the esophagus, stomach, or duodenum. The bacteria Helicobacter pylori (H. pylori) and use of nonsteroidal ... paleness shortness of breath vomit that looks like coffee grounds weakness A person with acute bleeding may ...

  20. Single vs double antiplatelet therapy in acute coronary syndrome: Predictors of bleeding after coronary artery bypass grafting

    Vincenzo; Tarzia; Giacomo; Bortolussi; Edward; Buratto; Carla; Paolini; Carlo; Dal; Lin; Giulio; Rizzoli; Tomaso; Bottio; Gino; Gerosa

    2015-01-01

    AIM:To investigate the contribution of anti-platelet therapy and derangements of pre-operative classical coagulation and thromboelastometry parameters to major bleeding post-coronary artery bypass grafting(CABG).METHODS:Two groups of CABG patients were studied:Group A,treated with aspirin alone(n=50),and Group B treated with aspirin and clopidogrel(n=50).Both had similar preoperative,clinical,biologic characteristics and operative management.Classic coagulation parameters and rotational thromboelastometry(ROTEM)profiles were determined preoperatively for both groups and the same heparin treatment was administered.ROTEM profiles(INTEM and EXTEM assays)were analyzed,both for traditional parameters,and thrombin generation potential,expressed by area-under-curve(AUC).RESULTS:There was no significant difference betweenrates of major bleeding between patients treated with aspirin alone,compared with those treated with aspirin and clopidogrel(12%vs 16%,P=0.77).In the 14 cases of major bleeding,pre-operative classic coagulation and traditional ROTEM parameters were comparable.Conversely we observed that the AUC in the EXTEM test was significantly lower in bleeders(5030±1115 Ohm*min)than non-bleeders(6568±548Ohm*min)(P<0.0001).CONCLUSION:We observed that patients with a low AUC value were at a significantly higher risk of bleeding compared to patients with higher AUC,regardless of antiplatelet treatment.This suggests that thrombin generation potential,irrespective of the degree of platelet inhibition,correlates with surgical bleeding.

  1. [Gastrointestinal bleeding].

    Lanas, Ángel

    2015-09-01

    In the Digestive Disease Week in 2015 there have been some new contributions in the field of gastrointestinal bleeding that deserve to be highlighted. Treatment of celecoxib with a proton pump inhibitor is safer than treatment with nonselective NSAID and a proton pump inhibitor in high risk gastrointestinal and cardiovascular patients who mostly also take acetylsalicylic acid. Several studies confirm the need to restart the antiplatelet or anticoagulant therapy at an early stage after a gastrointestinal hemorrhage. The need for urgent endoscopy before 6-12 h after the onset of upper gastrointestinal bleeding episode may be beneficial in patients with hemodynamic instability and high risk for comorbidity. It is confirmed that in Western but not in Japanese populations, gastrointestinal bleeding episodes admitted to hospital during weekend days are associated with a worse prognosis associated with delays in the clinical management of the events. The strategy of a restrictive policy on blood transfusions during an upper GI bleeding event has been challenged. Several studies have shown the benefit of identifying the bleeding vessel in non varicose underlying gastric lesions by Doppler ultrasound which allows direct endoscopic therapy in the patient with upper GI bleeding. Finally, it has been reported that lower gastrointestinal bleeding diverticula band ligation or hemoclipping are both safe and have the same long-term outcomes. PMID:26520197

  2. Outcome of Acute Upper Gastrointestinal Bleeding in Patients with Coronary Artery Disease: A Matched Case–control Study

    Kessarin Thanapirom; Wiriyaporn Ridtitid; Rungsun Rerknimitr; Rattikorn Thungsuk; Phadet Noophun; Chatchawan Wongjitrat; Somchai Luangjaru; Padet Vedkijkul; Comson Lertkupinit; Swangphong Poonsab; Thawee Ratanachu-ek; Piyathida Hansomburana; Bubpha Pornthisarn; Thirada Thongbai; Varocha Mahachai

    2016-01-01

    Background/Aim: The risk of upper gastrointestinal bleeding (UGIB) increases in patients with coronary artery disease (CAD) due to the frequent use of antiplatelets. There is some data reporting on treatment outcomes in CAD patients presenting with UGIB. We aim to determine the clinical characteristics and outcomes of UGIB in patients with CAD, compared with non-CAD patients. Patients and Methods: We conducted a prospective multi-center cohort study (THAI UGIB-2010) that enrolled 981 consecut...

  3. Internal Bleeding

    ... 2 Diabetes, Heart Disease a Dangerous Combo Are 'Workaholics' Prone to OCD, Anxiety? ALL NEWS > Resources First ... pelvis, that are broken. Initially, internal bleeding may cause no symptoms, although an injured organ that is ...

  4. Bleeding Disorders

    ... times I'd miss work and skip the gym because I felt so lousy. So I decided ... cell called platelets. Your body also needs blood proteins called clotting factors. In people with bleeding disorders, ...

  5. Outcome of non-variceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist: A two-year survey

    Fabrizio Parente; Andrea Anderloni; Stefano Bargiggia; Venerina Imbesi; Emilio Trabucchi; Cinzia Baratti; Silvano Gallus; Gabriele Bianchi Porro

    2005-01-01

    AIM: To prospectively assess the impact of time of endoscopy and endoscopist's experience on the outcome of non-variceal acute upper gastrointestinal (GI) bleeding patients in a large teaching hospital.METHODS: All patients admitted for non-variceal acute upper GI bleeding for over a 2-year period were potentially eligible for this study. They were managed by a team of seven endoscopists on 24-h call whose experience was categorized into two levels (high and low) according to the number of endoscopic hemostatic procedures undertaken before the study. Endoscopic treatment was standardized according to Forrest classification of lesions as well as the subsequent medical therapy. Time of endoscopy was subdivided into two time periods: routine (8 a.m.-5 p.m.) and on-call (5 p.m.-8 a.m.). For each category of experience and time periods rebleeding rate, transfusion requirement, need for surgery, length of hospital stay and mortality we compared. Multivariate analysis was used to discriminate the impact of different variables on the outcomes that were considered.RESULTS: Study population consisted of 272 patients (mean age 67.3 years) with endoscopic stigmata of hemorrhage. The patients were equally distributed among the endoscopists, whereas only 19% of procedures were done out of working hours. Rockall score and Forrest classification at admission did not differ between time periods and degree of experience.Univariate analysis showed that higher endoscopist's experience was associated with significant reduction in rebleeding rate (14% vs 37%), transfusion requirements (1.8±0.6 vs 3.0±1.7 units) as well as surgery (4% vs 10%), but not associated with the length of hospital stay nor mortality. By contrast, outcomes did not significantly differ between the two time periods of endoscopy.On multivariate analysis, endoscopist's experience was independently associated with rebleeding rate and transfusion requirements. Odds ratios for low experienced endoscopist were 4.47 for

  6. Red Blood Cell Transfusions and Iron Therapy for Patients Presenting with Acute Upper Gastrointestinal Bleeding: A Survey of Canadian Gastroenterologists and Hepatologists

    Fortinsky, Kyle J.; Razik, Roshan; Spiegle, Gillian; Gallinger, Zane R.; Grover, Samir C.; Pavenski, Katerina; Weizman, Adam V.; Kwapisz, Lukasz; Mehta, Sangeeta; Gray, Sarah

    2016-01-01

    Introduction. There is limited data evaluating physician transfusion practices in patients with acute upper gastrointestinal bleeding (UGIB). Methods. A web-based survey was sent to 500 gastroenterologists and hepatologists across Canada. The survey included clinical vignettes where physicians were asked to choose transfusion thresholds. Results. The response rate was 41% (N = 203). The reported hemoglobin (Hgb) transfusion trigger differed by up to 50 g/L. Transfusions were more liberal in hemodynamically unstable patients compared to stable patients (mean Hgb of 86.7 g/L versus 71.0 g/L; p iron to patients with UGIB who are anemic upon discharge. Conclusions. The transfusion practices of gastroenterologists in the management of UGIB vary widely and more high-quality evidence is needed to help assess the efficacy and safety of selected transfusion thresholds in varying patients presenting with UGIB. PMID:27446847

  7. High syndecan-1 levels in acute myeloid leukemia are associated with bleeding, thrombocytopathy, endothelial cell damage, and leukocytosis

    Larsen, Anne Mette Vestskov; Leinøe, Eva Birgitte; Johansson, Pär I;

    2013-01-01

    The risk of hemorrhage is influenced by multiple factors in acute myeloid leukemia (AML). We investigated whether hemorrhage in AML patients was associated with endothelial perturbation, potentially caused by thrombocytopenia, platelet dysfunction and leukocytosis. Biomarkers of endothelial pertu...

  8. A Review of Bleeding in Acute Coronary Syndrome%急性冠状动脉综合征抗栓治疗中出血的研究进展

    张佳慧

    2012-01-01

    Percutaneous transluminal coronary intervention and antithrombotic therapy have resulted in significant improvement in reducing ischemic events in acute coronary syndrome, while leading to an increase in the risk of bleeding. There has been an increasing amount of data demonstrating that bleeding has a strong association with subsequent adverse outcomes. Therefore, it is imperative to optimize patient outcomes by performing bleeding risk assessment and stratification, adopting pharmacological and nonphannacological strategies to minimize bleeding while maximizing treatment efficacy. This review focuses on the classifications, epidemiology, adverse outcomes, and management of bleeding in patients with acute coronary syndrome.%经皮冠状动脉介入治疗与抗栓药物在显著降低急性冠状动脉综合征患者缺血事件的同时,也相应增加了出血风险.出血发生率增高与患者不良临床预后强烈相关.全面评估患者出血风险进行危险分层,谨慎平衡缺血与出血风险制定治疗策略,预防控制出血并发症,在临床实践中非常重要.现就急性冠状动脉综合征出血分级标准、出血发生率、预后及预防控制做一综述.

  9. BLEED & BLEND

    Goodfellow, Paul

    2012-01-01

    BLEED & BLEND is an ambient artwork that was commissioned by Digital Media in Newcastle University's Culture Lab, as part of their data visualisation screening project: Data Elements. The aim of the project was to take an unconventional approach to interpreting and displaying scientific data through visual artworks. The work was projected onto Newcastle University's Kings Gate building in Newcastle city centre in October 2012. A useful and succinct description of Ambient Art is found in B...

  10. Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients

    Krag, Mette; Perner, Anders; Wetterslev, Jørn;

    2015-01-01

    replacement therapy (6.9, 2.7-17.5), co-existing coagulopathy (5.2, 2.3-11.8), acute coagulopathy (4.2, 1.7-10.2), use of acid suppressants (3.6, 1.3-10.2) and higher organ failure score (1.4, 1.2-1.5). In ICU, 73 % (71-76 %) of patients received acid suppressants; most received proton pump inhibitors. In...

  11. Analysis of Dosimetric Parameters Associated With Acute Gastrointestinal Toxicity and Upper Gastrointestinal Bleeding in Locally Advanced Pancreatic Cancer Patients Treated With Gemcitabine-Based Concurrent Chemoradiotherapy

    Nakamura, Akira [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Shibuya, Keiko, E-mail: kei@kuhp.kyoto-u.ac.jp [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Matsuo, Yukinori; Nakamura, Mitsuhiro; Shiinoki, Takehiro; Mizowaki, Takashi; Hiraoka, Masahiro [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan)

    2012-10-01

    Purpose: To identify the dosimetric parameters associated with gastrointestinal (GI) toxicity in patients with locally advanced pancreatic cancer (LAPC) treated with gemcitabine-based chemoradiotherapy. Methods and Materials: The data from 40 patients were analyzed retrospectively. Chemoradiotherapy consisted of conventional fractionated three-dimensional radiotherapy and weekly gemcitabine. Treatment-related acute GI toxicity and upper GI bleeding (UGB) were graded according to the Common Toxicity Criteria Adverse Events, version 4.0. The dosimetric parameters (mean dose, maximal absolute dose which covers 2 cm{sup 3} of the organ, and absolute volume receiving 10-50 Gy [V{sub 10-50}]) of the stomach, duodenum, small intestine, and a composite structure of the stomach and duodenum (StoDuo) were obtained. The planning target volume was also obtained. Univariate analyses were performed to identify the predictive factors for the risk of grade 2 or greater acute GI toxicity and grade 3 or greater UGB, respectively. Results: The median follow-up period was 15.7 months (range, 4-37). The actual incidence of acute GI toxicity was 33%. The estimated incidence of UGB at 1 year was 20%. Regarding acute GI toxicity, a V{sub 50} of {>=}16 cm{sup 3} of the stomach was the best predictor, and the actual incidence in patients with V{sub 50} <16 cm{sup 3} of the stomach vs. those with V{sub 50} of {>=}16 cm{sup 3} was 9% vs. 61%, respectively (p = 0.001). Regarding UGB, V{sub 50} of {>=}33 cm{sup 3} of the StoDuo was the best predictor, and the estimated incidence at 1 year in patients with V{sub 50} <33 cm{sup 3} of the StoDuo vs. those with V{sub 50} {>=}33 cm{sup 3} was 0% vs. 44%, respectively (p = 0.002). The dosimetric parameters correlated highly with one another. Conclusion: The irradiated absolute volume of the stomach and duodenum are important for the risk of acute GI toxicity and UGB. These results could be helpful in escalating the radiation doses using novel

  12. Bleeding Disorders Treatment Options

    ... Pictures Young Voices Compendium of Assessment Tools Educational Games Video Library Find a Treatment Centre Haemophilia Journal About Bleeding Disorders Bleeding Disorders The Clotting Process Drugs That Can Cause Bleeding Hemophilia How Do You ...

  13. Methods of Nuclear Medicine in gastrointestinal bleeding detection

    Several methods used in the diagnostic of gastrointestinal bleeding are presented. Two radioisotopic methods are considered the main ones: coloidal sulphur labeled with technetium-99m, more useful for low and acute bleeding and red blood cells labeled with technetium-99m, adequate for high and intermitent bleeding. (Author)

  14. Diagnosis of gastrointestinal bleeding: A practical guide for clinicians

    Bong; Sik; Matthew; Kim; Bob; T; Li; Alexander; Engel; Jaswinder; S; Samra; Stephen; Clarke; Ian; D; Norton; Angela; E; Li

    2014-01-01

    Gastrointestinal bleeding is a common problem encountered in the emergency department and in the primary care setting. Acute or overt gastrointestinal bleeding is visible in the form of hematemesis, melena or hematochezia. Chronic or occult gastrointestinal bleeding is notapparent to the patient and usually presents as positive fecal occult blood or iron deficiency anemia. Obscure gastrointestinal bleeding is recurrent bleeding when the source remains unidentified after upper endoscopy and colonoscopic evaluation and is usually from the small intestine. Accurate clinical diagnosis is crucial and guides definitive investigations and interventions. This review summarizes the overall diagnostic approach to gastrointestinal bleeding and provides a practical guide for clinicians.

  15. Bleeding from gums: Can it be a dengue

    Rajat Bansal; Purnita Goyel; Dinesh. C. Agarwal

    2014-01-01

    Introduction: Bleeding from gums is a common feature in periodontitis patient. But abnormal bleeding from the gingiva or other areas of the oral mucosa that is difficult to control is an important clinical sign suggesting a hematological disorder. Case Report: A-40-year old male patient reported to our clinic with the chief complaint of acute gingival bleeding. There was continuous bleeding, fever since 3-4 days with weakness, retro orbital pain, and severe backache. Patient gave a history of...

  16. Onyx (ethylene-vinyl-alcohol-copolymer). A novel approach to the endovascular treatment of acute bleeding; Onyx (Ethylen-Vinyl-Alkohol-Kopolymer). Ein neuer Anwendungsbereich in der endovaskulaeren Behandlung akuter peripherer Blutungen

    Mueller-Wille, R.; Herold, T.; Jung, E. M.; Rennert, J.; Heiss, P.; Feuerbach, S.; Zorger, N. [Inst. fuer Roentgendiagnostik, Universitaetsklinikum Regensburg (Germany); Lenhart, M. [Klinik fuer Diagnostische und Interventionelle Radiologie, Sozialstiftung Bamberg (Germany); Paetzel, C. [Inst. fuer Radiologische Diagnostik, Klinikum Weiden (Germany)

    2009-08-15

    Purpose: The purpose of our retrospective study was to determine the feasibility and efficacy of the endovascular embolization of peripheral acute arterial hemorrhage using Onyx. Materials and Methods: Between October 2003 and February 2007, 14 patients with acute arterial bleeding underwent percutaneous arterial embolization using Onyx. Bleeding was caused by iatrogenic vessel injury (6 patients), malignancy/inflammation (5 patients) and trauma (3 patients). Hematomas were located in the pelvis (5 patients), followed by liver (3 patients), retroperitoneal space (2 patients), thorax (2 patients), pancreas (1 patient), and thigh (1 patient). The number of embolized arteries, the volume and viscosity of embolic agent (Onyx), the number of additionally used coils, the embolization time, and the technical and clinical outcome were documented. Procedure-related complications, recurrent bleeding during hospital stay and outcome were recorded. Results: In 14 patients selective endovascular embolization of 15 arteries was performed. The average volume of injected Onyx was 1.3 {+-} 0.8 ml. In 6 cases (42.9%) Onyx was used in conjunction with coils. The average time between the correct placement of microcatheter and complete embolization was 24.9 {+-} 12.6 minutes. In 13 of 14 patients (92.8%), embolization was technically successful. In one case, procedure-related complications occurred and embolization was performed in a second session a day later. After technically successful embolization, no recurrent bleeding occurred during hospitalization. Out of 14 patients, six (42.9%) died 1 - 38 days after technically successful embolization due to multiple organ failure (2 patients), hypoxic brain injury (2 patients), septic shock (1 patient) or malignancy-associated death (1 patient). (orig.)

  17. Localization of bleeding using 4-row detector-CT in patients with clinical signs of acute gastrointestinal hemorrhage; Blutungslokalisation mittels 4-Zeilen-Spiral-CT bei Patienten mit klinischen Zeichen einer akuten gastrointestinalen Haemorrhagie

    Ko, H.S.; Tesdal, K.; Dominguez, E.; Kaehler, G.; Sadick, M.; Dueber, C.; Diehl, S. [Universitaetsklinikum Heidelberg (Germany). Kinderklinik

    2005-12-15

    Purpose: There is no gold-standard regarding the diagnostic work-up and therapy of an acute gastrointestinal (GI) hemorrhage. In most cases endoscopy provides the diagnosis but in a low percentage this modality is not feasible or negative. Purpose of this study was to evaluate the role of multi-phase Multi-Slice-Computertomography (MSCT) as a modality to diagnose and locate the site of acute GI hemorrhage in case of unfeasible or technically difficult endoscopy. Materials and methods: 58 patients, presenting with clinical signs of lower GI hemorrhage, were examined through a 24-month period. Preliminary endoscopy was either negative or unfeasible. Images were obtained with a four-detector row CT with an arterial (4 x 1 mm collimation, 0.8 mm increment, 1.25 mm slice width, 120 kV, 165 mAs) and portal venous series (4 x 2,5 mm collimation, 2 mm increment, 3 mm slice width, 120 kV, 165 mAs). Time interval between endoscopy and CT varied between 30 minutes and 3 hours. The results of the MSCT were correlated with clinical course and surgical or endoscopical treatment. Results: 20 of the 58 patients (34%) undergoing MSCT had a bleeding site identified, thus providing decisive information for the following intervention. In case of a following therapeutic intervention there was 100% correlation regarding the bleeding site. In 38 of the 58 patients (66%), a bleeding site was not identified by MSCT. Twenty of these 38 patients (53%) were stable and required no further treatment. In 18 of these 38 patients further interventional therapy was required due to continuing hemorrhage and in all of those patients the bleeding site was detected by intervention. (orig.)

  18. Large Duodenal Gastrointestinal Stromal Tumor Presenting with Acute Bleeding Managed by a Whipple Resection. A Review of Surgical Options and the Prognostic Indicators of Outcome

    Norman Oneil Machado

    2011-03-01

    Full Text Available Context Duodenal gastrointestinal stromal tumors (GISTs are uncommon and constitute a relatively small subset of GISTs which presents a unique dilemma having various surgical options. A case of a large ulcerating duodenal GIST arising from the second and third parts of the duodenum and involving the pancreas which was managed by a Whipple resection is presented. The literature is also reviewed to present the current status on surgical options, outcome, prognostic indicators and the role of imatinib mesylate in its management. Case report A 58-year-old patient presented with acute gastrointestinal bleeding which was diagnosed to be due to a duodenal GIST following CT scan and endoscopic biopsy. The mass which measured about 10x9 cm originated from the 2nd part and extended into the 3rd part of the duodenum. He underwent a Whipple resection, and histopathology confirmed a duodenal GIST having a greater than 10 mitotic count per fifty high power field and areas of necrosis. Postoperatively, he received imatinib mesylate 400 mg bid; however, 4 months later, he presented with multiple disseminated peritoneal metastases and succumbed to the disease 2 months later. Conclusion GISTs of the duodenum which are small in size and do not involve the papilla of Vater are better resolved using a limited resection of the duodenum since the outcome in terms of operative risk or disease recurrence is not influenced in these cases. However, large tumors with more extensive involvement would require a pancreaticoduodenectomy to achieve adequate tumor clearance. Even though duodenal GISTs have a relatively better prognosis as compared to GISTs at other sites, their aggressiveness ranges from small indolent tumors to aggressive sarcomas. Following tumor resection, a recurrence rate of about 40% has been reported. A more favorable prognosis in duodenal GISTs is attributed to a lower prevalence of P53 loss, the duodenal location of the tumor, a smaller size of the

  19. Recombinant coagulation factor VIIa labelled with the fac-99 mTc(CO)3-core: synthesis and in vitro evaluation of a putative new radiopharmaceutical for imaging in acute bleeding lesion

    Madsen, Jacob; Christensen, Jesper B.; Olsen, Ole H.;

    2011-01-01

    Coagulation in blood is initiated when coagulation factor VII (FVII) binds to exposed TF and is activated to FVIIa, and the TF/ FVIIa complex may therefore provide a marker of vascular injury potentially applicable in diagnostic imaging of acute gastrointestinal (GI) bleeding. Methods: Recombinant...... yield and in 495% radiochemical purity. Pull down experiments showed that the biological activity (binding to tissue factor and to anti-FVII antibody) of the radiolabelled product remained intact in the formulation mixture as well as in human serum. By computer modeling analysis, two candidate sites for...

  20. The risk factors and outcomes of gastrointestinal bleeding in acute ischaemic stroke%缺血性脑卒中并发消化道出血危险因素及预后分析

    邓晓风

    2012-01-01

    Objective Gastrointestinal(GI) bleeding is one of most serious complications after acute stage of ischemic stroke. This study is to investigate the risk factors as well as the prognosis of those cases with GI bleeding following acute stroke. Methods From Mar 2008 to Aug 2010, we prospectively collected ischemic stroke patients with or without GI bleeding in our intensive care unit grouped as research group and controls. A six month follow-up was conducted. Comparison was done between groups on the aspect of demography, predisposing factors and prognosis. Results Overall 3. 5% of GI bleeding was observed a-mong those ischemic stroke patients. The four major risk factors were coma ( 0R5.0 95% CI 1.4 ~ 17. 5 ) , incontinence ( OR5. 8 95% CI 1. 5 - 22. 2 ) , history of peptic ulcer or GI bleeding ( OR5. 2 95% CI 1. 3 ~ 21.1) and history of stroke ( OR3. 6 95% CI 1. 0 ~ 12. 7)respectively. During the follow-up, higher mortality rate was detected in research group (45. 5% ) especially those with sever GI bleeding (50% ) than that in controls (10% ). Conclusion Although GI bleeding is not a relative common complication after acute ischemic stroke, we should notice that it is associated with increased death risk. Thus we should be focused more attention on those risk factors.%目的 消化道出血是脑卒中后最严重的并发症之一.本研究探讨比较了其危险因素及相关预后.方法 收集2008年3月~2010年8月,我院重症监护室收治的脑梗死并发上消化道出血的患者(研究组)以及未并发上消化道出血的脑梗死患者(对照组),并进行6个月的随访.比较相关人口学数据、危险因素及相关预后.结果 研究发现,脑梗死并发消化道出血发生率为3.5%,其高危因素主要为昏迷(OR5.0 95% CI 1.4 ~ 17.5)、大小便失禁(OR5.8 95% CI1.5 ~22.2)、消化道溃疡或出血病史(OR5.2 95%CI 1.3 ~21.1)以及既往卒中病史(OR3.6 95%CI 1.0 ~ 12.7).在6个月的随访

  1. No early effect of storage time of transfused red blood cells on fatigue and plasma cytokines in patients with anaemia from non-acute gastrointestinal bleeding

    Mynster, Tommie; Dziegiel, Morten Hanefeld; Kofoed, Kristian

    2007-01-01

    .0 mmol/l, complaints of fatigue and no active bleeding were included. Eleven patients received two red cells units (SAGM) stored less than 1 week (short storage time, S), and 11 patients received two units stored more than 3 weeks (long storage time, L). Fatigue was self-estimated on a visual analogue...

  2. c-KIT positive Gastrointestinal Stromal Tumor presenting with acute bleeding in a patient with neurofibromatosis type 1: a case report

    Aboutaleb, Esam; Kothari, Manish; Damrah, Osama; Canelo, Roben

    2009-01-01

    Background Gastrointestinal stromal tumours are rare (GIST). However, the incidence of GIST among neurofibromatosis type 1 (NF-1) patients is approximately 3.9-25%. GIST can present clinically in different ways such as abdominal pain, gastrointestinal bleeding and obstruction. Case report We present 51 year female patient admitted with Background of neurofibromatosis type 1 admitted with melena. OGD has been done and showed duodenitis with large volume fresh blood in distal duodenum but no ob...

  3. Effects of Acute Bleeding Followed by Hydroxyethyl Starch 130/0.4 or a Crystalloid on Propofol Concentrations, Cerebral Oxygenation, and Electroencephalographic and Haemodynamic Variables in Pigs

    Aura Silva

    2014-01-01

    Full Text Available Bleeding changes the haemodynamics, compromising organ perfusion. In this study, the effects of bleeding followed by replacement with hydroxyethyl starch 130/0.4 (HES or lactated Ringer’s (LR on cerebral oxygenation and electroencephalogram-derived parameters were investigated. Twelve young pigs under propofol-remifentanil anaesthesia were bled 30 mL/kg and, after a 20-minute waiting period, volume replacement was performed with HES (GHES; N=6 or LR (GRL; N=6. Bleeding caused a decrease of more than 50% in mean arterial pressure (P<0.01 and a decrease in cerebral oximetry (P=0.039, bispectral index, and electroencephalogram total power (P=0.04 and P<0.01, resp., while propofol plasma concentrations increased (P<0.01. Both solutions restored the haemodynamics and cerebral oxygenation similarly and were accompanied by an increase in electroencephalogram total power. No differences between groups were found. However, one hour after the end of the volume replacement, the cardiac output (P=0.03 and the cerebral oxygenation (P=0.008 decreased in the GLR and were significantly lower than in GHES (P=0.02. Volume replacement with HES 130/0.4 was capable of maintaining the cardiac output and cerebral oxygenation during a longer period than LR and caused a decrease in the propofol plasma concentrations.

  4. Risk Factors and Outcome for Massive Intra-Abdominal Bleeding Among Patients With Infected Necrotizing Pancreatitis

    Shen, Xiao; Sun, Jing; Zhang, Jingzhu; Ke, Lu; Tong, Zhihui; Li, Gang; Jiang, Wei; Li, Weiqin; Li, Jieshou

    2015-01-01

    Abstract The incidence of acute bleeding is reported to be 13.5% in patients with acute necrotizing pancreatitis. However, of all the bleeding events, intra-abdominal bleeding was less studied in the literature and its risk factors have not been well defined yet. The purpose of the present study was to investigate the risk factors for massive intra-abdominal bleeding among the patients with infected necrotizing pancreatitis and assessed the outcome of these patients. Both univariate and multi...

  5. Scintigraphic detection and localization of gastrointestinal bleeding sites

    Successful management of acute gastrointestinal (GI) bleeding usually depends on accurate localization of the bleeding site. History and clinical findings are often misleading in determination of the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provide accurate diagnoses for the majority of patients bleeding from the upper GI tract, but lower GI bleeding still poses a serious diagnostic challenge. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases (3-5), has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding at a rate greater than 0.5 ml/min, and since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. The diagnosis of lower GI bleeding is usually easy to make. In contrast, localizing the site of bleeding may be extremely difficult. Using the techniques described the nuclear physician may be able to detect the bleeding site precisely. However, if the cautions detailed are not observed, the tracer studies will show GI bleeding, but not at the true bleeding site. This must be carefully understood and avoided. Done correctly, these tests can have a major impact on patient care

  6. Nonvariceal upper gastrointestinal bleeding

    Burke, Stephen J.; Weldon, Derik; Sun, Shiliang [University of Iowa, Department of Radiology, Iowa, IA (United States); Golzarian, Jafar [University of Iowa, Department of Radiology, Iowa, IA (United States); University of Iowa, Department of Radiology, Carver College of Medicine, Iowa, IA (United States)

    2007-07-15

    Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)

  7. 克罗恩病并发急性下消化道大出血的护理%Nursing of Crohn's disease complicated with acute lower gastrointestinal bleeding

    苏润婵; 黄美娟; 张萍

    2010-01-01

    Objective To explore the clinical features and nursing strategies of the Crohn's disease(CD) comphcated with acute lower gastrointestinal bleeding. Methods The clinical and nursing data of the CD admitted to our hospital with acute lower gastrointestinal bleeding in patients with 13 cases from 1998 to 2007 were collected and retrospectively analyzed to explore the nursing strategy. Results Four cases of thirteen patients improved after surgery, 9 cases received conservative therapy, 3 cases died. Conclusions Careful medical treatment and nursing during the conservative treatment can effectively control the progression of the disease and reduce mortality.%目的 探讨克罗恩病(Crohn's disease,CD)并发急性下消化道大出血患者的临床特点及护理对策.方法 1998-2007年我院收治的克罗恩病并发急性下消化道大出血患者13例,对其临床及护理资料进行回顾性分析,探讨其护理对策.结果 13例患者中4例接受手术治疗后好转,9例采取保守治疗,其中3例死亡.结论 内科保守治疗过程中精心的治疗与护理,可以有效控制病情发展,降低病死率.

  8. Do statins protect against upper gastrointestinal bleeding?

    Gulmez, Sinem Ezgi; Lassen, Annmarie Touborg; Aalykke, Claus; Dall, Michael; Andries, Alin; Andersen, Birthe Søgaard; Hansen, Jane Møller; Andersen, Morten; Hallas, Jesper

    2009-01-01

    AIMS: Recently, an apparent protective effect of statins against upper gastrointestinal bleeding (UGB) was postulated in a post hoc analysis of a randomized trial. We aimed to evaluate the effect of statin use on acute nonvariceal UGB alone or in combinations with low-dose aspirin and other...

  9. Scintigraphic detection of gastrointestinal bleeding: a review of current methods

    Recent experience with radionuclide imaging has provided the clinician with several techniques to noninvasively detect and locate sources of gastrointestinal hemorrhage. These tests can be rapidly performed and often in an ICU setting. One method used Tc-99m sulfur colloid which, in an animal model, has been shown to detect acute bleeding at rates as low as 0.1 ml/min. However, because the tracer remains in the blood for a short period of time, it may be suboptimal for identifying patients with intermittent bleeding. Tc-99m red cells is a tracer that remains within the blood and permits detection of both acute and intermittent bleeding. With tagged red cells, sites of bleeding from both the upper and lower gastrointestinal tract can be found. Both of these techniques can provide important information in the patient with suspected active gastrointestinal bleeding and aid the clinician in more effective management including the use of invasive diagnostic and therapeutic techniques

  10. Approach to bleeding patient

    Ramachandran Gopinath

    2014-01-01

    Full Text Available Managing a bleeding patient is very challenging for the perioperative physician. Bleeding in a patient would be due to inherited or acquired disorders of haemostasis. Identifying the patients at risk of bleeding and utilising prophylactic treatment protocols has good outcomes. Along with clinical signs, trends in monitoring coagulation parameters and analysing blood picture are necessary. Management of patients in the postoperative period and in intensive care unit should be focused on normalization of coagulation profile as early as possible with available blood and its products. Available recombinant factors should be given priority as per the approved indications. Exploring the surgical site should be considered for persistent bleeding because haemodynamic compromise, excessive transfusion of fluids, blood and its products and more inotropic support may have a negative impact on the patient outcome.

  11. Understanding Minor Rectal Bleeding

    ... are the possible causes of minor rectal bleeding? Hemorrhoids Anal fissures Proctitis (inflammation of the rectum) Polyps ... can be cured if detected early. What are hemorrhoids? Hemorrhoids (also called piles) are swollen blood vessels ...

  12. Excess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study

    Colin John Crooks; Timothy Richard Card; Joe West

    2013-01-01

    Editors' Summary Background Acute gastrointestinal bleeding is a potentially life-threatening abdominal emergency that remains a common cause of admission to hospital. Upper gastrointestinal bleeding (bleeding derived from a source above the ligament of Treitz, which connects the fourth portion of the duodenum to the diaphragm) is roughly four times as common as bleeding from the lower gastrointestinal tract and is a major cause of morbidity and mortality. Upper gastrointestinal bleeding is a...

  13. Bleeding from gums: Can it be a dengue

    Rajat Bansal

    2014-01-01

    Full Text Available Introduction: Bleeding from gums is a common feature in periodontitis patient. But abnormal bleeding from the gingiva or other areas of the oral mucosa that is difficult to control is an important clinical sign suggesting a hematological disorder. Case Report: A-40-year old male patient reported to our clinic with the chief complaint of acute gingival bleeding. There was continuous bleeding, fever since 3-4 days with weakness, retro orbital pain, and severe backache. Patient gave a history of bleeding from gums for last 24 hrs. His blood profile revealed; platelet count of 36,000, total wite blood cell (WBC count of 6000/cumm, differential leukocyte count (DLC (P45, L53, E2, and hemoglobin 12 g/dL. Patient sera was positive for dengue non-structural protein-1 antigen, anti-dengue immunoglobulin M (IgM, and anti-dengue immunoglobulin G (IgG antibodies. Discussion: Here is a case report capable of changing our vision that acute gingival bleeding can also occur in dengue fever. Dengue fever can also be considered as one of the differential diagnosis for the acute gingival bleeding.

  14. Acute GI bleeding by multiple jejunal gastrointestinal autonomic nerve tumour associated with neurofibromatosis type I Urgencia quirúrgica por sangrado intestinal debido a tumor intestinal de nervios autónomos asociados a neurofibromatosis tipo I

    Keese, M; Riester, T; K. Schwenke; Dinter, D.; Back, W; Palma, P.

    2007-01-01

    We describe a surgical emergency due to GI-bleeding caused by gastrointestinal autonomic nerve tumours (GANT's) in a patient with von Recklinghausen's disease. A 72 year old female patient with von Recklinghausen's disease was admitted with maelena. Endoscopy showed no active bleeding in the stomach and the colon. Therefore an angio-CT-scan was performed which revealed masses of the proximal jejunum as source of bleeding. Laparotomy was indicated and a 20 cm segment of jejunum which carried m...

  15. Bleeding during Pregnancy

    ... have placenta accreta, you are at risk of life-threatening blood loss during delivery. Your ob-gyn will plan your ... to be done right after delivery to prevent life-threatening blood loss. Can bleeding be a sign of preterm labor? ...

  16. Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

    The reasons more frequent of high gastrointestinal bleeding are the peptic gastric and duodenal, followed by acute erosions and the varicose veins in oesophagus and stomach. The diverticulosis of the small bowel is a very rare reason of gastrointestinal bleeding, must considerate in patients with bleeding without evident reason in oesophagus and stomach, the habitual is to diagnose this entity of accidental form in the course of endoscopic procedures, radiological or surgical. The complications associated with the diverticulosis duodenal are rare; it justifies supporting a not surgical attitude at first

  17. Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

    The reasons more frequent of high gastrointestinal bleeding are the peptic gastric and duodenal, followed by acute erosion and the varicose veins in oesophagus and stomachs. The diverticulosis of the small bowel is a very rare reason of gastrointestinal bleeding, must considerate in patients with bleeding without evident reason in oesophagus and stomach the habitual is to diagnose this entity of occidental form in the course of endoscopic procedures, radiological of surgical. The complications associated with the diverticulosis duodenal are rare; it justifies supporting a not surgical attitude at first

  18. Risk of bleeding related to antithrombotic treatment in cardiovascular disease

    Sørensen, Rikke; Olesen, Jonas B; Charlot, Mette;

    2012-01-01

    Antithrombotic therapy is a cornerstone of treatment in patients with cardiovascular disease with bleeding being the most feared complication. This review describes the risk of bleeding related to different combinations of antithrombotic drugs used for cardiovascular disease: acute coronary...... syndrome (ACS), atrial fibrillation (AF), cerebrovascular (CVD) and peripheral arterial disease (PAD). Different risk assessment schemes and bleeding definitions are compared. The HAS-BLED risk score is recommended in patients with AF and in ACS patients with AF. In patients with ACS with or without...

  19. Scintigraphic demonstration of gastrointestinal bleeding due to mesenteric varices

    Hansen, M.E.; Coleman, R.E. (Duke Univ. Medical Center, Durham, NC (USA))

    1990-07-01

    Mesenteric varices can appear as massive, acute lower gastrointestinal bleeding. The small bowel or colon may be involved, varices usually developing at sites of previous surgery or inflammation in patients with portal hypertension. Two patients with alcoholic cirrhosis and protal hypertension presented with rectal bleeding. Tc-99m RBC studies demonstrated varices and extravasation into the adjacent bowel. The varices were documented by mesenteric angiography. Characteristic features of Tc-99m labeled RBC studies can identify mesenteric varices as the cause of intestinal bleeding and localize the abnormal vessels.

  20. Embolization of Bleeding Stomal Varices by Direct Percutaneous Approach

    Stomal varices can occur in patients with stoma in the presence of portal hypertension. Suture ligation, sclerotherapy, angiographic embolization, stoma revision, beta blockade, portosystemic shunt, and liver transplantation have been described as therapeutic options for bleeding stomal varices. We report the case of a 21-year-old patient with primary sclerosing cholangitis and colectomy with ileostomy for ulcerative colitis, where stomal variceal bleeding was successfully treated by direct percutaneous embolization. We consider percutaneous embolization to be an effective way of treating acute stomal bleeding in decompensated patients while awaiting decisions regarding shunt procedures or liver transplantation.

  1. First trimester bleeding evaluation.

    Dogra, Vikram; Paspulati, Raj Mohan; Bhatt, Shweta

    2005-06-01

    First trimester bleeding is a common presentation in the emergency room. Ultrasound evaluation of patients with first trimester bleeding is the mainstay of the examination. The important causes of first trimester bleeding include spontaneous abortion, ectopic pregnancy, and gestational trophoblastic disease; 50% to 70% of spontaneous abortions are due to genetic abnormalities. In normal pregnancy, the serum beta hCG doubles or increases by at least 66% in 48 hours. The intrauterine GS should be visualized by TVUS with beta hCG levels between 1000 to 2000 mIU/mL IRP. Visualization of the yolk sac within the gestational sac is definitive evidence of intrauterine pregnancy. Embryonic cardiac activity can be identified with CRL of >5 mm. A GS with a mean sac diameter (MSD) of 8 mm or more without a yolk sac and a GS with an MSD of 16 mm or more without an embryo, are important predictors of a nonviable gestation. A GS with a mean sac diameter of 16 mm or more (TVUS) without an embryo is a sonographic sign of anembryonic gestation. A difference of subchorionic hematoma. The presence of an extra ovarian adnexal mass is the most common sonographic finding in ectopic pregnancy. Other findings include the tubal ring sign and hemorrhage. About 26% of ectopic pregnancies have normal pelvic sonograms on TVUS. Complete hydatidiform mole presents with a complex intrauterine mass with multiple anechoic areas of varying sizes (Snowstorm appearance). Twenty-five percent to 65% of molar pregnancies have associated theca-leutin cysts. Arteriovenous malformation of the uterus is a rare but life-threatening cause of vaginal bleeding in the first trimester. The sonographic findings in a patient with first trimester bleeding should be correlated with serum beta hCG levels to arrive at an appropriate clinical diagnosis. PMID:15905817

  2. Anemia Due to Excessive Bleeding

    ... 2 Diabetes, Heart Disease a Dangerous Combo Are 'Workaholics' Prone to OCD, Anxiety? ALL NEWS > Resources First ... needed to determine the source of bleeding. The cause of bleeding is corrected, and transfusions and iron ...

  3. Diagnosis of the Bleeding Child

    Yıldız, İnci

    1995-01-01

    Hemostasis is the body response to bleeding with the interaction of the blood vessel the platelets and the coagulation factors This article reviews the normal physiologic mechanism of hemostasis together with the diagnostic approach to the bleeding child The commonly used tests of hemostasis are described Key words: Bleeding Diagnosis Tests

  4. Risk of bleeding in patients with acute myocardial infarction treated with different combinations of aspirin, clopidogrel, and vitamin K antagonists in Denmark: a retrospective analysis of nationwide registry data

    Sørensen, Rikke; Hansen, Morten L; Abildstrøm, Steen;

    2009-01-01

    BACKGROUND: Combinations of aspirin, clopidogrel, and vitamin K antagonists are widely used in patients after myocardial infarction. However, data for the safety of combinations are sparse. We examined the risk of hospital admission for bleeding associated with different antithrombotic regimens. ...

  5. Story: A Bleeding Watermelon

    Nor bzang

    2010-12-01

    Full Text Available A Bleeding Watermelon was written by Norsang (Nor bzang;b. 1988, a native of Dpa ris (Rab rgyas (Huazangsi 华藏寺 Township, Tianzhu 天祝 Tibetan Autonomous County,Gansu 甘肃 Province. Norsang writes: I heard that a university student opened an elevator door in a campus building still under construction. The elevator shaft was empty and he fell to his death. Many people had questions about his death. This inspired me to write this story.

  6. Prothrombin complex concentrate for reversal of vitamin K antagonist treatment in bleeding and non-bleeding patients

    Johansen, Mathias; Wikkelsø, Anne; Lunde, Jens;

    2015-01-01

    well as patients at high risk of bleeding. Evidence is lacking regarding indication, dosing, efficacy and safety. OBJECTIVES: We assessed the benefits and harms of PCC compared with fresh frozen plasma in the acute medical and surgical setting involving vitamin K antagonist-treated bleeding and non......BACKGROUND: Treatment with vitamin K antagonists is associated with increased morbidity and mortality. Reversal therapy with prothrombin complex concentrate (PCC) is used increasingly and is recommended in the treatment of patients with bleeding complications undertaking surgical interventions, as......-bleeding patients. We investigated various outcomes and predefined subgroups and performed sensitivity analysis. We examined risks of bias and applied trial sequential analyses (TSA) to examine the level of evidence, and we prepared a 'Risk of bias' table to test the quality of the evidence. SEARCH METHODS: We...

  7. Dysfunctional uterine bleeding (DUB).

    Bulletti, C; Flamigni, C; Prefetto, R A; Polli, V; Giacomucci, E

    1994-09-30

    Cyclic or irregular uterine bleeding is common in perimenarchal and perimenopausal women with or without endometrial hyperplasia. The disturbance often requires surgical treatment because of its negative effects on both blood loss and abnormal endometrial growth including the development of endometrial cancer. The endometrium is often overstimulated during the perimenopausal period when estrogen/progesterone production is unbalanced. A therapeutical approach with gonadotropin-releasing hormone agonist (GnRHa) was proposed in a depot formulation (Zoladex) that induces a sustained and reversible ovarian suppression. To avoid the risk of osteoporosis and to obtain adequate endometrial proliferation and differentiation during ovarian suppression, transdermal 17-beta-estradiol and oral progestin were administered. Results of 20 cases versus 20 controls showed a reduction of metrorrhagia, a normalization of hemoglobin plasma concentration, and an adequate proliferation and secretory differentiation of the endometrium of patients with abnormal endometrial growth. Abnormal uterine bleeding is mainly due to uterine fibrosis and an inadequate estrogen and/or progesterone production or to a disordered estrogen transport from blood into the endometrium. In premenopausal women, endometrial hyperplasia may be part of a continuum that is ultimately manifested in the histological and biological pattern of endometrial carcinoma. The regression of endometrial hyperplasia obtained by using the therapeutic regimen mentioned above represents a preventive measure for endometrial cancer. Finally the normalization of blood loss offers a good medical alternative to surgery for patients with DUB. PMID:7978956

  8. Does recombinant human erythropoietin accelerate correction of post-ulcer-bleeding anaemia A pilot study

    Ladas, Spiros D.; Polymeros, Dimitrios; Pagonis, Thomas; Triantafyllou, Konstantinos; Paspatis, Gregorios; Hatziargiriou, Maria; Raptis, Sotirios A.

    2004-01-01

    AIM: Anaemia caused by acute upper gastrointestinal bleeding is treated with blood transfusion or iron, but patients usually face a two-month recovery period from post-haemorrhage anaemia. This prospective, randomised, open, pilot study was designed to investigate whether recombinant human erythropoietin (Epoetin) therapy accelerate haematocrit increase in the post-bleeding recovery period.

  9. Coronary interventions in patients with bleeding and bleeding tendency

    Thach Nguyen; Lan Nguyen

    2007-01-01

    @@ In general, percutaneous coronary intervention (PCI)is contra-indicated in patients with bleeding and those that are easy to bleed because during PCI the patients need full anticoagulation to counter any thrombotic formation caused by introduction and manipulation of devices in the vascular system.

  10. Preventive Effect of Periplaneta Americana Extract on Stress Ulcer Bleeding in Patients with Acute Lung Injury or Acute Respiratory Distress Syndrome%美洲大蠊提取物对急性肺损伤/急性呼吸窘迫综合征患者应激性溃疡出血的预防作用

    张宏伟; 魏立友; 张振宇; 刘淑正; 张静

    2012-01-01

    目的 探讨美洲大蠊提取物对急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者应激性溃疡出血的预防作用.方法 选取2009年1月-2010年1月我院中心ICU住院的严重创伤后ALI/ARDS患者64例为研究对象,随机数字表法分为治疗组和对照组,各32例,对照组给予积极常规综合治疗,治疗组在常规综合治疗基础上,于入院当天给予美洲大蠊提取物康复新液预防应激性溃疡出血,经胃管注入,10 ml/次,3次/d,连用7 d.分别于给药前及给药第7天,测定胃液pH值,测定氧分压,计算氧合指数(PaO2/FiO2);同时记录两组应激性溃疡出血发生率及病死率.结果 治疗前,两组患者胃液pH值、PaO2/FiO2比较,差异均无统计学意义(P>0.05);治疗后,两组患者胃液pH值、PaO2/FiO2比较,差异均有统计学意义(P<0.05).两组患者应激性溃疡出血发生率比较,差异有统计学意义(P<0.05);两组患者病死率比较,差异无统计学意义(P>0.05).结论 美洲大蠊提取物可改善ALI/ARDS患者胃液pH值、PaO2/FiO2,对应激性溃疡出血有预防作用.%Objective To study the preventive effect of periplaneta americana extract on stress ulcer bleeding in patients with acute lung injury and acute respiratory distress syndrome. Methods 64 in - patients with acute lung injury ( ALI ) or acute respiratory distress syndrome ( ARDS ) hospitalized in ICU from January 2009 to January 2010 were randomly divided into treatment group and control group with each group 32 cases. The control group was given positive routine treatment, while the treatment group was given periplaneta americana extract on the admission day to prevent stress ulcer bleeding in addition to routine treatment. The periplaneta americana extract was injected via gastronomy tube by 10 ml per time for seven consecutive days with each day three times. The pH value of gastric juice and oxygen partial pressure were detected before treatment and seven days after

  11. Differences in bleeding behavior after endoscopic band ligation: a retrospective analysis

    Schiefke Ingolf

    2010-01-01

    Full Text Available Abstract Background Endoscopic band ligation (EBL is generally accepted as the treatment of choice for bleeding from esophageal varices. It is also used for secondary prophylaxis of esophageal variceal hemorrhage. However, there is no data or guidelines concerning endoscopic control of ligation ulcers. We conducted a retrospective study of EBL procedures analyzing bleeding complications after EBL. Methods We retrospectively analyzed data from patients who underwent EBL. We analyzed several data points, including indication for the procedure, bleeding events and the time interval between EBL and bleeding. Results 255 patients and 387 ligation sessions were included in the analysis. We observed an overall bleeding rate after EBL of 7.8%. Bleeding events after elective treatment (3.9% were significantly lower than those after treatment for acute variceal hemorrhage (12.1%. The number of bleeding events from ligation ulcers and variceal rebleeding was 14 and 15, respectively. The bleeding rate from the ligation site in the group who underwent emergency ligation was 7.1% and 0.5% in the group who underwent elective ligation. Incidence of variceal rebleeding did not vary significantly. Seventy-five percent of all bleeding episodes after elective treatment occurred within four days after EBL. 20/22 of bleeding events after emergency ligation occured within 11 days after treatment. Elective EBL has a lower risk of bleeding from treatment-induced ulceration than emergency ligation. Conclusions Patients who underwent EBL for treatment of acute variceal bleeding should be kept under medical surveillance for 11 days. After elective EBL, it may be reasonable to restrict the period of surveillance to four days or even perform the procedure in an out-patient setting.

  12. Fibrinogen concentrate in bleeding patients

    Wikkelsø, Anne; Lunde, Jens; Johansen, Mathias;

    2013-01-01

    Hypofibrinogenaemia is associated with increased morbidity and mortality, but the optimal treatment level, the use of preemptive treatment and the preferred source of fibrinogen remain disputed. Fibrinogen concentrate is increasingly used and recommended for bleeding with acquired haemostatic...

  13. Computed tomography angiography in patients with active gastrointestinal bleeding

    Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding. (author)

  14. Computed tomography angiography in patients with active gastrointestinal bleeding

    Reis, Fatima Regina Silva; D' Ippolito, Giuseppe, E-mail: fatima.rsreis@gmail.com [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina; Cardia, P.P. [Hospital Vera Cruz, Campinas, SP (Brazil)

    2015-11-15

    Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding. (author)

  15. Update on the transfusion in gastrointestinal bleeding (TRIGGER) trial: statistical analysis plan for a cluster-randomised feasibility trial

    Kahan, B. C.; Jairath, V; Murphy, M F; Doré, C. J.

    2013-01-01

    Background Previous research has suggested an association between more liberal red blood cell (RBC) transfusion and greater risk of further bleeding and mortality following acute upper gastrointestinal bleeding (AUGIB). Methods and design The Transfusion in Gastrointestinal Bleeding (TRIGGER) trial is a pragmatic cluster-randomised feasibility trial which aims to evaluate the feasibility of implementing a restrictive vs. liberal RBC transfusion policy for adult patients admitted to hospital w...

  16. Acute GI bleeding by multiple jejunal gastrointestinal autonomic nerve tumour associated with neurofibromatosis type I Urgencia quirúrgica por sangrado intestinal debido a tumor intestinal de nervios autónomos asociados a neurofibromatosis tipo I

    M. Keese

    2007-10-01

    Full Text Available We describe a surgical emergency due to GI-bleeding caused by gastrointestinal autonomic nerve tumours (GANT's in a patient with von Recklinghausen's disease. A 72 year old female patient with von Recklinghausen's disease was admitted with maelena. Endoscopy showed no active bleeding in the stomach and the colon. Therefore an angio-CT-scan was performed which revealed masses of the proximal jejunum as source of bleeding. Laparotomy was indicated and a 20 cm segment of jejunum which carried multiple extraluminal tumours was resected. The source of the bleeding was a 2 cm tumour which had eroded the mucosal surface. Immunohistologically, evidence of neuronal differentiation could be shown in the spindle-formed cells with positive staining for C-Kit (CD 117, CD 34, and a locally positive staining for synaptophysine and S100. This case report illustrates the association between neurofibromatosis and stromal tumours and should alert surgeons and gastroenterologist about gastrointestinal manifestations in patients with von Recklinghausen's disease.Se describe una urgencia quirúrgica por sangrado intestinal debido a tumor gastrointestinal de nervios autónomos (GANT asociado a enfermedad de von Recklinghausen. Una mujer de 72 años con neurofibromatosis fue ingresada con signos de melena. La endoscopia digestiva alta y baja fue negativa. Se indicó TAC con contraste que advirtió tumores yeyunales como causa del sangrado. Se realizó laparotomía y resección de un segmento de 20 cm de yeyuno que incluía varios tumores. La causa del sangrado activo fue lesión en mucosa intestinal por erosión tumoral. El análisis por inmunohistoquímica de la pieza mostró diferenciación neuronal, con células fusiformes con tinción positiva para el C-Kit (CD 117, CD 34. Esta nota clínica pone de manifiesto la asociación entre la neurofibromatosis y los tumores estromales y debe alertar a gastroenterólogos y cirujanos sobre las posibles manifestaciones

  17. Endoscopic Management of Diverticular Bleeding

    Tarun Rustagi

    2014-01-01

    Full Text Available Diverticular hemorrhage is the most common reason for lower gastrointestinal bleeding (LGIB with substantial cost of hospitalization and a median length of hospital stay of 3 days. Bleeding usually is self-limited in 70–80% of cases but early rebleeding is not an uncommon problem that can be reduced with proper endoscopic therapies. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed by interventional endotherapy including injection, heat cautery, clip placement, and ligation to achieve endoscopic hemostasis. This review will serve to highlight the various interventions available to endoscopists with specific emphasis on superior modalities in the endoscopic management of diverticular bleeding.

  18. [Direct oral anticoagulant associated bleeding].

    Godier, A; Martin, A-C; Rosencher, N; Susen, S

    2016-07-01

    Direct oral anticoagulants (DOAC) are recommended for stroke prevention in atrial fibrillation and for the treatment of venous thromboembolism. However, they are associated with hemorrhagic complications. Management of DOAC-induced bleeding remains challenging. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. Therapeutic options also include antidotes: idarucizumab, antidote for dabigatran, has been approved for use whereas andexanet alpha, antidote for anti-Xa agents, and aripazine, antidote for all DOAC, are under development. Other options include hemodialysis for the treatment of dabigatran-associated bleeding and administration of oral charcoal if recent DOAC ingestion. DOAC plasma concentration measurement is necessary to guide DOAC reversal. We propose an update on DOAC-associated bleeding, integrating the availability of dabigatran antidote and the critical place of DOAC concentration measurements. PMID:27297642

  19. Microcirculatory remodeling in marginal zone of duodenal ulcer after bleeding

    Sulayeva О.N.

    2009-01-01

    Full Text Available To estimate objectively vessels network remodeling in duodenal mucosa after ulcer bleeding the morphometric analysis of marginal ulcer zone biopsies was performed in 32 patients. It was shown that reparation is accompanied with chronic inflammation and acute alteration of microcirculation. Injection hemostasis led to enhancement of microcirculation, development of edema and ischemic alteration of mucosal tissues. Acute neutrophilic infiltration during 1 day was changed on 3 day with granular tissue development and angiogenesis stimulation. Intensification and prolongation of angiogenesis paral-leled with lymphocytes infiltration after 7 days resulted to villi dysmorphogenesis and changes in cellular content of intestinal epithelium.

  20. The Clinical Outcomes of Transcatheter Microcoil Embolization in Patients with Active Lower Gastrointestinal Bleeding in the Small Bowel

    Kwak, Hyo Sung; Han, Young Min; Lee, Soo Teik [Chonbuk National University, Jeonju (Korea, Republic of)

    2009-08-15

    To assess the clinical outcomes of the transcatheter microcoil embolization in patients with active lower gastrointestinal (LGI) bleeding in the small bowel, as well as to compare the mortality rates between the two groups based on the visualization or non-visualization of the bleeding focus determined by an angiography. We retrospectively evaluated all of the consecutive patients who underwent an angiography for treatment of acute LGI bleeding between January 2003 and October 2007. In total, the study included 36 patients who underwent a colonoscopy and were diagnosed to have an active bleeding in the LGI tracts. Based on the visualization or non-visualization of the bleeding focus, determined by an angiography, the patients were classified into two groups. The clinical outcomes included technical success, clinical success (no rebleeding within 30 days), delayed rebleeding (> 30 days), as well as the major and minor complication rates. Of the 36 patients, 17 had angiography-proven bleeding that was distal to the marginal artery. The remaining 19 patients did not have a bleeding focus based on the angiography results. The technical and clinical success rates of performing transcatheter microcoil embolizations in patients with active bleeding were 100% and 88%, respectively (15 of 17). One patient died from continued LGI bleeding and one patient received surgery to treat the continued bleeding. There was no note made on the delayed bleeding or on the major or minor complications. Of the 19 patients without active bleeding, 16 (84%) did not have recurrent bleeding. One patient died due to continuous bleeding and multi-organ failure. The superselective microcoil embolization can help successfully treat patients with active LGI bleeding in the small bowel, identified by the results of an angiography. The mortality rate is not significantly different between the patients of the visualization and non-visualization groups on angiography.

  1. Pantoprazole for the Treatment of Peptic Ulcer Bleeding and Prevention of Rebleeding

    Susan Cheer; Van Rensburg, Christo J

    2012-01-01

    Adding proton pump inhibitors (PPIs) to endoscopic therapy has become the mainstay of treatment for peptic ulcer bleeding, with current consensus guidelines recommending high-dose intravenous (IV) PPI therapy (IV bolus followed by continuous therapy). However, whether or not high-dose PPI therapy is more effective than low-dose PPI therapy is still debated. Furthermore, maintaining pH ≥ 4 appears to prevent mucosal bleeding in patients with acute stress ulcers; thus, stress ulcer prophylaxis ...

  2. Gastrointestinal Bleeding Secondary to Calciphylaxis.

    Gupta, Nancy; Haq, Khwaja F; Mahajan, Sugandhi; Nagpal, Prashant; Doshi, Bijal

    2015-01-01

    BACKGROUND Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. CASE REPORT A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. CONCLUSIONS Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding. PMID:26572938

  3. Management of bleeding gastroduodenal ulcers

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B

    2012-01-01

    Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved by the...

  4. Bleeding events with dabigatran or warfarin in patients with venous thromboembolism.

    Majeed, Ammar; Goldhaber, Samuel Z; Kakkar, Ajay; Kearon, Clive; Eriksson, Henry; Kreuzer, Jörg; Feuring, Martin; Hantel, Stephan; Friedman, Jeffrey; Schellong, Sebastian; Schulman, Sam

    2016-01-01

    Dabigatran was as effective as warfarin for the acute treatment of venous thromboembolism in the RE-COVER and RE-COVER II trials. We compared the incidence of bleeding with dabigatran versus warfarin in pooled data from these studies. The localisation, bleeding severity, and the impact of key factors on the incidence of bleeding, were compared between the dabigatran and warfarin treatment group. Altogether, 2553 patients received dabigatran and 2554 warfarin, each for a mean of 164 days. The incidence of any bleeding event was significantly lower with dabigatran (hazard ratio [HR] 0.70; 95% confidence interval [CI], 0.61-0.79), as was the incidence of the composite of MBEs and clinically relevant non-major bleeding events (HR 0.62; 95% CI, 0.50-0.76). The incidence of major bleeding events (MBEs) was also significantly lower with dabigatran in the double-dummy phase (HR, 0.60; 95%CI, 0.36-0.99) but not statistically different between the two treatment arms when the entire treatment period is considered (HR 0.73 95% CI, 0.48-1.11). Increasing age, reduced renal function, Asian ethnicity, and concomitant antiplatelet therapy were associated with higher bleeding rates in both treatment groups. The reduction in bleeding with dabigatran compared to warfarin was consistent among the subgroups and with a similar pattern for intracranial, and urogenital major bleeding. In conclusion, treatment of venous thromboembolism with dabigatran is associated with a lower risk of bleeding compared to warfarin. This reduction did not differ with respect to the location of bleeding or among predefined subgroups. PMID:26403199

  5. Prevalence and risk factors of stress-induced gastrointestinal bleeding in critically ill children

    Chookhuan Nithiwathanapong; Sanit Reungrongrat; Nuthapong Ukarapol

    2005-01-01

    AIM: To assess the frequency and the risk factors of stress-induced gastrointestinal (GI) bleeding in children admitted to a pediatric intensive care unit (PICU).METHODS: The medical records of children aged between 1 month and 15 years admitted to the PICU between January 2002 and December 2002 were reviewed.Demographic data, indications for PICU admission, principle diagnosis, and basic laboratory investigations were recorded. Previously described factors for stress ulcer bleeding (mechanical ventilation, sepsis, acute respiratory distress syndrome, renal insufficiency, coagulopathy,thrombocytopenia, and intracranial pathology) were used as independent variables in a multivariate analysis.RESULTS: One hundred and seventy of two hundred and five medical records were eligible for review. The most common indication for PICU admission was respiratory failure (48.8%). Twenty-five children received stress ulcer bleeding prophylaxis with ranitidine. The incidence of stress ulcer bleeding was 43.5%, in which 5.3% were clinically significant bleeding. Only mechanical ventilation and thrombocytopenia were significantly associated with stress ulcer bleeding using the univariate analysis.The odds ratio and 95% confidence intervals were 5.13(1.86-14.12) and 2.26 (1.07-4.74), respectively. However, the logistic regression analysis showed that mechanicai ventilation was the only significant risk factor with the odds ratio of 14.1.CONCLUSION: The incidence of gastrointestinal bleeding was high in critically ill children. Mechanical ventilation was an important risk factor for gastrointestinal bleeding.

  6. Detection and localization of lower gastrointestinal bleeding site with scintigraphic techniques

    Successful management of acute gastrointestinal (GI) bleeding frequently depends on accurate localization of the bleeding site. History and clinical findings are often misleading in localizing the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provides accurate diagnoses for the majority of patients with upper GI tract hemorrhage, but lower GI bleeding still is a serious diagnostic problem. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases, has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding. Since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. Repeated angiography to pursue recurrent episodes of bleeding is impractical. Because of these shortcomings, in the past decade several noninvasive scintigraphic techniques have been developed to detect and localize sites of GI bleeding. In this chapter the authors discuss details related to the technetium 99m sulfur colloid (Tc-SC) and technetium 99m-labeled red blood cell (Tc-RBC) techniques

  7. An unusual cause of gastrointestinal bleed

    C K Adarsh

    2014-01-01

    Full Text Available Gastrointestinal (GI bleed often brings the patient to the emergency medical service with great anxiety. Known common causes of GI bleed include ulcers, varices, Mallory-Weiss among others. All causes of GI bleed should be considered however unusual during the evaluation. Aortoenteric fistula (AEF is one of the unusual causes of GI bleed, which has to be considered especially in patients with a history of abdominal surgery in general and aortic surgery in particular.

  8. Vitamin K deficiency bleeding of the newborn

    Vitamin K deficiency bleeding of the newborn (VKDB) is a bleeding disorder in babies. It most often develops shortly ... A lack of vitamin K may cause severe bleeding in newborn babies. Vitamin K plays an important role in blood clotting. Babies often have a ...

  9. Obscure gastrointestinal bleeding: preoperative CT-guided percutaneous needle localization of the bleeding small bowel segment.

    Heiss, Peter; Feuerbach, Stefan; Iesalnieks, Igors; Rockmann, Felix; Wrede, Christian E; Zorger, Niels; Schlitt, Hans J; Schölmerich, Jürgen; Hamer, Okka W

    2009-04-01

    A 57-year-old woman presented with obscure gastrointestinal bleeding. Double balloon enteroscopy, angiography, and surgery including intraoperative enteroscopy failed to identify the bleeding site. Multidetector computed tomography (CT) depicted active bleeding of a small bowel segment. The bleeding segment was localized by CT-guided percutaneous needle insertion and subsequently removed surgically. PMID:19328430

  10. Platelet Function Tests in Bleeding Disorders.

    Lassila, Riitta

    2016-04-01

    primarily aims at better management of hemostasis in case of emergency surgery or other interventions and acute bleeding events. PMID:26886396

  11. Management of severe perioperative bleeding

    Kozek-Langenecker, Sibylle A; Afshari, Arash; Albaladejo, Pierre;

    2013-01-01

    The aims of severe perioperative bleeding management are three-fold. First, preoperative identification by anamesis and laboratory testing of those patients for whom the perioperative bleeding risk may be increased. Second, implementation of strategies for correcting preoperative anaemia and...... with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of scientific...... cross-sectional surveys were selected. At the suggestion of the ESA Guideline Committee, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was initially used to assess the level of evidence and to grade recommendations. During the process of guideline development, the official...

  12. Role of videocapsule endoscopy for gastrointestinal bleeding

    Cristina Carretero; Ignacio Fernandez-Urien; Maite Betes; Miguel Mu(n)oz-Navas

    2008-01-01

    Obscure gastrointestinal bleeding (OGIB) is defined as bleeding of an unknown origin that persists or recurs after negative initial upper and lower endoscopies.Several techniques,such as endoscopy,arteriography,scintigraphy and barium radiology are helpful for recognizing the bleeding source;nevertheless,in about 5%-10% of cases the bleeding lesion cannot be determined.The development of videocapsule endoscopy (VCE) has permitted a direct visualization of the small intestine mucosa.We will analyze those techniques in more detail.The diagnostic yield of CE for OGIB varies from 38% to 93%,being in the higher range in those cases with obscure-overt bleeding.

  13. Scintigraphic diagnosis of lower GI bleeding

    Abdominal scintigraphy with 99mTc HSA, 99mTc Sn colloid, or 99mTc RBC was performed in 28 patients with melena to detect bleeding and determine the bleeding site in the lower gastrointestinal tract. Active bleedings and/or vascular lesions were identified in 16 patients. They were proved by antiography, endoscopy or barium enema in 14. We concluded that scintigraphy was an accurate and effective method to detect the bleeding and determine the bleeding site in the lower gastrointestinal tract. (author)

  14. Resuscitation of Polytrauma Patients: The Management of Massive Skeletal Bleeding.

    Guerado, Enrique; Bertrand, Maria Luisa; Valdes, Luis; Cruz, Encarnacion; Cano, Juan Ramon

    2015-01-01

    The term 'severely injured patient' is often synonymous of polytrauma patient, multiply-injured patient or, in some settings, polyfractured patient. Together with brain trauma, copious bleeding is the most severe complication of polytrauma. Consequently hypotension develop. Then, the perfusion of organs may be compromised, with the risk of organ failure. Treatment of chest bleeding after trauma is essential and is mainly addressed via surgical manoeuvres. As in the case of lesions to the pelvis, abdomen or extremities, this approach demonstrates the application of damage control (DC). The introduction of sonography has dramatically changed the diagnosis and prognosis of abdominal bleeding. In stable patients, a contrast CT-scan should be performed before any x-ray projection, because, in an emergency situation, spinal or pelvic fractures be missed by conventional radiological studies. Fractures or dislocation of the pelvis causing enlargement of the pelvic cavity, provoked by an anteroposterior trauma, and in particular cases presenting vertical instability, are the most severe types and require fast stabilisation by closing the pelvic ring diameter to normal dimensions and by stabilising the vertical shear. Controversy still exists about whether angiography or packing should be used as the first choice to address active bleeding after pelvic ring closure. Pelvic angiography plays a significant complementary role to pelvic packing for final haemorrhage control. Apart from pelvic trauma, fracture of the femur is the only fracture provoking acute life-threatening bleeding. If possible, femur fractures should be immobilised immediately, either by external fixation or by a sheet wrap around both extremities. PMID:26312112

  15. Vascular gastric anomalies as a cause of relapsing bleeding

    Golubović Gradimir

    2008-01-01

    Full Text Available Background. Although relatively rare, gastric vascular anomalies can be recognized as a source of both chronic and acute blood loss, most often presenting as long term iron deficiency anemia, rarely as severe acute gastrointestinal bleeding. Case report. We present five patients with various gastric vascular anomalies, diagnosed during the year of 2003. in the Clinical Hospital Center Zemun. The diagnosis was based on endoscopic appearances, clinical history and characteristic histological findings. Gastric vascular anomalies presented in our review were: portal hypertensive gastropathy, gastric antral vascular ectasia, angiodysplasia, hereditary hemorrhagic telangiectasia and Dieulafoy lesion. The used treatment modalities included surgery and various endoscopic techniques (schlerotherapy, argon plasma coagulation. Conclusion. Patients presented with chronic iron deficiency anemia or acute and recurrent gastrointestinal hemorrhage should be considered as having one of gastric vascular anomalies.

  16. Bleeding

    ... Latex gloves should be in every first aid kit. People allergic to latex can use a nonlatex glove. You can catch viral hepatitis if you touch infected blood. HIV can be spread if infected blood gets into ...

  17. Recurrent Renal Cell Carcinoma with Synchronous Tumor Growth in Azygoesophageal Recess and Duodenum: A Rare Cause of Anemia and Upper Gastrointestinal Bleeding

    Vootla, Vamshidhar R.; Kashif, Muhammad; Niazi, Masooma; Nayudu, Suresh K.

    2015-01-01

    Renal cell carcinoma (RCC) has potential to present with distant metastasis several years after complete resection. The common sites of metastases include the lungs, bones, liver, renal fossa, and brain. RCCs metastasize rarely to the duodenum, and duodenal metastasis presenting with acute gastrointestinal bleed is infrequently reported in literature. We present a case of synchronous presentation of duodenal and azygoesophageal metastasis manifesting as acute upper gastrointestinal bleeding, four years after undergoing nephrectomy for RCC. The patient underwent further workup and was treated with radiation. The synchronous presentation is rare and stresses the importance of searching for recurrence of RCC in patients presenting with acute gastrointestinal bleeding. PMID:26640732

  18. Valoración del pronóstico a corto y largo plazo de pacientes con cirrosis y hemorragia digestiva por hipertensión portal Assessing the short- and long-term prognosis of patients with cirrhosis and acute variceal bleeding

    L. Sempere

    2009-04-01

    -term survival in patients with cirrhosis and acute variceal bleeding. Material and methods: prognostic indicators were calculated for a cohort of 201 cirrhotic patients with acute variceal bleeding hospitalized in our center, a third-level teaching hospital. The studied variables were: age, sex, etiology of cirrhosis, endoscopic findings, previous variceal bleeding episodes, human immunodeficiency virus (HIV infection, hepatocellular carcinoma (HCC, infection during episode, and Child-Turcotte-Pugh (CTP and Model for End-stage Liver Disease (MELD scores within 24 hours of bleeding onset. Patients were followed up for at least 6 months until death, liver transplantation, or end of observation. Results: median follow-up was 66.85 weeks (range 0-432.4. The 6-week, 3-month, 12-month and 36-month mortality rates were 22.9, 24.9, 34.3, and 39.8%, respectively. Age ≥ 65 years, presence of HCC, CTP score ≥ 10, and MELD score ≥ 18 were the variables associated with mortality in the multivariate analysis. The accuracy of MELD scores as predictors of 6-week, 3-month, 12-month, and 36-month mortality was better than that of CTP scores (c-statistics: 6 week MELD 0.804, CTP 0.762; 3-month MELD 0.794, CTP 0.760; 12-month MELD 0.766, CTP 0.741; 36 month MELD 0.737, CTP 0.717. Conclusion: MELD and CTP scores together with age and a diagnosis of hepatocellular carcinoma are useful indicators to assess the short- and long-term prognosis of patients with acute variceal bleeding.

  19. A STUDY ON ENDOSCOPIC EVALUATION OF UPPER GASTROINTESTINAL BLEEDING

    Pranaya Kumar

    2016-03-01

    Full Text Available CONTEXT Upper gastrointestinal bleeding (UGIB is one of the commonest gastrointestinal emergencies encountered by clinicians. Peptic ulcers are the most common cause of UGIB. Endoscopy has become the preferred method for diagnosis in patients with acute UGIB. This study is done in a diagnostic upper gastrointestinal endoscopy (UGIE setup of a tertiary care hospital to ascertain the causes of UGIB prevalent in this part of our country which might differ from other studies. AIM To ascertain prevalent causes of UGIB in patients of this part of India admitted to a Govt. Tertiary Hospital with a provisional diagnosis of UGIB. METHOD One hundred consecutive patients with UGIB were subjected to UGIE to find out the aetiology. The clinical profile and endoscopic findings were analysed and compared with the data on UGIB from other studies. RESULTS The mean age of patients was 47.03 years with male: female ratio of 2.33:1. 58% of patients were first time bleeders. Majority of patients presented with melaena. Visualisation of active bleeding achieved to 85.7% when endoscopy was done within first 24 hrs. The commonest cause of UGIB was duodenal ulcer (DU which accounted for 41% cases. Gastric ulcer was responsible in 13% of cases. Portal hypertension was responsible for bleed in only 13%. Neoplasms accounted for 25% of cases. Other less common causes were erosive gastritis (3%, gastric polyp (3%, Mallory-Weiss tear (1%, and Dieulafoy’s lesion (1%. Among bleeding peptic ulcers, 27.8% of cases were classified as Forrest IIa and 20.4% in Forrest IIb & IIc each. Acid peptic disease was past history elicited in majority (33% followed by NSAID (26% and alcohol (26%. CONCLUSION The present study has diagnosed various causes of upper gastrointestinal bleeding in this part of country. The incidence of gastric carcinoma as a cause of upper gastrointestinal bleeding is significantly high compared to those in other studies. UGI endoscopy should be done in every case

  20. The practical management of bleedings during treatment with direct oral anticoagulants: the emergency reversal therapy

    Luca Masotti

    2013-12-01

    Full Text Available Bleeding represents the most feared complication of the new oral anticoagulants, direct oral anticoagulants (DOACs, as well as all the antithrombotic therapies. During the acute phase of bleeding in patients taking anticoagulants, restoration of an effective hemostasis represents the cornerstone of practical management. While vitamin K antagonists are effectively and promptly reversed by specific antidotes such as prothrombin complex concentrates (PCCs, fresh frozen plasma or vitamin K, it is still not clear how to manage the urgent reversal of DOACs during life-threatening or major bleedings due to the lack of specific antidotes. However, in vitro and ex vivo studies have suggested some potential strategies to reverse DOACs in clinical practice, other than general support measures that are always recommended. Activated charcoal could be used in subjects with DOAC-related bleedings presenting to the emergency department within two hours of the last oral intake. Non-activated or activated PCCs (FEIBA and recombinant activated Factor VII (raFVII seem to be the optimal strategy for urgent reversal of dabigatran, while non-activated PCCs seem to have efficacy in reversing rivaroxaban. Due to its low plasma protein binding, dabigatran could be also dialyzed in urgent cases. Clinically relevant non-major bleedings and minor bleedings should be treated with general and local measures, respectively, and, when necessary, with dose delay or drug withdrawal. In this article, the Authors describe the practical approach to bleedings occurring during DOACs treatment.

  1. Epinephrine plus argon plasma or heater probe coagulation in ulcer bleeding

    Ahmet Karaman; Mevlut Baskol; Sebnem Gursoy; Edip Torun; Alper Yurci; Banu Demet Ozel; Kadri Guven; Omer Ozbakir; Mehmet Yucesoy

    2011-01-01

    AIM: To compare the effectiveness of argon plasma coagulation (APC) and heater probe coagulation (HPC) in non-variceal upper gastrointestinal bleeding. METHODS: Eighty-five (18 female, 67 male) patients admitted for acute gastrointestinal bleeding due to gastric or duodenal ulcer were included in the study. Upper endoscopy was performed and HPC or APC were chosen randomly to stop the bleeding. Initial hemostasis and rebleeding rates were primary and secondary end-points of the study. RESULTS: Initial hemostasis was achieved in 97.7% (42/43) and 81% (36/42) of the APC and HPC groups, respectively (P 0.05). CONCLUSION: APC is an effective hemostatic method in bleeding peptic ulcers. Larger multicenter trials are necessary to confirm these results.

  2. Bleeding Risk, Management and Outcome in Patients Receiving Non-VKA Oral Anticoagulants (NOACs).

    Werth, Sebastian; Breslin, Tomás; NiAinle, Fionnuala; Beyer-Westendorf, Jan

    2015-08-01

    Modern direct-acting anticoagulants are rapidly replacing vitamin K antagonists (VKA) in the management of millions of patients worldwide who require anticoagulation. These drugs include agents that inhibit activated factor X (FXa) (such as apixaban and rivaroxaban) or thrombin (such as dabigatran), and are collectively known today as non-VKA oral anticoagulants (NOACs). Since bleeding is the most common and most dangerous side effect of long-term anticoagulation, and because NOACs have very different mechanisms of action and pharmacokinetics compared with VKA, physicians are naturally concerned about the lack of experience regarding frequency, management and outcome of NOAC-associated bleeding in daily care. This review appraises trial and registry (or "real-world") data pertaining to bleeding complications in patients taking NOACs and VKA and provides practical recommendations for the management of acute bleeding situations. PMID:25940651

  3. Management of bleeding gastroduodenal ulcers

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B.

    2012-01-01

    serious ulcer bleeding is suspected and blood found in gastric aspirate, endoscopy within 12 hours will result in faster discharge and reduced need for transfusions. Endoscopic hemostasis remains indicated for high-risk lesions. Clips, thermocoagulation, and epinephrine injection are effective in...... achieving endoscopic hemostasis. Use of endoscopic monotherapy with epinephrine injection is not recommended. Intravenous high-dose proton pump inhibitor (PPI) therapy for 72 hours after successful endoscopic hemostasis is recommended as it decreases both rebleeding rate and mortality in patients with high...

  4. Bleeding complications of femoral catheterization

    CT has been used to evaluate hematomas resulting from femoral catheterization (percutaneous transluminal coronary angioplasty, cardiac catheterization, angioplasty, valvuloplasty, and venous access) in 21 patients. Four distinct types of hematoma have been identified: retroperitoneal (N = 12); intraperitoneal (N = 3); groin/thigh (N = 9); and abdominal wall (N = 5). Seven patients had hematomas in two locations. CT contributed by estimating transfusion requirement, indicating the need for more intensive monitoring, and predicting the potential need for surgery. Type 1 and 2 bleeds were the most serious and had the most sequelae. Sequelae included transfusion in 17 patients (mean, 5 units/patient) and surgery in two patients

  5. [Diagnosis and therapy of bleeding in ENT].

    Schulz, T; Eßer, D

    2013-12-01

    Bleeding in the oral cavity, nose or ear are common events in the daily routine of ENT specialists. Apart from trivial cases that often get outpatient treatment, there are numerous cases of serious bleeding that require stationary treatment and if necessary, an operative or interventional therapy. In the following section the most frequent types of bleeding, their diagnosis and therapy will be explained. PMID:24285208

  6. Influence of variceal bleeding on natural history of ACLF and management options.

    Al-Mahtab, Mamun; Akbar, Sheikh Mohammad Fazle; Garg, Hitendra

    2016-05-01

    Patients with diagnosed and undiagnosed chronic liver diseases experience one or more acute assaults of a hepatic nature and develop a downhill course of liver diseases, a condition regarded as acute-on-chronic liver failure (ACLF). It is a medical emergency, the prognosis of ACLF is extremely bad and considerable numbers of patients with ACLF die even after diagnosis and receiving conservative treatment. ACLF is characterized by jaundice, coagulopathy, ascites and encephalopathy. ACLF patients are very sick and associated with different hemodynamic profiles and have very high 3-month mortality. As these groups of patients have high baseline hepatic venous pressure gradients, the chances of variceal bleed are also high, and the impact is also greater in comparison to stable cirrhosis; however, evidence is lacking to substantiate such effects. The aim of this review is to discuss the natural course of variceal bleeding in ACLF patients and to develop insights into the management of variceal bleeding in ACLF. PMID:26589951

  7. Cyclical rectal bleeding in colorectal endometriosis.

    Levitt, M D; Hodby, K J; van Merwyk, A J; Glancy, R J

    1989-12-01

    Three case reports of cyclical rectal bleeding in endometriosis affecting rectum and sigmoid colon emphasize the close relationship between such cyclical bleeding and intestinal endometriosis. The cause of bleeding, however, is still unclear. The predilection of endometriotic deposits for the outer layers of the bowel wall suggests that mucosal involvement is not a prerequisite for rectal bleeding. The frequent absence of identifiable intramural haemorrhage casts doubt on the premise that intestinal endometriotic deposits 'menstruate'. The cause may simply be a transient tear in normal mucosa due to swelling of an underlying endometriotic deposit at the time of menstruation. PMID:2597100

  8. Bleed condenser tube failure in KAPP-1

    Bleed condenser, a vertical, tube and shell type heat exchanger employed in bleed circuit of primary heat transport system of PHWR is used for condensing the flashing bleed (heavy water) on shell side and cold heavy water on the tubes side. Examinations conducted at various places indicate failure due to inadequate tube expansion (hydraulic expansion) followed by crevice corrosion. Mechanical rolling of tubes to larger extent (3 to 6% wall thinning) have been specified for this particular type of service in all bleed condensers for subsequent projects. 1 tab., 4 figs

  9. Diagnostic Strategies for Postmenopausal Bleeding

    M. C. Breijer

    2010-01-01

    Full Text Available Postmenopausal bleeding (PMB is a common clinical problem. Patients with PMB have 10%–15% chance of having endometrial carcinoma and therefore the diagnostic workup is aimed at excluding malignancy. Patient characteristics can alter the probability of having endometrial carcinoma in patients with PMB; in certain groups of patients the incidence has been reported to be as high as 29%. Transvaginal sonography (TVS is used as a first step in the diagnostic workup, but different authors have come to different conclusions assessing the accuracy of TVS for excluding endometrial carcinoma. Diagnostic procedures obtaining material for histological assessment (e.g., dilatation and curettage, hysteroscopy, and endometrial biopsy can be more accurate but are also more invasive. The best diagnostic strategy for diagnosing endometrial carcinoma in patients with PMB still remains controversial. Future research should be focussed on achieving a higher accuracy of different diagnostic strategies.

  10. First trimester bleeding and maternal cardiovascular morbidity

    Lykke, Jacob A; Langhoff-Roos, Jens

    2012-01-01

    First trimester bleeding without miscarriage is a risk factor for complications later in the pregnancy, such as preterm delivery. Also, first trimester miscarriage has been linked to subsequent maternal ischemic heart disease. We investigated the link between maternal cardiovascular disease prior...... to and subsequent to first trimester bleeding without miscarriage....

  11. Obstetric management of adolescents with bleeding disorders.

    James, Andra H

    2010-12-01

    Adolescents with bleeding disorders who become pregnant must contend with the dual challenges of their bleeding disorder and their pregnancy. Adolescents are more likely to terminate a pregnancy than adult women, and when they do carry a pregnancy, they are more likely to deliver prematurely. Otherwise, they are at risk for the same complications that adult women with bleeding disorders experience, particularly bleeding complications postpartum. Since one half to two thirds of adolescent pregnancies are unplanned, issues related to reproduction should be addressed during routine visits with the pediatrician, hematologist or gynecologist. Girls who are at risk of being carriers for hemophilia A and B, severe von Willebrand disease, and other severe bleeding disorders should have their bleeding disorder status determined before they become pregnant. During pregnancy, a plan should be established to ensure that both mother and fetus deliver safely. Young women at risk for severe bleeding or at risk of having a severely affected infant should be referred for prenatal care and delivery to a center where, in addition to specialists in high-risk obstetrics, there is a hemophilia treatment center or a hematologist with expertise in hemostasis. Prior to delivery or any invasive procedures, young women at risk for severe bleeding should receive prophylaxis. Since administration of desmopressin may result in hyponatremia, whenever available, virally inactivated or recombinant clotting factor concentrates should be used for replacement as opposed to fresh frozen plasma or cryoprecipitate. PMID:20934895

  12. Hemospray Application in Nonvariceal Upper Gastrointestinal Bleeding

    Smith, Lyn A; Stanley, Adrian J; Bergman, Jacques J; Kiesslich, Ralf; Hoffman, Arthur; Tjwa, Eric T; Kuipers, Ernst J; von Holstein, Christer Stael; Oberg, Stefan; Brullet, Enric; Schmidt, Palle N; Iqbal, Tariq; Mangiavillano, Benedetto; Masci, Enzo; Prat, Frederic; Morris, Allan J

    2014-01-01

    Hemospray TM (TC-325) is a novel hemostatic agent licensed for use in nonvariceal upper gastrointestinal bleeding (NVUGIB) in Europe.......Hemospray TM (TC-325) is a novel hemostatic agent licensed for use in nonvariceal upper gastrointestinal bleeding (NVUGIB) in Europe....

  13. Dramatic regression and bleeding of a duodenal GIST during preoperative imatinib therapy: case report and review

    Schwandner Thilo

    2010-06-01

    Full Text Available Abstract Background Gastrointestinal stromal tumors (GISTs are the most common mesenchymal tumors of the digestive tract. The majority of GISTs is located in the stomach. Only 3-5% of GISTs are located in the duodenum associated with an increased risk of gastrointestinal bleeding as primary manifestation. With response rates of up to 90%, but complications like bleeding due to tumor necrosis in 3%, imatinib mesylate dramatically altered the pre- and postoperative therapy for GIST patients. Case presentation A 58-year-old female patient presented with acute upper gastrointestinal bleeding 2 weeks after a giant GIST of the duodenum had been diagnosed. Neoadjuvant imatinib therapy had been initiated to achieve a tumor downsizing prior to surgery. During emergency laparotomy a partial duodenopancreatectomy was performed to achieve a complete resection of the mass. Histology revealed a high-malignancy GIST infiltrating the duodenal wall. Adjuvant imatinib therapy was initiated. At follow-up (19 months the patient is still alive and healthy. Conclusion Giant GISTs of the duodenum are rare and - in contrast to other localizations - harbour a higher risk of serious bleeding as primary manifestation. Tumor necrosis and tumor bleeding are rare but typical adverse effects of imatinib therapy especially during treatment of high-malignancy GIST. In GIST patients with increased risk of tumor bleeding neoadjuvant imatinib therapy should thoroughly be performed during hospitalization. In cases of duodenal GIST primary surgery should be considered as treatment alternative.

  14. Does recombinant human erythropoietin accelerate correction of post-ulcer-bleeding anaemia? A pilot study

    Spiros D. Ladas; Dimitrios Polymeros; Thomas Pagonis; Konstantinos Triantafyllou; Gregorios Paspatis; Maria Hatziargiriou; Sotirios A.Raptis

    2004-01-01

    AIM: Anaemia caused by acute upper gastrointestinal bleeding is treated with blood transfusion or iron, but patients usually face a two-month recovery period from posthaemorrhage anaemia. This prospective, randomised, open,pilot study was designed to investigate whether recombinant human erythropoietin (Epoetin) therapy accelerate haematocrit increase in the post-bleeding recovery period.METHODS: We studied hospitalised patients admitted because of acute ulcer bleeding or haemorrhagic gastritis,who had a haematocrit of 27-33% and did not receive blood transfusions. One day after the endoscopic confirmation of cessation of bleeding, they were randomised either to erythropoietin (20 000 IU Epoetin alfa subcutaneously, on days 0, 4 and 6) plus iron (100 mg im, on days 1- 6, (G1) or iron only (G2). Haematocrit was measured on days 0, 6, 14,30, 45, and 60, respectively.RESULTS: One patient from G1 and two from G2 were lost to follow-up. Therefore, 14 and 13 patients from G1 and G2respectively were analysed. Demographic characteristics, serum iron, ferritin, total iron binding capacity, reticulocytes, and haematocrit were not significantly different at entry to the study.Median reticulocyte counts were significantly different between groups on day six (G1: 4.0, 3.0-6.4 vsG2: 3.5, 2.1-4.4%,P=0.03) and median haematocrit on day fourteen [G1: 35.9,30.7-41.0 vsG2: 32.5, 29.5-37.0% (median, range), P=0.04].CONCLUSION: Erythropoietin administration significantly accelerates correction of anemia after acute ulcer bleeding.The haematocrit gain is equivalent to one unit of transfused blood two weeks after the bleeding episode.

  15. Usefulness of angiographic embolization endoscopic metallic clip placement in patient with non-variceal upper gastrointestinal bleeding

    Yoon, Min Jae; Hwang, Cheol Mog; Kim, Ho Jun; Cho, Young Jun; Bae, Seok Hwan [Dept. of Radiology, Konyang University Hospital, Daejeon (Korea, Republic of); Shin, Byung Seok; Ohm, Joon Young [Dept. of Radiology, Chungnam National University College of Medicine, Daejeon (Korea, Republic of); Kang, Chae Hoon [Dept. of Radiology, Inje University College of Medicine, Pusan Paik Hospital, Busan (Korea, Republic of)

    2013-08-15

    The aim of this study is to assess the usefulness of angiographic embolization after endoscopic metallic clip placement around the edge of non-variceal upper gastrointestinal bleeding ulcers. We have chosen 41 patients (mean age, 65.2 years) with acute bleeding ulcers (22 gastric ulcers, 16 duodenal ulcers, 3 malignant ulcers) between January 2010 and December 2012. We inserted metallic clips during the routine endoscopic treatments of the bleeding ulcers. Subsequent transcatheter arterial embolization was performed within 2 hours. We analyzed the angiographic positive rates, angiographic success rates and clinical success rates. Among the 41 patients during the angiography, 19 patients (46%) demonstrated active bleeding points. Both groups underwent embolization using microcoils, N-butyl-cyano-acrylate (NBCA), microcoils with NBCA or gelfoam particle. There are no statistically significant differences between these two groups according to which embolic materials are being used. The bleeding was initially stopped in all patients, except the two who experienced technical failures. Seven patients experienced repeated episodes of bleeding within two weeks. Among them, 4 patients were successful re-embolized. Another 3 patients underwent gastrectomy. Overall, clinical success was achieved in 36 of 41 (87.8%) patients. The endoscopic metallic clip placement was helpful to locate the correct target vessels for the angiographic embolization. In conclusion, this technique reduced re-bleeding rates, especially in patients who do not show active bleeding points.

  16. Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

    We wanted to assess the usefulness of rotational angiography after endoscopic marking with a metallic clip in upper gastrointestinal bleeding patients with no extravasation of contrast medium on conventional angiography. In 16 patients (mean age, 59.4 years) with acute bleeding ulcers (13 gastric ulcers, 2 duodenal ulcers, 1 malignant ulcer), a metallic clip was placed via gastroscopy and this had been preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. All patients had negative results from their angiographic studies. To localize the bleeding focus, rotational angiography and high pressure angiography as close as possible to the clip were used. Of the 16 patients, seven (44%) had positive results after high pressure angiography as close as possible to the clip and they underwent transcatheter arterial embolization (TAE) with microcoils. Nine patients without extravasation of contrast medium underwent TAE with microcoils as close as possible to the clip. The bleeding was stopped initially in all patients after treatment of the feeding artery. Two patients experienced a repeat episode of bleeding two days later. Of the two patients, one had subtle oozing from the ulcer margin and that patient underwent endoscopic treatment. One patient with malignant ulcer died due to disseminated intravascular coagulation one month after embolization. Complete clinical success was achieved in 14 of 16 (88%) patients. Delayed bleeding or major/minor complications were not noted. Rotational angiography after marking with a metallic clip helps to localize accurately the bleeding focus and thus to embolize the vessel correctly.

  17. Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

    Song, Ji Soo; Kwak, Hyo Sung; Chung, Gyung Ho [Chonbuk National University Medical School, Chonju (Korea, Republic of)

    2011-08-15

    We wanted to assess the usefulness of rotational angiography after endoscopic marking with a metallic clip in upper gastrointestinal bleeding patients with no extravasation of contrast medium on conventional angiography. In 16 patients (mean age, 59.4 years) with acute bleeding ulcers (13 gastric ulcers, 2 duodenal ulcers, 1 malignant ulcer), a metallic clip was placed via gastroscopy and this had been preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. All patients had negative results from their angiographic studies. To localize the bleeding focus, rotational angiography and high pressure angiography as close as possible to the clip were used. Of the 16 patients, seven (44%) had positive results after high pressure angiography as close as possible to the clip and they underwent transcatheter arterial embolization (TAE) with microcoils. Nine patients without extravasation of contrast medium underwent TAE with microcoils as close as possible to the clip. The bleeding was stopped initially in all patients after treatment of the feeding artery. Two patients experienced a repeat episode of bleeding two days later. Of the two patients, one had subtle oozing from the ulcer margin and that patient underwent endoscopic treatment. One patient with malignant ulcer died due to disseminated intravascular coagulation one month after embolization. Complete clinical success was achieved in 14 of 16 (88%) patients. Delayed bleeding or major/minor complications were not noted. Rotational angiography after marking with a metallic clip helps to localize accurately the bleeding focus and thus to embolize the vessel correctly.

  18. Incidence, predictors and prognostic implications of bleeding complicating primary percutaneous coronary intervention

    Matić Dragan M.

    2015-01-01

    Full Text Available Background/Aim. Data about bleeding complicating primary percutaneous coronary intervention (PCI are more frequently obtained from randomized clinical trials on patients with acute coronary syndromes (ACS, but less frequently from surveys or registries on patients with STelevation myocardial infarction (STEMI. The aim of this study was to investigate the incidence, predictors and prognostic impact of in-hospital major bleeding in the population of unselected real-world patients with acute STEMI undergoing primary PCI. Methods. All consecutive patients presenting with STEMI who underwent primary PCI at a single large tertiary healthcare center between January 2005 and July 2009, were studied. Major bleeding was defined according to the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO study criteria. We examined the association between in-hospital major bleeding and death or major adverse cardiac events (MACE in patients treated with PCI. The primary outcomes were in-hospital and 6-month mortality and MACE. Results. Of the 770 STEMI patients treated with primary PCI, in-hospital major bleeding occurred in 32 (4.2% patients. Independent predictors of major bleeding were advanced age (≥ 65 years, female gender, baseline anemia and elevated white blood cell (WBC count and signs of congestive heart failure at admission (Killip class II-IV. In-hospital and 6-month mortality and MACE rates were more than 2.5-fold-higher in patients who developed major bleeding compared with those who did not. Major bleeding was a predictor of 6- month MACE, independent of a few risk factors (previous MI, previous PCI, diabetes mellitus and hypertension; (OR = 3.02; 95% CI for OR 1.20-7.61; p = 0.019, but was not a true independent predictor of MACE and mortality in the fully adjusted models. Conclusion: Patients of advanced age, female gender, with baseline anemia and elevated WBC count and those with Killip class II-IV at presentation are at

  19. Endoscopic management of bleeding peptic ulcers

    Peptic ulcers account for more than half of the cases of non variceal upper gastrointestinal (GI) bleeding and therefore, are the focus of most of the methods of endoscopic hemostasis. Surgical intervention is now largely reserved for patients in whom endoscopic hemostasis has failed. A variety of endoscopic techniques have been employed to stop bleeding and reduce the risk of rebleeding, with no major differences in outcome between these methods. These include injection therapy, fibrin injection, heater probe, mono polar electrocautery, bipolar electrocautery, lasers and mechanical hemo clipping. The most important factor in determining outcome after gastrointestinal bleeding is rebleeding or persistent bleeding. The endoscopic appearance of an ulcer, however, provides the most useful prognostic information for bleeding. Recurrent bleeding after initial endoscopic hemostasis occurs in 15-20% of patients with a bleeding peptic ulcer. The best approach to these patients remains controversial; the current options are repeat endoscopic therapy with the same or a different technique, emergency surgery or semi elective surgery after repeat endoscopic hemostasis. The combination of epinephrine injection with thermal coagulation may be more effective than epinephrine injection alone. Newer modalities such as fibrin injection or the application of hemo clips appear promising and comparative studies are awaited. (author)

  20. Compressor bleed cooling fluid feed system

    Donahoo, Eric E; Ross, Christopher W

    2014-11-25

    A compressor bleed cooling fluid feed system for a turbine engine for directing cooling fluids from a compressor to a turbine airfoil cooling system to supply cooling fluids to one or more airfoils of a rotor assembly is disclosed. The compressor bleed cooling fluid feed system may enable cooling fluids to be exhausted from a compressor exhaust plenum through a downstream compressor bleed collection chamber and into the turbine airfoil cooling system. As such, the suction created in the compressor exhaust plenum mitigates boundary layer growth along the inner surface while providing flow of cooling fluids to the turbine airfoils.

  1. CLSM bleed water reduction test results

    Previous testing by BSRI/SRTC/Raytheon indicated that the CLSM specified for the Tank 20 closure generates about 6 gallons (23 liters) of bleed water per cubic yard of material (0.76 m3).1 This amount to about 10 percent of the total mixing water. HLWE requested that the CLSM mix be optimized to reduce bleed water while maintaining flow. Elimination of bleed water from the CLSM mix specified for High-Level Waste Tank Closure will result in waste minimization, time savings and cost savings. Over thirty mixes were formulated and evaluated at the on-site Raytheon Test Laboratory. Improved low bleed water CLSM mixes were identified. Results are documented in this report

  2. Management of radiation-induced rectal bleeding.

    Laterza, Liboria; Cecinato, Paolo; Guido, Alessandra; Mussetto, Alessandro; Fuccio, Lorenzo

    2013-11-01

    Pelvic radiation disease is one of the major complication after radiotherapy for pelvic cancers. The most commonly reported symptom is rectal bleeding which affects patients' quality of life. Therapeutic strategies for rectal bleeding are generally ignored and include medical, endoscopic, and hyperbaric oxygen treatments. Most cases of radiation-induced bleeding are mild and self-limiting, and treatment is normally not indicated. In cases of clinically significant bleeding (i.e. anaemia), medical therapies, including stool softeners, sucralfate enemas, and metronidazole, should be considered as first-line treatment options. In cases of failure, endoscopic therapy, mainly represented by argon plasma coagulation and hyperbaric oxygen treatments, are valid and complementary second-line treatment strategies. Although current treatment options are not always supported by high-quality studies, patients should be reassured that treatment options exist and success is achieved in most cases if the patient is referred to a dedicated centre. PMID:24101202

  3. Dysfunctional Uterine Bleeding (DUB) (For Teens)

    ... the body's hormones. Problems like compulsive exercise , not eating healthy foods, or too much stress can cause hormone changes. Some severe cases of AUB are caused by bleeding disorders such as von Willebrand disease . What Are the ...

  4. Genetic analysis of bleeding disorders.

    Edison, E; Konkle, B A; Goodeve, A C

    2016-07-01

    Molecular genetic analysis of inherited bleeding disorders has been practised for over 30 years. Technological changes have enabled advances, from analyses using extragenic linked markers to next-generation DNA sequencing and microarray analysis. Two approaches for genetic analysis are described, each suiting their environment. The Christian Medical Centre in Vellore, India, uses conformation-sensitive gel electrophoresis mutation screening of multiplexed PCR products to identify candidate mutations, followed by Sanger sequencing confirmation of variants identified. Specific analyses for F8 intron 1 and 22 inversions are also undertaken. The MyLifeOurFuture US project between the American Thrombosis and Hemostasis Network, the National Hemophilia Foundation, Bloodworks Northwest and Biogen uses molecular inversion probes (MIP) to capture target exons, splice sites plus 5' and 3' sequences and to detect F8 intron 1 and 22 inversions. This allows screening for all F8 and F9 variants in one sequencing run of multiple samples (196 or 392). Sequence variants identified are subsequently confirmed by a diagnostic laboratory. After having identified variants in genes of interest through these processes, a systematic procedure determining their likely pathogenicity should be applied. Several scientific societies have prepared guidelines. Systematic analysis of the available evidence facilitates reproducible scoring of likely pathogenicity. Documentation of frequency in population databases of variant prevalence and in locus-specific mutation databases can provide initial information on likely pathogenicity. Whereas null mutations are often pathogenic, missense and splice site variants often require in silico analyses to predict likely pathogenicity and using an accepted suite of tools can help standardize their documentation. PMID:27405681

  5. Cough-induced Tracheobronchial Mucosal Bleeding.

    Hira, Harmanjit Singh

    2011-01-01

    A 56-year-old man presented with moderate hemoptysis. It was preceded by a severe bout of cough. Flexible bronchoscopy showed diffuse tracheobronchial mucosal petechiae and bleeding. The patient was not suffering with any coagulopathies. He did not receive antiplatelet drugs. Hemoptysis resolved with cough suppressant. Subsequent bronchoscopy revealed the complete resolution of petechiae. The mechanism of bleeding after the bout of coughing is discussed. PMID:23169019

  6. Abnormal uterine bleeding: a clinicohistopathological analysis

    Anupamasuresh Y; Suresh YV; Prachi Jain*,

    2014-01-01

    Background: Abnormal uterine bleeding (AUB) is one of the most common problem for the patients and the gynecologists. It adversely effects on the quality of life and psychology of women. It is of special concern in developing country as it adds to the causes of anemia. Management of Abnormal Uterine Bleeding (AUB) is not complete without tissue diagnosis especially in perimenopausal and post-menopausal women. Histological characteristics of endometrial biopsy material as assessed by light mic...

  7. Management of nonvariceal upper gastrointestinal bleeding

    E Wee

    2011-01-01

    Full Text Available Nonvariceal upper gastrointestinal bleeding is unique from variceal bleeding in terms of patient characteristics, management, rebleeding rates, and prognosis, and should be managed differently. The majority of nonvariceal upper gastrointestinal bleeds will not rebleed once treated successfully. The incidence is 80 to 90% of all upper gastrointestinal bleeds and the mortality is between 5 to 10%. The causes include nonacid-related ulceration from tumors, infections, inflammatory disease, Mallory-Weiss tears, erosions, esophagitis, dieulafoy lesions, angiodysplasias, gastric antral vascular ectasia, and portal hypertensive gastropathy. Rarer causes include hemobilia, hemosuccus pancreaticus, and aortoenteric fistulas. Hematemesis and melena are the key features of bleeding from the upper gastrointestinal tract, but fresh per rectal bleeding may be present in a rapidly bleeding lesion. Resuscitation and stabilization before endoscopy leads to improved outcomes. Fluid resuscitation is essential to avoid hypotension. Though widely practiced, there is currently insufficient evidence to show that routine red cell transfusion is beneficial. Coagulopathy requires correction, but the optimal international normalized ratio has not been determined yet. Risk stratification scores such as the Rockall and Glasgow-Blatchford scores are useful to predict rebleeding, mortality, and to determine the urgency of endoscopy. Evidence suggests that high-dose proton pump inhibitors (PPI should be given as an infusion before endoscopy. If patients are intolerant of PPIs, histamine-2 receptor antagonists can be given, although their acid suppression is inferior. Endoscopic therapy includes thermal methods such as coaptive coagulation, argon plasma coagulation, and hemostatic clips. Four quadrant epinephrine injections combined with either thermal therapy or clipping reduces mortality. In hypoxic patients, endoscopy masks allow high-flow oxygen during upper

  8. CIRCUMCISION IN MALES WITH BLEEDING DISORDERS

    Hassan Mansouritorghabeh

    2013-01-01

    Full Text Available Introduction: Male circumcision practice is an invasive procedure that is using worldwide. It makes challenges to haemostatic system and its possible haemorrhagic side effects are more serious in bleeding individuals than normal subjects. In most cases, it can be complete controlled using infusion of appropriate amount of coagulation factors before and post circumcision.Aim: We aim to documentation type of coagulation therapy and post circumcision practice haemorrhagic presentation among 463 bleeder males of both common and rare bleeding disorders in north eastern part of country.Methods: We retrospectively gathered information using evaluation medical records in 3 major hospitals during last 15 years and list of patients with bleeding disorders that obtained from haemophilia center. Also a call phone established for each bleeder person to complete data and updating of them. The survey took time from Sep 2009- Mar 2011. The designed question form included data on doing circumcision or not? types of treatment before and post the procedure and occurrence of bleeding episodes after the surgery.Results: Overall among 424 cases with various common and rare bleeding disorders who had circumcised, 239 cases (56.3% had passed the procedure with bleeding experience, while 185 cases (43.7% had passed it successfully and without noticeable bleeding experience. The types of coagulation therapy in each group have been cited.Conclusion: The circumcision practice in unequipped medical center for bleeder ones may make challenges for them and medical services. Also it needed supervision of expert haematologist for adjusting treatment to ensure control of unwanted bleeding

  9. A rare cause of anemia due to upper gastrointestinal bleeding: Cameron lesion

    Ismet Özaydın

    2014-01-01

    Full Text Available Asymptomatic large hiatal hernias may lead to iron deficiency anemia due to occult and massive bleeding from linear gastric erosions or ulcers on the mucosal folds at the level of the diaphragm called the Cameron lesions. The diagnosis is usually made during upper gastrointestinal system endoscopies. Current therapy includes the medication with proton pump inhibitors in combination with oral iron supplements and in some cases surgical reconstruction of hiatal hernia with fundoplication. We present a case of a 78-year-old woman who was admitted to the outpatient clinic with the diagnosis of iron deficiency anemia without signs of acute gastrointestinal bleeding. She was treated with medication and her follow-up gastroscopy showed a total cure. She is asymptomatic for two years after treatment with proton pump inhibitors and iron supplements. Cameron lesions should be kept in mind as an unusual cause of iron deficiency anemia due to gastrointestinal bleeding

  10. Transcatheter arterial embolization for traumatic bleeding control

    Ryu, Choon Wook; Lee, Sang Kwon; Suh, Kyung Jin; Kim, Tae Heon; Kim, Yong Joo; Kang, Duck Sik [Kyungpook National University College of Medicine, Taegu (Korea, Republic of)

    1989-04-15

    Angiography is essential for the detection of bleeding vessels in traumatic vascular injury. Immediately after the diagnosis, transcatheter embolization can be performed for the control of bleeding effectively and easily with proper use of embolic materials. Transcatheter embolization is believed to be the treatment of choice when emergency control is needed, where surgical approach is difficult and in those who are poor candidate for surgery. We have tried bleeding control in 18 cases of trauma over recent 4 years. The results were as follows; 1. Causes of bleeding(cases): Blunt or penetrating trauma (10), latrogenic trauma (8), (Postoperative (5), Needle biopsy (2), Percutaneous hepatic procedure (1)) 2. Embolized vessels: Renal artery branches (8), Hepatic artery branches (2), Arteries supplying chest wall (2), External carotid artery branches (3), Internal carotid artery (1), Circumflex humeral artery (1), Internal iliac artery branches (1). 3. Embolic agents: Gelfoam cubes (16), Stainless steel coils (3), Detachable latex balloon (1). 4. Successful bleeding control was achieved in 17 cases and reduction of the amount of bleeding in one case without significant complications.

  11. Is tranexamic acid effective for acute upper gastrointestinal bleeding?

    Sebastián Flores

    2015-12-01

    Full Text Available La hemorragia digestiva alta corresponde a una emergencia médico-quirúrgica debido a la alta morbilidad y mortalidad que conlleva. El ácido tranexámico, un antifibrinolítico, podría ayudar a lograr un control precoz del sangrado, sin embargo existe controversia sobre su real utilidad. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos cinco revisiones sistemáticas que en conjunto incluyen ocho estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el ácido tranexámico probablemente disminuye el resangrado y la mortalidad, y no aumenta los efectos adversos tromboembólicos en pacientes con hemorragia digestiva alta.

  12. Is tranexamic acid effective for acute upper gastrointestinal bleeding?

    Sebastián Flores; Carolina Avilés; Gabriel Rada

    2015-01-01

    La hemorragia digestiva alta corresponde a una emergencia médico-quirúrgica debido a la alta morbilidad y mortalidad que conlleva. El ácido tranexámico, un antifibrinolítico, podría ayudar a lograr un control precoz del sangrado, sin embargo existe controversia sobre su real utilidad. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos cinco revisiones sistemáticas que en conjunto incluyen ocho estudios aleatorizados. Realizam...

  13. 14 CFR 23.1111 - Turbine engine bleed air system.

    2010-01-01

    ... using maximum bleed air must be established. (c) Hazardous contamination of cabin air systems may not... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Turbine engine bleed air system. 23.1111... Induction System § 23.1111 Turbine engine bleed air system. For turbine engine bleed air systems,...

  14. Octreotide in the Control of Post-Sclerotherapy Bleeding from Oesophageal Varices, Ulcers and Oesophagitis

    Spencer A. Jenkins

    1996-01-01

    Full Text Available Bleeding from oesophageal varices, oesophageal ulcers or oesophagitis is occasionally massive and difficult to control. Octreotide, a synthetic analogue of somatostin lowers portal pressure and collateral blood flow including that through varices, increases lower oesophageal sphincter pressure, and inhibits the gastric secretion of acid as well as pepsin. Our current experience suggests it is effective in controlling acute variceal haemorrhage. Therefore we have examined the efficacy of octreotide in the control of postsclerotherapy bleeding from oesophageal varices, oesophageal ulcers and oesophagitis. During the study period 77 patients experienced a significant gastrointestinal bleed (blood pressure 100 beats per min or the need to transfuse 2 or more units of blood to restore the haemoglobin level following injection sclerotherapy of oesophageal varices. The source of bleeding was varices in 42 patients, oesophageal ulcers in 31 and oesophagitis in 4. All patients received a continuous intravenous infusion of octreotide (50 μg/h for between 40–140h. If bleeding was not controlled in the first 12h after commencing octreotide hourly bolus doses (50 μg for 24h were superimposed on the continuous infusion. Haemorrhage was successfully controlled by an infusion of octreotide in 38 of the 42 patients with bleeding from varices, in 30 of 31 patients with oesophageal ulceration, and all patients with oesophagitis. In the 1 patient with persistent bleeding from oesophageal ulceration and in 2 of the 4 with continued haemorrhage from varices, haemostasis was achieved by hourly boluses of 50 μg octreotide for 24h in addition to the continuous infusion. No major complications were associated with octreotide administration. The results of this study clearly indicate that octreotide is a safe and effective treatment for the control of severe haemorrhage after technically successful injection sclerotherapy.

  15. Selective serotonin reuptake inhibitors and gastrointestinal bleeding: a case-control study.

    Alfonso Carvajal

    Full Text Available BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs have been associated with upper gastrointestinal (GI bleeding. Given their worldwide use, even small risks account for a large number of cases. This study has been conducted with carefully collected information to further investigate the relationship between SSRIs and upper GI bleeding. METHODS: We conducted a case-control study in hospitals in Spain and in Italy. Cases were patients aged ≥18 years with a primary diagnosis of acute upper GI bleeding diagnosed by endoscopy; three controls were matched by sex, age, date of admission (within 3 months and hospital among patients who were admitted for elective surgery for non-painful disorders. Exposures to SSRIs, other antidepressants and other drugs were defined as any use of these drugs in the 7 days before the day on which upper gastrointestinal bleeding started (index day. RESULTS: 581 cases of upper GI bleeding and 1358 controls were considered eligible for the study; no differences in age or sex distribution were observed between cases and controls after matching. Overall, 4.0% of the cases and 3.3% of controls used an SSRI antidepressant in the week before the index day. No significant risk of upper GI bleeding was encountered for SSRI antidepressants (adjusted odds ratio, 1.06, 95% CI, 0.57-1.96 or for whichever other grouping of antidepressants. CONCLUSIONS: The results of this case-control study showed no significant increase in upper GI bleeding with SSRIs and provide good evidence that the magnitude of any increase in risk is not greater than 2.

  16. Predictive Factors Study Of Rectal Bleeding Radical Radiotherapy In Prostate Cancer

    Full text: Objective: To determine clinical, para clinical or to predict dosimetric the occurrence of rectal bleeding after radical radiotherapy as primary treatment prostate cancer in patients treated at the National Cancer Institute (Inca) dimensional external beam radiation. Materials and Methods: From July 2008 to July 2011 132 patients were recruited, 86 of which met followed for 12 months. Side effect was recorded gastrointestinal track at different times of the patient with classifications RTOG / EORTC ( Radiation Therapy Oncology Group / European Organization for Research and Treatment of Cancer) and SOMA / LENT also used a questionnaire specifically built and tested by the Italian cooperative group. results were correlated with clinical parameters (PSA, Gleason score, clinical T, class risk, hypertension, and diabetes) and dosimetric ( treatment volume, volume rectum, total dose, maximum dose to the rectum mean dose to the rectum) to assess the correlation thereof with the occurrence of rectal bleeding. Results: In a cut to 12 months follow-up, there is a relationship between the appearance bleeding with time. The mean dose to the rectum and the initial PSA showed significance in correlation with the occurrence of rectal bleeding, with a p of 0.01 and 0.54 respectively. Conclusions: The rectal side effect is one of the major side effects both acute and chronic prostate radiotherapy in the present study has failed to demonstrate a correlation between two factors predictive identified as potentially priori significant the occurrence of rectal bleeding, as the initial PSA and the mean dose to the rectum

  17. Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature

    Arpad; Ivanecz; Marko; Sremec; Davorin; ?erani?; Stojan; Potr?; Pavel; Skok

    2014-01-01

    Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidenceof bariatric operations and coherently possible complications after such procedures, which modify patient’s anatomy and physiology.

  18. Secondary electric power generation with minimum engine bleed

    Tagge, G. E.

    1983-01-01

    Secondary electric power generation with minimum engine bleed is discussed. Present and future jet engine systems are compared. The role of auxiliary power units is evaluated. Details of secondary electric power generation systems with and without auxiliary power units are given. Advanced bleed systems are compared with minimum bleed systems. A cost model of ownership is given. The difference in the cost of ownership between a minimum bleed system and an advanced bleed system is given.

  19. Immediate bleeding complications in dental implants: A systematic review

    Balaguer Martí, José Carlos; Peñarrocha Oltra, David; Balaguer Martínez, José; Peñarrocha Diago, Miguel

    2014-01-01

    Objective: A review is made of the immediate or immediate postoperative bleeding complications in dental implants, with a view to identifying the areas of greatest bleeding risk, the causes of bleeding, the length of the implants associated with bleeding, the most frequently implicated blood vessels, and the treatments used to resolve these complications. Material and Methods: A Medline (PubMed) and Embase search was made of articles on immediate bleeding complications in dental implants publ...

  20. Spironolactone use and the risk of upper gastrointestinal bleeding

    Gulmez, Sinem E; Lassen, Annmarie T; Aalykke, Claus;

    2008-01-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT * Recent studies have suggested an increased risk of upper gastrointestinal bleeding (UGB) in spironolactone users. * We conducted this population-based case-control study to confirm the association between spironolactone use and acute nonvaricose UGB alone...... risk factors and quantify the absolute risk. METHODS A population based case-control study was conducted in the County of Funen, Denmark. Cases (n = 3652) were all subjects with a first discharge diagnosis of serious UGB during the period 1995 to 2006. Age- and gender-matched controls (10 for each case......) (n = 36 502) were selected by risk set sampling. Data on all subjects' drug exposure and past medical history were retrieved from a prescription database and from the County's patient register. Confounders were controlled by conditional logistic regression. RESULTS The adjusted odds ratio (OR...

  1. Absence of Helicobacter pylori is not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population

    Yeong Yeh Lee

    2014-02-01

    Full Text Available Aim. Helicobacter pylori (H. pylori infection is exceptionally rare in population from the north-eastern region of Peninsular Malaysia. This provides us an opportunity to contemplate the future without H. pylori in acute non-variceal upper gastrointestinal (GI bleeding. Methods. All cases in the GI registry with GI bleeding between 2003 and 2006 were reviewed. Cases with confirmed non-variceal aetiology were analysed. Rockall score > 5 was considered high risk for bleeding and primary outcomes studied were in-hospital mortality, recurrent bleeding and need for surgery. Results. The incidence of non-variceal upper GI bleeding was 2.2/100,000 person-years. Peptic ulcer bleeding was the most common aetiology (1.8/100,000 person-years. In-hospital mortality (3.6%, recurrent bleeding (9.6% and need for surgery (4.0% were uncommon in this population with a largely low risk score (85.2% with score ≤5. Elderly were at greater risk for bleeding (mean 68.5 years, P = 0.01 especially in the presence of duodenal ulcers (P = 0.04 despite gastric ulcers being more common. NSAIDs, aspirin and co-morbidities were the main risk factors. Conclusions. The absence of H. pylori infection may not reduce the risk of peptic ulcer bleeding in the presence of risk factors especially offending drugs in the elderly.

  2. BLEEDING DUODENAL ULCER-TREATMENT OPTIONS

    V. Poroch

    2009-11-01

    Full Text Available Actual treatment of bleeding duodenal ulcer is most frequently medical but also surgical. The aim of this study is to assess the factors that influence the outcomes for a group of 67 patients suffering of bleeding duodenal ulcer. Out of 67 patients considered in this study, 53 were men (79.1% and 14 were women (20.9%. The average age was 52 years for men and 53 years for women (range 19-86 years. 59 (88% were patients with known medical history of peptic ulcer disease. Endoscopy has been performed for 64 patients (95.6%. Specific medical treatment was started immediately for all patients. For 47 patients (70.1% the hemorrhage stopped with conservative treatment, 8 patients (12% benefit by endoscopic treatment and 12 patients (17.9% underwent surgery. The postoperative morbidity rate was 16.7%. Comorbidities were present in 43 patients (64.2%. Failure of medical conservative treatment has been observed in 7 cases (13%, and failure of endoscopic procedures in 2 cases (20%. The risk factors involved in therapy outcomes of bleeding duodenal ulcer are: age, the severity of hemorrhage confirmed by endoscopy, the hemorrhagic episodes in medical history and the time of surgery. Conclusion: The prognosis of bleeding duodenal ulcer after bleeding is highly correlated with the time that the treatment starts, the severity of hemorrhage, comorbid conditions and age.

  3. Accuracy of rockall score for in hospital re bleeding among cirrhotic patients with variceal bleed

    To assess the diagnostic accuracy of Roc kall scoring system for predicting in-hospital re-ble- eding in cirrhotic patients presenting with variceal bleed. Material and Methods: This descriptive case series study was conducted at Department of Medicine Combined Military Hospital Lahore from December 2013 to May 2014. We included patients with liver cirrhosis who presented with upper GI bleeding and showed varices as the cause of bleeding on endoscopy. Clinical and endoscopic features were noted to calculate Rockall score. Patients with score < 2 and > 8 were included. After treating with appropriate pharmacological and endoscopic therapy, patients were followed for re-bleeding for 10 days. Diagnostic accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive values using 2 x 2 tables. Results: In the study, 175 patients were included. Mean age was 51.5 ± 1.22 years. Male to female ratio was 1.5 to 1.0 out of 175 patients, 157 patients (89.7%) were of low risk group (score = 2) while 18 patients (10.3%) were in high risk group (score > 8). In low risk group, re-bleeding occurred only in 2 patients (1.2%) while in high risk group, re-bleeding occurred in 14 patients (78%). Rockall score was found to have good diagnostic accuracy with sensitivity of 87.5%, specificity of 97.48%, positive predictive value of 77.8% and negative predictive value of 98.7%. Conclusion: In cases of variceal bleed, frequency of re-bleed is less in patients who are in low risk category with lower Rockall score and high in high risk patients with higher rockall score. The Rockall score has a good diagnostic accuracy in prediction of re-bleed in variceal bleeding. (author)

  4. Concurrent amoebic and histoplasma colitis:A rare cause of massive lower gastrointestinal bleeding

    Peng; Soon; Koh; April; Camilla; Roslani; Kumar; Vasudeavan; Vimal; Mohd; Shariman; Ramasamy; Umasangar; Rajkumar; Lewellyn

    2010-01-01

    Infective colitis can be a cause of massive lower gastrointestinal bleeding requiring acute surgical intervention. Causative organisms include entamoeba and histoplasma species. However, concurrent colonic infection with both these organisms is very rare, and the in vivo consequences are not known. A 58-year-old male presented initially to the physicians with pyrexia of unknown origin and bloody diarrhea. Amoebic colitis was diagnosed based on biopsies, and he was treated with metronidazole. Five days later...

  5. Embolotherapy for Gastric Variceal Bleeding from Pseudoaneurysm of Short Gastric Artery: A Case Report

    Yang, Jae Han; Kim, Young Dae; Kim, Dong Hyun [Chosun University, Gwangju (Korea, Republic of)

    2008-12-15

    The complications of pancreatitis, such as pseudocyst or abscesses, are well known to radiologists. Yet formation of a pseudoaneurysm of the short gastric artery is an uncommon complication of acute pancreatitis. It is also very rare for a psuedoaneurysm of the short gastric artery to cause splenic vein occlusion and the final result is gastric varices. We report here on a case that showed the dramatic effect of embolotherapy for a pseudoaneurysm of the short gastric artery that caused gastric variceal bleeding

  6. Abnormal gastrointestinal accumulation of radiotracer by gastric bleeding during 99mTc-MDP bone scintigraphy

    We present a case in which a patient with acute hemorrhagic gastritis demonstrated abnormal gastrointestinal accumulation of radiotracer during 99mTc-methylene diphosphonate (MDP) skeletal scintigraphy. A hemorrhagic gastritis was subsequently demonstrated by endoscopy. The mechanism for the intestinal localization of 99mTc-MDP in this patients is not clear, but we guess that the extravasated blood containing the radiopharmaceutical cannot recirculate and stays at the bleeding site, so we can see the intestinal activity

  7. How I manage heavy menstrual bleeding.

    Pai, Menaka; Chan, Anthony; Barr, Ronald

    2013-09-01

    Heavy menstrual bleeding (HMB) is a common clinical problem; population-based studies estimate that approximately 10-35% of women report this symptom during their lifetime, while about 5% of women consult a physician for evaluation of HMB. Patients with HMB account for 15% of all referrals to gynaecologists and are frequently seen by haematologists in bleeding disorder clinics as well. Heavy menstrual bleeding can be caused by a wide variety of local and systemic factors, so a careful clinical and laboratory evaluation is often necessary to determine the aetiology and guide appropriate management. This review discusses the definition, causes and clinical outcomes of HMB. It outlines a diagnostic approach and focuses on medical (as opposed to surgical) treatments. Throughout, areas of controversy and opportunities for further research are highlighted. PMID:23829452

  8. Fibrinogen concentrate for bleeding - a systematic review

    Lunde, J; Stensballe, J; Wikkelsø, A;

    2014-01-01

    Fibrinogen concentrate as part of treatment protocols increasingly draws attention. Fibrinogen substitution in cases of hypofibrinogenaemia has the potential to reduce bleeding, transfusion requirement and subsequently reduce morbidity and mortality. A systematic search for randomised controlled...... trials (RCTs) and non-randomised studies investigating fibrinogen concentrate in bleeding patients was conducted up to November 2013. We included 30 studies of 3480 identified (7 RCTs and 23 non-randomised). Seven RCTs included a total of 268 patients (165 adults and 103 paediatric), and all were...... mortality were lacking. Weak evidence from RCTs supports the use of fibrinogen concentrate in bleeding patients, primarily in elective cardiac surgery, but a general use of fibrinogen across all settings is only supported by non-randomised studies with serious methodological shortcomings. It seems pre...

  9. Radionuclide detection of lower gastrointestinal bleeding sites

    A retrospective review of two years' experience with radionuclide screening to detect lower gastrointestinal bleeding sites was conducted at New York's Montefiore Medical Center. Of 82 studies performed in 63 patients, 13 identified active bleeding sites. Only three of eight angiograms obtained in these 13 patients were positive. Thirteen contrast angiograms were performed in the group of 50 patients with negative radionuclide studies of which ten were negative and one was equivocal. The results of this study suggest that the Tc-99m sulfur colloid study for active lower gastrointestinal (GI) bleeding is an effective screening procedure. Positive studies help determine which vessel to catheterize selectively if an angiogram is to be performed. If vascular ectasis is still suspected following a negative radionuclide study, contrast angiography can be more efficaciously performed on a nonemergent basis

  10. Radiotherapy in benign uterine bleeding disorders

    Radiotherapy was earlier a method of choice for treatment of benign bleeding disorders (metropathia), especially in woman of high surgical risk. During the period 1912 to 1977 933 women with benign bleeding disorders were treated at Radiumhemmet with intracavitary brachytherapy or external irradiation or a combination of both. The result with regard to cure of the uterine bleedings was good (48%). Hormonal withdrawal symptoms after treatment were noted in 45% of the patients. In the long term follow up an increased risk of cardiovascular death was found in women treated before menopause. Malignant tumours occurred in 107 cases versus 90.2 expected. The estimated ovarian dose of ionizing radiation varied from 3.5 Gy to 6.0 Gy for the three standard techniques. Two women gave birth to a healthy child 4 and 5 years after intracavitary radium treatment. The estimated absorbed dose to the ovaries in these two women were 1 Gy and 4 Gy, respectively

  11. [Jejunal GIST with obscure gastrointestinal bleeding].

    Nelly Manrique, María; Frisancho, Oscar; Rivas Wong, Luz; Palomino, Américo

    2011-01-01

    We report the case of a woman of 84 years with a history of cardiac arrhythmia and hemorrhoids. She had multiple hospitalizations and transfusions for symptomatic iron deficiency anemia, endoscopic studies showed only small diverticula and colon polyps. He was later hospitalized with bloody stools red wines, upper endoscopy and colonoscopy showed gastritis, small colonic ulcers, colonic polyp and multiple diverticula. Readmitted with bleeding of obscure origin, on that occasion showed gastritis, antral erosions, small ulcers, colon polyps and colon ulcers in the process of healing, capsule endoscopy showed angiodysplasia in jejunum, anterograde enteroscopy detected some erythematous lesions in proximal jejunum without evidence of bleeding. Again hospitalized for melena and abdominal. PMID:22086325

  12. Bleeding risk assessment and management in atrial fibrillation patients: a position document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis.

    Lip, Gregory Y H; Andreotti, Felicita; Fauchier, Laurent; Huber, Kurt; Hylek, Elaine; Knight, Eve; Lane, Deirdre A; Levi, Marcel; Marin, Francisco; Palareti, Gualtiero; Kirchhof, Paulus; Collet, Jean-Philippe; Rubboli, Andrea; Poli, Daniela; Camm, John

    2011-05-01

    Despite the clear net clinical benefit of oral anticoagulation (OAC) in atrial fibrillation (AF) patients at risk for stroke, major bleeding events (especially intra-cranial bleeds) may be devastating events when they do occur. The decision for OAC is often based on a careful assessment of both stroke risk and bleeding risk, but clinical scores for bleeding risk estimation are much less well validated than stroke risk scales. Also, the estimation of bleeding risk is rendered difficult since many of the known factors that increase bleeding risk overlap with stroke risk factors. As well as this, many factors that increase bleeding risk are transient, such as variable international normalized ratio values, operations, vascular procedures, or drug-drug and food-drug interactions. In this Position Document, we comprehensively review the published evidence and propose a consensus on bleeding risk assessments in AF patients, with a view to summarizing 'best practice' when approaching antithrombotic therapy in AF patients. We address the epidemiology and size of the problem of bleeding risk in AF and review established bleeding risk factors. We also summarize definitions of bleeding in the published literature. Patient values and preferences balancing the risk of bleeding against thrombo-embolism is reviewed, and the prognostic implications of bleeding are discussed. We also review bleeding risk stratification and currently published bleeding risk schema. A brief discussion of special situations [e.g. peri-ablation, peri-devices (implantable cardioverter-defibrillator, pacemakers) and presentation with acute coronary syndromes and/or requiring percutaneous coronary interventions/stents and bridging therapy], as well as a discussion of prevention of bleeds and managing bleeding complications, is made. Finally, this document also puts forwards consensus statements that may help to define evidence gaps and assist in everyday clinical practice. Bleeding risk is almost

  13. Predictive Factors and Management of Rectal Bleeding Side Effects Following Prostate Cancer Brachytherapy

    Price, Jeremy G. [Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York (United States); Stone, Nelson N. [Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York (United States); Stock, Richard G., E-mail: Richard.Stock@mountsinai.org [Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York (United States)

    2013-08-01

    Purpose: To report on the incidence, nature, and management of rectal toxicities following individual or combination brachytherapy following treatment for prostate cancer over a 17-year period. We also report the patient and treatment factors predisposing to acute ≥grade 2 proctitis. Methods and Materials: A total of 2752 patients were treated for prostate cancer between October 1990 and April 2007 with either low-dose-rate brachytherapy alone or in combination with androgen depletion therapy (ADT) or external beam radiation therapy (EBRT) and were followed for a median of 5.86 years (minimum 1.0 years; maximum 19.19 years). We investigated the 10-year incidence, nature, and treatment of acute and chronic rectal toxicities following BT. Using univariate, and multivariate analyses, we determined the treatment and comorbidity factors predisposing to rectal toxicities. We also outline the most common and effective management for these toxicities. Results: Actuarial risk of ≥grade 2 rectal bleeding was 6.4%, though notably only 0.9% of all patients required medical intervention to manage this toxicity. The majority of rectal bleeding episodes (72%) occurred within the first 3 years following placement of BT seeds. Of the 27 patients requiring management for their rectal bleeding, 18 underwent formalin treatment and nine underwent cauterization. Post-hoc univariate statistical analysis revealed that coronary artery disease (CAD), biologically effective dose, rectal volume receiving 100% of the prescription dose (RV100), and treatment modality predict the likelihood of grade ≥2 rectal bleeding. Only CAD, treatment type, and RV100 fit a Cox regression multivariate model. Conclusions: Low-dose-rate prostate brachytherapy is very well tolerated and rectal bleeding toxicities are either self-resolving or effectively managed by medical intervention. Treatment planning incorporating adjuvant ADT while minimizing RV100 has yielded the best toxicity-free survival following

  14. Henoch-Schönlein purpura in an older man presenting as rectal bleeding and IgA mesangioproliferative glomerulonephritis: a case report

    Howarth Charles B; Jirajariyavej Teeranun; Cheungpasitporn Wisit; Rosen Raquel M

    2011-01-01

    Abstract Introduction Henoch-Schönlein purpura is the most common systemic vasculitis in children. Typical presentations are palpable purpura, abdominal pain, arthritis, and hematuria. This vasculitic syndrome can present as an uncommon cause of rectal bleeding in older patients. We report a case of an older man with Henoch-Schönlein purpura. He presented with rectal bleeding and acute kidney injury secondary to IgA mesangioproliferative glomerulonephritis. Case presentation A 75-year-old Pol...

  15. Frank hematuria as the presentation feature of acute leukemia

    Suriya Owais

    2010-01-01

    Full Text Available Muco-cutaneous bleeding is a common presenting feature of acute leukemias. Mucosal bleeding usually manifests as gum bleeding and/or epistaxis but may occur in any mucosal surface of the body. Hematuria as an isolated or main presenting feature of acute leukemia is rare. We describe two cases of acute leukemia, a 19 year old male with acute lymphoblastic leukemia and a 52 year old male with acute myeloid leukemia, both presenting with gross hematuria. There was no demonstrable leukemic infiltration of the urinary tract on imaging studies. Hematuria in these patients was likely to be due to occult leukemic infiltration of the urinary system, aggravated by thrombocytopenia, as it subsided after starting chemotherapy. Our cases highlight that hematuria should be remembered as a rare presenting feature of acute leukemia.

  16. [OMEPRAZOL VS RANITIDINE IN UPPER DIGESTIVE BLEEDING

    Regis R, Regina; Bisso A, Aland; Rebaza, Segundo

    1999-01-01

    Pectic ulcer is the most frequent cause of gastrointestinal bleeding. The homeostatic mechanism of bleeding, and coagulation, does not happen with values of pH less than 5,0. Therefore neutralization of gastric acidity (pH more than 5,0) is a recourse of control, improve the evolution and healing of peptic ulcer and to avoid a new bleeding. The aim of this study was to compare the results of treatment with omeprazole and ranitidine, in 57 patients admitted at emergency room of the Hospital Central de la Polic a Nacional del Per with endoscopic diagnosis of peptic ulcer, using Forrest classification. Patients received omeprazole 40 mg in bolus IV, followed by continuos infusion of 8 mg/hour for 72 hours (group A) or ranitidine 50 mg IV each 8 hours for 72 hours (group B). A new endoscopy was made 72 hours after admission demostrated a succesful therapy in both group. Bleeding stopped in 26/27 patients in group A (96,2%) and in 23/30 patients in group B (76,6%) (pomeprazole IV is more effective than ranitidine IV in the control of UGB because of peptic ulcer and provides a faster healing. PMID:12181579

  17. Endometrial biopsy findings in postmenopausal bleeding

    To study endometrial histopathology in women presenting with postmenopausal bleeding. A two-year study from January 2003 to December 2004 of 100 cases of postmenopausal bleeding was conducted at Combined Military Hospital, Sialkot. The histopathology of endometrial biopsy specimens was done to find out the causes of postmenopausal bleeding in these ladies. All these 100 patients had confirmed menopause and the average age was 55 years and above. The most common histopathological diagnosis was senile endometrial atrophy (27%), followed by simple cystic hyperplasia in (17%). Three cases of simple cystic hyperplasia had coexistent ovarian tumors. Glandular hyperplasia without atypia was seen in 6% and with atypia in 4%. Other causes were endometritis (13%), endometrial polyps (8%), proliferative phase endometrium (6%) and secretary phase endometrium (5%). Endometrial carcinoma was seen in (6%) cases, (8%) biopsy specimens were non-representative. Although senile endometrial atrophy was most commonly found in these ladies but a significant percentage of endometrial hyperplasia and endometrial cancer implies the need for investigating all cases of postmenopausal bleeding. Bimanual examination and pelvic ultrasonography should be combined with endometrial sampling so that rare pelvic pathologies may not be missed. (author)

  18. Dysfunctional uterine bleedings of a climacteric period

    Climacteric period of some women is complicated by dysfunctional uterine bleedings (DUB). Bearing in mind the fact that DUBS are caused by disorder of estrin rhysmic secretion, the paper presents the methods of differential diagnostics for investigations into functional disorders in the hypothalamus -hypophysis - ovaries - uterus system. The preference is given to roentgenologic and radioimmunologic diagnostic methods

  19. Value of serum OPN levels in patients with acute cerebral hemorrhage for assessment of nerve function impairment

    Jian-Ming Li

    2016-05-01

    Conclusions: The level of serum OPN in patients with acute cerebral hemorrhage increased significantly. The level of serum OPN could estimate the bleeding volume and the severity of nerve function impairment for patients with acute cerebral hemorrhage.

  20. Inhibidores de la bomba de protones por vía intravenosa en la hemorragia por úlcera péptica: ¿es necesaria la supresión ácida máxima para disminuir el resangrado? Intravenous proton-pump for acute peptic ulcer bleeding: is profound acid supression beneficial to reduce the risk of rebleeding?

    A. Garrido

    2008-08-01

    Full Text Available Objetivo: comparar dos pautas de pantoprazol por vía intravenosa en pacientes con hemorragia digestiva alta (HDA ulcerosa de alto riesgo para presentar persistencia o recidiva hemorrágica. Material y método: se randomizaron los pacientes en dos grupos: grupo 0: tratamiento con bolo de 80 mg i.v. de pantoprazol y perfusión continua a 8 mg/h durante 72 horas; grupo 1: tratamiento con 40 mg i.v. de pantoprazol diarios. Se analizó el porcentaje de persistencia/recidiva hemorrágica entre ambos grupos, requerimientos transfusionales, necesidad de cirugía y mortalidad del episodio hemorrágico. Resultados: se incluyeron 20 pacientes en el grupo 0 y 21 en el grupo 1. No se encontraron diferencias entre ambos grupos en cuanto al sexo, edad, hábito tabáquico, consumo de AINE, presencia de inestabilidad hemodinámica, estigma sobre el nicho ulceroso (Forrest Ia 5 vs. 14,3%, p = 0,322; Forrest Ib 30 vs. 33,3%, p = 0,819; Forrest IIa 60 vs. 50,1%, p = 0,753. El 90% de los pacientes del grupo 0 recibió tratamiento endoscópico vs. el 100% del grupo 1, p = 0,232. El 50% de los pacientes del grupo 0 recibió transfusión vs. el 52,4% del grupo 1, p = 0,879. Dos pacientes (10,5% del grupo 0 presentaron recidiva hemorrágica vs. 3 pacientes (14,3% del grupo 1, precisando cirugía 1 paciente de cada grupo y falleciendo 1 paciente del grupo 0. Conclusiones: la inhibición ácida máxima de la secreción ácida gástrica mediante bolo e infusión continua de pantoprazol no ofrece resultados superiores al tratamiento con dosis convencionales en el episodio hemorrágico agudo.Objective: to compare two regimens of pantoprazole administered intravenously in patients with ulcerative gastrointestinal bleeding (UGB, and a high risk of presenting with persitent or recurrent hemorrhage. Material and method: patients were randomized into two groups: group 0 - treatment with a 80 mg bolus of pantoprazole administered intravenously, followed by continuous infusion of

  1. Correlation of bleeding pattern with endometrial histopathologic results in perimenopausal women with abnormal uterine bleeding

    Zehra Yilmaz

    2015-06-01

    Full Text Available Background: Abnormal Uterine Bleeding (AUB is referred as bleeding outside of normal menstruation pattern and it is the most common gynecological problem for women of all ages. This study was evaluated the correlation of menstrual bleeding patterns and endometrial histopathological findings in perimenopausal women. Methods: This study was done on perimenopausal aged women presented with AUB for the last 6 months at a gynecology clinic of a tertiary medical center. Only the patients with isolated endometrial causes of AUB were selected for study. A total of 313 cases were included in the study. Abnormal bleeding patterns of the patients were recorded and endometrial sampling was performed to all women. AUB was classified as menorrhagia, metrorrhagia, menometrorrhagia, polymenorrhea, intermenstrual bleeding, and histopathological findings were classified as Proliferative Endometrium (PE, Secretory Endometrium (SE, Disordered Proliferative Pattern (DPP, Endometrial Polyp (EP, Chronic Endometritis (CE, Endometrial Hyperplasia (EH, and Endometrial Adenocarcinoma (CA. Results: The most common bleeding pattern was menorrhagia (45.0% and the most common histopathological finding was PE+SE (52.0% in our study. PE+SE and endometrial hyperplasia without atypia were found more common in menorrhagia group. The most histopathological findings were found PE+SE in menometrorrhagia and polymenorrhea group (P 0.05. Conclusions: We concluded that although menometrorrhagia and polymenorrhea were significantly more associated with PE+SE, intermenstrual bleeding was significantly more associated with EP and CE. It is noteworthy that endometrial hyperplasia without atypia is significantly higher in patients with menorrhagia which is the most common abnormal bleeding pattern in perimenopausal aged women. [Int J Reprod Contracept Obstet Gynecol 2015; 4(3.000: 547-550

  2. Bleeding from the pancreas - a comparison of imaging methods

    Roedl, W.; Nebel, G.; Englehard, K.

    1984-05-01

    Four patients with spontaneous bleeding from the pancreas are described. Transpapillary bleeding is diagnosed endoscopically. Angiography can demonstrate the eroded vessel directly. Ultrasound, CT and ERCP demonstrate the underlying abnormality in the pancreas. Bleeding into a cyst produces characteristic echoes, or an increase in density. NMR is able to demonstrate pancreatitis and pancreatic pseudo-cysts. Early diagnosis is extremely important, since without appropriate surgery, pancreatic bleeding is frequently fatal. 7 figs.

  3. 消化道出血概述%Overview of Gastrointestinal Bleeding

    刘文忠

    2015-01-01

    消化道出血是急诊科和消化科常见的临床病况之一。急性大量出血可危及生命,慢性失血可产生贫血症状,部分消化道出血是一些严重疾病,包括胃肠道恶性肿瘤的临床表现。熟悉和掌握消化道出血的临床表现、分类和处理原则,将有助于提高其预防和治疗水平。%Gastrointestinal(GI)bleeding is one of the commonly seen clinical problems in departments of emergency and gastroenterology. Acute massive bleeding may be life-threatening,and chronic blood loss can present symptoms of anemia. GI bleeding is the clinical manifestation of some serious diseases,including GI malignancies. Familiar with and mastering the clinical manifestations,classification and principles of management of GI bleeding will help to improve its prevention and treatment.

  4. Evaluation and outcomes of patients with obscure gastrointestinal bleeding

    Santhakumar, Cositha; Liu, Ken

    2014-01-01

    Obscure gastrointestinal bleeding (OGIB) is defined as recurrent or persistent bleeding or presence of iron deficiency anaemia after evaluation with a negative bidirectional endoscopy. OGIB accounts for 5% of gastrointestinal bleeding and presents a diagnostic challenge. Current modalities available for the investigation of OGIB include capsule endoscopy, balloon assisted enteroscopy, spiral enteroscopy and computed tomography enterography. These modalities overcome the limitations of previou...

  5. 14 CFR 23.1109 - Turbocharger bleed air system.

    2010-01-01

    ... Induction System § 23.1109 Turbocharger bleed air system. The following applies to turbocharged bleed air systems used for cabin pressurization: (a) The cabin air system may not be subject to hazardous... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Turbocharger bleed air system....

  6. Obesity and risk of bleeding : The SMART study

    Braekkan, S. K.; van der Graaf, Y.; Visseren, F. L J; Algra, A.

    2016-01-01

    Essentials: Whether obesity protects against clinically relevant bleeding is unclear. We investigated the risk of bleeding according to various measures of obesity in a cohort of 9736 patients. Obesity was not associated with a lower risk of bleeding. The procoagulant profile in obese subjects may n

  7. Endoscopic Management of Bleeding Ectopic Varices With Histoacryl

    1999-01-01

    Bleeding from antral and duodenal varices is an uncommon feature in patients with portal hypertension. We report a patient with cirrhosis and portal vein thrombosis, who had a massive bleed from antral and duodenal varices. Bleeding was controlled with endoscopic injection of varices using histoacryl. Endoscopic treatment and the relatively uncommon occurrence of antral and duodenal varices are highlighted.

  8. Uso de octreotida na hemorragia digestiva alta secundária à hipertensão portal em pacientes pediátricos: experiência de um serviço terciário Uso de octreotide en la hemorragia digestiva alta secundaria a hipertensión portal en pacientes pediátricos: experiencia de un servicio terciario Octreotide for acute gastrointestinal bleeding secondary to portal hypertension in pediatric patients: experience of a tertiary center

    Daniela Gois Meneses

    2011-12-01

    ños, variación de 7 meses a 18,9 años, en el periodo de 1998 a 2006, en un hospital terciario universitario. El diagnóstico de hipertensión portal fue establecido por ultrasonografía y la cirrosis fue confirmada por la histología y clasificada respecto a la gravedad por el escore Child-Pugh. RESULTADOS: Las causas de la hipertensión portal fueron obstrucción extrahepática de la vena porta en 11/17 casos (64,7% y cirrosis hepática en 6/17 (35,3%. El sangramiento fue controlado en 14/17 pacientes (82,3%. El tiempo de infusión de la droga necesario para control del sangramiento fue semejante entre cirróticos y no cirróticos, pero la caída en los niveles de hemoglobina, el volumen transfusional requerido y el tiempo de internación fueron superiores en los pacientes con cirrosis, aunque sin diferencia estadística. Esas mismas variables no se modificaron respecto a los dos distintos esquemas de infusión de la droga: con dosis de ataque o iniciando con dosis de mantenimiento. Fracaso terapéutico fue observado con mayor frecuencia entre los pacientes cirróticos (33,3%. Hiperglucemia fue el único efecto secundario detectado durante la infusión. CONCLUSIONES: La administración de octreotide en niños y adolescentes con sangramiento digestivo por hipertensión portal fue segura y efectiva en el control del sangramiento agudo, independiente de la causa de la hipertensión portal y del esquema de infusión.OBJECTIVE: To describe clinical data of children and adolescents with portal hypertension, during with and without liver cirrhosis, treated with octreotide during episodes of acute upper gastrointestinal bleeding. METHODS: Retrospective and descriptive study of 26 episodes of gastrointestinal bleeding in 17 patients (mean age: 8.6 years; range: seven months to 18.9 years assisted at a tertiary university hospital from 1996 to 2006. Portal hypertension diagnosis was based on ultrasonography. Liver cirrhosis was confirmed by histology and hepatic function was

  9. Bronchial artery embolization for therapy of pulmonary bleeding in patients with cystic fibrosis

    Introduction: Acute pulmonary emergencies in patient with cystic fibrosis (CF) can be found in cases of pneumothorax as well as hemoptysis. If the bleeding cannot be stopped by conservative methods, an embolization of the bronchial arteries should be done. Materials and Method: 11 patients were embolized using a combination of PVA particles and microcoils. Results: From January 1996 to June 2001 17 bronchial arteries in 11 patients were embolized. 7 patients suffered from chronical hemoptysis, 4 patients had an acute hemoptysis. In 4 patients both sides were embolized, in 3 patients only one side. The remaining 4 patients needed a second intervention, embolizing the other side. The primary embolizated bronchial artery was still closed in all 4 patients. In 1 patient the selective catheterization of a bronchial artery was not successful, thus the embolization could not be carried out. 1 patient died 5 days after the intervention due to a fulminant pneumonia (Pseudomonas aeruginosa) without recurrent bleeding. In two patients atypical branches from intercostal arteries feeding the bronchial arteries were detected and successfully embolized. All patients profited from the therapy, as bleeding could be stopped or at least be reduced. 3 patients suffered from back pain during or after intervention. There were no severe complications like neurological deficiencies or necroses. (orig.)

  10. Tranexamic acid for upper gastrointestinal bleeding

    Bennett, Cathy; Klingenberg, Sarah Louise; Langholz, Ebbe;

    2014-01-01

    2011. The number of participants randomly assigned ranged from 47 to 216 (median 204). All trials reported mortality. In total, 42 of 851 participants randomly assigned to tranexamic acid and 71 of 850 in the control group died (RR 0.60, 95% CI 0.42 to 0.87; P value 0.007; I² = 0%). The analysis was...... review will be much more informative in a few years. Further examination of tranexamic acid would require inclusion of high-quality randomised controlled trials. Timing of randomisation is essential to avoid attrition bias and to limit the number of withdrawals. Future trials may use a pragmatic design...... and should include all participants with suspected bleeding or with endoscopically verified bleeding, as well as a tranexamic placebo arm and co-administration of pump inhibitors and endoscopic therapy. Assessment of outcome measures in such studies should be clearly defined. Endoscopic examination...

  11. Reoperation for bleeding in cardiac surgery

    Kristensen, Katrine Lawaetz; Rauer, Line Juul; Mortensen, Poul Erik; Kjeldsen, Bo Juel

    2012-01-01

    At Odense University Hospital (OUH), 5-9% of all unselected cardiac surgical patients undergo reoperation due to excessive bleeding. The reoperated patients have an approximately three times greater mortality than non-reoperated. To reduce the rate of reoperations and mortality due to postoperative...... bleeding, we aim to identify risk factors that predict reoperation. A total of 1452 consecutive patients undergoing cardiac surgery using extracorporeal circulation (ECC) between November 2005 and December 2008 at OUH were analysed. Statistical tests were used to identify risk factors for reoperation. We...... after cardiac surgery was low ejection fraction, high EuroSCORE, procedures other than isolated CABG, elongated time on ECC, low body mass index, diabetes mellitus and preoperatively elevated s-creatinine. Reoperated patients significantly had a greater increase in postoperative s-creatinine and higher...

  12. Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort

    Olesen, J B; Lip, G Y H; Hansen, P R;

    2011-01-01

    Oral anticoagulation (OAC) in patients with atrial fibrillation (AF) is a double-edged sword, because it decreases the risk of stroke at the cost of an increased risk of bleeding. We compared the performance of a new bleeding prediction scheme, HAS-BLED, with an older bleeding prediction scheme, ......, HEMORR(2)HAGES, in a cohort of 'real-world' AF patients....

  13. Bleeding risk assessment and management in atrial fibrillation patients. Executive Summary of a Position Document from the European Heart Rhythm Association [EHRA], endorsed by the European Society of Cardiology [ESC] Working Group on Thrombosis.

    Lip, Gregory Y H; Andreotti, Felicita; Fauchier, Laurent; Huber, Kurt; Hylek, Elaine; Knight, Eve; Lane, Deirdre; Levi, Marcel; Marín, Francisco; Palareti, Gualtiero; Kirchhof, Paulus

    2011-12-01

    In this executive summary of a Consensus Document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis, we comprehensively review the published evidence and propose a consensus on bleeding risk assessments in atrial fibrillation (AF) patients. The main aim of the document was to summarise 'best practice' in dealing with bleeding risk in AF patients when approaching antithrombotic therapy, by addressing the epidemiology and size of the problem, and review established bleeding risk factors. We also summarise definitions of bleeding in the published literature. Patient values and preferences balancing the risk of bleeding against thromboembolism as well as the prognostic implications of bleeding are reviewed. We also provide an overview of published bleeding risk stratification and bleeding risk schema. Brief discussion of special situations (e.g. periablation, peri-devices such as implantable cardioverter defibrillators [ICD] or pacemakers, presentation with acute coronary syndromes and/or requiring percutanous coronary interventions/stents and bridging therapy) is made, as well as a discussion of the prevention of bleeds and managing bleeding complications. Finally, this document puts forwards consensus statements that may help to define evidence gaps and assist in everyday clinical practice. PMID:22048796

  14. The selective bleed variable cycle engine

    Nascimento, M. A. R.

    1992-01-01

    A new concept in aircraft propulsion is described in this work. In particular, variable jet engine is investigated for supersonic ASTOVL aircraft. This engine is a Selective Bleed Variable Cycle, twin shaft turbofan. At low flight speeds the engine operates as a medium bypass turbofan. At supersonic cruise it operates as low bypass turbofan without reheat. The performance of the engine and its components is analyzed using a novel matching procedure. Off-design engine performance characterist...

  15. Sedimentation and Bleeding of Cement Paste

    Peng, Ya

    2014-01-01

    The lower viscosity and high matrix volume of Self-Compacting Concrete (SCC) compared to ordinary concrete can lead to instability in the form of particle segregation, sedimentation and bleeding. This is a problem for the exploitation of all the benefits from the use of SCC for the ready mix industry and contractors. This research started from the investigation on the main factors influencing the stability of the paste as well as the applicability of generally used theories on particle sedime...

  16. Otorrhagia bleeding due to leech bite

    Narges Askari; Afrooz Eshaghian

    2012-01-01

    Leeches are blood-sucking hermaphroditic parasites that attach to vertebrate hosts, bite through the skin, and suck out blood. When leeches feed, they secrete an anticoagulant (hirudin), which helps them get a full meal of blood. This is the first report of leech removal from external auditory canal. Previous leech involvement cases were explained in nasopharynx, larynx, pharynx, eye, and gastrointestinal tract. Prominent sign of all cases was active bleeding from the leech attachment site; t...

  17. Single session treatment for bleeding hemorrhoids

    Weinstein, S.J.; Rypins, E.B.; Houck, J.; Thrower, S.

    1987-12-01

    Fifty consecutive outpatients with bleeding internal hemorrhoids were prospectively treated with a single application of rubber band ligation or infrared coagulation. Complete follow-up observation was obtained in 48 patients (23 underwent rubber band ligation and 25 underwent infrared coagulation). At one month after treatment, 22 patients who underwent rubber band ligation and 16 who underwent infrared coagulation, were symptomatically improved (p less than 0.05). At six months, 15 patients who had undergone rubber band ligation and ten who had infrared coagulation treatment, remained improved (p less than 0.05). There was no statistical difference in the discomfort experienced by either group during or after the procedure as determined by a self-assessment scale. Two patients who underwent rubber band ligation experienced complications--a thrombosed external hemorrhoid developed in one patient and another had delayed rectal bleeding. Although associated with occasional complications after treatment, rubber band ligation is more effective than in infrared coagulation for single session treatment of bleeding internal hemorrhoids.

  18. Endoscopic hemoclip treatment for bleeding peptic ulcer

    Yung Chih Lai; Sien Sing Yang; Chi Hwa Wu; Tzen Kwan Chen

    2000-01-01

    AIM To evaluate the efficacy of endoscopic hemoclip in the treatment of bleeding peptic ulcer.METHODS Totally, 40 patients with F1a and F1b hemorrhagic activity of peptic ulcers were enrolled in this uncontrolled prospective study for endoscopic hemoclip treatment. We used a newly developed rotatable clip-device for the application of hemoclip (MD850) to stop bleeding. Endoscopy was repeated if there was any sign or suspicion of rebleeding, and reclipping was performed if necessary and feasible.RESULTS Initial hemostatic rate by clipping was 95%, and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%, 96%, and 93% in the F1a and F1b subgroups, and total cases, respectively. In patients with shock on admission, hemoclipping achieved ultimate hemostasis of 71% and 83% in F1a and F1b subgroups, respectively. Hemostasis reached 100% in patients without shock regardless of hemorrhagic activity being F1a or F1b. The average number of clips used per case was 3.0 (range 2- 5). Spurting bleeders required more clips on average than did oozing bleeders (3.4 versus 2.8 ). We observed no obvious complications, no tissue injury, or impairment of ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placement is an effective and safe method. With the improvement of the clip and application device,the procedure has become easier and much more efficient. Endoscopic hemoclipping deserves further study in the treatment of bleeding peptic ulcers.

  19. [Obscure digestive bleeding by ileal carcinoid tumor].

    Nelly Manrique, María; Frisancho, Oscar; Zumaeta, Eduardo; Palomino, Américo; Rodriguez, César

    2011-01-01

    The patient is an 82 year-old female with a history of osteoarthritis, hypothyroidism and anemia for 14 years (receiving blood transfusions). She was admited to our hospital with a nine months history of malaise, anorexia, fatigue and weakness, associated with intermitten episodes of abdominal pain. She was diagnosed anemia and occult blood positive stools. Physical examination revealed a patient in generally fair condition, obese, with mild edema of lower limbs, no changes in the evaluation of chest, cardiovascular, abdomen, etc. Laboratory data was unremarkable, except for iron deficiency anemia. The upper endoscopy showed duodenal ulcer scar, fundic polyposis and chronic gastritis. Colonoscopy revealed some diverticula, a small sessile polyp and internal hemorrhoids. The diagnosis of obscure gastrointestinal bleeding was made. The CT scan of the abdomen showed gallstones and fatty liver; a radiograph of intestinal transit detected a lesion apparently protruded intestinal loop for distal jejunum; enteroscopy was performed (with one team ball) anterograde and retrograde achieving assess distal jejunum and distal ileum without observing any injuries. The study of capsule endoscopy showed a polypoid tumor intestinal with evidence of having bleeding. Surgery detected the tumor in proximal ileum. The surgical specimen findings showed three tumors 0.7 mm, 10 mm and 15 mm on the proximal ileum. The microscopic examination revealed that these lesions were neuroendocrine tumors (carcinoid). The Ileal carcinoid tumor may rarely presented with obscure gastrointestinal bleeding. PMID:21544161

  20. [Bleeding gastric inflammatory fibroid polyp (Vanek's tumor)].

    Guţu, E; Ghidirim, Gh; Mişin, I; Iakovleva, Iraida; Vozian, M

    2010-01-01

    Inflammatory fibroid polyp's (IFP) or Vanek tumor of the gastrointestinal tract represents a relatively unusual entity. IFP is an extremely rare cause of upper gastrointestinal bleeding. We report herein a case of a 30-year-old woman who had a gastric IFP complicated by gastrointestinal bleeding and obstructive symptoms. The lesion was mistaken on endoscopic, radiologic examination and in the operating room for a gastrointestinal stromal tumor (GIST). Preoperative endoscopic examination revealed a protruding oval-shaped submucosal lesion (approximately 7 cm in size) of the gastric antrum, with ulceration of the mucosal surface. Multiple endoscopic biopsies were negative for neoplastic changes. Barium meal study disclosed a large tumor in the prepyloric area of the stomach. Presumptive preoperative diagnosis was GIST. Subtotal Bilroth II gastrectomy en bloc with the mass and lymphadenectomy was performed. Surprisingly, the final histological diagnosis was IFP. Postoperative course was uneventful and no recurrences were observed during 4 years follow-up. With reference to case report, the etiology, diagnosis and treatment strategy of IFP will be discussed. This case highlights an unusual presentation of IFP. Although bleeding may represent a rare complication due IFP, it should be considered in the differential diagnosis of upper gastrointestinal hemorrhage of uncertain etiology. PMID:20405696

  1. The role of computerized tomography in the evaluation of gastrointestinal bleeding following negative or failed endoscopy: A review of current status

    Stunell H

    2008-01-01

    Full Text Available Gastrointestinal bleeding remains an important cause for emergency hospital admission with a significant related morbidity and mortality. Bleeding may relate to the upper or lower gastrointestinal tracts and clinical history and examination may guide investigations to the more likely source of bleeding. The now widespread availability of endoscopic equipment has made a huge impact on the rapid identification of the bleeding source. However, there remains a large group of patients with negative or failed endoscopy, in whom additional techniques are required to identify the source of bleeding. In the past, catheter angiography and radionuclide red cell labeling techniques were the preferred ′next step′ modalities used to aid in identifying a bleeding source within the gastrointestinal tract. However, these techniques are time-consuming and of limited sensitivity and specificity. In addition, catheter angiography is a relatively invasive procedure. In recent years, computerized tomography (CT has undergone major technological advances in its speed, resolution, multiplanar techniques and angiographic abilities. It has allowed excellent visualization of the both the small and large bowel allowing precise anatomical visualization of many causes of gastrointestinal tract (GIT bleeding. In addition, recent advances in multiphasic imaging now allow direct visualization of bleeding into the bowel. In many centers CT has therefore become the ′next step′ technique in identifying a bleeding source within the GIT following negative or failed endoscopy in the acute setting. In this review article, we review the current literature and discuss the current status of CT as a modality in investigating the patient with GIT bleeding.

  2. Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

    Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao, E-mail: simonlixiao@126.com [West China Hospital, Sichuan University, Department of Gastroenterology (China)

    2013-05-02

    PurposeRegional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.MethodsFrom December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).ResultsTechnical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3–34) months, no recurrence of GI bleeding was observed.ConclusionsTransjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.

  3. Usefulness of Transjugular Intrahepatic Portosystemic Shunt in the Management of Bleeding Ectopic Varices in Cirrhotic Patients

    Purpose. To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the control of bleeding from ectopic varices. Methods. From 1995 to 2004, 24 cirrhotic patients, bleeding from ectopic varices, mean age 54.5 years (range 15-76 years), were treated by TIPS. The etiology of cirrhosis was alcoholic in 13 patients and nonalcoholic in 11 patients. The location of the varices was duodenal (n = 5), stomal (n = 8), ileocolic (n = 6), anorectal (n = 3), umbilical (n = 1), and peritoneal (n 1). Results. TIPS controlled the bleeding in all patients and induced a decrease in the portacaval gradient from 19.7 ± 5.4 to 6.4 ± 3.1 mmHg. Postoperative complications included self-limited intra-abdominal bleeding (n = 2), self-limited hemobilia (n = 1), acute thrombosis of the shunt (n = 1), and bile leak treated by a covered stent (n = 1). Median follow-up was 592 days (range 28-2482 days). Rebleeding occurred in 6 patients. In 2 cases rebleeding was observed despite a post-TIPS portacaval gradient lower than 12 mmHg and was controlled by variceal embolization; 1 patient underwent surgical portacaval shunt and never rebled; in 3 patients rebleeding was related to TIPS stenosis and treated with shunt dilatation with addition of a new stent. The cumulative rate of rebleeding was 23% and 31% at 1 and 2 years, respectively. One- and 2-year survival rates were 80% and 76%, respectively. Conclusion. The present series demonstrates that bleeding from ectopic varices, a challenging clinical problem, can be managed safely by TIPS placement with low rebleeding and good survival rates

  4. Comparison of detectable bleeding rates of radiopharmaceuticals for localization of gastrointestinal bleeding in sheep using a closed system

    Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M. (Kuwait Univ. (Kuwait). Dept. of Nuclear Medicine); Al-Wafai, I.; Vallgren, S. (Kuwait Univ. (Kuwait). Dept. of Surgery)

    1989-06-01

    The closed experimental animal model system was used to compare the detectable gastrointestinal (GI) bleeding rates of {sup 99m}Tc-DTPA, {sup 99m}Tc-RBCs and {sup 99m}Tc tin colloid in sheep. The three radiopharmaceuticals were used to detect the upper GI bleeding sites at rates of 0.57 and 0.25 ml/min. At the lower bleeding rate of 0.1 ml/min, both {sup 99m}Tc-DTPA and {sup 99m}Tc-RBCs were successful in detecting the bleeding site. At the lowest rate of 0.07 ml/min only {sup 99m}Tc-DTPA was successful in detecting the bleeding site. The results indicate that {sup 99m}Tc-DTPA is the most useful {sup 99m}Tc radiopharmaceutical for detecting the upper GI bleeding site at the slowest bleeding rate studied. (orig.).

  5. Endoscopic hemostasis state of the art - Nonvariceal bleeding.

    Goelder, Stefan Karl; Brueckner, Juliane; Messmann, Helmut

    2016-02-25

    New endoscopic techniques for hemostasis in nonvariceal bleeding were introduced and known methods further improved. Hemospray and Endoclot are two new compounds for topical treatment of bleeding. Initial studies in this area have shown a good hemostatic effect, especially in active large scale oozing bleeding, e.g., tumor bleedings. For further evaluation larger prospective studies comparing the substanced with other methods of endoscopic hemostasis are needed. For localized active arterial bleeding primary injection therapy in the area of ​​bleeding as well as in the four adjacent quadrants offers a good method to reduce bleeding activity. The injection is technically easy to learn and practicable. After bleeding activity is reduced the bleeding source can be localized more clearly for clip application. Today many different through-the-scope (TTS) clips are available. The ability to close and reopen a clip can aid towards good positioning at the bleeding site. Even more important is the rotatability of a clip before application. Often multiple TTS clips are required for secure closure of a bleeding vessel. One model has the ability to use three clips in series without changing the applicator. Severe arterial bleeding from vessels larger than 2 mm is often unmanageable with these conventional methods. Here is the over-the-scope-clip system another newly available method. It is similar to the ligation of esophageal varices and involves aspiration of tissue into a transparent cap before closure of the clip. Thus a greater vascular occlusion pressure can be achieved and larger vessels can be treated endoscopically. Patients with severe arterial bleeding from the upper gastrointestinal tract have a very high rate of recurrence after initial endoscopic treatment. These patients should always be managed in an interdisciplinary team of interventional radiologist and surgeons. PMID:26962402

  6. Spectrum of histopathological findings in postmenopausal bleeding

    To determine the frequencies of histopathological findings in endometrial and endocervical biopsy samples with clinical history of Postmenopausal Bleeding (PMB). Study Design: Descriptive cross-sectional study. Place and Duration of Study: Section of Histopathology, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from February 2012 to January 2013. Methodology: A total of 157 consecutive endometrial and endocervical biopsy specimens with history of postmenopausal bleeding were included. After microscopic examination, frequencies of histological findings in different age groups were generated. Chi-square and independent sample t-tests were applied to see whether the difference was significant which was set at p < 0.05. Results: One hundred and twenty-one (77.1%) specimens showed benign pathologies while 36 (22.9%) were malignant. Endometrial polyp was seen in 67 (42.7%) cases followed by endometrial carcinomas in 25 (15.9%), endometrial hyperplasia in 21 (13.4%), cervical carcinoma in 12 (7.6%) and cervical polyps in 9 (5.7%) cases. Ahighly significant increase in the percentage of malignant and pre-malignant lesions was seen with increasing age group (p < 0.001). Mean age of patients with type-2 endometrial carcinoma was higher than type-1 endometrial carcinoma but statistical significance was not observed (70.2 ± 6.5 vs. 61.8 ± 9.1 years respectively, p=0.069). Conclusion: Although benign pathologies were more common in postmenopausal bleeding but the collective proportion of endometrial and cervical malignancies and pre-malignant conditions was quite high. Therefore, PMB should be urgently evaluated for cause and early commencement of treatment. (author)

  7. Emergent Bleeding in Patients Receiving Direct Oral Anticoagulants.

    Summers, Richard L; Sterling, Sarah A

    2016-01-01

    Direct oral anticoagulants (DOACs) offer clinical advantages over warfarin, such as minimal medication and food interactions and fixed dosing without the need for routine monitoring of coagulation status. As with all anticoagulants, bleeding, either spontaneous or provoked, is the most common complication. The long-term use of these drugs is increasing, and there is a crucial need for emergency medicine service professionals to understand the optimal management of associated bleeding. This review aims to describe the indications and pharmacokinetics of available DOACs; to discuss the risk of bleeding; to provide a treatment algorithm to manage DOAC-associated emergency bleeding; and to discuss future directions in bleeding management, including the role of specific reversal agents, such as the recently approved idarucizumab for reversal of the direct thrombin inhibitor dabigatran. Because air medical personnel are increasingly likely to encounter patients receiving DOACs, it is important that they have an understanding of how to manage patients with emergent bleeding. PMID:27255877

  8. Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

    Supot Pongprasobchai; Sireethorn Nimitvilai; Jaroon Chasawat; Sathaporn Manatsathit

    2009-01-01

    AIM: To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding (UGIB) Etiology Score for predicting the types of UGIB and validate the score.METHODS: Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected.Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB.RESULTS: Among 261 patients with UGIB, 47 (18%) had variceal and 214 (82%) had non-variceal bleeding.Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding;previous diagnosis of cirrhosis or signs of chronic liver disease (OR 22.4, 95% CI 8.3-60.4, P < 0.001), red vomitus (OR4.6, 95% CI 1.8-11.9, P = 0.02), and red nasogastric (NG) aspirate (OR 3.3, 95% CI 1.3-8.3, P = 0.011).The UGIB Etiology Score was calculated from (3.1 x previous diagnosis of cirrhosis or signs of chronic liver disease) + (1.5 × red vornitus) + (1.2 × red NG aspirate), when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) in predicting variceal bleeding were 85%, 81%,82%, 50%, and 96%, respectively. The score was prospectively validated in another set of 195 UGIB cases (46 variceal and 149 non-variceal bleeding). The PPV and NPV of a score ≥3.1 for variceal bleeding were 79% and 97%, respectively.CONCLUSION: The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.

  9. Helical CT in the diagnosis of acute lower gastrointestinal haemorrhage

    Introduction: A pilot study to evaluate helical computer tomography (CT) as a diagnostic tool for acute lower gastrointestinal tract (GIT) bleeding. CT was compared to conventional angiography (CA) and colonoscopy for the diagnosis and detection of bleeding site in suspected cases of acute lower GIT bleeding. Methods: Seven patients presenting with acute lower GIT bleeding, between June and November 2002, underwent CT examinations. All of these seven patients underwent CA following CT. Emergency colonoscopies were performed on five patients investigated with both CT and CA. Median delay from the most recent episode of hematochezia to CT was two and a half hours, to CA was 3 h, and to colonoscopy was 4 h. None of the patients underwent nuclear medicine (NM) bleeding studies. Results: Haemoglobin drop in all patients was greater than 15 g/L in the first 24 h of presentation. The mean age was 68.86 years (range, 49-83 years). Comparing CT and CA, there were four concordant and three discordant results. Both modalities had concordant findings of two active bleeding sites, one non-bleeding rectal tumour, and one negative case result. In three patients, the source of bleeding was found on CT whereas CA was negative. Emergency colonoscopies performed in all of these three patients confirmed blood in the colon/ileum. Conclusion: Early experience suggests that CT is a safe, convenient and accurate diagnostic tool for acute lower GIT haemorrhage. It raises questions regarding the sensitivity of CA. A new management algorithm for acute lower GIT haemorrhage using CT as the pre-CA screening tool is being proposed based on the preliminary findings. Positive CT will allow directed therapeutic angiography, while negative CT will triage patients into alternative management pathways

  10. Helical CT in the diagnosis of acute lower gastrointestinal haemorrhage

    Sabharwal, Rohan [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia); Vladica, Philip [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia)]. E-mail: rpvl@imag.wsahs.nsw.gov.au; Chou, Roger [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia); Law, W. Phillip [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia)

    2006-05-15

    Introduction: A pilot study to evaluate helical computer tomography (CT) as a diagnostic tool for acute lower gastrointestinal tract (GIT) bleeding. CT was compared to conventional angiography (CA) and colonoscopy for the diagnosis and detection of bleeding site in suspected cases of acute lower GIT bleeding. Methods: Seven patients presenting with acute lower GIT bleeding, between June and November 2002, underwent CT examinations. All of these seven patients underwent CA following CT. Emergency colonoscopies were performed on five patients investigated with both CT and CA. Median delay from the most recent episode of hematochezia to CT was two and a half hours, to CA was 3 h, and to colonoscopy was 4 h. None of the patients underwent nuclear medicine (NM) bleeding studies. Results: Haemoglobin drop in all patients was greater than 15 g/L in the first 24 h of presentation. The mean age was 68.86 years (range, 49-83 years). Comparing CT and CA, there were four concordant and three discordant results. Both modalities had concordant findings of two active bleeding sites, one non-bleeding rectal tumour, and one negative case result. In three patients, the source of bleeding was found on CT whereas CA was negative. Emergency colonoscopies performed in all of these three patients confirmed blood in the colon/ileum. Conclusion: Early experience suggests that CT is a safe, convenient and accurate diagnostic tool for acute lower GIT haemorrhage. It raises questions regarding the sensitivity of CA. A new management algorithm for acute lower GIT haemorrhage using CT as the pre-CA screening tool is being proposed based on the preliminary findings. Positive CT will allow directed therapeutic angiography, while negative CT will triage patients into alternative management pathways.

  11. Obscure bleeding colonic duplication responds to proton pump inhibitor therapy

    2013-01-01

    We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding. Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5 and 2 years previously. An emergency abdominal computed tomography scan, gastroscopy and colonoscopy, performed after hemodynamic stabilization, were considered normal. High-dose intravenous proton pump inhibitor (PPI) therapy was initiated and bleeding stopped spontaneously. Two othe...

  12. Bleeding and Filtration of Cement-Based Grout

    Draganovic, Almir

    2009-01-01

    Grouting is a common method of sealing rock around tunnels to reduce or stop water inflow. Successful grouting significantly minimizes the maintenance cost and safety of the tunnel. Some questions about bleeding and penetrability of the grouts have to be examined more closely to carry out a successful grouting. Bleeding of cement-based grout is a complex problem. Measuring methods used today originate from the measuring of the bleeding of cement pastes used in ordinary building industry. Whet...

  13. Performance analysis of bleed condenser used in Indian PHWR

    Condensation of hot two phase bleed from the Primary Heat Transport (PHT) system is carried out by two different cooling modes in the bleed condenser of Indian PHWRs. These are the reflux and spray cooling modes. A computer code has been developed to predict the performance of bleed condensers used in Indian PHWRs for the above two cooling modes. Using the computer code the performance analysis was carried out for the reflux cooling and spray cooling modes separately. (author). 19 refs., 8 figs

  14. Otorrhagia bleeding due to leech bite

    Narges Askari

    2012-01-01

    Full Text Available Leeches are blood-sucking hermaphroditic parasites that attach to vertebrate hosts, bite through the skin, and suck out blood. When leeches feed, they secrete an anticoagulant (hirudin, which helps them get a full meal of blood. This is the first report of leech removal from external auditory canal. Previous leech involvement cases were explained in nasopharynx, larynx, pharynx, eye, and gastrointestinal tract. Prominent sign of all cases was active bleeding from the leech attachment site; that stopped with leech removal. A 24-year-old man was presented to Al-Zahra hospital with left otorrhagia and otalgia from 2 days ago. After suction of ear a small soft foreign body was seen in the external ear near the tympanic membrane, then the ear filled with glycerine phenice, the patient explained decreased movement of foreign body. Four hours later the bloody discharge stopped and otalgia decreased. After suction of clots, a leech was extruded from external auditory canal by alligator. Leech infestation is a rare cause of otorrhagia and should be suspected in the endemic region in all of unusual bleeding; it can be diagnosed and treated by exact inspection and removal.

  15. Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

    Shin, Ji Hoon [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-02-15

    Nonvariceal upper gastrointestinal (UGI) bleeding is a frequent complication with significant morbidity and mortality. Although endoscopic hemostasis remains the initial treatment modality, severe bleeding despite endoscopic management occurs in 5-10% of patients, necessitating surgery or interventional embolotherapy. Endovascular embolotherapy is now considered the first-line therapy for massive UGI bleeding that is refractory to endoscopic management. Interventional radiologists need to be familiar with the choice of embolic materials, technical aspects of embolotherapy, and the factors affecting the favorable or unfavorable outcomes after embolotherapy for UGI bleeding.

  16. Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

    Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

  17. Abnormal gastrointestinal accumulation of radiotracer by gastric bleeding during {sup 99m}Tc-MDP bone scintigraphy

    Chun, Kyung A.; Lee, Sang Woo; Lee, Jae Tae; Lee, Kyu Bo [College of Medicine, Kyungpook National Univ., Taegu (Korea, Republic of)

    1998-06-01

    We present a case in which a patient with acute hemorrhagic gastritis demonstrated abnormal gastrointestinal accumulation of radiotracer during {sup 99m}Tc-methylene diphosphonate (MDP) skeletal scintigraphy. A hemorrhagic gastritis was subsequently demonstrated by endoscopy. The mechanism for the intestinal localization of {sup 99m}Tc-MDP in this patients is not clear, but we guess that the extravasated blood containing the radiopharmaceutical cannot recirculate and stays at the bleeding site, so we can see the intestinal activity.

  18. The characteristics of adults with upper gastrointestinal bleeding admitted to Tripoli Medical Center: a retrospective case-series analysis

    Elghuel, Abdulbaset

    2011-01-01

    Background: Acute upper gastrointestinal bleeding (UGIB) is a common reason for hospital admissions worldwide. Aetiological causes of UGIB vary according to geographic region and socioeconomic status. However, despite the implementation of early endoscopy as the standard method for the diagnosis and treatment of UGIB, data on the characteristics of patients with UGIB in Libya are still minimal. In this study, we describe patient demographics, aetiological causes for UGIB, and possible risk fa...

  19. Delayed Bleeding and Pelvic Haematoma after Low-Energy Osteoporotic Pubic Rami Fracture in a Warfarin Patient: An Unusual Cause of Abdominal Pain

    Andrea Sandri

    2014-01-01

    Full Text Available Introduction. Acute abdominal pain may be the presenting symptom in a wide range of diseases in the elderly. Acute abdominal pain related to a delayed bleeding and pelvic haematoma after a low-energy pubic rami fracture is rare and can have important consequences; to the best of our knowledge, only one case has been previously described. Case Report. We present an unusual case of an 83-year-old woman taking warfarin for atrial fibrillation, admitted to the Emergency Department (ED with acute abdominal pain and progressive anemia related to a delayed bleeding and pelvic haematoma 72 hours after a low-energy osteoporotic pubic rami fracture. Warfarin was withheld, anticoagulation was reversed by using fresh frozen plasma and vitamin K, and concentrated red blood cells were given. Haemoglobin level gradually returned to normal with a progressive resorption of the haematoma. Conclusion. Delayed bleeding and pelvic haematoma after osteoporotic pubic rami fracture should be considered in the differential diagnosis of acute abdominal pain in the elderly. This case indicates the need for hospital admission, careful haemodynamic monitoring, and early identification of bleeding in patients with “benign” osteoporotic pubic rami fracture, especially those receiving anticoagulants, to provide an adequate management and prevent severe complications.

  20. Massive Upper Gastrointestinal Bleeding Secondary to Duodenal Metastasis of Transitional Cell Carcinoma of the Urinary Bladder

    Carlos H.F. Chan

    2011-04-01

    Full Text Available Acute upper gastrointestinal (UGI bleeding is a common problem in our clinical practice and is often due to peptic ulcer diseases. Occasionally, malignancy may be implicated in these situations. Here we report a rare case of UGI bleeding secondary to metastatic transitional cell carcinoma (TCC of the urinary bladder. A 62-year-old man with a history of stage IIIb TCC of the urinary bladder presented with hematemesis. Endoscopy showed a large tumor in the second stage of the duodenum that occupied 40% of the duodenal circumference, over 7 cm in length. Biopsies revealed a poorly differentiated malignant neoplasm consistent with metastasis from urothelial carcinoma that was identical to the previous surgical specimen of the urinary bladder. He was treated with supportive therapy and intravenous proton pump inhibitor and was discharged home 2 weeks later. Two weeks after discharge, the patient returned to the hospital with a painful swelling of the floor of his mouth. Biopsy again showed the same cancer type. He had unremitting bleeding from his mouth requiring multiple transfusions and a course of palliative radiation therapy. He progressively deteriorated in his cardiopulmonary and neurological functions and expired with cardiopulmonary arrest one month later.

  1. Abnormal uterine bleeding: a clinicohistopathological analysis

    Anupamasuresh Y

    2014-06-01

    Methods: In our prospective study of 359 Patients of the age between 46 and 73 years, clinical characteristics and the pattern of endometrial histopathology and their association in women, who present with abnormal uterine bleeding, are categorised into six groups. Results: In our study, a significant correlation of histopathology and BMI was observed with endometrial hyperplasia and malignancy in obese patient i.e. 37 out 96 and 13 out of 23 respectively. The incidence of malignancy has been increasing with the age being 1.6% in 46-50 years to 60% in 70-75 years. In our study 116 (32.3% had hypertension, 33 patients (9.2% had diabetes mellitus, 40 patients (11.1% had hypothyroidism. Conclusions: We found a maximum incidence of AUB in multiparous women. Clinicohistopathological analysis of AUB revealed endometrial hyperplasia in majority of patients. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 656-661

  2. Helping mothers survive bleeding after birth

    Nelissen, Ellen; Ersdal, Hege; Ostergaard, Doris;

    2014-01-01

    OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants, and...... ambulance drivers involved in maternity care. METHODS: In March 2012, health care workers were trained in HMS BAB, a half-day simulation-based training, using a train-the-trainer model. The training focused on basic delivery care, active management of third stage of labor, and treatment of postpartum...... hemorrhage, including bimanual uterine compression. MAIN OUTCOME MEASURES: Evaluation questionnaires provided information on course perception. Knowledge, skills, and confidence of facilitators and learners were tested before and after training. RESULTS: Four master trainers trained eight local facilitators...

  3. Digestive bleeding in children Sangrado digestivo en el niño.

    Luis Antonio García Rodríguez

    2005-12-01

    Full Text Available Usually gastrointestinal bleeding doesn't have serious consequences in children, although the newborns and infants are more vulnerable to it. It can appear to any age, with more incidence of acute lesions of gastric and duodenal mucous in bleeding of upper gastrointestinal tract, and fissures and polyps in lower gastrointestinal tract causes. The most serious bleedings are secondary to esophageal varices and Meckel's diverticulum. A good clinical trial, supported by image and endoscopic tests, and standardized therapy, are the key elements for the reduction of mortality in these patients. We presented the Good Clinical Practices Guideline for Gastrointestinal bleeding, approved by consensus in the the 4th National Good Clinical Practices Workshop in Pediatric Surgery (Las Tunas, Cuba; March 2005

    La hemorragia digestiva no suele tener en general consecuencias graves en los niños, aunque los neonatos y lactantes son más vulnerables a ella. Puede aparecer a cualquier edad, con mayor incidencia de las lesiones agudas de la mucosa gastroduodenal en los de origen alto, y las fisuras y los pólipos de recto en los de causas bajas. Los sangrados más graves son los secundarios a rotura de várices esofágicas y divertículos de Meckel. Un juicio clínico certero, apoyado en los estudios imaginológicos y endoscópicos, así como una terapéutica pautada, son elementos claves para la reducción de la morbimortalidad en estos pacientes. Se presenta la Guía de Buenas Prácticas Clínicas para sangrado digestivo, aprobada por consenso en el 4º Taller Nacional de Buenas Prácticas Clínicas en Cirugía Pediátrica (Las Tunas, 2005.

  4. Genotypes of Helicobacter pylori in patients with peptic ulcer bleeding

    Perng, Chin-Lin; Lin, Hwai-Jeng; Lo, Wen-Ching; Tseng, Guan-Ying; Sun, I-Chen; Ou, Yueh-Hsing

    2004-01-01

    AIM: Helicobacter pylori causes chronic gastritis, peptic ulcer, gastric cancer and MALT-lymphoma. Different genotypes of Helicobacter pylori are confirmed from diverse geographic areas. Its association with bleeding peptic ulcer remains controversial. The aim of this study was to investigate the Helicobacter pylori vacA alleles, cagA and iceA in patients with bleeding peptic ulcer.

  5. Management of bleeding complications in patients with cancer on DOACs.

    Schulman, Sam; Shrum, Jeffrey; Majeed, Ammar

    2016-04-01

    There has been a concern that major bleeding events (MBE) on direct-acting oral anticoagulants (DOACs) will be more difficult to manage than on vitamin K antagonists. Patients with cancer and DOAC-associated bleeding may be even more of a challenge to manage. We therefore reviewed the literature on bleeding in patients with cancer on DOACs. In addition, we performed an analysis of individual patient data from 5 phase III trials on treatment with dabigatran with focus on those with cancer. In 6 randomized trials the risk of MBE in patients with cancer was similar on treatment with DOACs compared to vitamin K antagonists. Bleeding was in the majority of patients managed with supportive therapy alone. In the individual patient data analysis there were no significant differences in use of hemostatic products, transfusion of red cells, effectiveness of management, bleeding-related mortality or 30-day all-cause mortality between patients with cancer treated with dabigatran or with warfarin. Local hemostatic therapy, including resection of the cancer site was more common in patients with gastrointestinal bleeding with cancer than among those without cancer. We conclude that management of bleeding in patients with cancer and on a DOAC does not pose a greater challenge than management of bleeding in patients without cancer. PMID:27067968

  6. NCIDENCE OF BLEEDING MANIFESTATIONS IN FEVER WITH THROMBOCYTOPENIA CASES

    Putta

    2015-04-01

    Full Text Available INTRODUCTION: Fever is the cardinal manifestation of infection. Platelets are necessary to prevent bleeding manifestations. Certain infections cause thrombocytopenia and bleeding manifestations. AIMS AND OBJECTIVES: To study the incidence of bleeding manifestations in i nfections which cause fever and thrombocytopenia. MATERIALS AND METHODS: INCLUSION CRITERIA: Patients who were admitted with fever and thrombocytopenia, aged above 12 years, in S.V.R.R.G.G.H, Tirupati were taken for the study. EXCLUSION CRITERIA: Patients who are admitted with thrombocytopenia and without fever were excluded. Patients who are admitted with fever and normal platelet count were excluded. RESULTS AND CONCLUSI ON: Fever with thrombocytopenia is the commonest presenting problem in the medical war ds. In the present study the commonest infectious etiology of fever with thrombocytopenia was malaria fever (36%, followed by undiagnosed fevers (28%, dengue fever (26%, typhoid fever (6% and scrub typhus (4%. In the present study bleeding manifestati ons were seen in 16 cases (32% and bleeding manifestations were not seen in 34 cases (68%. The commonest bleeding manifestation was cutaneous, followed by hematemesis, malena, bleeding gums, hematuria and epistaxis. Bleeding manifestation was commonly se en in thrombocytopenia with dengue fever (14%, followed by malaria (8%, undiagnosed cases (8% and typhoid (2%.

  7. Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia

    Kjeldsen, A D; Kjeldsen, J

    2000-01-01

    Gastrointestinal bleeding occurs in a number of patients with hereditary hemorrhagic telangiectasia (HHT) and may lead to a high transfusion need. The aim of this study was to estimate the occurrence and severity of gastrointestinal bleeding in a geographically well defined HHT population....

  8. Transfusion of fresh frozen plasma in non-bleeding ICU patients -TOPIC TRIAL: study protocol for a randomized controlled trial

    Müller Marcella CA

    2011-12-01

    Full Text Available Abstract Background Fresh frozen plasma (FFP is an effective therapy to correct for a deficiency of multiple coagulation factors during bleeding. In past years, use of FFP has increased, in particular in patients on the Intensive Care Unit (ICU, and has expanded to include prophylactic use in patients with a coagulopathy prior to undergoing an invasive procedure. Retrospective studies suggest that prophylactic use of FFP does not prevent bleeding, but carries the risk of transfusion-related morbidity. However, up to 50% of FFP is administered to non-bleeding ICU patients. With the aim to investigate whether prophylactic FFP transfusions to critically ill patients can be safely omitted, a multi-center randomized clinical trial is conducted in ICU patients with a coagulopathy undergoing an invasive procedure. Methods A non-inferiority, prospective, multicenter randomized open-label, blinded end point evaluation (PROBE trial. In the intervention group, a prophylactic transfusion of FFP prior to an invasive procedure is omitted compared to transfusion of a fixed dose of 12 ml/kg in the control group. Primary outcome measure is relevant bleeding. Secondary outcome measures are minor bleeding, correction of International Normalized Ratio, onset of acute lung injury, length of ventilation days and length of Intensive Care Unit stay. Discussion The Transfusion of Fresh Frozen Plasma in non-bleeding ICU patients (TOPIC trial is the first multi-center randomized controlled trial powered to investigate whether it is safe to withhold FFP transfusion to coagulopathic critically ill patients undergoing an invasive procedure. Trial Registration Trial registration: Dutch Trial Register NTR2262 and ClinicalTrials.gov: NCT01143909

  9. New insights to occult gastrointestinal bleeding: From pathophysiology to therapeutics

    Antonio; Damián; Sánchez-Capilla; Paloma; De; La; Torre-Rubio; Eduardo; Redondo-Cerezo

    2014-01-01

    Obscure gastrointestinal bleeding is still a clinical challenge for gastroenterologists. The recent development of novel technologies for the diagnosis and treatment of different bleeding causes has allowed a better management of patients, but it also determines the need of a deeper comprehension of pathophysiology and the analysis of local expertise in order to develop a rational management algorithm. Obscure gastrointestinal bleeding can be divided in occult, when a positive occult blood fecal test is the main manifestation, and overt, when external sings of bleeding are visible. In this paper we are going to focus on overt gastrointestinal bleeding, describing the physiopathology of the most usual causes, analyzing the diagnostic procedures available, from the most classical to the novel ones, and establishing a standard algorithm which can be adapted depending on the local expertise or availability. Finally, we will review the main therapeutic options for this complex and not so uncommon clinical problem.

  10. Lower Gastrointestinal Bleeding And Risk of Gastrointestinal Cancer

    Viborg, Søren; Søgaard, Kirstine Kobberøe; Farkas, Dóra Körmendiné; Nørrelund, Helene; Pedersen, Lars; Sørensen, Henrik Toft

    2016-01-01

    OBJECTIVES: Lower gastrointestinal (GI) bleeding is a well-known symptom of colorectal cancer (CRC). Whether incident GI bleeding is also a marker of other GI cancers remains unclear. METHODS: This nationwide cohort study examined the risk of various GI cancer types in patients with lower GI...... bleeding. We used Danish medical registries to identify all patients with a first-time hospital diagnosis of lower GI bleeding during 1995-2011 and followed them for 10 years to identify subsequent GI cancer diagnoses. We computed absolute risks of cancer, treating death as a competing risk, and calculated...... standardized incidence ratios (SIRs) by comparing observed cancer cases with expected cancer incidence rates in the general population. RESULTS: Among 58,593 patients with lower GI bleeding, we observed 2,806 GI cancers during complete 10-year follow-up. During the first year of follow-up, the absolute GI...

  11. Acute Lower Gastrointestinal Haemorrhage Secondary to Small Bowel Ascariasis

    Daphne Dewi, Stephen; Sze Li, Siow

    2012-01-01

    Acute lower gastrointestinal haemorrhage secondary to small bowel ascariasis is extremely rare. A high level of suspicion should be maintained when dealing with acute gastrointestinal haemorrhage in migrants and travellers. Small bowel examination is warranted when carefully repeated upper and lower endoscopies have failed to elicit the source of bleeding. Appropriate test selection is determined by the availability of local expertise. We present a case of acute lower gastrointestinal haemorr...

  12. Iatrogenic Complications in Five Patients with Upper Gastrointestinal Bleeding due to Ambient Air: Case Series and Literature Review

    Christine N. Manser

    2012-04-01

    Full Text Available Despite the increasing use of carbon dioxide for endoscopies during the last years, ambient air is still used. The amount of air depends on several factors such as examination time, presumable diameter of the endoscope channel and of course active use of air by the operator. Although endoscopic complications due to ambient air in the gastrointestinal (GI tract are a rare observation and mostly described in the colon, we report five cases in the upper GI tract due to insufflating large amounts of air through the endoscopes. All 5 patients needed an emergency upper endoscopy for acute presumed upper GI bleeding. In two cases both esophageal variceal bleeding and ulcer bleeding were detected; the fifth case presented with a bleeding due to gastric cancer. Due to insufflation of inadequate amounts of air through the endoscope channel, all patients deteriorated in circulation and ventilation. Two rumenocenteses and consecutively three laparotomies had to be performed in three patients. In the other two, gastroscopies had to be stopped for an emergency computed tomography. All critical incidents were believed to be a consequence of a long-lasting examination with use of too much air. Therefore in emergency situations, endoscopies should be performed with either submersion, low air flow pumps or even better by the use of carbon dioxide.

  13. Severe renal bleeding caused by a ruptured renal sheath: case report of a rare complication of percutaneous nephrolithotomy

    Gunes Ali

    2002-09-01

    Full Text Available Abstract Background Percutaneous nephrolithotomy is a minimally invasive intervention for renal stone disease. Complications, which are rare and usually presented as case reports, are diversified as the utilization of the procedure is expanded. The procedure causes less blood loss and less morbidity when compared to open surgical procedures. Yet, there are some reports involving severe bleeding and relevant morbidity during surgery. These are usually related with the surgical technique or experience of the surgeon. Renal sheaths are designed to cause minimal trauma inside the kidney and, to our knowledge, there are no reports presenting the rupture of a sheath causing severe bleeding during the procedure. Case report We present an adult patient who had severe bleeding during percutaneous nephrolithotomy due to parenchymal injury caused by a ruptured renal sheath. During retrieval, due probably to rough handling of the equipment, a piece of stone with serrated edges ruptured the tip of the sheath, and this tip caused damage inside the kidney. The operation was terminated and measures were taken to control bleeding. The patient was transfused with a total of 1600 ml of blood, and the stones were cleared in a second look operation. Conclusion Although considered to be a minimally invasive procedure, some unexpected complications may arise during percutaneous nephrolithotomy. After being fragmanted, stone pieces may damage surgical equipment, causing acute and severe harm to the kidney. Surgeons must manipulate the equipment with fine and careful movements in order to prevent this situation.

  14. Obscure bleeding colonic duplication responds to proton pump inhibitor therapy.

    Jacques, Jérémie; Projetti, Fabrice; Legros, Romain; Valgueblasse, Virginie; Sarabi, Matthieu; Carrier, Paul; Fredon, Fabien; Bouvier, Stéphane; Loustaud-Ratti, Véronique; Sautereau, Denis

    2013-09-21

    We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding. Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5 and 2 years previously. An emergency abdominal computed tomography scan, gastroscopy and colonoscopy, performed after hemodynamic stabilization, were considered normal. High-dose intravenous proton pump inhibitor (PPI) therapy was initiated and bleeding stopped spontaneously. Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy. This showed long tubular duplication of the right colon, with fresh blood in the duplicated colon. Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening. The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy. Obscure gastrointestinal bleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel's diverticulum or gastrointestinal duplication, and gastroenterologists should be aware of this potential medical situation. PMID:24124344

  15. PRE-AETHIOLOGICAL TREATMENT IN UPPER GASTRO-INTESTINAL BLEEDING

    G. Dimofte

    2005-01-01

    Full Text Available Upper gastro-intestinal bleeding remains a cornerstone in surgical practice and unfortunately its’ management is profoundly variable according to hospital protocols and local standards of care. Medical interventions are acting at different levels of medical care and a range of specialist are involved in the process, starting from family practitioners to surgeons, as well as highly trained specialist in interventional endoscopy or radiology. This review is trying to establish the landmarks in the early assessment and care of patients with upper gastro-intestinal bleeding, irrespective of the morphological cause of the bleeding. We propose a protocol for the management both of portal and non-portal upper-gastrointestinal bleedings, prior to endoscopic diagnosis. It is fundamental to establish a standard of care which is feasible in Romania and can work both in university and district hospitals. The protocol is marking the essential gestures with their relevance for the bleeding patient but also reminds the significance of clinical evaluation and safety in transportation of the patient to the nearest emergency room. A battery of simple test should be performed in every patient and data interpreted with care, as results vary according to the level of haemodynamic compensation. Standard empiric therapy for upper gastro-intestinal bleeding is not yet been established but a couple of alternatives emerge as possible solutions. We discuss the benefits of a standard therapy based on H2 blockers, proton pump inhibitors, octreoctide and somatostatin regarding both portal and non-portal bleedings.

  16. Selective serotonin reuptake inhibitors and the risk of bleeding

    Padma L

    2013-06-01

    Full Text Available Background: Selective serotonin reuptake inhibitors (SSRIs are commonly prescribed agents for various conditions in general psychiatry. There is a strong consensus that blockade of serotonin reuptake affects primary hemostasis, namely platelet activity, thus resulting in a bleeding tendency. Considering that SSRIs are commonly prescribed, this study was conducted to assess if they were associated with an increased risk of bleeding. Methods: This was a prospective, open-label study of 30 patients attending the Psychiatry out-patient department, Dr. B. R. Ambedkar Medical College, Bangalore who satisfied DSM-IV criteria for a primary diagnosis of depression, treated with SSRIs. Bleeding time, clotting time, prothrombin time, partial thromboplastin time and platelet count were assessed at baseline and at the end of 6 weeks of treatment or occurrence of bleeding symptom. Results: The patients aged between 18-55 years of whom 21 were females, were treated with an SSRI (fluoxetine 12, escitalopram 12 and sertraline 6 patients. Six patients had overt symptoms of bleeding (upper gastrointestinal bleeding (hematemesis 4; epistaxis 2 and petechiae 2 of whom one patient gave a history of both hematemesis and petechiae and another of hematemesis and epistaxis. The average day after treatment beginning, on which patients reported with bleeding was 30.33 (26-40 days. There was a significant increase in the bleeding time (p=0.028 and clotting time (p=0.042, implying derangement in platelet aggregation. There was no significant change in the other parameters. Conclusion: Treatment with SSRIs increases the risk of bleeding. However, large, randomized controlled trials are required to re-affirm these findings. [Int J Basic Clin Pharmacol 2013; 2(3.000: 272-274

  17. Intraoperative bleeding control by uniportal video-assisted thoracoscopic surgery†.

    Gonzalez-Rivas, Diego; Stupnik, Tomaz; Fernandez, Ricardo; de la Torre, Mercedes; Velasco, Carlos; Yang, Yang; Lee, Wentao; Jiang, Gening

    2016-01-01

    Owing to advances in video-assisted thoracic surgery (VATS), the majority of pulmonary resections can currently be performed by VATS in a safe manner with a low level of morbidity and mortality. The majority of the complications that occur during VATS can be minimized with correct preoperative planning of the case as well as careful pulmonary dissection. Coordination of the whole surgical team is essential when confronting an emergency such as major bleeding. This is particularly important during the VATS learning curve, where the occurrence of intraoperative complications, particularly significant bleeding, usually ends in a conversion to open surgery. However, conversion should not be considered as a failure of the VATS approach, but as a resource to maintain the patient's safety. The correct assessment of any bleeding is of paramount importance during major thoracoscopic procedures. Inadequate management of the source of bleeding may result in major vessel injury and massive bleeding. If bleeding occurs, a sponge stick should be readily available to apply pressure immediately to control the haemorrhage. It is always important to remain calm and not to panic. With the bleeding temporarily controlled, a decision must be made promptly as to whether a thoracotomy is needed or if the bleeding can be solved through the VATS approach. This will depend primarily on the surgeon's experience. The operative vision provided with high-definition cameras, specially designed or adapted instruments and the new sealants are factors that facilitate the surgeon's control. After experience has been acquired with conventional or uniportal VATS, the rate of complications diminishes and the majority of bleeding events are controlled without the need for conversion to thoracotomy. PMID:26424873

  18. Quality laboratory issues in bleeding disorders.

    Adcock, D M; Mammen, J; Nair, S C; de Lima Montalvão, S A

    2016-07-01

    Selected quality issues pertinent to the determination of accurate results in the haemostasis laboratory are discussed. Specifically, the implementation of a successful external quality-assessment scheme is described, including its impact on result accuracy as well as the programme's unique challenges and opportunities. Errors in the preanalytical phase of laboratory testing represent the greatest source for reporting incorrect test results. Some of the most common preanalytical errors are described including those that necessitate sample rejection. Analytical means to identify potential sources of error and analytical means to overcome particular interferences are described. Representing the most important clinical complication in the treatment of patients with haemophilia, quality issues related to determination of the presence of inhibitory antibodies against factor VIII (FVIII) are reviewed. Heat treatment of patient plasma prior to testing, particularly in patients receiving replacement FVIII concentrate or during induction of immune tolerance to achieve more accurate results is recommended, while screening activated partial thromboplastin time-based mixing tests to rule out inhibitor presence is discouraged. The initiatives presented in this review can be implemented in robust and resource restricted settings to improve the quality of laboratory testing in patients with bleeding disorders. PMID:27405682

  19. Splenic angiosarcoma metastasis to small bowel presented with gastrointestinal bleeding

    Jun-Te Hsu; Chin-Yew Lin; Ting-Jun Wu; Han-Ming Chen; Tsann-Long Hwang; Yi-Yin Jan

    2005-01-01

    Primary splenic angiosarcoma is a very rare,aggressive neoplasm with a high metastatic rate and dismal prognosis. This neoplasm usually presents with abdominal pain, splenomegaly, anemia, and thrombocytopenia. Splenic angiosarcoma with bleeding gastrointestinal metastases is extremely rare. The literature contains only two case reports. This study reported a 44-year-old male patient with splenic angiosarcoma with sustained repeated gastrointestinal bleeding due to small bowel metastases. Salvage surgery was performed by splenectomy and resection of the metastatic small bowel tumors. The post-operative course was uneventful; the patient survived with the disease and had no GI bleeding, 7 mo after surgery.

  20. Bleed condenser pressure relief valves for CANDU reactors

    Four test programs of Bleed Condenser pressure relief valves (RVs) have been completed. This work was initiated following two events in which Bleed Condenser REs were damaged. During one event, the piping connecting one of the RV's to the Bleed Condenser also failed. The author describes the investigations of these events and subsequent testing of several different RV designs. Based on the test results, pressure relief valve designs suitable for this service have been determined. Lessons learned are applicable to pressure relief valves in liquid services

  1. Bleeding following deep hypothermia and circulatory arrest in children.

    Mossad, Emad B; Machado, Sandra; Apostolakis, John

    2007-03-01

    Deep hypothermic circulatory arrest (DHCA) is a technique of extracorporeal circulation commonly used in children with complex congenital heart defects undergoing surgical repairs. The use of profound cooling (20 degrees C) and complete cessation of circulation allow adequate exposure and correction of these complex lesions, with enhanced cerebral protection. However, the profound physiologic state of DHCA results in significant derangement of the coagulation system and a high incidence of postoperative bleeding. This review examines the impact of DHCA on bleeding and transfusion requirements in children and the pathophysiology of DHCA-induced platelet dysfunction. It also focuses on possible pharmacologic interventions to decrease bleeding following DHCA in children. PMID:17484172

  2. Clinical Presentations of Acute Leukemia

    Objective: To document the clinical presentation and epidemiology of various types of acute leukemia with their respective referral source at a tertiary level centre in Peshawar. Study Design: An observational study. Place and Duration of Study: Department of Pathology, Hayatabad Medical Complex (HMC), Peshawar, from January 2011 to May 2012. Methodology: A total of 618 bone marrow biopsy reports were reviewed. All biopsy reports labeled as acute leukemia were reviewed for age, gender, address, referring unit, diagnosis on bone marrow examination, presenting complaints, duration of illness and findings of clinical examination. Results: Ninety-two patients were diagnosed as suffering from acute leukemias (15%). ALL was most prevalent (46%), followed by AML (38%) and undifferentiated acute leukemia (16%). Males were affected more compared to females (60% vs. 40%). ALL and AML were predominant in pediatric (64%) and adults (77%) patients respectively. Patients from Afghanistan accounted for 33% of all cases followed by Peshawar (14%). Fever (77%), pallor (33%) and bleeding disorders (23%) were the main presenting complaints. Enlargement of liver, spleen and lymph nodes together was associated with ALL compared with AML (p = 0.004). Conclusion: ALL-L1 and AML-M4 were the most common sub-types. Fever, pallor and bleeding disorders were the main presenting complaints. Enlargement of liver, spleen and lymph nodes was more frequently associated with ALL compared to AML. (author)

  3. Radionuclide-monitoring of gastro-intestinal bleeding-activity

    Radionuclide-monitoring was done in 50 patients to assess gastro-intestinal bleeding, activity and location. Monitoring with 99mTc-in vivo-labelled erythrocytes was performed as sequential scintigraphy in increments of 1-2 hours up to 62 hours. 23 patients without active GI-bleeding were correctly identified. 27 patients showed pathologic activities in abdominal bloodpool-scintigraphy. In 25 patients peristaltic movement of these activities were seen - in each case we correctly diagnosed active GI-bleeding. In 2 patients the activity stayed for a longer period in the same location - one patient had a liverhemangioma, the other patient had an aneurysma of the arteria mesenterica superior. The great impact of radionuclide-monitoring on diagnostic and therapeutic management of gastrointestinal bleeding is emphasized. (orig.)

  4. Pregnancy Complications: Bleeding and Spotting from the Vagina

    ... problem, but they can be a sign of miscarriage or other serious complications. Miscarriage is when a baby dies in the womb ... is a sign of a serious problem, like: Miscarriage . Almost all women who miscarry have bleeding or ...

  5. Fibrinogen concentrates for bleeding trauma patients: what is the evidence?

    Meyer, Martin; Ostrowski, S R; Windeløv, N A;

    2011-01-01

    A balanced transfusion of red blood cells, fresh frozen plasma and platelets are recommended for massively bleeding trauma patients. Fibrinogen concentrates could potentially lessen or replace the need for fresh frozen plasma and/or platelet transfusions....

  6. Modern issues on the treatment of peptic ulcer bleedings

    Potakhin S.N.

    2014-03-01

    Full Text Available Despite the success of therapeutic treatment of peptic ulcer and the introduction of endoscopic technologies, the problem of peptic ulcer hemorrhage remains valid. A large number of publications in foreign literature are dedicated to epidemiology and prevention of bleeding, evaluation of modern tactics and search for new methods of treatment. The works relating to organization of aid to patients with peptic ulcer bleeding are of particular interest. According to the recent data not all clinics even in economically developed countries manage to follow the recommendations of an international consensus-2010 for non-variceal bleeding treatment of upper gastrointestinal tract. Among the causes of non-compliance of international recommendations there are subjective and objective factors, the understanding of which can significantly affect the optimization of aid to patients with peptic ulcer bleeding.

  7. Improving the management of gastrointestinal bleeding in patients with cirrhosis.

    Williams, Michael J; Hayes, Peter

    2016-04-01

    Gastrointestinal bleeding remains a major cause of mortality in patients with cirrhosis. The most common source of bleeding is from gastroesophageal varices but non-variceal bleeding from peptic ulcer disease also carries a significant risk in patients with liver disease. The prognosis is related to the severity of the underlying liver disease, and deaths often occur due to liver failure, infection or renal failure. Optimal management should therefore not only achieve haemostasis but address these complications as well. The management of gastrointestinal bleeding in patients with cirrhosis includes a range of medical, endoscopic and radiological interventions. This article updates the recent developments in this area and highlights topics where further research is still required. PMID:26581713

  8. Anode reactive bleed and injector shift control strategy

    Cai, Jun [Rochester, NY; Chowdhury, Akbar [Pittsford, NY; Lerner, Seth E [Honeoye Falls, NY; Marley, William S [Rush, NY; Savage, David R [Rochester, NY; Leary, James K [Rochester, NY

    2012-01-03

    A system and method for correcting a large fuel cell voltage spread for a split sub-stack fuel cell system. The system includes a hydrogen source that provides hydrogen to each split sub-stack and bleed valves for bleeding the anode side of the sub-stacks. The system also includes a voltage measuring device for measuring the voltage of each cell in the split sub-stacks. The system provides two levels for correcting a large stack voltage spread problem. The first level includes sending fresh hydrogen to the weak sub-stack well before a normal reactive bleed would occur, and the second level includes sending fresh hydrogen to the weak sub-stack and opening the bleed valve of the other sub-stack when the cell voltage spread is close to stack failure.

  9. Cambios en la etiología, resultados y características de los pacientes con hemorragia digestiva aguda grave a lo largo del periodo 1999-2005 Changes in the etiology, outcome, and characteristics of patients with acute gastrointestinal bleeding between 1999 and 2005

    A. Garrido

    2007-05-01

    Full Text Available Objetivos: analizar la evolución, a lo largo del periodo 1999-2005, de las siguientes variables de los pacientes ingresados por hemorragia digestiva (HD en una Unidad de Sangrantes: etiología, patología de base, consumo de AINE/anticoagulación y mortalidad. Material y métodos: durante el periodo 1999-2005 se ha estudiado la evolución de las siguientes causas de HD que requirieron ingreso en la Unidad de Sangrantes: ulcus duodenal (UD, ulcus gástrico (UG, hipertensión portal (HPT y otros. De igual forma se ha analizado la evolución en el porcentaje de enfermos ingresados con patología de base, consumo de fármacos AINE/anticoagulantes y mortalidad. Resultados: se han incluido 1.611 pacientes en el estudio con una edad media de 60,45 años (59,7-61,2, 76,41% hombres (74,3-78,5. La UD fue responsable del 22,20% de episodios (20,2-24,3, la UG del 18,40% (16,6-20,4 y la HPT del 33,60% (31,3-36,0. De forma global realizaban tratamiento con AINE el 34,5% (32,6-37,3, anticoagulación el 7,1% (6,0-8,6, presentaban patología de base el 72,6% (70,4-74,8 y la mortalidad global fue del 6,27% (5,16-7,59. A lo largo del periodo estudiado se constató un aumento de los pacientes con patología de base (p Objectives: to analyze the evolution of the following variables in patients admitted to a Blood Unit for gastrointestinal bleeding throughout 1999-2005: etiology, comorbid diseases, use of NSAIDs/anticoagulants, and mortality. Material and methods: we analyzed the evolution of the following causes of GIB that required admission to the Blood Unit from 1999 to 2005: duodenal ulcer (DU, gastric ulcer (GU, portal hypertension (PHT, and others. We also analyzed changes in the percentage of patients admitted with comorbid disease, use of NSAIDs/anticoagulants, and mortality. Results: 1,611 patients with a mean age of 60.45 years (59.7-61.2 were included in this study; 76.41% were males (74.3-78.5. DU was the cause of bleeding in 22.20% of cases (20

  10. Spinal Hemangiopericytoma Which Needed Intraoperative Embolization due to Unexpected Bleeding

    Lee, Chang-Hyun; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

    2013-01-01

    Spinal intradural hemangiopericytoma is a very rare tumor and can be characterized by massive bleeding during surgeries, frequent recurrence, and metastasis. However, definite radiologic differential points of hemangiopericytoma are not known. We describe an unexpected hemangiopericytoma case with large bleeding and management of the tumor. A 21-year-old man visited complaining of progressive neck pain and tingling sensation in both hands. Magnetic resonance imaging of his spine revealed C1-2...

  11. Systematic review: tranexamic acid for upper gastrointestinal bleeding

    Klingenberg, S.L.; Langholz, S.E.; Gluud, Lise Lotte

    2008-01-01

    BACKGROUND: Tranexamic acid may reduce upper gastrointestinal bleeding and stabilize patients before endoscopic treatments. AIM: To review randomized trials on tranexamic acid for upper gastrointestinal bleeding. METHODS: Manual and electronic searches of The Cochrane Library, MEDLINE, EMBASE and...... were unclearly reported. Data from three of the included trials suggested that tranexamic acid did not significantly increase the risk of thromboembolic disease. CONCLUSIONS: The present review suggests that tranexamic acid may reduce all-cause mortality. However, because of limitations in the internal...

  12. Fibrinogen concentrates for bleeding trauma patients: what is the evidence?

    Meyer, Martin; Ostrowski, S R; Windeløv, N A;

    2011-01-01

    A balanced transfusion of red blood cells, fresh frozen plasma and platelets are recommended for massively bleeding trauma patients. Fibrinogen concentrates could potentially lessen or replace the need for fresh frozen plasma and/or platelet transfusions.......A balanced transfusion of red blood cells, fresh frozen plasma and platelets are recommended for massively bleeding trauma patients. Fibrinogen concentrates could potentially lessen or replace the need for fresh frozen plasma and/or platelet transfusions....

  13. Therapeutic angiography for giant bleeding gastro-duodenal artery pseudoaneurysm

    Ram; Elazary; Mahmoud; Abu-Gazala; Avraham; Schlager; Noam; Shussman; Avraham; I; Rivkind; Allan; I; Bloom

    2010-01-01

    We present the case of an 18-year-old female transferred to our center from an outside hospital due to persistent gastrointestinal bleeding. Two weeks prior to her transfer she underwent duodenal omentopexy for a perforated duodenal peptic ulcer. The patient underwent a computed tomography angiogram which identified the source of bleeding as a giant gastroduodenal artery (GDA) pseudoaneurysm. The patient was taken to interventional radiology where successful microcoil embolization was performed. We present ...

  14. Prolonged bleeding on the neck in leech therapy: Case report

    Atakan Savrun; Selim Bozkurt; Mehmet Okumus; Emre Gokcen; Murat Turkaslan

    2015-01-01

    Superficial skin bleeding can usually be stopped by applying short-time compression, unless the patient suffers from coagulation disorders or uses anticoagulant. Because of the anticoagulant component of leech saliva, a leech bite may cause long-time bleeding, which cannot be stopped via compression. In this study, the case of a patient who applied leech therapy on her neck for the treatment of migraine has been presented. [Arch Clin Exp Surg 2015; 4(4.000): 234-237

  15. Evaluation of endometrium in peri-menopausal abnormal uterine bleeding

    Kotdawala, Parul; Kotdawala, Sonal; Nagar, Nidhi

    2013-01-01

    Abnormal Uterine Bleeding (AUB) is one of the most common health problems encountered by women. It affects about 20% women of reproductive age, and accounts for almost two thirds of all hysterectomies. Gynaecologists are often unable to identify the cause of abnormal bleeding even after a thorough history and physical examination. Diagnostic evaluations and treatment modalities have been evolving over time. The onus in AUB management is to exclude complex endometrial hyperplasia and endometri...

  16. Lessons Learned from Animal Models of Inherited Bleeding Disorders

    Nichols, Timothy C.

    2014-01-01

    Advances in treatment of hemophilia and von Willebrand disease (VWD) depend heavily on the availability of well-characterized animal models. These animals faithfully recapitulate the severe bleeding phenotype that occurs in humans with these inherited bleeding disorders. Research in these animal models represents important early and intermediate steps of translational research aimed at addressing current limitations in treatment such as the development of inhibitory antibodies to coagulation ...

  17. The Significance of Small Cerebral Bleeds in Neurodegenerative Dementia Syndromes

    De Reuck, Jacques L.

    2012-01-01

    Small cerebral bleeds are frequently observed in brains of patients with Alzheimer disease (AD) and cerebral amyloid angiopathy (CAA). However, they are also observed in patients with other neurodegenerative dementias and in persons without cognitive impairment. The aim of this survey is to compare the bleeding load in brains with different dementia syndromes and in age-matched controls. Hundred sixty-five brains were examined. The prevalence and the severity of the different cerebrovascular ...

  18. Endoscopic Removal of an Unusual Foreign Body Causing Gastrointestinal Bleeding

    A. Karaman

    2010-09-01

    Full Text Available Foreign body ingestion is a condition more common in the pediatric population than in adults. In adults, although foreign body ingestion can be well tolerated, approximately 10–20% of patients require endoscopic intervention. Delayed diagnosis and unremoved foreign bodies can cause serious and fatal complications including perforation, fistula and gastrointestinal bleeding. Here we report a patient with bleeding duodenal ulcer thought to be initiated by a large foreign body.

  19. Double-balloon enteroscopy in detecting small intestinal bleeding

    ZHI Fa-chao; PAN De-shou; ZHOU Dian-yuan; XIAO Bing; JIANG Bo; WAN Tian-mo; GUO Yu; ZHOU Dan; WANG Li-hui; CHEN Jin-feng; XIE Lu

    2005-01-01

    @@ Digestive tract hemorrhage is a common disease of the digestive system, but about 0.4%-5% intestinal bleeding can not be detected with gastroscope or colonscope.1 Since the intestine is long, tortuous, far away from both ends of the digestive tract and unfixed in position, clinical diagnosis of the bleeding is relatively difficult. Yamamoto and Sugano2 reported the clinical application of double-balloon enteroscope at American DDW in 2003.

  20. An unusual cause of upper gastrointestinal system bleeding: Duodenal varices

    Yılmaz, Ömer; Ataseven, Hilmi

    2012-01-01

    Abstract Duodenal varices are an uncommon site of hemorrhage in patients with portal hypertension, but their rupture is a serious and often fatal event. We report the case of a 27- year- old man with liver cirrhosis who presented with upper gastrointestinal bleeding. Upper gastrointestinal endoscopy revealed nodular varices in the second portion of the duodenum which were considered to be the source of bleeding. We decided to inject N-butyl-2-cyanoacrylate (Histoacryl), an adhesive agent, and...

  1. Successful use of N-acetyl cysteine and activated recombinant factor VII in fulminant hepatic failure and massive bleeding secondary to dengue hemorrhagic fever

    Edirisooriya Maddumage Manoj

    2014-01-01

    Full Text Available Consensus on management of complicated cases of dengue infection is evolving. Dengue hemorrhagic fever (DHF occasionally progress to fulminant liver failure with high fatality rate. Inadvertent use of blood products to control massive bleeding in dengue shock syndrome may worsen fluid overload and subsequently the multi-organ dysfunction. We report a case of 37-years-old Sri Lankan man who developed fulminant liver failure and massive bleeding associated with DHF, subsequently recovered completely with supportive measures including administration of N-acetyl cysteine and activated recombinant factor VII. In conclusion, prevention of ischemic injury to liver and adoption of early aggressive supportive measures in complicated cases of dengue hemorrhagic fever is crucial for a favorable outcome. Indications for rFVIIa to arrest uncontrolled internal bleeding and use of NAC in non-acetaminophen-induced acute liver failure in complicated DHF are a platform for discussion.

  2. Bleeding after endoscopic submucosal dissection: Risk factors and preventive methods

    Kataoka, Yosuke; Tsuji, Yosuke; Sakaguchi, Yoshiki; Minatsuki, Chihiro; Asada-Hirayama, Itsuko; Niimi, Keiko; Ono, Satoshi; Kodashima, Shinya; Yamamichi, Nobutake; Fujishiro, Mitsuhiro; Koike, Kazuhiko

    2016-01-01

    Endoscopic submucosal dissection (ESD) has become widely accepted as a standard method of treatment for superficial gastrointestinal neoplasms because it enables en block resection even for large lesions or fibrotic lesions with minimal invasiveness, and decreases the local recurrence rate. Moreover, specimens resected in an en block fashion enable accurate histological assessment. Taking these factors into consideration, ESD seems to be more advantageous than conventional endoscopic mucosal resection (EMR), but the associated risks of perioperative adverse events are higher than in EMR. Bleeding after ESD is the most frequent among these adverse events. Although post-ESD bleeding can be controlled by endoscopic hemostasis in most cases, it may lead to serious conditions including hemorrhagic shock. Even with preventive methods including administration of acid secretion inhibitors and preventive hemostasis, post-ESD bleeding cannot be completely prevented. In addition high-risk cases for post-ESD bleeding, which include cases with the use of antithrombotic agents or which require large resection, are increasing. Although there have been many reports about associated risk factors and methods of preventing post-ESD bleeding, many issues remain unsolved. Therefore, in this review, we have overviewed risk factors and methods of preventing post-ESD bleeding from previous studies. Endoscopists should have sufficient knowledge of these risk factors and preventive methods when performing ESD.

  3. Congenital portosystemic shunts with and without gastrointestinal bleeding - case series

    Gong, Ying; Chen, Jun; Chen, Qi; Ji, Min; Pa, Mier; Qiao, Zhongwei [Children' s Hospital of Fudan University, Department of Radiology, Shanghai (China); Zhu, Hui [Fudan University Shanghai Cancer Center, Department of Radiology, Shanghai (China); Zheng, Shan [Children' s Hospital of Fudan University, Department of Surgery, Shanghai (China)

    2015-12-15

    The clinical presentation of congenital portosystemic shunt is variable and gastrointestinal bleeding is an uncommon presentation. To describe the imaging features of congenital portosystemic shunt as it presented in 11 children with (n = 6) and without gastrointestinal bleeding (n = 5). We performed a retrospective study on a clinical and imaging dataset of 11 children diagnosed with congenital portosystemic shunt. A total of 11 children with congenital portosystemic shunt were included in this study, 7 with extrahepatic portosystemic shunts and 4 with intrahepatic portosystemic shunts. Six patients with gastrointestinal bleeding had an extrahepatic portosystemic shunt, and the imaging results showed that the shunts originated from the splenomesenteric junction (n = 5) or splenic vein (n = 1) and connected to the internal iliac vein. Among the five cases of congenital portosystemic shunt without gastrointestinal bleeding, one case was an extrahepatic portosystemic shunt and the other four were intrahepatic portosystemic shunts. Most congenital portosystemic shunt patients with gastrointestinal bleeding had a shunt that drained portal blood into the iliac vein via an inferior mesenteric vein. This type of shunt was uncommon, but the concomitant rate of gastrointestinal bleeding with this type of shunt was high. (orig.)

  4. A retrospective study on estrogen or contraceptives in the treatment of dysfunctional uterine bleeding in adolescent patients

    Liu Ying; Xu Ling

    2006-01-01

    Objective: To investigate the clinical efficacy of estrogen or contraceptives in the treatment of acute bleeding of dysfunctional uterine bleeding (DUB) in adolescent patients and the optimal starting dosage of drugs.Methods: The clinical records of 106 girls who with DUB and moderate or severe anemia from February 1990 to July 2005 were analyzed retrospectively.Results: All 106 patients received hormonal therapy. 56 patients were treated with estradiol benzoate(E2), 30 patients with conjugated equine estrogen(CEE) and 20 patients with combined oral contraceptives (COCs). The rates for rapidly controlling bleeding and for rapidly stopping bleeding in E2 group were higher than those in CEE group ,but similar to those in COCs group. The days for controlling and completely stopping bleeding were not significantly different between the starting dosages (≤8 mg/d and >8 mg/d) of E2 groups, and also there were no statistical difference between the starting dosages (<7.5 mg/d and ≥7.5 mg/d) of CEE groups, but during the treatment the rate of increasing the dosage in <7.5 mg/d group was higher than that of ≥7.5 mg/d group(40% vs. 5%),while there were no statistical difference between the starting dosages (≤3 pills/d and >3 pills/d) of COCs groups. Conclusions: The clinical efficiency of E2 treatment on DUB in adolescent patients is similar to that of COCs. And the efficacies of treatment of DUB with E2, CEE and COCs in the different dosages are similar.

  5. Acute Bronchitis

    ... of bronchitis: acute and chronic. Most cases of acute bronchitis get better within several days. But your cough ... that cause colds and the flu often cause acute bronchitis. These viruses spread through the air when people ...

  6. A novel semi-quantitative method for measuring tissue bleeding.

    Vukcevic, G; Volarevic, V; Raicevic, S; Tanaskovic, I; Milicic, B; Vulovic, T; Arsenijevic, S

    2014-03-01

    In this study, we describe a new semi-quantitative method for measuring the extent of bleeding in pathohistological tissue samples. To test our novel method, we recruited 120 female patients in their first trimester of pregnancy and divided them into three groups of 40. Group I was the control group, in which no dilation was applied. Group II was an experimental group, in which dilation was performed using classical mechanical dilators. Group III was also an experimental group, in which dilation was performed using a hydraulic dilator. Tissue samples were taken from the patients' cervical canals using a Novak's probe via energetic single-step curettage prior to any dilation in Group I and after dilation in Groups II and III. After the tissue samples were prepared, light microscopy was used to obtain microphotographs at 100x magnification. The surfaces affected by bleeding were measured in the microphotographs using the Autodesk AutoCAD 2009 program and its "polylines" function. The lines were used to mark the area around the entire sample (marked A) and to create "polyline" areas around each bleeding area on the sample (marked B). The percentage of the total area affected by bleeding was calculated using the formula: N = Bt x 100 / At where N is the percentage (%) of the tissue sample surface affected by bleeding, At (A total) is the sum of the surfaces of all of the tissue samples and Bt (B total) is the sum of all the surfaces affected by bleeding in all of the tissue samples. This novel semi-quantitative method utilizes the Autodesk AutoCAD 2009 program, which is simple to use and widely available, thereby offering a new, objective and precise approach to estimate the extent of bleeding in tissue samples. PMID:24190861

  7. Protein C deficiency related obscure gastrointestinal bleeding treated by enteroscopy and anticoagulant therapy

    Hsu, Wei-Fan; Tsang, Yuk-Ming; Teng, Chung-Jen; Chung, Chen-Shuan

    2015-01-01

    Obscure gastrointestinal bleeding is an uncommonly encountered and difficult-to-treat clinical problem in gastroenterology, but advancements in endoscopic and radiologic imaging modalities allow for greater accuracy in diagnosing obscure gastrointestinal bleeding. Ectopic varices account for less than 5% of all variceal bleeding cases, and jejunal variceal bleeding due to extrahepatic portal hypertension is rare. We present a 47-year-old man suffering from obscure gastrointestinal bleeding. C...

  8. Management and outcome of bleeding pseudoaneurysm associated with chronic pancreatitis

    Jan Yi-Yin

    2006-01-01

    Full Text Available Abstract Background A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare and potentially lethal complication. Optimal treatment of bleeding peripancreatic pseudoaneurysm remains controversial. This study reports on experience at Chang Gung Memorial Hospital (CGMH in managing of bleeding pseudoaneurysms associated with chronic pancreatitis. Methods The medical records of 9 patients (8 males and 1 female; age range, 28 – 71 years; median, 36 years with bleeding pseudoaneurysms associated with chronic pancreatitis treated at CGMH between Aug. 1992 and Sep. 2004 were retrospectively reviewed. Alcohol abuse (n = 7;78% was the predominant predisposing factor. Diagnoses of bleeding pseudoaneurysms were based on angiographic (7/7, computed tomographic (4/7, ultrasound (2/5, and surgical (2/2 findings. Whether surgery or angiographic embolization was performed was primarily based on patient clinical condition. Median follow-up was 38 months (range, 4 – 87 months. Results Abdominal computed tomography revealed bleeding pseudoaneurysms in 4 of 7 patients (57%. Angiography determined correct diagnosis in 7 patients (7/7, 100%. The splenic artery was involved in 5 cases, the pancreaticoduodenal artery in 2, the gastroduodenal artery in 1, and the middle colic artery in 1. Initial treatment was emergency (n = 4 or elective (n = 3 surgery in 7 patients and arterial embolization in 2. Rebleeding was detected after initial treatment in 3 patients. Overall, 5 arterial embolizations and 9 surgical interventions were performed; the respective rates of success of these treatments were 20% (1/5 and 89% (8/9. Five patients developed pseudocysts before treatment (n = 3 or following intervention (n = 2. Pseudocyst formation was identified in 2 of the 3 rebleeding patients. Five patients underwent surgical treatment for associated pseudocysts and bleeding did not recur. One patient died from angiography-related complications. Overall mortality

  9. A jejunal GIST presenting with obscure gastrointestinal bleeding and small bowel obstruction secondary to intussusception.

    Sadeghi, Peter; Lanzon-Miller, Sandro

    2015-01-01

    A 68-year-old man with episodes of overt obscure gastrointestinal (GI) bleeding was investigated with multiple upper and lower GI endoscopies, CT enterography and capsule endoscopy, but no cause was found. He then presented acutely with small bowel obstruction. A laparotomy revealed complete small bowel obstruction secondary to jejunal intussusception over a 4 cm intraluminal polyp. Following resection and primary anastomosis, histology revealed that the polyp was a GI stromal tumour (GIST). This is an exceptionally uncommon presentation of a rare tumour. It is surprising that this tumour was not detected by CT enterography and not seen on capsule endoscopy. Immunohistochemistry and mutation analysis of the GIST suggested that it had a low risk of metastatic disease, but a high risk of recurrence. Staging CT scans did not reveal evidence of distal spread. The patient is currently receiving 3 years of chemotherapy with imatinib. PMID:26527610

  10. Bleed water testing program for controlled low strength material

    Bleed water measurements for two Controlled Low Strength Material (CLSM) mixes were conducted to provide engineering data for the Tank 20F closure activities. CLSM Mix 1 contained 150 pounds of cement per cubic yard whereas CLSM Mix 2 contained 50 pounds per cub yard. SRS currently used CLSM Mix 2 for various applications. Bleed water percentages and generation rates were measured along with flow and compressive strength. This information will be used to select a mix design for the Tank 20F closure activities and to establish the engineering requirements, such as, lift height, time required between lifts and quantity of bleed water to be removed from the tank during the placement activities. Mix 1 is recommended for placement within Tank 20F because it has better flow characteristics, less segregation, lower percentage of bleed water and slightly higher strength. Optimization of Mix 1 was beyond the scope of this study. However, further testing of thickening additives, such as clays (bentonite), sodium silicate or fine silicas maybe useful for decreasing or eliminating bleed water

  11. Bleeding as a consequence of chorion villus sampling.

    Liu, D T; Jeavons, B; Preston, C; Slater, E; Symonds, E M

    1989-03-01

    A series of 4 separate studies were conducted to assess the incidence and short term consequence of bleeding associated with chorion villus sampling. Results support previous reports that risk of foetal-maternal transfusion as suggested by a rise in maternal serum alpha-fetoprotein (MSAFP) can occur. This occurrence is not consistent and need not be obvious even after therapeutic abortion. It is also transient and did not complicate mid-trimester neural tube screening or subsequent course of pregnancy. Eighty-seven percent of blood contaminating villus samples are of maternal origin. Following diagnosis 37% of patients reported some vaginal bleeding. This is mainly in the form of spotting which did not preclude normal pregnancy. Foetal loss occurred in 4 of the patients when bleeding considered heavier than spotting continued. In rhesus negative patients prophylactic anti-D gamma-globulin is advised, since neither Kleihauer counts nor MSAFP estimation reliably detect all foetal-maternal transfusions. PMID:2472129

  12. PALM-COEIN Nomenclature for Abnormal Uterine Bleeding.

    Deneris, Angela

    2016-05-01

    Approximately 30% of women will experience abnormal uterine bleeding (AUB) during their life time. Previous terms defining AUB have been confusing and imprecisely applied. As a consequence, both clinical management and research on this common problem have been negatively impacted. In 2011, the International Federation of Gynecology and Obstetrics (FIGO) Menstrual Disorders Group (FMDG) published PALM-COEIN, a new classification system for abnormal bleeding in the reproductive years. Terms such as menorrhagia, menometrorrhagia, metrorrhagia, dysfunctional uterine bleeding, polymenorrhea, oligomenorrhea, and uterine hemorrhage are no longer recommended. The PALM-COEIN system was developed to standardize nomenclature to describe the etiology and severity of AUB. A brief description of the PALM-COEIN nomenclature is presented as well as treatment options for each etiology. Clinicians will frequently encounter women with AUB and should report findings utilizing the PALM-COEIN system. PMID:26969858

  13. Detection of abdominal bleeding in blunt abdominal trauma

    Arterial hemorrhage is the most serious immediate complication of blunt abdominal trauma. This paper discusses the detection and localization of active hemorrhage in nonpenetrating injury, as a modification of the technique using technetium-99m sulfur colloid to localize the site of active bleeding in the gastrointestinal tract. Any imaging protocol for suspected hepatosplenic injury can be easily modified to search for active intra-abdominal hemorrhage. The timely detection of unsuspected bleeding improves patient management by allowing the surgeon to reorder his or her treatment priorities. The early detection of clinically unsuspected intra-abdominal, retroperitoneal, or pelvic hemorrhage will identify those patients who may need more definitive diagnostic procedures, interventional angiography for control of bleeding, or surgical intervention. The 500,000-count view of the abdomen and pelvis can be easily incorporated into any existing trauma protocol using technetium-99m sulfur colloid, is of proven value, and adds little additional time to the study

  14. Predictors of recurrent venous thromboembolism and bleeding on anticoagulation.

    Menapace, Laurel A; McCrae, Keith R; Khorana, Alok A

    2016-04-01

    The impact of venous thromboembolism (VTE) in the cancer population remains substantial despite significant advances in detecting and treating thrombotic events. While there is extensive literature regarding predictors of first VTE event in cancer patients as well as a validated predictive score, less data exist regarding recurrent VTE in cancer cohorts and associated predictive variables. A similar paucity of data in regard to bleeding events in cancer patients receiving anticoagulation has been observed. This review article will highlight clinical risk factors as well as predictive biomarkers associated with recurrent VTE and bleeding in cancer patients receiving therapeutic anticoagulation. Predictive risk assessment models for cancer-associated recurrent VTE and bleeding are also discussed. PMID:27067987

  15. Reduced bleed air extraction for DC-10 cabin air conditioning

    Newman, W. H.; Viele, M. R.; Hrach, F. J.

    1980-01-01

    It is noted that a significant fuel savings can be achieved by reducing bleed air used for cabin air conditioning. Air in the cabin can be recirculated to maintain comfortable ventilation rates but the quality of the air tends to decrease due to entrainment of smoke and odors. Attention is given to a development system designed and fabricated under the NASA Engine Component Improvement Program to define the recirculation limit for the DC-10. It is shown that with the system, a wide range of bleed air reductions and recirculation rates is possible. A goal of 0.8% fuel savings has been achieved which results from a 50% reduction in bleed extraction from the engine.

  16. Bleeding Jejunal Diverticulosis in a Patient with Myasthenia Gravis

    F. Kullmann

    2008-03-01

    Full Text Available A seventy-year-old male presented with severe myasthenia gravis and an episode of obscure bleeding. There was a history of gastric ulcer leading to Billroth II surgery twenty-five years ago. Upper endoscopy revealed no pathology. Colonoscopy showed a few solitary diverticula and traces of old blood in the terminal ileum. Capsule endoscopy pictured red smear in the upper jejunum. Diverticula were seen as well. Suspecting bleeding jejunal diverticulosis double balloon enteroscopy was performed. The complete jejunal ascending loop and about 100 cm of the jejunum through the descending jejunal loop could be inspected. Large diverticula with fecoliths were found in both loops. Bleeding had ceased. The patient was discharged to neurology for optimizing therapy for myasthenia gravis.

  17. Therapeutic Strategies in Acute Intracerebral Hemorrhage

    Brouwers, H. Bart; Joshua N Goldstein

    2011-01-01

    Intracerebral hemorrhage is a devastating disease, and no specific therapy has been proven to reduce mortality in a randomized controlled trial. However, management in a neuroscience intensive care unit does appear to improve outcomes, suggesting that many available therapies do in fact provide benefit. In the acute phase of intracerebral hemorrhage care, strategies aimed at minimizing ongoing bleeding include reversal of anticoagulation and modest blood pressure reduction. In addition, the m...

  18. Henoch-Schönlein purpura in an older man presenting as rectal bleeding and IgA mesangioproliferative glomerulonephritis: a case report

    Howarth Charles B

    2011-08-01

    Full Text Available Abstract Introduction Henoch-Schönlein purpura is the most common systemic vasculitis in children. Typical presentations are palpable purpura, abdominal pain, arthritis, and hematuria. This vasculitic syndrome can present as an uncommon cause of rectal bleeding in older patients. We report a case of an older man with Henoch-Schönlein purpura. He presented with rectal bleeding and acute kidney injury secondary to IgA mesangioproliferative glomerulonephritis. Case presentation A 75-year-old Polish man with a history of diverticulosis presented with a five-day history of rectal bleeding. He had first noticed colicky left lower abdominal pain two months previously. At that time he was treated with a 10-day course of ciprofloxacin and metronidazole for possible diverticulitis. He subsequently presented with rectal bleeding to our emergency department. Physical examination revealed generalized palpable purpuric rash and tenderness on his left lower abdomen. Laboratory testing showed a mildly elevated serum creatinine of 1.3. Computed tomography of his abdomen revealed a diffusely edematous and thickened sigmoid colon. Flexible sigmoidoscopy showed severe petechiae throughout the colon. Colonic biopsy showed small vessel acute inflammation. Skin biopsy resulted in a diagnosis of leukocytoclastic vasculitis. Due to worsening kidney function, microscopic hematuria and new onset proteinuria, he underwent a kidney biopsy which demonstrated IgA mesangioproliferative glomerulonephritis. A diagnosis of Henoch-Schönlein purpura was made. Intravenous methylprednisolone was initially started and transitioned to prednisone tapering orally to complete six months of therapy. There was marked improvement of abdominal pain. Skin lesions gradually faded and gastrointestinal bleeding stopped. Acute kidney injury also improved. Conclusion Henoch-Schönlein purpura, an uncommon vasculitic syndrome in older patients, can present with lower gastrointestinal bleeding

  19. Acute arthritis in Crimean-Congo hemorrhagic fever

    Salih Ahmeti

    2014-01-01

    Full Text Available Crimean-Congo hemorrhagic fever is a severe viral disease caused by a Nairovirus. An atypical manifestation in the form of acute arthritis was found in a confirmed Crimean-Congo hemorrhagic fever virus Kosova-Hoti strain positive patient. Acute arthritis in Crimean-Congo hemorrhagic fever (CCHF may be as a result of immune mechanisms or the bleeding disorder underlying CCHF.

  20. Acute Arthritis in Crimean-Congo Hemorrhagic Fever

    Ahmeti, Salih; Ajazaj-Berisha, Lindita; Halili, Bahrije; Shala, Anita

    2014-01-01

    Crimean-Congo hemorrhagic fever is a severe viral disease caused by a Nairovirus. An atypical manifestation in the form of acute arthritis was found in a confirmed Crimean-Congo hemorrhagic fever virus Kosova-Hoti strain positive patient. Acute arthritis in Crimean-Congo hemorrhagic fever (CCHF) may be as a result of immune mechanisms or the bleeding disorder underlying CCHF. PMID:24926169

  1. Spontaneous acute subdural hematoma in a patient with multiple myeloma

    Abrar Ahad Wani

    2012-01-01

    Full Text Available Acute spontaneous subdural hematoma in a patient of multiple myeloma receiving chemotherapy is an unknown event, needing an urgent neurosurgical management. We report this patient who presented with progressive neurological deterioration and a low platelet count. She was successfully managed by craniotomy and evacuation of subdural hematoma with intraoperative transfusion of platelets. The acute spontaneous subdural hematoma in her was probably related to the bleeding diathesis due to thrombocytopenia associated with chemotherapy.

  2. Lower Gastrointestinal Bleeding And Risk of Gastrointestinal Cancer

    Viborg, Søren; Søgaard, Kirstine Kobberøe; Farkas, Dóra Körmendiné; Nørrelund, Helene; Pedersen, Lars; Sørensen, Henrik Toft

    2016-01-01

    OBJECTIVES: Lower gastrointestinal (GI) bleeding is a well-known symptom of colorectal cancer (CRC). Whether incident GI bleeding is also a marker of other GI cancers remains unclear. METHODS: This nationwide cohort study examined the risk of various GI cancer types in patients with lower GI bleeding. We used Danish medical registries to identify all patients with a first-time hospital diagnosis of lower GI bleeding during 1995–2011 and followed them for 10 years to identify subsequent GI cancer diagnoses. We computed absolute risks of cancer, treating death as a competing risk, and calculated standardized incidence ratios (SIRs) by comparing observed cancer cases with expected cancer incidence rates in the general population. RESULTS: Among 58,593 patients with lower GI bleeding, we observed 2,806 GI cancers during complete 10-year follow-up. During the first year of follow-up, the absolute GI cancer risk was 3.6%, and the SIR of any GI cancer was 16.3 (95% confidence interval (CI): 15.6–17.0). Colorectal cancers accounted for the majority of diagnoses, but risks of all GI cancers were increased. During 1–5 years of follow-up, the SIR of any GI cancer declined to 1.36 (95% CI: 1.25–1.49), but risks remained increased for several GI cancers. Beyond 5 years of follow-up, the overall GI cancer risk was close to unity, with reduced risk of rectal cancer and increased risk of liver and pancreatic cancers. CONCLUSIONS: A hospital-based diagnosis of lower GI bleeding is a strong clinical marker of prevalent GI cancer, particularly CRC. It also predicts an increased risk of any GI cancer beyond 1 year of follow-up. PMID:27054580

  3. Dosimetric Analysis of Radiation-induced Gastric Bleeding

    Purpose: Radiation-induced gastric bleeding has been poorly understood. In this study, we described dosimetric predictors for gastric bleeding after fractionated radiation therapy. Methods and Materials: The records of 139 sequential patients treated with 3-dimensional conformal radiation therapy (3D-CRT) for intrahepatic malignancies were reviewed. Median follow-up was 7.4 months. The parameters of a Lyman normal tissue complication probability (NTCP) model for the occurrence of ≥grade 3 gastric bleed, adjusted for cirrhosis, were fitted to the data. The principle of maximum likelihood was used to estimate parameters for NTCP models. Results: Sixteen of 116 evaluable patients (14%) developed gastric bleeds at a median time of 4.0 months (mean, 6.5 months; range, 2.1-28.3 months) following completion of RT. The median and mean maximum doses to the stomach were 61 and 63 Gy (range, 46-86 Gy), respectively, after biocorrection of each part of the 3D dose distributions to equivalent 2-Gy daily fractions. The Lyman NTCP model with parameters adjusted for cirrhosis predicted gastric bleed. Best-fit Lyman NTCP model parameters were n=0.10 and m=0.21 and with TD50 (normal) = 56 Gy and TD50 (cirrhosis) = 22 Gy. The low n value is consistent with the importance of maximum dose; a lower TD50 value for the cirrhosis patients points out their greater sensitivity. Conclusions: This study demonstrates that the Lyman NTCP model has utility for predicting gastric bleeding and that the presence of cirrhosis greatly increases this risk. These findings should facilitate the design of future clinical trials involving high-dose upper abdominal radiation.

  4. The effect of Adernalinated lidpcaine on Blood Pressure, Heart rate and Bleeding during DCR surgery in General Anesthesia

    M. Shakhrezaee

    2005-01-01

    Full Text Available Background and purpose : NLD obstraction causes chronic or acute Dacryiocytits resistant epiphora. Current treatment is DCR for persistent conection between lscrimal sac and nasal cavity. Vasocontrictor drugs are used facilitasing the operation.Materials and methods : Being approved in the ethics committee of the Mazandaran University of Medical Sciences the study performed on 57 patients ASAL, II whom were divided in to two groups; Adrenaline group, no=23 and non adrenaline group no= 34. 10-15-ml adrenalin 1/200000 was injected at surgical area, before surgery in AG. BP, PR and bleeding were recorded during before and 1, 3, 5, 10,… min during the surgery. The results were analysed using t-test, and paired t-test at a significance level of< 0.05.Results : Maximum BP was measured at 3 minuts after adrenaline injection. The average of bleeding in adrenaline group was 38.3 ml and in nonadernaline group was 49.16 ml(P=0.007. The time of surgery in adrenalin group is shorter than non adrenaline group(P=0.003.Conclusion : Althragh adrenaline decreased the bleeding during surgery and facilitated the procedure, it is potentially dangerous for patients with cardiovascular disease during DCR syrgery.

  5. Acute Tension Pneumothorax Following Cardiac Herniation after Pneumonectomy

    Daniel Steinmann; Eva Rohr; Andreas Kirschbaum

    2010-01-01

    A tension pneumothorax is one of the main causes of cardiac arrest in the initial postoperative period after thoracic surgery. Tension pneumothorax and cardiac herniation must be taken into account in hemodynamically unstable patients after pneumonectomy. We report an unusual case of successful treatment of acute tension pneumothorax following cardiac herniation and intrathoracic bleeding after pneumonectomy.

  6. Acute spontaneous spinal epidural haematoma in a child

    Spontaneous spinal epidural haematomas rarely occur. Patients tend to be in their sixties or seventies. Acute spontaneous spinal epidural haematomas in children without a predisposition for bleeding disorders, trauma, vascular malformations or anticoagulant therapy have seldom been described. We present a case of a 4-year-old girl with a spontaneous cervical epidural haematoma diagnosed with MR. (orig.)

  7. Prolonged bleeding on the neck in leech therapy: Case report

    Atakan Savrun

    2015-12-01

    Full Text Available Superficial skin bleeding can usually be stopped by applying short-time compression, unless the patient suffers from coagulation disorders or uses anticoagulant. Because of the anticoagulant component of leech saliva, a leech bite may cause long-time bleeding, which cannot be stopped via compression. In this study, the case of a patient who applied leech therapy on her neck for the treatment of migraine has been presented. [Arch Clin Exp Surg 2015; 4(4.000: 234-237

  8. Successful excision of a massive bleeding schwannoma by thoracoscopic surgery.

    Ishibashi, Hironori; Takasaki, Chihiro; Okubo, Kenichi

    2016-06-01

    Massive intrathoracic bleeding caused by rupture of a benign schwannoma is extremely rare. A 73-year-old man was admitted to our emergency department because of chest pain and dyspnea. Computed tomography revealed massive pleural effusion and a posterior mediastinal tumor. Chest tube thoracostomy was performed, and the initial blood drainage was 1700 mL. Magnetic resonance imaging revealed that the tumor at the 8th costal level measured 46 × 60 mm. The tumor, located beside the 8th vertebra, had ruptured and caused the bleeding. It was successfully excised by thoracoscopic surgery and diagnosed as a benign schwannoma. PMID:27095705

  9. A Cause of Mortal Massive Upper Gastrointestinal Bleeding: Aortoesophageal Fistula

    Akin, Mete; Yalcinkaya, Tolga; Alkan, Erhan; Arslan, Gokhan; Tuna, Yasar; Yildirim, Bulent

    2016-01-01

    Introduction: Aortoesophageal fistula is an uncommon but mortal cause of massive upper gastrointestinal bleeding. The most common causes are thoracic aortic aneurisym, foreign body reaction, malignancy and postoperative complication. It can be seen in different pattern on upper gastrointestinal endoscopy. There are surgical, endoscopic and interventional radiological treatment options, however, definitive treatment is surgical intervention. Diagnosis and treatment desicion should be made quickly because of rapid and mortal course. Case report: In this article, a case of aortoesophageal fistula was presented that resulted in mortality as a result of massive bleeding. PMID:26980940

  10. [Emergency embolization in gynaecological bleeding. Two case reports].

    Hatremi, Rajhi; Sameh, Amous; Azza, Salem; Najla, Mnif; Rym, Ben Hmid; Sami, Mahjoub; Faouzia, Zouari; Radhi, Hamza

    2005-08-01

    Two patients with gynaecological hemorrhage underwent successfully trans-arterial embolization. The first womanhad an uncontrollable perineal hemorrhage following a delivery with forceps. Angiography showed extravasation of contrast from right and left vaginal artery. Hyperselective embolisation stopped the vaginal bleeding. The second woman had massive hemorrhage following radiotherapy for cervical cancer. Angiography demonstrated extravasation of contrast from both uterine arteries. The bleeding was controlled after hyperselective embolisation. Emergency arterial embolisation is a safe and effective means of control of irrepressible genital hemorrhage. PMID:16238279

  11. Gum and Nose Bleeding as a Presentation of Pediatric Brucellosis

    Hosseininasab

    2016-01-01

    Full Text Available Introduction Brucellosis symptoms are nonspecific; the most common complaints include fever, sweats, anorexia, headache, malaise, and arthralgia. Hematological manifestations of active brucellosis vary from mild anemia and leukopenia to thrombocytopenia and rarely pancytopenia. Case Presentation We report on an eight-year-old boy who presented epistaxis and gum bleeding. The physical examination revealed petechiae, purpura, ecchymosis, and cervical while inguinal lymphadenopathy and splenomegaly were noted. Brucella agglutinin titer was positive. After five days of specific therapy for brucellosis, fever was controlled, clinical signs and symptoms were improved and platelet count was dramatically increased. Conclusions Sever thrombocytopenia and bleeding may be the presentation of brucellosis.

  12. Increased accuracy in heparin and protamine administration decreases bleeding

    Runge, Marx; Møller, Christian H; Steinbrüchel, Daniel A

    2009-01-01

    Three to 5 percent of the patients undergoing cardiac surgery are reoperated because of bleeding. When a surgical cause can be excluded, heparin/protamine mismatch may be considered. Insufficient reversal of heparin and overdosing of protamine may cause postoperative bleeding. The purpose of the...... ACT values were obtained in both groups. Using the Hemochron RxDx, we observed a significant reduction in postoperative blood loss, as well as the amount of heparin and initial doses of protamine used during CPB. Individual patient managed anticoagulation during cardiac surgery using dose...

  13. Massive extra-enteric gastrointestinal bleeding: angiographic diagnosis.

    Koehler, P R; Nelson, J A; Berenson, M M

    1976-04-01

    Two patients with massive gastrointestinal bleeding are reported. One bled from an aneurysm of a branch of the left hepatic artery, the blood reaching the bowel through communication with the biliary tree. The second had an aneurysm of a branch of the splenic artery which communicated with the pancreatic duct. This type of bleeding is intermittent and, consequently, actual extravasation of contrast media is not always seen. Therefore, if one sees an aneurysm of a visceral artery, even if it does not directly supply the enteric tract, one should consider the possibility that it is the origin of the hemorrhage. Pathogenesis, diagnostic modalities, and therapeutic implications are discussed. PMID:1083037

  14. Retained fetal bones: an unusual cause of abnormal uterine bleeding

    Sonia Chawla

    2016-06-01

    Full Text Available Abnormal uterine bleeding (AUB is a common gynaecological problem with most common causes being fibroid, polyp, endometritis, neoplasia and coagulation disorder. Presence of retained intrauterine fetal bones as a cause of AUB, is a rare but well recognized entity. Patient may present with subfertility, secondary infertility, chronic pelvic pain, vaginal discharge, pelvic inflammatory disease, abnormal uterine bleeding. Incidence reported in literature is 0.15% among patients undergoing diagnostic hysteroscopy. Calcification appears as hyperechoeic area on ultrasound. Hysteroscopy guided removal of bony fragments is the gold standard and leads to complete resolution of symptoms. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 2032-2033

  15. Infliximab stopped severe gastrointestinal bleeding in Crohn's disease

    Aniwan, Satimai; Eakpongpaisit, Surasak; Imraporn, Boonlert; Amornsawadwatana, Surachai; Rerknimitr, Rungsun

    2012-01-01

    To report the result of rapid ulcer healing by infliximab in Crohn’s patients with severe enterocolic bleeding. During 2005 and 2010, inflammatory bowel disease database of King Chulalongkorn Memorial and Samitivej hospitals were reviewed. There were seven Crohn’s disease (CD) patients (4 women and 3 men; mean age 52 ± 10.4 years; range: 11-86 years). Two of the seven patients developed severe gastrointestinal bleeding (GIB) as a flare up of CD whereas the other five patients presented with G...

  16. Application of double-balloon enteroscopy in jejunal diverticular bleeding

    Tsung-Hsing; Chen; Cheng-Tang; Chiu; Chen-Ming; Hsu

    2010-01-01

    AIM:To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.METHODS:From January 2004 to September 2009,154 patients underwent double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding.Ten consecutive patients with jejunal diverticula (5 males and 5 females) at the age of 68.7 ± 2.1 years (range 1995 years) at Chang Gung Memorial Hospital,Academic Tertiary Referral Center,were enrolled in this study.RESULTS:Of the 10 patients,5 had melena,2 had hematochezi...

  17. Haemorrhoids leading to post-mortem bleeding artefact.

    Kanchan, Tanuj; Menezes, Ritesh G; Manipady, Shahnavaz

    2006-07-01

    We present a case where a 54-year-old man suffering from haemorrhoids, committed suicide by hanging. Gravitational forces due to the upright position of the body facilitated post-mortem per-rectal bleeding from the ulcerated haemorrhoids. The bleeding stained his under garment and wrap around cloth. Frank blood was also seen on the floor beneath the hanging body. The blood at the crime scene was wrongly interpreted by the investigating police as that due to self-inflicted injury or possibly case of homicide followed by post-mortem suspension of the body. Observation of the crime scene by forensic medicine experts and subsequent autopsy findings revealed that the bleeding was from the haemorrhoids. This case is reported for its rarity, for the awareness of the possible post-mortem haemorrhoidal bleeding artefact, to explain the circumstances of such a possibility, and to emphasize the importance of involving forensic medicine experts as a part of the crime scene investigation team. PMID:16442833

  18. Embolotherapy using N-butyl cyanoacrylate for abdominal wall bleeding

    Choi, Young Ho; Koh, Young Hwan; Han, Dae Hee; Kim, Ji Hoon; Cha, Joo Hee; Lee, Eun Hye; Song, Chi Sung [Seoul National University Boramae Hospital, Seoul (Korea, Republic of)

    2008-05-15

    We describe our experience with the use of N-butyl cyanoacrylate (NBCA) embolization of abdominal wall bleeding and we evaluate the clinical effectiveness of the procedure. Embolization was performed in nine patients with abdominal wall bleeding. The sites of embolization were the left first lumbar (n = 1), left second lumbar (n = 1), right inferior epigastric (n 2), left inferior epigastric (n = 3), right circumflex iliac (n = 1), and left circumflex iliac artery (n = 1). A coil was used with NBCA in one patient due to difficulty in selecting only a bleeding focus and anticipated reflux. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:4. Blood pressure and heart rate were measured before and after the embolization procedure, and the serial hemoglobin and hematocrit levels and transfusion requirements were reviewed to evaluate hemostasis and rebleeding. Hemostasis was obtained in six out of the nine patients and technical success was achieved in all patients. There were no procedure-related complications. Four out of the nine patients died due to rebleeding of a subarachnoid hemorrhage (n = 1), multiorgan failure (n = 1), and hepatic failure (n =2) that occurred two to nine days after the embolization procedure. One patient had rebleeding. The five surviving patients had no rebleeding, and the patients continue to visit the clinical on an outpatient basis. NBCA embolization is a clinically safe procedure and is effective for abdominal wall bleeding.

  19. Embolotherapy using N-butyl cyanoacrylate for abdominal wall bleeding

    We describe our experience with the use of N-butyl cyanoacrylate (NBCA) embolization of abdominal wall bleeding and we evaluate the clinical effectiveness of the procedure. Embolization was performed in nine patients with abdominal wall bleeding. The sites of embolization were the left first lumbar (n = 1), left second lumbar (n = 1), right inferior epigastric (n 2), left inferior epigastric (n = 3), right circumflex iliac (n = 1), and left circumflex iliac artery (n = 1). A coil was used with NBCA in one patient due to difficulty in selecting only a bleeding focus and anticipated reflux. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:4. Blood pressure and heart rate were measured before and after the embolization procedure, and the serial hemoglobin and hematocrit levels and transfusion requirements were reviewed to evaluate hemostasis and rebleeding. Hemostasis was obtained in six out of the nine patients and technical success was achieved in all patients. There were no procedure-related complications. Four out of the nine patients died due to rebleeding of a subarachnoid hemorrhage (n = 1), multiorgan failure (n = 1), and hepatic failure (n =2) that occurred two to nine days after the embolization procedure. One patient had rebleeding. The five surviving patients had no rebleeding, and the patients continue to visit the clinical on an outpatient basis. NBCA embolization is a clinically safe procedure and is effective for abdominal wall bleeding

  20. Histopathological study of endometrium in cases of abnormal uterine bleeding

    Saroj A. Bolde

    2014-08-01

    Full Text Available Background: Abnormal uterine bleeding is one of the commonest complaints in women and when it occurs without organic lesions like tumor, inflammation, it is called as dysfunctional uterine bleeding. Aim of current study was to find out the histopathological pattern of endometrium in Abnormal Uterine Bleeding (AUB also to study organic causes of AUB. Methods: Specimens received as endometrial curettage and hysterectomy specimens were studied followed by correlation of histopathology with age and clinical presentation. Results: The patients were mainly from the age group of 30-49 years (74.24%. The most common menstrual disorder was menorrhagia (46.86%. In dysfunctional uterine bleeding the most common histological pattern of endometrium includes proliferative endometrium (22.8% followed by endometrial hyperplasia (19.40%, atrophic endometrium (7.16%, secretory endometrium (5.97%, irregular shedding [1.80%], irregular ripening (1.20% and anovulatory endometrium (0.59%. Organic lesions encountered in AUB cases were leiomyoma (17.92%, endometrial polyp (1.79%, endometrial carcinoma (1.50%, endometriosis (0.59% and choriocarcinoma (0.29%. Conclusion: It is important to know the histological pattern of the endometrium like proliferative endometrium, endometrial hyperplasia, atrophic endometrium, secretory endometrium, irregular ripening and shredding and organic lesions in patients diagnosed as AUB in different age groups since recognition of these conditions will help and will avoid further complications. [Int J Res Med Sci 2014; 2(4.000: 1378-1381

  1. [Intravesical active prostate bleeding diagnosed in B-mode ultrasound].

    Kirchgesner, T; Danse, E; Tombal, B

    2013-09-01

    Hematuria is one of the most frequent minor complications after prostatic biopsy. We would like to report the case of a 68-year-old patient with massive hematuria after prostatic biopsy and intravesical active prostate bleeding diagnosed in B-mode ultrasonography. PMID:24034804

  2. A sensitive venous bleeding model in haemophilia A mice

    Pastoft, Anne Engedahl; Lykkesfeldt, Jens; Ezban, M.;

    2012-01-01

    evaluation of pro-coagulant compounds for treatment of haemophilia. Interestingly, the vena saphena model proved to be sensitive towards FVIII in plasma levels that approach the levels preventing bleeding in haemophilia patients, and may, thus, in particular be valuable for testing of new long...

  3. Postmenopausal bleeding: causes and risk of genital tract malignancy

    Background: Postmenopausal bleeding (PMB) is bleeding occurring after 6-12 months of amenorrhea in a woman of age where the menopause can be expected. Objectives of this study were to ascertain various causes and prevalence of genital organ malignancy in patients presenting with postmenopausal bleeding. Methods: A prospective observational study carried out in the Department of Obstetrics and Gynaecology, Fauji Foundation Hospital, Rawalpindi comprising of 167 consecutive cases presenting with postmenopausal bleeding one year after menopause. Women having undergone hysterectomy and bilateral salpingo-oophorectomy, receiving radiotherapy or chemotherapy, suffered trauma to the genital tract, having coagulation disorder or on anticoagulant or hormone replacement therapy were excluded. Detailed history was obtained and a thorough clinical examination was conducted. Data were entered into hospital computer database (Medix) system. Mean +- SD were calculated for age, percentage was calculated for types of histopathological findings. Results: The commonest cause of PMB was atrophic endometritis and vaginitis 33 (21.2%). Overall incidence of various genital tract malignancies was 25 (16.0%). Conclusion: The overall incidence of genital tract malignancies in patients presenting with PMB is high (16.0%), therefore, it needs to be taken seriously and requires prompt and thorough investigations. (author)

  4. Frequency of endometrial carcinoma in patients with postmenopausal bleeding

    Introduction: Postmenopausal bleeding (PMB) is defined as bleeding that occurs after 1 year of amenorrhea in a woman who is not receiving hormone replacement therapy (HRT). About 10% of women with postmenopausal bleeding have a primary or secondary malignancy. Common malignancies among them are endometrial cancer (80%), cervical cancer or an ovarian tumour. Endometrial cancer is the second most common cancer associated with hereditary non-polyposis colorectal cancer. Ninety percent of patients have benign causes. Objective: The objective of this study was to determine the frequency of endometrial carcinoma in patients with post-menopausal bleeding. Study Design: Descriptive case series study. Setting: Department of obstetrics and gynaecology, Lady Willingdon, Lahore. Duration of Study: This study was conducted over a period of six months from January, 1 2009 to June 30, 2009. Subjects and Methods: 50 cases with postmenopausal bleeding. Results: During the period of this study a total number of 50 consecutive patients who met inclusion criteria were enrolled in the study. Ages of the patients who presented with PMB ranged between 48 years and 80 years with a mean age of 59 years. Malignancy was found in 18 out of 50 cases (36%).Cases with endometrial CA were 14 out of 50 cases (28%) and CA cervix constituted 4 out of 50 cases (8%). Benign pathology was more frequent (64%). 13 of 50 cases (26%) had hyperplasia out of which 1 case (2%) was of atypical hyperplasia. Endometrial polyp was found in 4 of 50 cases (8%). 3 of 50 cases (6%) had chronic endometritis. 5 of 50 cases (10%) had chronic cervicitis. While 7 cases (14%) had postmenopausal bleeding due to decubitus ulcer of uterovaginal prolapse. Among malignancies (36%), endometrial cancer is the most frequent malignancy in women with postmenopausal bleeding with mean age of 65 years. Conclusion: In this study it was concluded that the majority of cases of PMB would be expected to be suffering from benign problems

  5. Screening Bleeding Disorders in Adolescents and Young Women with Menorrhagia

    Suar Çakı Kılıç

    2013-06-01

    Full Text Available OBJECTIVE: Chronic menorrhagia causes anemia and impairment of life quality. In this study the aim was the screening of bleeding disorders in adolescents and young women with menorrhagia. METHODS: The study was performed prospectively by pediatric hematologists. A form including demographic characteristics of the patients, bleedings other than menorrhagia, familial bleeding history, characteristics of the menorrhagia, and impairment of life quality due to menorrhagia was filled out by the researcher during a face-to-face interview with the patient. A pictorial blood assessment chart was also used for evaluation of blood loss. All patients underwent pelvic ultrasound sonography testing and women also received pelvic examination by gynecologists. Whole blood count, peripheral blood smear, blood group, serum transaminases, urea, creatinine, ferritin, PFA-100, PT, aPTT, INR, TT, fibrinogen, VWF: Ag, VWF: RCo, FVIII, and platelet aggregation assays were performed. Platelet aggregations were studied by lumiaggregometer. RESULTS: Out of 75 patients enrolled, 60 patients completed the study. The mean age was 20.68±10.34 (range: 10-48 years and 65% (n=39 of the patients were younger than 18 years. In 18 (46% of the adolescents, menorrhagia subsided spontaneously. In 20% (n=12 of the patients, a bleeding disorder was detected (1 case of type 3 von Willebrand disease, 2 patients with low VWF: Ag, 1 case of probable von Willebrand disease, 3 cases of Bernard-Soulier syndrome, 2 cases of Glanzmann thrombasthenia, 2 cases of immune thrombocytopenic purpura, 1 case of congenital factor VII deficiency. CONCLUSION: In patients with menorrhagia, at least complete blood count, peripheral smear, aPTT, PT, VWF: Ag, VWF: RCo, FVIII, and fibrinogen assays must be performed. When there is history of nose and gum bleeding, platelet function assay by lumiaggregometer must also be performed. In nearly 50% of adolescents, menorrhagia is dysfunctional and transient

  6. Acute Pancreatitis and Pregnancy

    ... Acute Pancreatitis > Acute Pancreatitis and Pregnancy test Acute Pancreatitis and Pregnancy Timothy Gardner, MD Acute pancreatitis is ... of acute pancreatitis in pregnancy. Reasons for Acute Pancreatitis and Pregnancy While acute pancreatitis is responsible for ...

  7. Could a Clot-Busting Drug Help Treat a 'Bleeding' Stroke?

    ... a Clot-Busting Drug Help Treat a 'Bleeding' Stroke? Two studies suggest that tPA infusion to brain ... tPA might help patients suffering a hemorrhagic ("bleeding") stroke. According to the American Stroke Association, only about ...

  8. TREATMENT OF 100 CASES OF DYSFUNCTIONAL UTERINE BLEEDING BY SCRATCHING THERAPY

    WANG Gui-qing

    2006-01-01

    @@ Dysfunctional uterine bleeding, a common gynecological disorder, is generally of two kinds, pubescent and climacteric, characterized by menorrhagia, menostaxis, irregular bleeding, associated with dysmenorrhea, soreness and bearing down sensation in the lumbosacral region.

  9. Protect Your Baby from Bleeds: Talk to Your Healthcare Provider about Vitamin K

    ... Bleeds – Talk to Your Healthcare Provider about Vitamin K Without enough vitamin K, your baby has a chance of bleeding into ... death. Infants who do not receive the vitamin K shot at birth can develop VKDB up to ...

  10. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients

    Schulman, S; Angerås, U; Bergqvist, D;

    2010-01-01

    The definition of major bleeding varies between studies on surgical patients, particularly regarding the criteria for surgical wound-related bleeding. This diversity contributes to the difficulties in comparing data between trials. The Scientific and Standardization Committee (SSC), through its...

  11. Bronchitis - acute

    ... sharing features on this page, please enable JavaScript. Acute bronchitis is swelling and inflammation in the main passages ... present only for a short time. Causes When acute bronchitis occurs, it almost always comes after having a ...

  12. Bronchitis - acute

    Acute bronchitis is swelling and inflammation in the main passages that carry air to the lungs. The swelling narrows ... makes it harder to breathe. Another symptom of bronchitis is a cough. Acute means the symptoms have ...

  13. Acute Bronchitis

    Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It ... chest tightness. There are two main types of bronchitis: acute and chronic. Most cases of acute bronchitis ...

  14. Acute pancreatitis

    Bo-Guang Fan; Åke Andrén-Sandberg

    2010-01-01

    Background : Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims : The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods : We reviewed the English-language literature (Medline) addressing pancreatitis. Results : Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingest...

  15. Acute pancreatitis

    Bo-Guang Fan; Åke Andrén-Sandberg

    2010-01-01

    Background: Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims: The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods: We reviewed the English-language literature (Medline) addressing pancreatitis. Results: Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion....

  16. The nursing effect of postoperative adenoid-tonsillectomy bleeding by low-temperature plasma in children

    Chen, Xin

    2014-01-01

    To observe the nursing effect of postoperative adenoid tonsil bleeding by low-temperature plasma in children. 12 patients received the operation successfully without bleeding. The nursing methods include psychological nursing, observation, apnea prevention and diet nursing. Low-temperature plasma is an effective and safe way to cure postoperative bleeding without complications.

  17. Recent pharmacological management of oral bleeding in hemophilic patient

    Monica Widyawati Setiawan

    2011-09-01

    Full Text Available Background: Hemophilia is a hereditary bleeding disorder that can increase the risk of disease in oral cavity. Sometimes hemophilia is not always established already in a patient. The lack of awareness of hemophilia presence can cause serious problem. Purpose: The purpose of this review is to explain about dental bleeding manifestation and management in hemophilic patient. Reviews: Hemophilia can be manifested as dental bleeding that cannot stop spontaneously. It should be treated with factor VIIII either by giving whole blood, fresh plasma, fresh frozen plasma, cryoprecipitate, and factor VIII concentrate. Factor VIII dose for hemophilia treatment can be calculated based on factor VIII present in hemophilia patient’s body. Factor VIII can also be given as prophylaxis to prevent bleeding. Complications that can be caused by factor VIII replacement therapy are the presence of factor VIII inhibitor and transfusion related diseases. Treatment of dental bleeding due to hemophilia consists of factor replacement therapy and supportive therapy. Conclusion: Treatment of dental bleeding due to hemophilia consists of factor replacement therapy and supportive therapy. There are complications that can happen due to factor VIII replacement therapy that should be considered and anticipated.Latar belakang: Hemofilia adalah kelainan pembekuan darah yang diturunkan. Hemophilia dapat meningkatkan resiko penyakit rongga mulut. Hemofilia tidak selalu sudah terdiagnosa saat penderita melakukan kunjungan ke dokter gigi. Kurangnya kewaspadaan akan adanya hemofilia dapat menyebabkan masalah serius. Tujuan: Tujuan dari kajian pustaka ini adalah memaparkan tentang manifestasi dan penanganan perdarahan gigi pada penderita hemofilia. Tinjauan pustaka: hemofilia dapat bermanifestasi sebagai perdarahan gigi yang tidak dapat berhenti secara spontan. Pada keadaan perdarahan tersebut, pemberian faktor VIII yang diberikan sebagai whole blood, fresh plasma, fresh frozen plasma

  18. Hemorrhagic syndrome and Acute renal failure in a pregnant woman after contact with Lonomia caterpillars: a case report

    FAN Hui Wen

    1998-01-01

    Full Text Available A case of a 37-week pregnant woman who developed a hemorrhagic syndrome and acute renal failure after contact with Lonomia caterpillars is reported. The accident also initiated labour and the patient gave birth to an alive child. Some pathophysiological aspects of the genital bleeding and of the acute renal failure are discussed.

  19. Rectal bleeding after hypofractionated radiotherapy for prostate cancer: Correlation between clinical and dosimetric parameters and the incidence of grade 2 or worse rectal bleeding

    Purpose: To investigate the incidence and severity of rectal bleeding after high-dose hypofractionated radiotherapy (RT) for prostate cancer, and to explore the factors affecting the incidence of Grade 2 or worse rectal bleeding. Methods and materials: The data of 52 patients who had been treated by external beam RT for localized prostate cancer between 1999 and 2002 were analyzed. All the patients had received hypofractionated external beam RT to a total dose of 69 Gy in 3-Gy fractions, three fractions weekly. The clinical and dosimetric factors affecting the incidence of Grade 2 or worse late rectal bleeding were analyzed by univariate and multivariate analyses. The effect of the percentage of the whole rectal volume receiving 30%, 50%, 80%, and 90% of the prescribed radiation dose (V30, V50, V80, and V90, respectively) on the incidence of rectal bleeding was evaluated. Results: Of the 52 patients, 13 (25%) developed Grade 2 or worse rectal bleeding. One patient who needed laser coagulation and blood transfusion for the treatment of rectal bleeding was classified as having Grade 3 rectal bleeding. The median time to the development of Grade 2 or worse rectal bleeding was 11 months. The results of the univariate analysis revealed that the presence of a history of diabetes mellitus (p 30 ≥ 60%, V50 ≥ 40% (p 80 ≥ 25%, and V90 ≥ 15% (p < 0.001) were statistically significant risk factors for the occurrence of Grade 2 or worse rectal bleeding. The results of the multivariate analysis revealed that a history of diabetes mellitus was the most statistically significant risk factor for the occurrence of rectal bleeding after hypofractionated RT for prostate cancer (p < 0.05). Conclusion: A history of diabetes mellitus was the most statistically significant risk factor for the occurrence of Grade 2 or worse rectal bleeding after high-dose hypofractionated RT, although dosimetric factors were also closely associated with the risk of rectal bleeding

  20. Acute pancreatitis

    Bo-Guang Fan

    2010-05-01

    Full Text Available Background: Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims: The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods: We reviewed the English-language literature (Medline addressing pancreatitis. Results: Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions: Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  1. Acute pancreatitis

    Bo-Guang Fan

    2010-01-01

    Full Text Available Background : Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims : The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods : We reviewed the English-language literature (Medline addressing pancreatitis. Results : Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions : Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  2. Double blind, placebo-controlled trial of Tranexamic acid on recent internal hemorrhoid bleeding

    Abdul A. Rani

    2002-12-01

    Full Text Available Double blind randomized placebo controlled trial was conducted to evaluate the efficacy of Tranexamic acid in 54 patients with recent hemorrhoid bleeding. Age, gender, body weight, height, grade of hemorrhoid, time of onset of recent bleeding were comparable between two groups. Analysis of haemostatic effect or stop bleeding as an immediate outcome of this study revealed that in the grade 2 patients, 23/23 (100% of tranexamic group and 18/23(78.26% of placebo group the bleeding stop. After 3 days of observation, there was statistically significant different for the rate of stop bleeding as well as at the end of observation. Bleeding stop earlier in the Tranexamic group with median 4 days (3-5 days, compare to placebo, median 11(9.55-12.45. Analysis of recurrent bleeding as an outcome of this study revealed that in the placebo group 9/18(50% of grade 2 patients and all grade 3 (100%patients suffered from recurrent bleeding. Since the days 4, both group have significant different time for recurrent bleeding and at the end of observation, cumulative probability of free of bleeding between two groups significantly different. Median still stop bleeding in the placebo group was 36 days, and the tranexamic group never reaches the median until the end of observation. Conclusion: tranexamic acid was an effective drug to stop recent hemorrhoid bleeding and prevent further recurrent bleeding, significantly better than placebo. (Med J Indones 2002;11: 215-21Keywords: Tranexamic acid, hemorrhoid bleeding, haemostatic effect, recurrent bleeding.

  3. Gastrointestinal bleeding and obstructive jaundice: Think of hepatic artery aneurysm.

    Vultaggio, Fabrice; Morère, Pierre-Henri; Constantin, Christophe; Christodoulou, Michel; Roulin, Didier

    2016-06-27

    Hemobilia is an uncommon and potential life-threatening condition mainly due to hepato-biliary tree traumatic or iatrogenic injuries. Spontaneously ruptured aneurysm of the hepatic artery is seldom described. We report the case of an 89-year-old woman presenting with abdominal pain, jaundice and gastrointestinal bleeding, whose ultrasound and computed tomography revealed a non-traumatic, spontaneous aneurysm of the right hepatic artery. The oeso-gastro-duodenoscopy and colonoscopy did not reveal any bleeding at the ampulla of Vater, nor anywhere else. Selective angiography confirmed the diagnosis of hepatic artery aneurysm and revealed a full hepatic artery originating from the superior mesenteric artery. The patient was successfully treated by selective embolization of microcoils. We discuss the etiologies of hemobilia and its treatment with selective embolization, which remains favored over surgical treatment. Although aneurysm of the hepatic artery is rare, especially without trauma, a high index of suspicion is needed in order to ensure appropriate treatment. PMID:27358680

  4. Endoscopic Evaluation of Upper and Lower Gastro-Intestinal Bleeding

    Emeka Ray-Offor; Elenwo, Solomon N

    2015-01-01

    Introduction: A myriad of pathologies lead to gastro-intestinal bleeding (GIB). The common clinical presentations are hematemesis, melena, and hematochezia. Endoscopy aids localization and treatment of these lesions. Aims: The aim was to study the differential diagnosis of GIB emphasizing the role of endoscopy in diagnosis and treatment of GIB. Patients and Methods: A prospective study of patients with GIB referred to the Endoscopy unit of two health facilities in Port Harcourt Nigeria from F...

  5. CLINICAL APPLICATION OF LIDUI (ST 45) BLEEDING METHOD

    李春研; 王军

    2004-01-01

    Lidui (厉兑 ST 45) is the Jing (井 Well) point of the Stomach Meridian of Foot-Yangming. It's effective to reduce the heat from the stomach or the Stomach Meridian. The Stomach Meridian is abundant with qi and blood, and is in charge of hemopathy. So, in clinic, we often apply Lidui (ST 45) point bleeding method to the treatment of many kinds of diseases and get good therapeutic effects. Following are 3 typical cases.

  6. Small bowel stromal tumour revealed by a lower gastrointestinal bleeding

    Assamoi B. F. Kassi

    2016-04-01

    Full Text Available Small bowel stromal tumour must be systematically researched in the presence of obscure and persistent low gastrointestinal bleeding despite a normal endoscopic examination (OGDF and colonoscopy. Video capsule endoscopy is the best diagnosis examination; if it is not available a CT enterography could be useful. Surgical treatment is effective on localized and weak malignancy small bowel stromal tumours. [Int J Res Med Sci 2016; 4(4.000: 1248-1250

  7. Small bowel stromal tumour revealed by a lower gastrointestinal bleeding

    Assamoi B. F. Kassi; Lebeau, R; Y. S. Kacou; K. J. N'dah; Traore, M.

    2016-01-01

    Small bowel stromal tumour must be systematically researched in the presence of obscure and persistent low gastrointestinal bleeding despite a normal endoscopic examination (OGDF and colonoscopy). Video capsule endoscopy is the best diagnosis examination; if it is not available a CT enterography could be useful. Surgical treatment is effective on localized and weak malignancy small bowel stromal tumours. [Int J Res Med Sci 2016; 4(4.000): 1248-1250

  8. Trends on gastrointestinal bleeding and mortality: Where are we standing?

    Ahmed Mahmoud EI-Tawil

    2012-01-01

    Bleeding from the gastrointestinal tract and its management are associated with significant morbidity and mortality.The predisposing factors that led to the occurrence of these hemorrhagic instances are largely linked to the life style of the affected persons.Designing a new strategy aimed at educating the publics and improving their awareness of the problem could effectively help in eradicating this problem with no associated risks and in bringing the mortality rates down to almost zero.

  9. Dynamic of gastroduodenal bleeding distribution after Chernobyl catastrophe

    It was investigated the evidence of gastroduodenal bleeding between Belarus population from 1989 to 1996 period. 27981 occurrences of this disease were registered. The annual permanent growth of the disease was revealed. Between persons, having worked in the Chernobyl region in the first year after the catastrophe, it was found the ulcer disease distribution in 7 times greater than between the whole population. It was concluded about heavy course of ulcer disease in residents of Belarus in the modern conditions

  10. Risperidone-induced Gingival Bleeding in a Pediatric Case: A Dose-dependent Side Effect.

    Hergüner, Sabri; Özayhan, Hatice Yardım; Erdur, Emire Aybuke

    2016-05-31

    There are several case reports on risperidone-related bleeding; however, to our knowledge, there is no report about gingival bleeding associated with risperidone in the literature. We presented a case who experienced gingival bleeding when risperidone dose was increased to 0.5 mg/day, and subsided after decreasing the dose to 0.25 mg/day, suggesting a dose-dependent side-effect. The bleeding side effect of risperidone might be caused by several mechanisms, including 5-hydroxytryptamine 2A receptor antagonism. Although bleeding associated with risperidone is rarely reported, clinicians should be aware of this side effect. PMID:27121433

  11. Chattering of bleed condenser relief valves in Darlington NGS

    The Bleed Condenser (BC) is part of the Pressure and Inventory Control System. The Primary Heat Transport System (PHTS) will transfer water to the Bleed Condenser via the PHT liquid relief valves (LRV) every time overpressure occurs in the main circuit. The BC is designed to withstand full PHT pressure and is protected against overpressurization by two spring loaded Relief Valves (RV). Chattering of these relief valves was observed during commissioning tests in Darlington, when opening of the LRVs pressurized the bleed condenser above the RVs set point. The chattering caused a drift in the valve setpoint and ruptured a pipe connected to the relief line. Similar undesirable events were observed in Bruce NGS. This paper presents the thermalhydraulic analysis of the system, during the above mentioned event and proposes several possible solutions to the problem. The computer simulation was performed using the SOPHT code, developed by Ontario Hydro. Considering the various limitations imposed by design on the relief valves and on the system, the recommended solution is to prolong the valve closing time by 400-800 milliseconds. (author) 9 refs., 11 figs

  12. Recurrent Epistaxis and Bleeding as the Initial Manifestation of Brucellosis.

    Kamali Aghdam, Mojtaba; Davari, Kambiz; Eftekhari, Kambiz

    2016-03-01

    Severe thrombocytopenia with bleeding is rarely reported in children with brucellosis, and recurrent epistaxis is extremely rare. Brucellosis with hemorrhage should be differentiated from viral hemorrhagic fever, malignancy, and other blood disorders. Bone marrow aspiration (BMA) is mandatory to differentiate from other blood diseases. An 8-year-old boy was admitted with recurrent epistaxis, petechiae and purpura on face and extremities and bleeding from the gums. During the hospitalization, he was febrile and complained of muscle pain. Leukopenias associated with thrombocytopenia were observed. BMA showed to be normal. Among the multiple tests requested, only serum agglutination test (SAT) and 2-MercaptoEthanol test (2-ME) were positive. He was treated with Intravenous immunoglobulin (IVIG) associated with co-trimoxazole and rifampin. Finally, fever subsided, and he was discharged with good condition and normal platelet count. Brucellosis should be a differential diagnosis in patients with fever and bleeding disorders and a history of consumption of unpasteurized dairy, in endemic areas. PMID:27107528

  13. Endoscopic evaluation of upper and lower gastro-intestinal bleeding

    Emeka Ray-Offor

    2015-01-01

    Full Text Available Introduction: A myriad of pathologies lead to gastro-intestinal bleeding (GIB. The common clinical presentations are hematemesis, melena, and hematochezia. Endoscopy aids localization and treatment of these lesions. Aims: The aim was to study the differential diagnosis of GIB emphasizing the role of endoscopy in diagnosis and treatment of GIB. Patients and Methods: A prospective study of patients with GIB referred to the Endoscopy unit of two health facilities in Port Harcourt Nigeria from February 2012 to August 2014. The variables studied included: Demographics, clinical presentation, risk score, endoscopic findings, therapeutic procedure, and outcome. Data were collated and analyzed using SPSS version 20 software. Results: A total of 159 upper and lower gastro-intestinal (GI endoscopies were performed during the study period with 59 cases of GI bleeding. There were 50 males and 9 females with an age range of 13-86 years (mean age 52.4 ΁ 20.6 years. The primary presentations were hematochezia, hematemesis, and melena in 44 (75%, 9 (15%, and 6 (10% cases, respectively. Hemorrhoids were the leading cause of lower GIB seen in 15 cases (41%. The majority of pathologies in upper GIB were seen in the stomach (39%: Gastritis and benign gastric ulcer. Injection sclerotherapy was successfully performed in the hemorrhoids and a case of gastric varices. The mortality recorded was 0%. Conclusion: Endoscopy is vital in the diagnosis and treatment of GIB. Gastritis and Haemorrhoid are the most common causes of upper and lower GI bleeding respectively, in our environment

  14. Meatspace is Cyberspace: The Pynchonian Posthuman in Bleeding Edge

    Jason Siegel

    2016-06-01

    Full Text Available This article examines Thomas Pynchon’s indirect critique of utopian posthumanism in 'Bleeding Edge' by analyzing the deleterious effects that an emerging Internet culture has on the novel’s characters. By seeping into every aspect of their lives, embedding itself in their minds, and becoming a prosthetic consciousness, the Internet has transformed the characters into posthumans and altered their subject positions within a technological global capitalist culture. Contrasting the novel’s take on the posthuman with the posthuman theories of Donna Harraway, N. Katherine Hayles, Robert Pepperell, Rosi Braidotti, David Roden and Seb Franklin, I argue that, while the dominant utopian strain in posthuman theory imagines the advent of posthumanism as an opportunity for liberation from the sexism, racism, and colonial oppression that are enabled by the positing of the classical humanist subject, Pynchon demonstrates that because the Internet technology that brought about the posthuman condition is controlled by governments and corporations, it has become just one more lost chance at freedom that was converted into an instrument of increased control and surveillance. Reading 'Bleeding Edge' against William Gibson’s prototypical posthuman novel Neuromancer, I also contend that while Gibson, despite challenging the ontological primacy of meatspace over cyberspace, keeps the two realms separate, Pynchon, who borrows Gibson’s terms, shows that cyberspace has already merged with meatspace. As a result, Maxine Tarnow, the protagonist of 'Bleeding Edge', has nowhere to run in her attempt to find a provisional refuge for herself and her family.

  15. Sex hormones alter the effect of aspirin on bleeding

    Muhammad Tariq Aftab

    2013-10-01

    Full Text Available Background: Interaction of aspirin and sex hormones was investigated through bleeding time. Methods: Bleeding time in 32 males and 105 unmarried females with previous 6 normal menstrual cycles and all aged between 18 to 21 years was found by Duke’s method before and after 2 hours of aspirin administration. Phase of menstrual cycle of each female was determined by present menstrual history. Results: Bleeding time in 32 male was 69.33± 4.94 seconds and in 105 female was 73.03±1.89 seconds which were not statistically different (P>0.05.This time was increased to 107.66±4.76 seconds in males and 113.65±3.73 seconds in females after aspirin administration which were statistically different (P0.05 difference after aspirin administration with a greater effect in Follicular phase probably due to estradiol. Conclusion: Males respond to aspirin more as compared to females which is likely the effect of the drug and testosterone interaction. Similarly females in the follicular phase respond to aspirin more as compared to females in the luteal phase which may be a result of interaction of estrogen and aspirin. [Int J Basic Clin Pharmacol 2013; 2(5.000: 537-540

  16. Duration of increased bleeding tendency after cessation of aspirin therapy.

    Cahill, Ronan A

    2012-02-03

    BACKGROUND: Aspirin has a significant effect on hemostasis, so it is often recommended that patients taking aspirin discontinue treatment before elective surgery. While off aspirin, these patients may be at risk of thrombosis. The optimum period of time that aspirin should be withheld is controversial. The aim of this study was to establish the duration of the antihemostatic effect of prolonged aspirin therapy. STUDY DESIGN: In a prospective study, 51 healthy volunteers were randomly assigned into 3 groups, each receiving an identical tablet for 14 days. One group received a placebo tablet; individuals in the other two groups received either 75 mg or 300 mg of aspirin once a day. Template bleeding times and specific platelet function testing (using the PFA-100; Dade Behring) were carried out on subjects before therapy and again after its completion until they returned to baseline. RESULTS: Thirty-eight volunteers complied sufficiently with the protocol to provide useful results. All bleeding times normalized within 96 hours and all platelet function tests within 144 hours after stopping aspirin. There was no demonstrable hemostatic defect in any volunteer persisting by or beyond the sixth day after treatment cessation. There was no apparent difference in duration of effect between those taking either 75 mg or 300 mg of aspirin. CONCLUSIONS: This study uses sensitive measures of platelet function to demonstrate the duration of increased bleeding tendency after withdrawal of aspirin therapy. It supports discontinuation of aspirin therapy 5 days before elective surgery (with the operation being performed on the sixth day).

  17. Critical gastrointestinal bleed due to secondary aortoenteric fistula.

    Malik, Mohammad U; Ucbilek, Enver; Sherwal, Amanpreet S

    2015-01-01

    Secondary aortoenteric fistula (SAEF) is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A). The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF. PMID:26653698

  18. Critical gastrointestinal bleed due to secondary aortoenteric fistula

    Mohammad U. Malik

    2015-12-01

    Full Text Available Secondary aortoenteric fistula (SAEF is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A. The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF.

  19. Heavy menstrual bleeding in adolescents: hormonal or hematologic?

    Appelbaum, H; Acharya, S S

    2011-12-01

    Adolescence in girls is marked by a host of physical and psychological changes including those associated with menstruation. Heavy menstrual bleeding is one of the most commonly encountered medical problems during transition from childhood to adulthood. Although common, it is likely underreported given that the definition is dependent upon personal experience and influenced by their perception of "normal". Anovulatory cycles related to an immaturity of the hypothalamic pituitary ovarian axis seems to be common, however bleeding disorders such as coagulation factor deficiencies including von Willebrand disease, and quantitative and qualitative abnormalities of platelets must be ruled out. Other medical conditions such as endocrinopathies including diabetes mellitus, Cushing syndrome, polycystic ovarian syndrome, hypothyroidism, chronic hepatic and renal disease, anatomical uterine anomalies, pregnancy, obesity, medications causing hyperprolactinemia must also be considered. Management is based on the presence of hemodynamic instability and acuity of presentation. Treatment options include the use of combined oral contraceptive pills and antifibrinolytic agents; levonorgesterel impregnated intrauterine devices and or treatment of the specific underling bleeding disorder or endocrinopathy. Ongoing management needs to be accomplished through a multi disciplinary team approach in a comprehensive care setting with an adolescent gynecologist, hematologist, pediatrician, and nutritionist involved in the program for a better outcome of this problem. PMID:22036758

  20. Stroke and bleeding risk assessment: where are we now?

    Mikhail S Dzeshka; Gregory Y.H. Lip

    2014-04-01

    Full Text Available Atrial fibrillation (AF is one of major problems of the contemporary cardiology. Ischaemic stroke is a common complication of the AF, and effective prophylaxis requires treatment with oral anticoagulants. The purpose of this current review article is to provide an overview of the various stroke and bleeding risk assessment scores that help decision making with respect to thromboprophylaxis. Particular focus is made on the currently guideline-recommended stroke and bleeding risk scores, such as CHA2DS2-VASc (congestive heart failure or left ventricular dysfunction, hypertension, age ≥75, diabetes, stroke, vascular disease, age 65–74 and sex category [female] and HAS-BLED (uncontrolled hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly [e.g. age >65, frail condition], drugs [e.g. aspirin, nonsteroidal anti-inflammatory drugs]/excessive alcohol is made. Future directions for improvement of predictive ability of risk assessment with clinical factors and biomarkers are also discussed.

  1. Infliximab stopped severe gastrointestinal bleeding in Crohn's disease

    Satimai Aniwan; Surasak Eakpongpaisit; Boonlert Imraporn; Surachai Amornsawadwatana; Rungsun Rerknimitr

    2012-01-01

    To report the result of rapid ulcer healing by infliximab in Crohn's patients with severe enterocolic bleeding.During 2005 and 2010,inflammatory bowel disease database of King Chulalongkorn Memorial and Samitivej hospitals were reviewed.There were seven Crohn's disease (CD) patients (4 women and 3 men; mean age 52 ± 10.4 years; range:11-86 years).Two of the seven patients developed severe gastrointestinal bleeding (GIB) as a flare up of CD whereas the other five patients presented with GIB as their first symptom for CD.Their mean hemoglobin level dropped from 12 ± 1.3 g/dL to 8.7 ± 1.3 g/dL in a 3-d period.Median packed red blood cells units needed for resuscitation was 4 units.Because of uncontrolled bleeding,surgical resection was considered.However,due to the poor surgical candidacy of these patients (n =3) and/or possible development of short bowel syndrome (n =6),surgery was not pursued.Likewise angiographic embolization was not considered in any due to the risk of large infarction.All severe GIBs successfully stopped by one or two doses of intravenous infliximab.Our data suggests that infliximab is an alternative therapy for CD with severe GIB when surgery has limitation or patient is a high risk.

  2. A new candidate as a hemostatic agent for difficult situations during variceal bleeding: Ankaferd blood stopper

    Ersan Ozaslan

    2011-01-01

    Full Text Available Variceal bleeding is the most challenging emergent situation among the causes of upper gastrointestinal bleeding. Despite substantial improvement, a need remains for therapeutic armamentarium of such cases, which is easy, effective and without side-effect. Ankaferd blood stopper (ABS is a standardized herbal extract acting as a hemostatic agent on the bleeding or injured areas. In this observational study, a total of four patients with variceal bleeding were treated with endoscopic ABS application. The lesions were bleeding gastric varices (n:3 and bleeding duodenal varix (n:1. ABS was selected as a bridge to definitive therapies due to unavailability or inappropriateness of bleeding lesions to conventional measures. ABS was instilled or flushed onto the bleeding areas by sclerotherotherapy needle or heater probe catheter. Periprocedural control of the bleeding was achieved in all instances. Thereafter, on an elective basis, two patients with gastric varices underwent cyanoacrylate injection, while third underwent Transjugular intrahepatic portosystemic shunt and embolization. The patient with duodenal varix refused further therapy, after a few hours after admission and was discharged. He again presented the same day with rebleeding, but died before any attempt could be made to control his bleeding. ABS seems to be effective in cases of variceal bleeding as a bridge to therapy. Its major advantages are the ease of use and lack of side-effects.

  3. Successful treatment of Depot Medroxyprogesterone acetate-related vaginal bleeding improves continuation rates in Adolescents

    Kristin M. Rager

    2006-01-01

    Full Text Available High discontinuation rates for depot medroxyprogesterone acetate (DMPA in adolescents may contribute to the number of unintended pregnancies. Many cite vaginal bleeding as a reason for discontinuing DMPA use. In this study, we attempted to determine if treating DMPA-associated vaginal bleeding with monophasic oral contraceptive pills (OCP raised continuation rates. A total of 131 patients who reported vaginal bleeding while on DMPA were included in this study and 83 were treated with monophasic OCP. Of those who received OCP, 38.7% reported that vaginal bleeding stopped completely, 51.8% reported that vaginal bleeding stopped temporarily, and 6.0% reported no change. Overall, 94% of enrolled patients who received OCP as a treatment for DMPA-associated vaginal bleeding continued DMPA use. Our findings indicate that vaginal bleeding due to DMPA can be successfully treated, leading to improvement in continuation rates.

  4. Clinical audit of inherited bleeding disorders in a developing country

    Sajid Raihan

    2010-01-01

    Full Text Available Objective: We did a clinical audit to determine the status of coagulation disorders in a hemophilia care center in Pakistan. Setting: Fatimid foundation blood bank and hematological diseases center, Lahore. Study Design: This is a retrospective descriptive study. Materials and Methods: All patients registered at Lahore center were included. Data was collected using a questionnaire including age, gender, diagnosis, hepatitis and human immune deficiency virus (HIV status, number of episodes of bleeding, most common site of bleeding, severity of disorder and number of transfusions required to treat the episode. Results: During the study period, a total of 923 registered patients were reviewed at Lahore center and of these, 408 patients (44.2% were on regular follow-up. Inherited bleeding disorders identified in these patients included hemophilia A, hemophilia B, vWD, factor VII deficiency, factor V deficiency, factor X deficiency, dysfibrinogenemia, afibrinogenemia, factor XIII deficiency; and platelet function defects. Median age was 17 years with a range of three to 57 years. Median age at diagnosis was one year. There were 329 (80.6% males and 79 (19.3% females. The products used in these patients included factor VIII concentrate, fresh frozen plasma, cryoprecipitate, cryosupernatant and platelets. Testing for transmission of viral infections was also done in these patients and one patient (0.2% was found hepatitis B positive, six patients (1.4% were hepatitis C positive and two patients (0.49% were HIV positive. Conclusion: Hemophilia A, hemophilia B and vWD are the commonly encountered inherited bleeding disorders in our patients followed by other recessively transmitted disorders with a median age of 17 years and male to female ratio of 4: 1. Most of the patients utilized services available at Fatimid foundation with good clinical results. In Pakistan, non-governmental organizations (NGOs are trying their best for providing optimal treatment

  5. Acute retroperitoneal bleeding due to inferior mesenteric artery aneurysm: Case report

    Ferrón JA

    2010-06-01

    Full Text Available Abstract Background Visceral artery aneurysms (VAA, although uncommon, are increasingly being detected. We describe a case of spontaneous retroperitoneal hemorrhage from a ruptured IMA aneurysm associated with stenosis of the superior mesenteric artery (SMA and celiac trunk, successfully treated with surgery. Methods A 65-year-old man presented with abdominal pain and hypovolemic shock. Abdominal CT scan showed an aneurysm of the inferior mesenteric artery with retroperitoneal hematoma. In addition, an obstructive disease of the superior mesenteric artery and celiac axis was observed. Results Upon emergency laparotomy a ruptured inferior mesenteric artery aneurysm was detected. The aneurysm was excised and the artery reconstructed by end-to-end anastomosis. Conclusions This report discusses the etiology, presentation, diagnosis and case management of inferior mesenteric artery aneurysms.

  6. A Therapeutic Dose of Ketoprofen Causes Acute Gastrointestinal Bleeding, Erosions, and Ulcers in Rats

    Shientag, Lisa J; Wheeler, Suzanne M; Garlick, David S.; Maranda, Louise S

    2012-01-01

    Perioperative treatment of several rats in our facility with ketoprofen (5 mg/kg SC) resulted in blood loss, peritonitis, and death within a day to a little more than a week after surgery that was not related to the gastrointestinal tract. Published reports have established the 5-mg/kg dose as safe and effective for rats. Because ketoprofen is a nonselective nonsteroidal antiinflammatory drug that can damage the gastrointestinal tract, the putative diagnosis for these morbidities and mortalit...

  7. Use of CO2 as an angiographic contrast material in the diagnosis of acute hepatic hemorrhage a case report

    Selective abdominal arteriography with an iodinated contrast material is the method of choice for detecting the site of bleeding in patients with acute gastrointestinal hemorrhage in whom the results of endoscopic examination were negative CO2, has been used successfully as a contrast material for arteriography of abdomen and lower limbs. We present the case of a patient in whom suspected gastrointestinal bleeding was detected more rapidly and reliably with co2 than with an iodinated contrast material. (Author) 18 Refs

  8. Relationship of pelvic bone fracture pattern and bleeding foci on angiography

    The purpose of this study is to evaluate the relationship between the patterns of pelvic bone fracture and location of hemorrhage on angiography. We retrospectively reviewed 56 patients with pelvic bone fracture and active bleeding. Fractures were classified according to Tile classification. Locations of bleedings were divided into four groups; main trunk/anterior/posterior divisions of internal iliac artery, and other locations. The relationship between the fracture pattern and bleedings were analyzed statistically. Forty one bleedings were in 22 patients with type A fracture. Twenty (49%) were at the anterior division, 12 (29%) were at the posterior division, and 9 (22%) were found in other location. Thirty three bleedings were in 23 patients with type B fracture. Fifteen (45%) were at the posterior division, 10 (30%) were at the anterior division, 3 (9%) were at the main trunk of the internal iliac artery, and 5 (16%) were at other location. Eighteen bleedings were in 11 patients with type C fracture. Thirteen (72%) were at the posterior division, 4 (22%) were at the anterior division, and 1 (6%) was at main trunk of internal iliac artery. Anterior divisional bleedings were more common in type A, posterior divisional bleedings were more common in type B and C fractures (p = 0.014). The distribution of bleeding is significantly related to the fracture patterns. Fracture pattern may help in predicting the location of bleeding foci on embolization

  9. Women’s perceptions about reducing the frequency of monthly bleeding: results from a multinational survey

    Szarewski A

    2013-05-01

    Full Text Available Anne Szarewski,1 Cecilia Moeller2 1Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; 2Bayer HealthCare Pharmaceuticals, Global Market Research General Medicine, Berlin, Germany Background: Monthly bleeding can have a negative impact on daily life and, given the choice, many women would reduce the frequency of bleeding. While some women choose to occasionally postpone or reduce bleeding frequency with an oral contraceptive (OC, most women have no or limited experience of regularly reducing the frequency of scheduled bleeding with OCs, ie, the extended OC regimen. Study design: An online survey of 4039 women aged 15–49 years who were currently using, had used, or would consider using any form of hormonal contraception was conducted in Brazil, Canada, Czech Republic, France, Germany, Italy, UK, and USA to assess awareness of and the reasons for and against reducing bleeding frequency. Results: Overall, 51.1% and 30.7% of women surveyed were aware that they could occasionally or regularly reduce bleeding frequency with an OC. Moreover, 27.6% and 9.9% of previous/current OC users had occasionally or regularly reduced bleeding frequency with an OC. The main reasons for reducing bleeding frequency were convenience, physician recommendations, special events, and relief of problems associated with bleeding. Many women mistakenly believed that reducing bleeding frequency would have a negative health impact. Conclusion: Additional efforts are needed to educate women about the possibility and potential health benefits of reducing bleeding frequency and to dispel misconceptions about the use of extended OC regimens. Keywords: extended regimen, menstruation, oral contraceptive, withdrawal bleeding, scheduled bleeding

  10. Whole blood for hemostatic resuscitation of major bleeding.

    Spinella, Philip C; Pidcoke, Heather F; Strandenes, Geir; Hervig, Tor; Fisher, Andrew; Jenkins, Donald; Yazer, Mark; Stubbs, James; Murdock, Alan; Sailliol, Anne; Ness, Paul M; Cap, Andrew P

    2016-04-01

    Recent combat experience reignited interest in transfusing whole blood (WB) for patients with life-threatening bleeding. US Army data indicate that WB transfusion is associated with improved or comparable survival compared to resuscitation with blood components. These data complement randomized controlled trials that indicate that platelet (PLT)-containing blood products stored at 4°C have superior hemostatic function, based on reduced bleeding and improved functional measures of hemostasis, compared to PLT-containing blood products at 22°C. WB is rarely available in civilian hospitals and as a result is rarely transfused for patients with hemorrhagic shock. Recent developments suggest that impediments to WB availability can be overcome, specifically the misconceptions that WB must be ABO specific, that WB cannot be leukoreduced and maintain PLTs, and finally that cold storage causes loss of PLT function. Data indicate that the use of low anti-A and anti-B titer group O WB is safe as a universal donor, WB can be leukoreduced with PLT-sparing filters, and WB stored at 4°C retains PLT function during 15 days of storage. The understanding that these perceived barriers are not insurmountable will improve the availability of WB and facilitate its use. In addition, there are logistic and economic advantages of WB-based resuscitation compared to component therapy for hemorrhagic shock. The use of low-titer group O WB stored for up to 15 days at 4°C merits further study to compare its efficacy and safety with current resuscitation approaches for all patients with life-threatening bleeding. PMID:27100756

  11. Ultrasonographic evaluation of abnormal uterine bleeding in postmenopausal women

    Bindushree Kadakola

    2015-02-01

    Full Text Available Background: Objectives of current study were to diagnose causes of Abnormal Uterine Bleeding (AUB in postmenopausal women (PMW and to correlate it with curettage and histopathological findings, hysteroscopy and thereby minimizing unnecessary interventions in the form of operations and hysteroscopy where sonography depicts normal findings. Methods: After obtaining ethical clearance present prospective observational study was conducted from November 2010 to November 2012, to evaluate the endometrium in 50 postmenopausal women (PMW with bleeding per vagina referred to the department of Radio diagnosis by the department of gynaecology in Bangalore medical college and research institute. After applying inclusion and exclusion criterias the cases were evaluated with ultrasonography both transabdominal (TAS and transvaginal scan (TVS where ever necessary. Histopathological and hysteroscopic correlation was done in all cases. Results: 58% of the PMW with bleed were in the age group of 51-60 years. Most common cause of PMB was atrophic endometrium (44%, endometrial polyp (22%, followed by malignancy (14%, and hyperplastic endometrium (6%. At Endometrium thickness less than 4 mm there were nil chances of carcinoma. Conclusions: In women with AUB in postmenopausal age ultrasonography (USG can be considered as an initial imaging modality for diagnosing endometrial diseases. The sensitivity and specificity of USG for Atrophic endometrium is 100% and 84% respectively with accuracy of 100%, endometrial polyp the specificity is 100% with accuracy of 88%. For malignancy USG showed 100% specificity and accuracy of 100%. Hence USG is highly accurate for evaluating endometrial pathologies. Being noninvasive, less costly and good patient compliance USG should be considered as an initial imaging modality over invasive investigations like D and C, hysteroscopy in evaluating endometrial disorders. [Int J Reprod Contracept Obstet Gynecol 2015; 4(1.000: 229-234

  12. Thyroid abnormality in perimenopausal women with abnormal uterine bleeding

    Prasanna Byna

    2015-11-01

    Full Text Available Background: AUB is a common but complicated clinical presentation and occurs in 15-20% of women between menarche to menopause and significantly affects the women's health. Women with thyroid dysfunction often have menstrual irregularities, infertility and increased morbidity during pregnancy. The objective of present study is to find the correlation between thyroid disorders and AUB in perimenopausal women attending gynecology OPD. Methods: In the present study, fifty five patients with AUB were included and were evaluated for the cause including thyroid abnormality. Thyroid function tests were done in all patients. Results: Among 55 patients, 12 patients were diagnosed as hypothyroidism and 7 as hyperthyroidism, women with AUB 36 (65.4% were euthyroid. Among 19 women with thyroid abnormality, heavy menstrual bleeding was seen in 8 (42% women, 6 (31.57% had polymenorrhagia, 5 (26.31% had oligomenorrhoea. The frequent menstrual abnormality in women with hypothyroidism (12 women was heavy menstrual bleeding in 5 (41.6% women, 3 (25% had oligomennorhoea, 4 (33.3% had polymenorrhagia. Out of 7 women with hyperthyroidism, 2 (28.57% had oligomenorrhoea, 3 (42.8% had heavy menstrual bleeding, 2 (28.57% had polymenorrhagia. In a total of 55 patients with AUB, 11 (20% had structural abnormalities in uterus and ovaries. 5 (9% had adenomyosis, 3 (5.4% had ovarian cysts, 3 (5.4% had fibroids. Conclusions: It is important to screen all women for thyroid abnormality who are presenting with AUB especially with non-structural causes of AUB. Correction of thyroid abnormalities also relieves AUB. This will avoid unnecessary hormonal treatment and surgery. [Int J Res Med Sci 2015; 3(11.000: 3250-3253

  13. Sangrado de origen ginecológico Gynaecological bleeding

    I. Jiménez Ubieto

    2009-01-01

    Full Text Available El sangrado genital es la alteración ginecológica más frecuente en las mujeres en edad reproductiva siendo, en los países occidentales, una de las causas más frecuentes de anemia y que puede ser motivo de absentismo laboral. Ante una paciente con sangrado en el Servicio de Urgencias lo primero habrá que valorar la repercusión hemodinámica, adoptando las medidas necesarias. Se realizará una anamnesis y exploración detalladas para establecer el origen. Cuando aparece sangrado en el área genital generalmente se piensa en un origen uterino, pero no siempre es así y habrá que descartar origen en el tracto genital inferior, en el tracto genital superior u otro origen extraginecológico en el área digestiva y/o urológica. Con el diagnóstico se valorará el tratamiento oportuno y la necesidad o no de ingreso hospitalario.Genital bleeding is the most frequent gynaecological alteration in women of reproductive age. In industrial countries it is one of the most frequent causes of anaemia and can be a cause of labour absenteeism. Facing a patient with bleeding in the Accident and Emergency Service, the first thing is to evaluate the haemodynamic repercussion and take the necessary measures. A detailed case history and exploration are carried out to establish its origin. A uterine origin is usually considered when bleeding appears in the genital area, but this is not always the case, and it is necessary to rule out an origin in the lower genital tract, upper genital tract or an extragynaecological origin in the digestive and/or urological area. With the diagnosis an appropriate treatment will be considered, as well the possible need for hospital admission.

  14. Improving Quality of Care in Peptic Ulcer Bleeding

    Rosenstock, Steffen J; Møller, Morten H; Larsson, Heidi; Johnsen, Søren P; Madsen, Anders H; Bendix, Jørgen; Adamsen, Sven; Jensen, Anders G; Zimmermann-Nielsen, Erik; Nielsen, Ann-Sophie; Kallehave, Finn; Oxholm, Dorthe; Skarbye, Mona; Jølving, Line R; Jørgensen, Henrik S; de Muckadell, Ove B Schaffalitzky; Thomsen, Reimar W

    2013-01-01

    OBJECTIVES:The treatment of peptic ulcer bleeding (PUB) is complex, and mortality remains high. We present results from a nationwide initiative to monitor and improve the quality of care (QOC) in PUB.METHODS:All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered...... demographic, clinical, and prognostic data. QOC was evaluated using eight process and outcome indicators, including time to initial endoscopy, hemostasis obtainment, proportion undergoing surgery, rebleeding risks, and 30-day mortality.RESULTS:A total of 13,498 PUB patients (median age 74 years) were included...

  15. Three infants with rotavirus gastroenteritis complicated by severe gastrointestinal bleeding.

    Kawamura, Yoshiki; Miura, Hiroki; Mori, Yuji; Sugata, Ken; Nakajima, Yoichi; Yamamoto, Yasuto; Morooka, Masashi; Tsuge, Ikuya; Yoshikawa, Akiko; Taniguchi, Koki; Yoshikawa, Tetsushi

    2016-01-01

    Rotavirus gastroenteritis causes substantial morbidity and mortality worldwide in children. We report three infants with rotavirus gastroenteritis complicated by various severity of gastrointestinal bleeding. Two patients (cases 1 and 2) recovered completely without any specific treatments. One patient (case 3) died despite extensive treatments including a red blood cell transfusion and endoscopic hemostatic therapy. Rotavirus genotypes G1P[8] and G9P[8] were detected in cases 2 and 3, respectively. Rotavirus antigenemia levels were not high at the onset of melena, suggesting that systemic rotaviral infection does not play an important role in causing melena. PMID:26100228

  16. A CASE OF FACTITIOUS BLEEDING: MUNCHAUSEN’S SYNDROME

    Emre

    2015-06-01

    Full Text Available Munchausen’s syndrome is a psychiatric disorder in which patients inflict on themselves an illness or injury for the primary purpose of assuming the sick role. These patients can present with many different complaints and clinical symptoms including self - inflicted blee ding. This report describes a case of lately diagnosed Munchausen’s syndrome who presented with hemoptysis and developed hematochezia and hematuria during the hospitalization period. Physicians should always consider this rare disorder in cases presented w ith bleeding symptoms of unknown origin.

  17. Von Willebrand factor in patients on mechanical circulatory support – a double-edged sword between bleeding and thrombosis

    Kaczmarski, Jacek; Pacholewicz, Jerzy; Zakliczynski, Michal; Gasior, Mariusz; Zembala, Marian

    2015-01-01

    Mechanical circulatory support (MCS) is an umbrella term describing the various technologies used in both short- and long-term management of patients with either end-stage chronic heart failure (HF) or acute HF. Most often, MCS has emerged as a bridge to transplantation, but more recently it is also used as a destination therapy. Mechanical circulatory support includes left ventricular assist device (LVAD) or bi-ventricular assist device (Bi-VAD). Currently, 2- to 3-year survival in carefully selected patients is much better than with medical therapy. However, MCS therapy is hampered by sometimes life-threatening complications including bleeding and device thrombosis. Von Willebrand factor (vWF) has two major functions in haemostasis. First, it plays a crucial role in platelet-subendothelium adhesion and platelet-platelet interactions (aggregation). Second, it is the carrier of factor VIII (FVIII) in plasma. Von Willebrand factor prolongs FVIII half-time by protecting it from proteolytic degradation. It delivers FVIII to the site of vascular injury thus enhancing haemostatic process. On one hand, high plasma levels of vWF have been associated with an increased risk of thrombosis. On the other, defects or deficiencies of vWF underlie the inherited von Willebrand disease or acquired von Willebrand syndrome. Here we review the pathophysiology of thrombosis and bleeding associated with vWF. PMID:26702279

  18. Superselective embolization with microcoil in acute gastronitestinal hemorrhage

    Ko, Eun Hye; Kim, Jae Kyu; Jang, Nam Kyu [Medical School, Chonnam University, Kwangju (Korea, Republic of)] [and others

    2000-04-01

    To evaluate the efficacy and safety of superselective arterial embolization using the microcoil in acute gastrointerstinal hemorrhage. We evaluated 11 of 42 patients who had undergone diagnostic angiography and transcatheter arterial embolization due to acute gastrointestinal hemorrhage and subsequently underwent superselective arterial embolization using the microcoil. Nine were males and two were females, and their age ranged from 33 to 70 (mean, 51) years. The etiologies were bleeding ulcer (n=3D5), pseudoaneurysm from pancreatitis (n=3D3), and postoperative bleeding (n=3D3). The symptoms were melena, hematemesis, and hematochzia, and the critical signs were cecreased hemoglobin and worsening of vital signs. All patients underwent superselective embolization using the microcatheter and microcoil. Bleeding occurred in the gastroduodenal artery (n=3D5), inferior pancreaticoduodenal artery (n=3D2), left gastric artery (n=3D2), right hepatic artery (n=3D1), and ileal branch of the superior mesenteric artery (n=3D1). All cases were treated succesfully, without complications. In one case in which there was bleeding in the right hepatic artery, reembolization with a microcoil was needed because of persistent melena. During follow up, three patients died from complications arising underlying diseases, namely disseminated intravascular coagulopathy, chronic renal failure, and adult resiratory distress syndrome. (author)=20.

  19. Superselective embolization with microcoil in acute gastronitestinal hemorrhage

    To evaluate the efficacy and safety of superselective arterial embolization using the microcoil in acute gastrointerstinal hemorrhage. We evaluated 11 of 42 patients who had undergone diagnostic angiography and transcatheter arterial embolization due to acute gastrointestinal hemorrhage and subsequently underwent superselective arterial embolization using the microcoil. Nine were males and two were females, and their age ranged from 33 to 70 (mean, 51) years. The etiologies were bleeding ulcer (n=3D5), pseudoaneurysm from pancreatitis (n=3D3), and postoperative bleeding (n=3D3). The symptoms were melena, hematemesis, and hematochzia, and the critical signs were cecreased hemoglobin and worsening of vital signs. All patients underwent superselective embolization using the microcatheter and microcoil. Bleeding occurred in the gastroduodenal artery (n=3D5), inferior pancreaticoduodenal artery (n=3D2), left gastric artery (n=3D2), right hepatic artery (n=3D1), and ileal branch of the superior mesenteric artery (n=3D1). All cases were treated succesfully, without complications. In one case in which there was bleeding in the right hepatic artery, reembolization with a microcoil was needed because of persistent melena. During follow up, three patients died from complications arising underlying diseases, namely disseminated intravascular coagulopathy, chronic renal failure, and adult resiratory distress syndrome. (author)=20

  20. Placement of Covered Self-Expandable Metal Biliary Stent for the Treatment of Severe Postsphincterotomy Bleeding: Outcomes of Two Cases

    Davide Cintorino; Luca Barresi; Ilaria Tarantino; Marta Di Pisa; Mario Traina

    2010-01-01

    We report two cases of severe postsphincterotomy bleeding in an adult and a pediatric patient treated, as first options, with available techniques to induce hemostasis without success. Because of persisting bleeding, an expandable, partially covered, metallic stent was placed into the choledocho to mechanically compress the bleeding site. The bleeding was stopped. In the following days, both patients remained hemodynamically stable with no further episodes of bleeding. We believe that the app...

  1. SPECT/CT with a hybrid imaging system in the study of lower gastrointestinal bleeding with technetium-99m red blood cells

    Aim. Lower gastrointestinal (G I) hemorrhage is a complex clinical problem that requires disciplined evaluation for successful management. This study was conducted to evaluate the applicability of single photon emission computed tomography/computed tomography (SPECT/CT) in patients with acute lower gastrointestinal bleeding undergoing scintigraphy with 99m Tc-labelled red blood cells (RBC), and to assess the additional clinical value of fused images when compared to the standard radionuclide scan. Methods. Twenty-seven patients presenting with acute lower G I tract hemorrhage were studied with conventional dynamic and planar 99m Tc-RBC imaging. In 19 patients with positive findings on scans taken within 6 hours, a SPECT/CT study was immediately performed using a hybrid system composed of a dual-head, variable angle gamma camera and an X-ray tube. The number of patients in whom SPECT/CT changed the scintigraphic interpretation with regard to the presence or site of G I blood loss as confirmed by other diagnostic or therapeutical procedures was recorded. Results. Image fusion was easy and successful in all patients showing perfect correspondence between SPECT and CT data and allowing precise anatomical localization of the sites of 99m Tc-RBC extravasation. SPECT/CT had significant impact on the scintigraphic results in 7/19 patients (36.8%): in 6 patients it precisely localized the bleeding foci whose location could not be identified in standard scans and in one it excluded the presence of an active G I hemorrhage. Conclusion. SPECT/CT with a hybrid system is feasible and useful for facilitating imaging interpretation and improving the accuracy of 99m Tc-RBC scintigraphy in patients with acute lower G I bleeding.

  2. Oral manifestations of acute leukaemia

    Ivanović Mirjana

    2011-01-01

    Full Text Available Acute leukaemia is the most common form of chilhood cancer. The aim of this paper was to underline the importance of oral manifestations in children with acute leukaemia. The disease and its treatment can directly or indirectly affect oral health. Oral manifestations are gingival inflammation and enlargement. Leukaemic cells are capable of infiltrating the gingiva and the deeper periodontal tissues which leads to ulceration and infection of oral tissues. Gingival bleeding is a common sign in patients with leukaemia. Symptoms include local lymphadenopathy, mucous membrane Petechiae and ecchymoses. Cytotoxic drugs have direct effects like mucositis, involving atrophy, desquamation and ulceration of the mucosa, with increasing the risk for local and systemic infections. Leukaemia can directly influence dental care and dental treatment, while oral lesions may have life-threatening consequences. Knowledge and skills among dentists may also not be adequate to treat children with acute leukaemia. It is therefore imperative that all stomatologists be aware of dental problems that occur in leukaemia in order to be able to effectively carry out appropriate measures to mitigate these problems.

  3. Compressor discharge bleed air circuit in gas turbine plants and related method

    Anand, Ashok Kumar; Berrahou, Philip Fadhel; Jandrisevits, Michael

    2002-01-01

    A gas turbine system that includes a compressor, a turbine component and a load, wherein fuel and compressor discharge bleed air are supplied to a combustor and gaseous products of combustion are introduced into the turbine component and subsequently exhausted to atmosphere. A compressor discharge bleed air circuit removes bleed air from the compressor and supplies one portion of the bleed air to the combustor and another portion of the compressor discharge bleed air to an exhaust stack of the turbine component in a single cycle system, or to a heat recovery steam generator in a combined cycle system. In both systems, the bleed air diverted from the combustor may be expanded in an air expander to reduce pressure upstream of the exhaust stack or heat recovery steam generator.

  4. Role of proton pump inhibitors in the management of peptic ulcer bleeding

    Hwai-Jeng; Lin

    2010-01-01

    Peptic ulcer bleeding is a serious medical problem with significant morbidity and mortality.Endoscopic therapy significantly reduces further bleeding,surgery and mortality in patients with bleeding peptic ulcers and is now recommended as the first hemostatic modality for these patients.The efficacy of large-dose proton pump inhibitor(PPI) therapy in reducing re-bleeding after endoscopic therapy has been supported by evidence derived from randomized controlled trials.It may be premature to recommend small-dose intravenous injection PPI after endoscopic hemostasis in patients with bleeding ulcers.An updated systematic review shows that PPI therapy before endoscopy significantly reduces the proportion with major stigmata and requirement for endoscopic therapy at index endoscopy.Some studies show that there is no significant difference between oral and intravenous PPIs in raising intragastric pH.However,clinical data is lacking in patients with peptic ulcer bleeding to date.

  5. Severe upper gastrointestinal bleeding in extraluminal diverticula in the third part of the duodenum

    Andersen, Johnny Fredsbo; Wilhelmsen, Michael; Lauritsen, Morten Laksafoss

    2014-01-01

    The successful management of upper gastrointestinal (GI) bleeding requires identification of the source of bleeding and when this is achieved the bleeding can often be treated endoscopically. However, the identification of the bleeding can be challenging due to the location of the bleeding or...... technical aspects. Therefore it might be necessary to use other measures than endoscopy such as CT angiography. Duodenal diverticula is a rare cause of upper GI bleeding and can be challenging to diagnose as they often require specialised endoscopy procedures such as endoscopy with a side-viewing scope....... This case describes the first successful management of this rare condition with an upper GI endoscopy with a colonoscope and afterwards intravascular coiling....

  6. Emergency transcatheter arterial embolization for patients with acute massive duodenal ulcer hemorrhage

    Yong-Li Wang; Ying-Sheng Cheng; Li-Zhen Liu; Zhong-Hui He; Kun-Hong Ding

    2012-01-01

    AIM:To evaluate the efficacy and safety of emergency transcatheter arterial embolization (ETAE) for patients with acute massive duodenal ulcer hemorrhage.METHODS:Twenty-nine consecutive patients with acute massive bleeding of duodenal ulcer were admitted to our hospital from 2006 to 2011.Superselective angiography of the celiac and gastroduodenal arteries was performed to find out the bleeding sites before ETAE,then,embolotherapy was done with gelatin sponge particles or microstrips via a 5 French angiographic catheter or 3 French microcatheter.After ETAE,further superior mesenteric arteriography was undertaken in case collateral circulation supplied areas of the duodenal ulcer.Technical and clinical success rates were analyzed.Changes in the mucous membrane were observed using endoscopy following ETAE.RESULTS:Angiography showed active bleeding with extravasation of contrast medium in seven cases with a 24% positive rate of celiac artery bleeding,and in 19 cases with a 65.5% rate of gastroduodenal artery bleeding.There were no angiographic signs of bleeding in three patients who underwent endoscopy prior to ETAE.Twenty-six patients achieved immediate hemostasis and technical success rate reached 90%.No hemostasis was observed in 27 patients within 30 d after ETAE and clinical success rate was 93%.Recurrent hemorrhage occurred in two patients who drank a lot of wine who were treated by a second embolotherapy in the same way.Five patients underwent transient ischem with light abdominal pain under xiphoid,spontaneous restoration without special treatment.No mucous necrosis happened to 29 cases for ischem of gastroduodenal arteries embolized.CONCLUSION:ETAE is an effective and safe measure to control acute massive bleeding of duodenal ulcer.

  7. Preterm delivery risk among pregnancies with history of first trimester vaginal bleeding and intrauterin hematoma

    ULUĞ, Ulun; Jozwiak, Esra Aksoy; TOSUN, Süleyman; BAHÇECİ, Mustafa

    2006-01-01

    Aim:Vaginal bleeding during the first trimester is considered as threatened abortion. Vaginal bleeding can be associated by sonographic demonstration of subchorionic hematoma. This study evaluates the risk of preterm delivery among pregnancies with a history of intrauterin hematoma with vaginal bleeding during the first trimester. Materials and Methods: The files of singleton pregnancies followed up at our center between 2001 and 2003 were retrospectively evaluated. Gestations with vaginal bl...

  8. The Results of Helicobacter Pylori Eradication on Repeated Bleeding in Patients with Stomach Ulcer

    Horvat, Darko; Včev, Aleksandar; Soldo˛, Ivan; Timarac, Jasna; Dmitrović, Branko; Mišević, Tonči; Ivezić, Zdravko; Kraljika, Nikola

    2005-01-01

    The triple therapy of Helicobacter pylori eradication prevents repeated bleeding from stomach ulcer. The aim of this one-way blind prospective study was to evaluate the efficiency of the two-week triple therapy for Helicobacter pylori eradication in preventing renewed bleeding in patients with stomach ulcer within one year. This research included 60 hospitalized patients with bleeding stomach ulcer and positive Helicobacter pylori infection, 34 men and 26 women (average age 59.7 years). The p...

  9. Cerebral and splenic infarctions after injection of N-butyl-2-cyanoacrylate in esophageal variceal bleeding

    Myung, Dae-Seong; Chung, Cho-Yun; Park, Hyung-Chul; Kim, Jong-Sun; Cho, Sung-Bum; Lee, Wan-Sik; Choi, Sung-Kyu; Joo, Young-Eun

    2013-01-01

    Variceal bleeding is the most serious complication of portal hypertension, and it accounts for approximately one fifth to one third of all deaths in liver cirrhosis patients. Currently, endoscopic treatment remains the predominant method for the prevention and treatment of variceal bleeding. Endoscopic treatments include band ligation and injection sclerotherapy. Injection sclerotherapy with N-butyl-2-cyanoacrylate has been successfully used to treat variceal bleeding. Although injection scle...

  10. Can Plasma Fibrinogen Levels Predict Bleeding After Coronary Artery Bypass Grafting?

    Jalali, Alireza; Ghiasi, Mohammadsaeid; Aghaei, Aghdas; Khaleghparast, Shiva; Ghanbari, Behrooz; Bakhshandeh, Hooman

    2014-01-01

    Background: Fibrinogen is the main biomarker for bleeding. To prevent excessive postoperative bleeding, it would be useful to identify high-risk patients before coronary artery bypass grafting (CABG). Objectives: In order to predicating bleeding after CABG, we sought to determine whether preoperative fibrinogen concentration was associated with the amount of bleeding following CABG. Patients and Methods: A total of 144 patients (mean age = 61.50 ± 9.42 years; 65.7% men), undergoing elective and isolated CABG, were included in this case-series study. The same anesthesia technique and medicines were selected for all the patients. In the ICU, the patients were assessed in terms of bleeding at 12 and 24 hours post-operation, amount of contingent blood products received, and relevant tests. Statistical tests were subsequently conducted to analyze the correlation between preoperative fibrinogen concentration and the amount of post-CABG bleeding. Results: The mean ± standard deviation of bleeding at 12 and 24 hours post-operation was 285.37 ± 280.27 and 499.31 ± 355.57 mL, respectively. The results showed that postoperative bleeding was associated with different factors whereas pre-anesthesia fibrinogen was not correlated with bleeding at 12 (P = 0.856) and 24 hours (P = 0.936) post-operation. There were correlations between the extra-corporal circulation time and bleeding at 12 hours post-operation (ρ = 0.231, P = 0.007) and bleeding at 24 hours post-operation (ρ = 0.218, P = 0.013). Conclusions: Preoperative assessment of plasma fibrinogen levels failed to predict post-CABG bleeding. PMID:25478546

  11. Molecular Pathology of Rare Bleeding Disorders (RBDs) in India: A Systematic Review

    Kulkarni, Bipin P.; Nair, Sona B.; Vijapurkar, Manasi; Mota, Leenam; Shanbhag, Sharda; Ali, Shehnaz; Shetty, Shrimati D.; Ghosh, Kanjaksha

    2014-01-01

    Background Though rare in occurrence, patients with rare bleeding disorders (RBDs) are highly heterogeneous and may manifest with severe bleeding diathesis. Due to the high rate of consanguinity in many caste groups, these autosomal recessive bleeding disorders which are of rare occurrence in populations across the world, may not be as rare in India. Objectives To comprehensively analyze the frequency and nature of mutations in Indian patients with RBDs. Methods Pubmed search was used (www.pu...

  12. Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation

    Staerk, Laila; Lip, Gregory Y H; Olesen, Jonas B;

    2015-01-01

    -2012) included all patients with atrial fibrillation discharged from hospital after gastrointestinal bleeding while receiving antithrombotic treatment. Restarted treatment regimens were single or combined antithrombotic drugs with oral anticoagulation and antiplatelets. Follow-up started 90 days after discharge...... to avoid confounding from use of previously prescribed drugs on discharge. Risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding were estimated with competing risks models and time dependent multiple Cox regression models. STUDY ANSWER AND LIMITATIONS...

  13. CT enteroclysis in the diagnosis of obscure gastrointestinal bleeding: initial results

    Jain, T.P. [Department ofRadiodiagnosis, All India Institute of Medical Sciences, New Delhi (India); Gulati, M.S. [Department of Imaging, Queen Elizabeth Hospital NHS Trust, London (United Kingdom); Makharia, G.K. [Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi (India)]. E-mail: govindmakharia@aiims.ac.in; Bandhu, S. [Department ofRadiodiagnosis, All India Institute of Medical Sciences, New Delhi (India); Garg, P.K. [Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi (India)

    2007-07-15

    Aim: To evaluate the usefulness of computed tomography (CT) enteroclysis in patients with obscure gastrointestinal (GI) bleeding. Materials and methods: In a prospective study, CT enteroclysis was performed in 21 patients (median age 50 years; range 13-71 years) with obscure GI bleeding in which the source of the bleeding could not be detected despite the patient having undergone both upper GI endoscopic and colonoscopic examinations. The entire abdomen and pelvis was examined in the arterial and venous phases using multisection CT after distending the small intestine with 2 l of 0.5% methylcellulose as a neutral enteral contrast medium and the administration of 150 ml intravenous contrast medium. Results: Adequate distension of the small intestine was achieved in 20 of the 21 (95.2%) patients. Potential causes of GI bleeding were identified in 10 of the 21 (47.6%) patients using CT enteroclysis. The cause of the bleeding could be detected nine of 14 (64.3%) patients with overt, obscure GI bleeding. However, for patients with occult, obscure GI bleeding, the cause of the bleeding was identified in only one of the seven (14.3%) patients. The lesions identified by CT enteroclysis included small bowel tumours (n = 2), small bowel intussusceptions (n = 2), intestinal tuberculosis (n = 2), and vascular lesions (n = 3). All vascular lesions were seen equally well in both the arterial and venous phases. Conclusions: The success rate in detection of the cause of bleeding using CT enteroclysis was 47.6% in patients with obscure GI bleeding. The diagnostic yield was higher in patients with overt, obscure GI bleeding than in those with occult obscure GI bleeding.

  14. Successful treatment of Depot Medroxyprogesterone acetate-related vaginal bleeding improves continuation rates in Adolescents

    Kristin M. Rager; Amy Fowler; Hatim A. Omar

    2006-01-01

    High discontinuation rates for depot medroxyprogesterone acetate (DMPA) in adolescents may contribute to the number of unintended pregnancies. Many cite vaginal bleeding as a reason for discontinuing DMPA use. In this study, we attempted to determine if treating DMPA-associated vaginal bleeding with monophasic oral contraceptive pills (OCP) raised continuation rates. A total of 131 patients who reported vaginal bleeding while on DMPA were included in this study and 83 were treated with monoph...

  15. Women’s perceptions about reducing the frequency of monthly bleeding: results from a multinational survey

    Szarewski A; Moeller C

    2013-01-01

    Anne Szarewski,1 Cecilia Moeller2 1Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; 2Bayer HealthCare Pharmaceuticals, Global Market Research General Medicine, Berlin, Germany Background: Monthly bleeding can have a negative impact on daily life and, given the choice, many women would reduce the frequency of bleeding. While some women choose to occasionally postpone or reduce bleeding frequency with an oral contra...

  16. Selective Embolization for Post-Endoscopic Sphincterotomy Bleeding: Technical Aspects and Clinical Efficacy

    So, Young Ho; Choi, Young Ho [Seoul National University Boramae Medical Center, Seoul (Korea, Republic of); Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University Hospital, Seoul (Korea, Republic of); Song, Soon Young [Hanyang University Hospital, Seoul (Korea, Republic of)

    2012-01-15

    The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. We reviewed the records of 10 patients (3%; M:F 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; {+-} 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.

  17. Traumatic intercostal arterial bleeding controlled with a novel surgical technique: a case report

    Miettinen Simo; Hakala Tapio

    2012-01-01

    Abstract Introduction A blunt thoracic trauma may cause arterial bleeding requiring operative treatment or endovascular embolization or endovascular aortic stenting. A novel damage control technique to stop such bleeding is presented. Case presentation We present the case of an 82-year-old Caucasian man who experienced rib fractures I-VII on the left side and bleeding from damaged intercostal arteries after a blunt thoracic trauma. Emergency thoracotomy was performed. Conclusions Effective he...

  18. A Method to Control Turbofan Engine Starting by Varying Compressor Surge Valve Bleed

    Sexton, Wayne Randolph

    2001-01-01

    A METHOD TO CONTROL TURBOFAN ENGINE STARTING BY VARYING COMPRESSOR SURGE VALVE BLEED Wayne R. Sexton (ABSTRACT) This thesis reports the results of a study of the starting conditions of a turbofan engine. The research focused on ways to minimize turbine inlet temperature while maintaining an adequate compressor stall margin during engine start by varying the surge valve bleed. Varying the surge valve bleed was also shown to reduce compressor and fan required torque. ...

  19. Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

    Ignacio Couto-Worner; Benito González-Conde; Emilio Estévez-Prieto; Pedro Alonso-Aguirre

    2013-01-01

    Diverticular disease is the most frequent cause of lower gastrointestinal bleeding. Most of the times, bleeding stops without any intervention but in 10-20 % of the cases it is necessary to treat the hemorrhage. Several modalities of endoscopic treatment have been described after purging the colon. We present five cases of severe diverticular bleeding treated with injection of epinephrine and hemoclips. All the colonoscopies were performed without purging of the colon in an emergency setting,...

  20. ACR appropriateness Criteria® second and third trimester bleeding.

    Podrasky, Ann E; Javitt, Marcia C; Glanc, Phyllis; Dubinsky, Theodore; Harisinghani, Mukesh G; Harris, Robert D; Khati, Nadia J; Mitchell, Donald G; Pandharipande, Pari V; Pannu, Harpreet K; Shipp, Thomas D; Siegel, Cary Lynn; Simpson, Lynn; Wall, Darci J; Wong-You-Cheong, Jade J; Zelop, Carolyn M

    2013-12-01

    Vaginal bleeding occurring in the second or third trimesters of pregnancy can variably affect perinatal outcome, depending on whether it is minor (i.e. a single, mild episode) or major (heavy bleeding or multiple episodes.) Ultrasound is used to evaluate these patients. Sonographic findings may range from marginal subchorionic hematoma to placental abruption. Abnormal placentations such as placenta previa, placenta accreta and vasa previa require accurate diagnosis for clinical management. In cases of placenta accreta, magnetic resonance imaging is useful as an adjunct to ultrasound and is often appropriate for evaluation of the extent of placental invasiveness and potential involvement of adjacent structures. MRI is useful for preplanning for cases of complex delivery, which may necessitate a multi-disciplinary approach for optimal care.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:24263752

  1. Gastric Glomus Tumor: A Rare Cause of Upper Gastrointestinal Bleeding

    Yoshinori Handa

    2015-01-01

    Full Text Available A 24-year-old woman was referred to our department because of melena. These symptoms combined with severe anemia prompted us to perform an emergency upper endoscopy, which showed bleeding from an ulcerated 30 mm submucosal tumor in the gastric antrum. A computed tomography scan revealed a homogeneously enhanced mass, and endoscopic ultrasonography identified a well-demarcated mass in the third and fourth layers of the gastric wall. Because analysis of the possible medical causes remained inconclusive and the risk of rebleeding, laparoscopy-assisted gastric wedge resection was performed after administration of 10 units of red cell concentrate. Histological and immunohistological analysis revealed the tumor to be a gastric glomus tumor. Gastric submucosal tumors remain challenging to diagnose preoperatively as they show a variety of radiologic and clinicopathologic features and are associated with the risk of bleeding upon biopsy, as is indicated in the guidelines for gastric submucosal tumors. Gastric glomus tumors characteristically present with exsanguinating gastrointestinal hemorrhaging that often requires blood transfusion. Additionally, gastric submucosal tumors typically occur in elderly patients; however, this case involved a young patient who was 24 years old. Here, we describe this case in order to identify features that may aid in early differentiation of gastric submucosal tumors.

  2. Origins of movements following stunning and during bleeding in cattle.

    Terlouw, E M Claudia; Bourguet, Cécile; Deiss, Véronique; Mallet, Christophe

    2015-12-01

    At slaughter, after stunning, the absence of certain physical signs such as eye movements/reflexes or rhythmic breathing helps determine whether the loss of consciousness was actually achieved. Cattle frequently show movements of neck and/or legs during the post-stun period. We evaluated 1) the origins of these movements in stunned unconscious cattle and 2) relationships with presence of ocular signs or breathing and shot characteristics. In stunned unconscious cattle, movements appear to be reflex-like, generated in the brain stem and/or spinal cord. First, in stunned unconscious cattle, movements could continue until 3 min after the start of bleeding. Second, severing the spinal cord in stunned unconscious cattle did not influence amount of movements. Third, in reaction to the skin cut and sticking, some unconscious animals showed a nociceptive withdrawal reflex. In bulls, following longer stun-stick delays, this response was weaker. Shot placement, post-stun movements and initial bleeding efficiency seemed related but the underlying mechanisms remain to be elucidated. PMID:26225929

  3. Bleeding complications in laparoscopic cholecystectomy: Incidence, mechanisms, prevention and management

    Kaushik Robin

    2010-01-01

    Full Text Available Background: Laparoscopic cholecystectomy (LC has established itself firmly as the ′gold standard′ for the treatment of gallstone disease, but it can, at times, be associated with significant morbidity and mortality. Existing literature has focused almost exclusively on the biliary complications of this procedure, but other complications such as significant haemorrhage can also be encountered, with an immediate mortality if not recognized and treated in a timely manner. Materials and Methods: Publications in English language literature that have reported the complication of bleeding during or after the performance of LC were identified and accessed. The results thus obtained were tabulated and analyzed to get a true picture of this complication, its mechanism and preventive measures. Results: Bleeding has been reported to occur with an incidence of up to nearly 10% in various series, and can occur at any time during LC (during trocar insertion, dissection technique or slippage of clips/ ligatures or in the postoperative period. It can range from minor haematomas to life-threatening injuries to major intra-abdominal vessels (such as aorta, vena cava and iliacs. Conclusion: Good surgical technique, awareness and early recognition and management of such cases are keys to success when dealing with this problem.

  4. Bronchoscopic intratumoral injection of tranexamic acid to prevent excessive bleeding during multiple forceps biopsies of lesions with a high risk of bleeding: a prospective case series

    Significant bleeding may occur following endobronchial forceps biopsy or brushing of necrotic or hypervascular tumors in the airways. In some cases, methods such as endobronchial instillation of iced saline lavage and epinephrine may fail to control bleeding. The present study evaluated the efficacy and safety of a new bronchoscopic technique using intratumoral injection of tranexamic acid (IIT) for control of bleeding during forceps biopsy in patients with endobronchial tumors with a high risk of bleeding. The study was a prospective case series carried out in a single center. Bronchoscopic IIT was performed in those patients who had endoscopically visible tumoral lesions with persistent active bleeding following the first attempt at bronchoscopic sampling. Tranexamic acid (TEA) was injected through a 22-gauge Wang cytology needle into the lesion in nominal doses of 250–500 mg. After 2–3 minutes, multiple forceps biopsy specimens were obtained from the lesion. Of the 57 consecutive patients included in the study, 20 patients (35.1%) underwent bronchoscopic IIT. The first attempt in 18 patients was endobronchial forceps biopsy (EBB), and because of a high risk of bleeding, the first attempt for the remaining two patients, who were on continuous dual antiplatelet therapy (aspirin and clopidogrel), employed endobronchial needle aspiration (EBNA) as a precautionary measure. Following IIT, subsequent specimens were obtained using EBB in all patients. Multiple forceps biopsy specimens (3–10) were obtained from the lesions (8 necrotic and 12 hypervascular) without incurring active bleeding. The following histopathologic diagnoses were made: squamous cell carcinoma (n = 14), adenocarcinoma (n = 2), small-cell lung cancer (n = 3), and malignant mesenchymal tumor (n = 1). No side effects of TEA were observed. Bronchoscopic IIT is a useful and safe technique for controlling significant bleeding from a forceps biopsy procedure and can be considered as a pre

  5. Lingual Haematoma due to Tenecteplase in a Patient with Acute Myocardial Infarction

    Muhlis Bal

    2013-01-01

    Full Text Available The use of intravenous thrombolytic agents has revolutionised the treatment of acute myocardial infarction. However, the improvement in mortality rate achieved with these drugs is tempered by the risk of serious bleeding complications, including intracranial haemorrhage. Tenecteplase is a genetically engineered mutant tissue plasminogen activator. Haemorrhagic complications of tissue plasminogen activator (tPA are well known. Compared to other tPAs, tenecteplase use leads to lower rates of bleeding complications. Here, we report a case of unusual site of spontaneous bleeding, intralingual haematoma during tenecteplase therapy following acute myocardial infarction, which caused significant upper airway obstruction and required tracheotomy to maintain the patient’s airway. Clinical dilemmas related to securing the airway or reversing the effects of tissue plasminogen activator are discussed.

  6. Anisakiasis Causing Acute Dysentery in Malaysia.

    Amir, Amirah; Ngui, Romano; Ismail, Wan Hafiz Wan; Wong, Kum T; Ong, Jaxinthe S K; Lim, Yvonne A L; Lau, Yee-Ling; Mahmud, Rohela

    2016-08-01

    Human anisakiasis is a zoonosis acquired by eating raw or undercooked infected seafood. Herein, we report a case of acute dysentery caused by anisakiasis in a 64-year-old man in Malaysia. A colonoscopy was performed and a nematode larva was found penetrating the mucosa of the ascending colon. Bleeding was observed at the site of penetration. Y-shaped lateral epidermal cords were seen from the cross section of the worm, which is a prominent feature of Anisakis larva. Molecular analysis using polymerase chain reaction of cytochrome oxidase 2 (cox2) gene confirmed the specimen to be larva of Anisakis simplex. PMID:27325803

  7. Therapeutic hypothermia for acute liver failure

    Stravitz, R.T.; Larsen, Finn Stolze

    2009-01-01

    transplantation or spontaneous liver regeneration follows in short order. To buy time, the induction of therapeutic hypothermia (core temperature 32 degrees C-35 degrees C) has been shown to effectively bridge patients to transplant. Similar to the experience in patients with cerebral edema after other neurologic...... of liver injury. Hypothermia has not been adequately studied for its safety and theoretically may increase the risk of infection, cardiac dysrhythmias, and bleeding, all complications independently associated with acute liver failure. Therefore, although an ample body of experimental and human data...

  8. Gastrointestinal stromal tumor: acute liquefaction necrosis

    Stromal tumors, together with leiomyomas and schwannomas, constitute the sol-called mesenchymal tumors of the intestinal wall. Stromal tumors are histologically differentiated from other mesenchymal tumors in that they are derived from the interstitial cell of Cajal. These tumors can be encountered at any point throughout the entire digestive tract, by usually develop in stomach or small bowel. the clinical presentation in anemia secondary to gastrointestinal bleeding. Acute abdomen due to perforation or necrosis is rare. We present a case of jejunal stromal tumors with massive liquefaction necrosis, a circumstance that resulted in the peculiar radiological features observed. (Author) 9 refs,

  9. Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

    To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding. Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated. The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18). TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy

  10. Surgical repair of ruptured abdominal aortic aneurysm with non-bleeding aortocaval fistula.

    Unosawa, Satoshi; Kimura, Haruka; Niino, Tetsuya

    2013-01-01

    We present a case of an aortocaval fistula (ACF) without bleeding because a clot was covering the fistula. A 60-year-old man was diagnosed as having a ruptured abdominal aortic aneurysm (AAA) and an aortocaval fistula, by enhanced computed tomography (CT). After the aneurysm had been opened, the fistula was detected, but there was no bleeding because it was covered with clot. After graft repair, bleeding from the fistula occurred when the clot was removed by suction. Direct closure of the fistula was achieved after bleeding was controlled by digital compression. PMID:23825505

  11. Recurrent gastrointestinal bleeding diagnosed by delayed scintigraphy with Tc-99m-labeled red blood cells.

    Nwakanma, Lois; Meyerrose, Gary; Kennedy, Shalyn; Rakvit, Ariwan; Bohannon, Todd; Silva, Micheal

    2003-08-01

    A 56-year-old woman presented with bright-red blood from the rectum. Esophagogastroduodenoscopy revealed mild gastritis. Colonoscopy demonstrated diverticulosis without active bleeding, and in vitro tagged red blood cell scintigraphy was unremarkable. There was no further evidence of bleeding and the patient was discharged home. The patient returned with recurrent bright-red blood from the rectum. Although delayed scintigraphic images seldom demonstrate the site of bleeding, delayed images at 12 hours demonstrated active bleeding near the hepatic flexure in this patient. This was confirmed with selective mesenteric angiography, and was treated with coil embolization of the tertiary branches of the right middle colic artery. PMID:12897664

  12. Detection of gastrointestinal bleeding with /sup 99m/Tc-sulfur colloid

    We have developed a single scintigraphic technique to detect and localize the site of bleeding in the gastrointestinal tract. This examination requires only intravenous administration of /sup 99m/Tc sulfur colloid and imaging of the abdomen. Very shortly after the introduction of the radiopharmaceutical, a fraction of the injected activity extravasates at the bleeding site and is eliminated from the circulation. This phenomenon is repeated each time the blood recirculates adding another, but smaller fraction to the extravasated activity at the site of hemorrhage. Because of continued clearance of the radiopharmaceutical from the vascular pool by the reticuloendothelial system, a contrast is eventually reached between the site of bleeding and surrounding background. Based on animal experiments bleeding rates as low as .05-0.1 cc/min can be detected with this technique. The sensitivity of the approach in the detection of the site of hemorrhage is significantly higher than arteriography or other techniques which utilize radioactive blood pool indicators. We have mainly used this technique in the evaluation of patients with GI bleeding. In more than 25 patients with negative scintigrams for hemorrhage, arteriography showed no evidence of bleeding. In 38 patients with scintigraphic evidence of bleeding. In 38 patients with scintigraphic evidence of hemorrhage, arteriograms were positive for bleeding in les than 50% of the cases. No false positive results have been noted in the latter group. This technique appears to offer a simple, practical and reliable approach to the evaluation of patients with gastrointestinal bleeding

  13. Multiple smooth muscle tumours in neurofibromatosis presenting with chronic gastrointestinal bleeding.

    Cox, J. G.; Royston, C M; Sutton, D. R.

    1988-01-01

    Gastrointestinal involvement in neurofibromatosis is well recognised. We present an unusual manifestation of gastro-intestinal neurofibromatosis--chronic gastrointestinal bleeding from extensive smooth muscle tumours.

  14. Active gastrointestinal bleeding:Use of hemostatic forceps beyond endoscopic submucosal dissection

    Dimitri; Coumaros; Niki; Tsesmeli

    2010-01-01

    To the best of our knowledge,this is the f irst report of the application of hemostatic forceps in active gastrointestinal(GI) bleeding that is not related to endoscopic submucosal dissection.An 86-year-old woman with chronic intake of low-dose aspirin had a Dieulafoy's lesion of the third duodenal portion.Bleeding control with epinephrine injection was unsuccessful.A 60-year-old man presented with a bleeding ulcer in the duodenal bulb.Ten days after combined endotherapy,he had recurrent bleeding from two m...

  15. Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding.

    Fujishiro, Mitsuhiro; Iguchi, Mikitaka; Kakushima, Naomi; Kato, Motohiko; Sakata, Yasuhisa; Hoteya, Shu; Kataoka, Mikinori; Shimaoka, Shunji; Yahagi, Naohisa; Fujimoto, Kazuma

    2016-05-01

    Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first-line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research. PMID:26900095

  16. MEXICANA DE CANANEA TO START UP BREAKTHROUGH PROCESS TO ELIMINATE ELECTROLYTE BLEEDING

    FaniaLisa

    1997-01-01

    Copper processors using solvent extraction/electrowinning(SX/EW) have known for years that eliminating the electrolyte bleed could benefit process economics dramatically Until now.there was no practical solution to eliminate the bleed.Available processes either could nor reduce iron contaminants sufficiently,or pulled out too much valuable copper and cobalt along with the iron.Based on pilot tests of a new breed of ion exchange separatioin system at three different mine sites on representative electrolytes,an alternmative to bleeding electrolytes now exists.On this basis,processors can shelve the wasteful electrolyte bleeding practice.Already,one major copper producer is installing a fullscale system.

  17. Risperidone-induced Gingival Bleeding in a Pediatric Case: A Dose-dependent Side Effect

    Hergüner, Sabri; Özayhan, Hatice Yardım; Erdur, Emire Aybuke

    2016-01-01

    There are several case reports on risperidone-related bleeding; however, to our knowledge, there is no report about gingival bleeding associated with risperidone in the literature. We presented a case who experienced gingival bleeding when risperidone dose was increased to 0.5 mg/day, and subsided after decreasing the dose to 0.25 mg/day, suggesting a dose-dependent side-effect. The bleeding side effect of risperidone might be caused by several mechanisms, including 5-hydroxytryptamine 2A rec...

  18. Transrectal ultrasound-guided biopsy of the prostate: aspirin increases the incidence of minor bleeding complications

    Halliwell, O.T. [Department of Radiology, Southampton General Hospital, Southampton (United Kingdom)], E-mail: hallo99@doctors.org.uk; Yadegafar, G. [Public Health Sciences and Medical Statistics Division, School of Medicine, Southampton General Hospital, Southampton University, Southampton (United Kingdom); Lane, C.; Dewbury, K.C. [Department of Radiology, Southampton General Hospital, Southampton (United Kingdom)

    2008-05-15

    Aim: To assess whether patients taking aspirin were more likely to experience bleeding complications after transrectal ultrasound (TRUS)-guided prostate biopsy. Materials and methods: Three hundred and eighty-seven patients taking aspirin who underwent prostate biopsy over a 3.5 year period and 731 patients not taking aspirin over a 2 year period returned a questionnaire assessing the incidence and severity of bleeding complications. Results: Patients taking aspirin had a significantly higher cumulative incidence of haematuria and rectal bleeding, but not of haemospermia. They also had a longer mean duration of bleeding, but no increase in bleeding severity. Severe bleeding was very uncommon in both groups and no patients required intervention for bleeding complications. Conclusion: Aspirin exacerbates minor bleeding complications in patients undergoing TRUS guided biopsy of the prostate, but in this large group of aspirin-taking patients no dangerous bleeding complications were encountered. It may be that the risks associated with aspirin cessation outweigh the risks of haemorrhagic complications.

  19. Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

    Jae, Hwan Jun; Chung, Jin Wook; Jung, Ah Young; Lee, Whal; Park, Jae Hyung [Seoul National University Hospital, Institute of Radiation Medicine, Seoul (Korea, Republic of)

    2007-02-15

    To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding. Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated. The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18). TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy.

  20. Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

    Ignacio Couto-Worner

    2013-09-01

    Full Text Available Diverticular disease is the most frequent cause of lower gastrointestinal bleeding. Most of the times, bleeding stops without any intervention but in 10-20 % of the cases it is necessary to treat the hemorrhage. Several modalities of endoscopic treatment have been described after purging the colon. We present five cases of severe diverticular bleeding treated with injection of epinephrine and hemoclips. All the colonoscopies were performed without purging of the colon in an emergency setting, with correct visualization of the point of bleeding. Patients recovered well avoiding other aggressive procedures such as angiography or surgery.

  1. Lassa fever presenting as acute abdomen: a case series

    Andrew E. Dongo; Kesieme, Emeka B.; Iyamu, Christopher E; Okokhere, Peter O; Akhuemokhan, Odigie C.; Akpede, George O.

    2013-01-01

    Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefo...

  2. Acute respiratory failure as a manifestation of an arachnoid cyst

    Pillai Lalitha; Achari Gopal; Desai Sanjay; Patil Vinayak

    2008-01-01

    Arachnoid cysts are the most common congenital cystic lesions in the brain occurring in the middle fossa, suprasellar region and occasionally in the posterior fossa. Conventionally all cysts are considered as benign and symptoms are attributed to expansion of cysts causing compression of adjacent neurological structures, bleeds within the cyst or due to the development of acute hydrocephalus. We are reporting this case of a 15-year-old female patient with non-progressive weakness in the limbs...

  3. Acute pancreatitis

    ... page: //medlineplus.gov/ency/article/000287.htm Acute pancreatitis To use the sharing features on this page, ... fatty foods after the attack has improved. Outlook (Prognosis) Most cases go away in a week. However, ...

  4. Acute Pericarditis

    ... Sugar Control Helps Fight Diabetic Eye Disease Are 'Workaholics' Prone to OCD, Anxiety? ALL NEWS > Resources First ... cancer, or heart surgery, the fluid is blood. Causes Acute pericarditis usually results from infection or other ...

  5. Hematocolpos as a Result of Delayed Treatment of Acute Straddle Injury in an Adolescent Girl

    Hae Jin Hwang; Hyun Wook Lim; Young Shin Han; Jeong In Choi; Min Jeong Kim

    2016-01-01

    Accidental genital trauma is most commonly caused by straddle-type injuries and is usually treatable by nonoperative management, and most of the injuries have a good prognosis. When the bleeding occurred due to straddle injury in adolescent girl, experienced gynecological examination and treatment were very important. We experienced a case of straddle injury to the posterior fourchette that caused acute hematocolpos due to delayed adequate treatment with hypotension and acute abdomen in an ad...

  6. Acute promyelocytic leukemia in a hemophilia A patient:a case report

    张磊; 李洪强; 赵辉; 王婷婷; 季林祥; 杨仁池; 韩忠朝

    2004-01-01

    @@ Acute promyelocytic leukemia (APL) is the M3 subtype of the French-American-British (FAB) classification of acute myeloid leukemia (AML). Hemophilia is a congenital bleeding disorder characterized by a deficiency of coagulation factor VIII or IX. In our center, more than one thousand patients with haemophilia A have been treated since 1980.1 In June 2002, APL was first diagnosed in one person with haemophilia (PWH). The coincidence of these two diseases led to challenges in developing a treatment strategy.

  7. Two Cases of Acute Abdomen after an Intravitreal Injection of Bevacizumab

    Onoda, Yasutaka; Shiba, Tomoaki; Hori, Yuichi; Maeno, Takatoshi; Takahashi, Mao

    2015-01-01

    We report on a patient with ischemic colitis and another with paralytic ileus, both of whom experienced an acute abdomen after intravitreal injection of bevacizumab (IVB). Case 1 was a 78-year-old woman. Her medical history included surgery for colon carcinoma 10 years earlier. The patient developed acute severe abdominal pain and nausea the day after IVB for retinal vein occlusion with macular edema, and massive lower gastrointestinal bleeding occurred. Ischemic colitis was diagnosed. Case 2...

  8. Lower Body Positive Pressure Application with an Antigravity Suit in Acute Carotid Occlusion

    Karine Berthet

    2010-01-01

    Full Text Available The challenge in acute stroke is still to reperfuse as early as possible the ischemic territory. Since fibrinolytic therapies have a limited window with potential risk of bleeding, having a nonpharmacologic mean to recruit vessels in area surrounding necrosis might be useful. We propose here to use antigravity suit inflated at “venous” pressure levels to shift blood towards thoracic and brain territories. We report two cases of spectacular clinical recovery after acute carotid occlusion.

  9. Lower Body Positive Pressure Application with an Antigravity Suit in Acute Carotid Occlusion

    Didier Payen; Anne Claire Lukaszewicz; Marie-Germaine Bousser; Karine Berthet

    2010-01-01

    The challenge in acute stroke is still to reperfuse as early as possible the ischemic territory. Since fibrinolytic therapies have a limited window with potential risk of bleeding, having a nonpharmacologic mean to recruit vessels in area surrounding necrosis might be useful. We propose here to use antigravity suit inflated at “venous” pressure levels to shift blood towards thoracic and brain territories. We report two cases of spectacular clinical recovery after acute carotid occlusion.

  10. Lower body positive pressure application with an antigravity suit in acute carotid occlusion.

    Berthet, Karine; Lukaszewicz, Anne Claire; Bousser, Marie-Germaine; Payen, Didier

    2010-01-01

    The challenge in acute stroke is still to reperfuse as early as possible the ischemic territory. Since fibrinolytic therapies have a limited window with potential risk of bleeding, having a nonpharmacologic mean to recruit vessels in area surrounding necrosis might be useful. We propose here to use antigravity suit inflated at "venous" pressure levels to shift blood towards thoracic and brain territories. We report two cases of spectacular clinical recovery after acute carotid occlusion. PMID:20798842

  11. Acute dyspnea

    Radiodiagnosis is applied to determine the causes of acute dyspnea. Acute dyspnea is shown to aggravate the course of pulmonary diseases (bronchial asthma, obstructive bronchitis, pulmonary edema, throboembolism of pulmonary arteries etc) and cardiovascular diseases (desiseas of myocardium). The main tasks of radiodiagnosis are to determine volume and state of the lungs, localization and type of pulmonary injuries, to verify heart disease and to reveal concomitant complications

  12. Bronchitis (acute)

    Wark, Peter

    2008-01-01

    Acute bronchitis, with transient inflammation of the trachea and major bronchi, affects over 40/1000 adults a year in the UK. The causes are usually considered to be infective, but only around half of people have identifiable pathogens.The role of smoking or environmental tobacco smoke inhalation in predisposing to acute bronchitis is unclear.A third of people may have longer-term symptoms or recurrence.

  13. Superselective arterial embolisation with a liquid polyvinyl alcohol copolymer in patients with acute gastrointestinal haemorrhage

    Lenhart, Markus; Schneider, Hans [Sozialstiftung Bamberg, Department of Diagnostic and Interventional Radiology, Bamberg (Germany); Paetzel, Christian [Klinikum Weiden, Department of Radiology, Weiden (Germany); Sackmann, Michael [Sozialstiftung Bamberg, Department of Gastroenterology, Bamberg (Germany); Jung, Ernst Michael; Schreyer, Andreas G.; Feuerbach, Stefan; Zorger, Niels [University of Regensburg, Department of Radiology, Regensburg (Germany)

    2010-08-15

    To evaluate the results of emergency embolisation in acute arterial bleeding of the gastrointestinal tract with a liquid polyvinyl alcohol copolymer from two centres. We retrospectively analysed 16 cases (15 patients) of acute arterial bleeding of the gastrointestinal tract where emergency embolotherapy was performed by using the copolymer when acute haemorrhage was not treatable with endoscopic techniques alone. Cause of haemorrhage and technical and clinical success were documented. Arterial embolotherapy was successful in all 16 cases. The technical success rate was 100%. The cause of bleeding was pancreatitis in four, graft-versus-host disease (GVHD) of the colon in three, malignancy in three, angiodysplasia in two, ulcer in two and panarteritis no dosa and trauma in one each. There were no procedure-related complications. No bowel necrosis occurred because of embolisation. In 13 cases, the patients were discharged in good condition (81%); the three patients with GVHD died because of the underlying disease. The copolymer seems to have great potential in embolotherapy of acute arterial gastrointestinal bleeding. In our series none of the patients had rebleeding at the site of embolisation and no clinically obvious bowel necrosis occurred. (orig.)

  14. Causes of arterial bleeding after living donor liver transplantation and the results of transcatheter arterial embolization

    To analyze the causes of arterial bleeding after living donor liver transplantation (LDLT) and to evaluate the efficacy of transcatheter arterial embolization (TAE). Forty-two sessions of conventional arteriography were performed in 32 of the 195 patients who underwent LDLT during the past 2 years. This was done in search of bleeding foci of arterial origin. TAE was performed with microcoils or gelatin sponge particles. The causes of arterial bleeding, the technical and clinical success rates of TAE and the complications were retrospectively evaluated. Forty-two bleeding foci of arterial origin were identified on 30 sessions of arteriography in 21 patients. The most common cause of bleeding was percutaneous procedures in 40% of the patients (17 of the 42 bleeding foci) followed by surgical procedures in 36% (15/42). The overall technical and clinical success rates of TAE were 21 (70%) and 20 (67%) of the 30 sessions, respectively. The overall technical success rate of TAE for the treatment of bleeding from the hepatic resection margin, hepatic artery anastomotic site and hepaticojejunostomy was only 18% (2/11), whereas for the treatment of bleeding in the other locations the technical and clinical success rates of TAE were 100% and 95%, respectively. No procedure-related major complications occurred. In the case of arterial bleeding after LDLT, percutaneous procedure-related hemorrhages were as common as surgery-related hemorrhages. There were technical difficulties in using TAE for the treatment of hepatic arterial bleeding. However, in the other locations, TAE seems to be safe and effective for the control of arterial bleeding in LDLT recipients

  15. Acute Stent Thrombosis After Primary Percutaneous Coronary Intervention

    Clemmensen, Peter; Wiberg, Sebastian; Van't Hof, Arnoud;

    2015-01-01

    OBJECTIVES: This study sought to determine clinical, procedural, and treatment factors associated with acute stent thrombosis (AST) in the EUROMAX (European Ambulance Acute Coronary Syndrome Angiography) trial. BACKGROUND: Bivalirudin started during transport for primary percutaneous coronary...... intervention (PCI) for ST-segment elevation myocardial infarction significantly reduced major bleeding compared with heparin with or without glycoprotein IIb/IIIa inhibitors (GPI), but it was associated with an increase in AST. METHODS: We compared patients with (n = 12) or without AST (n = 2,184) regarding...

  16. Clinical use of Plasma and Plasma Fractions in Bleeding Disorders

    王兆钺

    2008-01-01

    Internal and/or external bleeding is a common and sometimes very severe clinical manifestations of disorders of hemostasis. It may follow minor trauma or may arise apparently spontaneously. Disorders of hemostasis are generally divided into those caused by abnormalities of platelets, abnormalities of blood vessels, abnormalities of plasma coagulation factors, and hyperfibrinolysis, or com-binations of these. The use of plasma and plasma fractions dependents on the causing diseases and their severity. Several plasma products and plasma fractions are availa-ble in China and other plasma components and deriva-tives are commercially obtained. There have been the guidelines for their clinical use, and the revised ones will soon be published by Chinese Medical Association.

  17. Invasive mole: a rare cause of postmenopausal bleeding

    Mamour Guèye

    2013-06-01

    Full Text Available Gestational trophoblastic disease (GTD describes a number of gynaecological tumours that originate in the trophoblast layer, including hydatidiform mole (complete or partial, placental site trophoblastic tumour, choriocarcinoma and invasive mole. Invasive moles are responsible of most cases of localized gestational trophoblastic neoplasia (GTN. Invasive mole is a condition where a molar pregnancy, such as a partial hydatidiform mole or complete hydatidiform mole, invades the wall of the uterus. It is an extremely rare condition. As GTN is not considered in the differential diagnosis of postmenopausal uterine malignancies, its preoperative diagnosis is challenging. We report a case of invasive hydatidiform mole in a postmenopausal woman discovered in a context of postmenopausal bleeding. She underwent hysterectomy and followed up till her beta hCG levels were within normal limits. The patient is in complete remission in the first postoperative year. [Int J Reprod Contracept Obstet Gynecol 2013; 2(3.000: 451-453

  18. Rectal bleeding in a 4-month-old boy

    A case of bleeding Meckel's diverticulum is described in an infant. A 4-month-old boy was seen initially with a 24-hour history of painless hematochezia. His parents had noted two episodes of maroon-colored stool that did not appear to be associated with any abdominal distress. His medical history was unremarkable, with normal growth and development. Physical examination revealed a well-nourished, well-hydrated infant in no apparent distress. Vital signs were normal. Rectal examination revealed no masses, but bright-red blood was noted on the examining finger. Findings from the remainder of the examination were normal. An upright roentgenogram of the abdomen was obtained and demonstrated no abnormalities. The abdominal technetium scan was abnormal. An exploratory laparotomy was performed later on the day of admission

  19. Spectrum of dysfunctional uterine bleeding and its conservative management

    To find out the proportion of dysfunctional uterine bleeding (DUB) and the response of patients of DUB to medical treatment at Abbasi Shaheed Hospital. Results: Two hundred and ten out of 1300 patients were diagnosed as having DUB with the proportion of 16.1%. Response rate was 20 - 30 % with oral mafenamic acid, 50% with capsule tranexamic acid, 60% and 50% respectively with oral contraceptive pills containing ethinylestradiol and norethisterone, and norethisterone alone. The response rate with capsulated micronised flavonoid and derivative of ethinyltestosterone was 90% and 75% respectively. Conclusion: The patients in adolescent age group are good responders to conservative treatment. Most of the patients preferred micronised flavonoid over derivative of ethinyltestosterone for some misconceptions regarding this medicine. The former was better tolerated with less side effects. (author)

  20. Placement of Covered Self-Expandable Metal Biliary Stent for the Treatment of Severe Postsphincterotomy Bleeding: Outcomes of Two Cases

    Marta Di Pisa

    2010-01-01

    Full Text Available We report two cases of severe postsphincterotomy bleeding in an adult and a pediatric patient treated, as first options, with available techniques to induce hemostasis without success. Because of persisting bleeding, an expandable, partially covered, metallic stent was placed into the choledocho to mechanically compress the bleeding site. The bleeding was stopped. In the following days, both patients remained hemodynamically stable with no further episodes of bleeding. We believe that the application of a covered metallic stent in a severe postendoscopic-sphincterotomy bleeding, refractory to injection therapy, should be considered to avoid additional interventions, which carry a higher risk of complications, even in pediatric patients.

  1. Coagulopathy induced by acidosis, hypothermia and hypocalcaemia in severe bleeding.

    De Robertis, E; Kozek-Langenecker, S A; Tufano, R; Romano, G M; Piazza, O; Zito Marinosci, G

    2015-01-01

    Acidosis, hypothermia and hypocalcaemia are determinants for morbidity and mortality during massive hemorrhages. However, precise pathological mechanisms of these environmental factors and their potential additive or synergistic anticoagulant and/or antiplatelet effects are not fully elucidated and are at least in part controversial. Best available evidences from experimental trials indicate that acidosis and hypothermia progressively impair platelet aggregability and clot formation. Considering the cell-based model of coagulation physiology, hypothermia predominantly prolongs the initiation phase, while acidosis prolongs the propagation phase of thrombin generation. Acidosis increases fibrinogen breakdown while hypothermia impairs its synthesis. Acidosis and hypothermia have additive effects. The effect of hypocalcaemia on coagulopathy is less investigated but it appears that below the cut-off of 0.9 mmol/L, several enzymatic steps in the plasmatic coagulation system are blocked while above that cut-off effects remain without clinical sequalae. The impact of environmental factor on hemostasis is underestimated in clinical practice due to our current practice of using routine coagulation laboratory tests such as partial thromboplastin time or prothrombin time, which are performed at standardized test temperature, after pH correction, and upon recalcification. Temperature-adjustments are feasible in viscoelastic point-of-care tests such as thrombelastography and thromboelastometry which may permit quantification of hypothermia-induced coagulopathy. Rewarming hypothermic bleeding patients is highly recommended because it improves patient outcome. Despite the absence of high-quality evidence, calcium supplementation is clinical routine in bleeding management. Buffer administration may not reverse acidosis-induced coagulopathy but may be essential for the efficacy of coagulation factor concentrates such as recombinant activated factor VII. PMID:24608516

  2. Acute myelogenous leukemia (AML) - children

    Acute myelogenous leukemia - children; AML; Acute myeloid leukemia - children; Acute granulocytic leukemia - children; Acute myeloblastic leukemia - children; Acute non-lymphocytic leukemia (ANLL) - children

  3. Predictors of re-operation due to post-surgical bleeding in breast cancer patients

    Winther Lietzen, L; Cronin-Fenton, Deirdre; Garne, Jens Peter;

    2012-01-01

    To assess the risk of re-operation due to post-surgical bleeding after initial breast cancer surgery and to identify predictors of re-operation.......To assess the risk of re-operation due to post-surgical bleeding after initial breast cancer surgery and to identify predictors of re-operation....

  4. Gastrointestinal bleeding in a patient with a continuous-flow biventricular assist device

    Mirasol, Raymond V; Tholany, Jason J; Reddy, Hasini; Fyfe-Kirschner, Billie S; Cheng, Christina L; Moubarak, Issam F; Nosher, John L

    2016-01-01

    The association between continuous-flow left ventricular assist devices (CF-LVADs) and gastrointestinal (GI) bleeding from angiodysplasia is well recognized. However, the association between continuous-flow biventricular assist devices (CF-BIVADs) and bleeding angiodysplasia is less understood. We report a case of GI bleeding from a patient with a CF-BIVAD. The location of GI bleeding was identified by nuclear red blood cell bleeding scan. The vascular malformation leading to the bleed was identified and localized on angiography and then by pathology. The intensity of bleeding, reflected by number of units of packed red blood cells needed for normalization of hemoglobin, as well as the time to onset of bleeding after transplantation, are similar to that seen in the literature for CF-LVADs and pulsatile BIVADs. While angiography only detected a dilated late draining vein, pathology demonstrated the presence of both arterial and venous dilation in the submucosa, vascular abnormalities characteristic of a late arteriovenous malformation. PMID:27158430

  5. A Source-Term Based Boundary Layer Bleed/Effusion Model for Passive Shock Control

    Baurle, Robert A.; Norris, Andrew T.

    2011-01-01

    A modeling framework for boundary layer effusion has been developed based on the use of source (or sink) terms instead of the usual practice of specifying bleed directly as a boundary condition. This framework allows the surface boundary condition (i.e. isothermal wall, adiabatic wall, slip wall, etc.) to remain unaltered in the presence of bleed. This approach also lends itself to easily permit the addition of empirical models for second order effects that are not easily accounted for by simply defining effective transpiration values. Two effusion models formulated for supersonic flows have been implemented into this framework; the Doerffer/Bohning law and the Slater formulation. These models were applied to unit problems that contain key aspects of the flow physics applicable to bleed systems designed for hypersonic air-breathing propulsion systems. The ability of each model to predict bulk bleed properties was assessed, as well as the response of the boundary layer as it passes through and downstream of a porous bleed system. The model assessment was performed with and without the presence of shock waves. Three-dimensional CFD simulations that included the geometric details of the porous plate bleed systems were also carried out to supplement the experimental data, and provide additional insights into the bleed flow physics. Overall, both bleed formulations fared well for the tests performed in this study. However, the sample of test problems considered in this effort was not large enough to permit a comprehensive validation of the models.

  6. Chronic portomesenteic venous thrombosis complicated by a high flow arteriovenous malformation presenting with gastrointestinal bleeding.

    Plotnik, Adam N; Hebroni, Frank; McWilliams, Justin

    2016-02-01

    Portomesenteric venous thrombosis is a rare but potentially life-threatening condition. The presenting symptoms of chronic portomesenteric venous thrombosis are often non-specific but may present with variceal bleeding. We present the first reported case of chronic portomesenteric venous thrombosis causing a high flow arteriovenous malformation that resulted in extensive gastrointestinal bleeding. PMID:25871943

  7. Localization of gastrointestinal bleeding: superiority of 99mTc sulfur colloid compared with angiography

    Preliminary experience with technetium-99m sulfur colloid scintigraphy in 43 patients with lower gastrointestinal bleeding is described. Within minutes of the intravenous introduction of the radiopharmaceutical, a fraction of the injected activity extravasates at the bleeding site and is eliminated from the circulation. Because of rapid clearance of the radiopharmaceutical from the vascular pool by the reticuloendothelial system, a contrast develops between the site of bleeding and surrounding background. Based on animal experiments, bleeding rates as low as 0.05-0.1 ml/min can be detected with this technique. The sensitivity of this technique in the detection of the site of hemorrhage is significantly higher than arteriography or other techniques that use radioactive blood pool indicators. In this study all patients underwent both scintigraphy and arteriography within several hours. In 20 patients with negative scintigrams, arteriography showed no evidence of bleeding. In the other 23 patients with scintigraphic evidence of hemorrhage, arteriograms were positive for bleeding only in 10. In 19 of the 23 patients, a cause for bleeding was eventually established by other means. This technique appears to offer a simple, practical, and reliable approach to the evaluation of patients with lower gastrointestinal bleeding

  8. Localization of gastrointestinal bleeding: superiority of /sup 99m/Tc sulfur colloid compared with angiography

    Preliminary experience with technetium-99m sulfur colloid scintigraphy in 43 patients with lower gastrointestinal bleeding is described. Within minutes of the intravenous introduction of the radiopharmaceutical, a fraction of the injected activity extravasates at the bleeding site and is eliminated from the circulation. Because of rapid clearance of the radiopharmaceutical from the vascular pool by the rediculoendothelial system, a contrast develops between the site of bleeding and surrounding background. Based on animal experiments, bleeding rates as low as 0.05-0.1 ml/min can be detected with this technique. The sensitivity of this technique in the detection of the site of hemorrhage is significantly higher than arteriography or other techniques that use radioactive blood pool indicators. In this study all patients underwent both scintigraphy and arteriography within several hours. In 20 patients with negative scintigrams, arteriography showed no evidence of bleeding. In the other 23 patients with scintigraphic evidence of hemorrhage, arteriograms were positive for bleeding only in 10. In 19 of the 23 patients, a cause for bleeding was eventually established by other means. This technique appears to offer a simple, practical, and reliable approach to the evaluation of patients with lower gastrointestinal bleeding

  9. The role of capsule endoscopy after negative CT enterography in patients with obscure gastrointestinal bleeding

    The aim of the present study was to evaluate the role of capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) after negative computed tomographic (CT) enterography. We retrospectively included 30 patients with OGIB who received capsule endoscopy after negative CT enterography. The median age of the patients was 60 years, and 60% of patients were male. The median follow-up duration was 8 months. Overt bleeding was 60%, and occult bleeding was 40%. Based on capsule endoscopy results, a definitive diagnosis was made for 17 patients (57%): ulcer in nine patients (30%), active bleeding with no identifiable cause in five (17%), angiodysplasia in two (7%) and Dieulafoy's lesion in one (3%). Two patients with jejunal ulcers were diagnosed with Crohn's disease. Seven patients (41%) with positive capsule endoscopy received double balloon enteroscopy and two patients (12%) received steroid treatment for Crohn's disease. Patients with overt bleeding, a previous history of bleeding, or who received large amounts of blood transfusions were more likely to show positive capsule endoscopy. Capsule endoscopy showed high diagnostic yields in patients with OGIB after negative CT enterography and may help to provide further therapeutic plans for patients with OGIB and negative CT enterography. circle CT enterography has been widely used in evaluating obscure gastrointestinal bleeding (OGIB). circle Capsule endoscopy showed high diagnostic yield for OGIB after negative CT enterography. circle Negative CT enterography does not exclude important causes of small bowel bleeding. circle Most lesions missed at CT-enterography are flat and can be detected by capsule endoscopy. (orig.)

  10. Determinants of Bleeding Risk in Patients on Antithrombotic and Antifibrinolytic Drugs

    Meijer, Karina; Schulman, Sam

    2008-01-01

    The risk of bleeding associated with antithrombotic and fibrinolytic therapy depends on factors that are specific for the drugs and the patients. In this narrative review, we describe the most important risk factors for bleeding for each class of drugs. Pertinent examples are recent initiation of th

  11. 77 FR 41930 - Bleed Air Cleaning and Monitoring Equipment and Technology

    2012-07-17

    ... technology for the engine and auxiliary power unit bleed air supplied to the passenger cabin and flight deck... Privacy Act Statement can be found in the Federal Register published on April 11, 2000 (65 FR 19477-19478... of removing oil-based contaminants from the bleed air supplied to the passenger cabin and flight...

  12. Techno-economic comparison of technologies for the concentration of a mixed leachant bleed stream

    Brouwer, J.P.; Alkemade, M.M.C.; Bierman, G.

    1995-01-01

    In a new hydrometallurgical process for recovery of lead from lead oxide secondaries, liquid effluence is minimized by jointly treating contaminated washing water and leachant bleed. To enable internal recycling of the leachant bleed and recover pure water, it is necessary to incorporate a concentra

  13. The effect of transcatheter arterial embolisation for nonvariceal upper gastrointestinal bleeding

    Andersen, Poul Erik; Duvnjak, Stevo

    2010-01-01

    The aim of this investigation was to evaluate the clinical efficacy and safety of transcatheter arterial embolisation with coils for nonvariceal upper gastrointestinal (GI) bleeding after failed endoscopic therapy.......The aim of this investigation was to evaluate the clinical efficacy and safety of transcatheter arterial embolisation with coils for nonvariceal upper gastrointestinal (GI) bleeding after failed endoscopic therapy....

  14. Increased accuracy in heparin and protamine administration decreases bleeding: a pilot study

    Runge, Marx; Møller, Christian H; Steinbrüchel, Daniel A

    2009-01-01

    Three to 5 percent of the patients undergoing cardiac surgery are reoperated because of bleeding. When a surgical cause can be excluded, heparin/protamine mismatch may be considered. Insufficient reversal of heparin and overdosing of protamine may cause postoperative bleeding. The purpose of the ...

  15. Esophageal Dieulafoy's lesion: an exceedingly rare cause of massive upper GI bleeding.

    Malliaras, George P; Carollo, Andrea; Bogen, Gregg

    2016-01-01

    Dieulafoy's lesion, a dilated aberrant submucosal vessel which erodes the overlying epithelium, is a relatively rare but potentially fatal cause of gastrointestinal (Gl) bleeding. The esophagus is a very rare location for the lesion. Here we present a case of massive upper GI bleeding, secondary to this remarkably rare occurrence, which was amendable to endoscopic intervention. PMID:27302497

  16. Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis.

    Cooper, Natalie A M; Barton, Pelham M; Breijer, Maria; Caffrey, Orla; Opmeer, Brent C; Timmermans, Anne; Mol, Ben W J; Khan, Khalid S; Clark, T Justin

    2014-01-01

    BACKGROUND Heavy menstrual bleeding (HMB) and post-menopausal bleeding (PMB) together constitute the commonest gynaecological presentation in secondary care and impose substantial demands on health service resources. Accurate diagnosis is of key importance to realising effective treatment, reducing morbidity and, in the case of PMB, reducing mortality. There are many tests available, including transvaginal scan (TVS), endometrial biopsy (EBx), saline infusion sonography and outpatient hysteroscopy (OPH); however, optimal diagnostic work-up is unclear. OBJECTIVES To determine the most cost-effective diagnostic testing strategy for the diagnosis and treatment of (i) HMB and (ii) PMB. DATA SOURCES Parameter inputs were derived from systematic quantitative reviews, individual patient data (IPD) from existing data sets and focused searches for specific data. In the absence of data estimates, the consensus view of an expert clinical panel was obtained. METHODS Two clinically informed decision-analytic models were constructed to reflect current service provision for the diagnostic work-up of women presenting with HMB and PMB. The model-based economic evaluation took the form of a cost-effectiveness analysis from the perspective of the NHS in a contemporary, 'one-stop' secondary care clinical setting, where all indicated testing modalities would be available during a single visit. RESULTS Two potentially cost-effective testing strategies for the initial investigation of women with HMB were identified: OPH alone or in combination with EBx. Although a combination testing strategy of OPH + EBx was marginally more effective, the incremental cost-effectiveness ratio (ICER) was approximately £21,000 to gain one more satisfied patient, whereas for OPH it was just £360 when compared with treatment with the levonorgestrel intrauterine system (LNG-IUS) without investigation. Initial testing with OPH was the most cost-effective testing approach for women wishing to preserve

  17. Mucosal polymerase chain reaction for diagnosing Helicobacter pylori infection in patients with bleeding peptic ulcers

    Hwai-Jeng Lin; Wen-Ching Lo; Chin-Lin Perng; Guan-Ying Tseng; Anna Fen-Yau Li; Yueh-Hsing Ou

    2005-01-01

    AIM: Helicobacter pylori(Hpylori) has been linked to chronic gastritis, peptic ulcers, gastric cancer and MALT-lymphoma.Conventional invasive tests are less sensitive than noninvasive tests in diagnosing H pylori infection in patients with bleeding peptic ulcers. Polymerase chain reaction is a sensitive and accurate method for diagnosing H pylori infection. The aim of this study was to evaluate the diagnostic role of mucosal polymerase chain reaction for H pylori infection in patients with bleeding peptic ulcers.METHODS: In patients with bleeding, non-bleeding peptic ulcers and chronic gastritis, we checked rapid urease test,histology, bacterial culture and mucosal polymerase chain reaction for detecting H pylori infection. Positive H pylori infection was defined as positive culture or both a positive histology and a positive rapid urease test. For mucosal polymerase chain reaction of Hpylori, we checked vacA (s1a, s1b, s1c, s2, m1, m1T, m2),iceA1,iceA2 and cag A.RESULTS: Between October 2000 and April 2002, 88 patients with bleeding peptic ulcers (males/females: 60/28, gastric ulcers/duodenal ulcers: 55/33), 81 patients with non-bleeding peptic ulcers (males/females: 54/27, gastric ulcers/duodenal ulcers: 45/36) and 37 patients with chronic gastritis (males/females: 24/13) were enrolled in this study. In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, 45 patients (51%), 71 patients (88%)and 20 patients (54%) respectively were found to have positive H pylori infection (P<0.001). In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, polymerase chain reaction for H pylori infection was positive in 54 patients (61%), 70 patients (86%) and 20 patients (54%) respectively (P<0.001). The sensitivity,positive predictive value and diagnostic accuracy of mucosal polymerase reaction for Hpylori infection were significantly lower in patients with bleeding peptic ulcers (84%, 79%and 81%) than in

  18. Prognostic factors for recurrence of gastrointestinal bleeding due to Dieulafoy's lesion

    Yuliana Jamanca-Poma; Antonio Velasco-Guardado; Concepción Pi(n)ero-Pérez; Renzo Calderón-Begazo; Josue Uma(n)a-Mejía; Fernando Geijo-Martínez; Antonio Rodríguez-Pérez

    2012-01-01

    AIM:To analyze the effectiveness of the endoscopic therapy and to identify prognostic factors for recurrent bleeding.METHODS:Retrospective study of patients with gastrointestinal bleeding secondary to Dieulafoy's lesion (DL) from 2005 to 2011.We analyzed the demographic characteristics of the patients,risk factors for gastrointestinal bleeding,endoscopic findings,characteristics of the endoscopic treatment,and the recurrence of bleeding.We included cases in which endoscopy described a lesion compatible with Dieulafoy.We excluded patients who had potentially bleeding lesions such as angiodysplasia in other areas or had undergone other gastrointestinal endoscopic procedures.RESULTS:Twenty-nine patients with DL were identified.Most of them were men with an average age of 71.5 years.Fifty-five percent of the patients received antiaggregatory or anticoagulant therapy.The most common location for DL was the stomach (51.7%).The main type of bleeding was oozing in 65.5% of cases.In 27.6% of cases,there was arterial (spurting) bleeding,and 6.9% of the patients presented with an adherent clot.A single endoscopic treatment was applied to nine patients (31%); eight of them with adrenaline and one with argon,while 69% of the patients received combined treatment.Six patients (20.7%)presented with recurrent bleeding at a median of 4 d after endoscopy (interquartile range =97.75).Within these six patients,the new endoscopic treatment obtained a therapeutic success of 100%.The presence of arterial bleeding at endoscopy was associated with a higher recurrence rate for bleeding (50% vs 33.3% for other type of bleeding) [P =0.024,odds ratio (OR) =8.5,95% CI =1.13-63.87].The use of combined endoscopic treatment prevented the recurrence of bleeding (10% vs 44.4% of single treatment) (P =0.034,OR =0.14,95% CI =0.19-0.99).CONCLUSION:Endoscopic treatment of DL is safe and effective.Adrenaline monotherapy and arterial (spurting) bleeding are associated with a

  19. Acute Paraplegia due to Thoracic Hematomyelia

    Celik, Bahattin; Canbek, Ihsan; Karavelioğlu, Ergun

    2016-01-01

    Spontaneous intraspinal intramedullary hemorrhage is a rare entity with the acute onset of neurologic symptoms. The etiology of idiopathic spontaneous hematomyelia (ISH) is unknown, and there are few published case reports. Hematomyelia is mostly associated with trauma, but the other nontraumatic etiologies are vascular malformations, tumors, bleeding disorders, syphilis, syrinx, and myelitis. MRI is a good choice for early diagnosis. Hematomyelia usually causes acute spinal cord syndrome due to the compression and destruction of the spinal cord. A high-dose steroid treatment and surgical decompression and evacuation of hematoma are the urgent solution methods. We present idiopathic spontaneous hematomyelia of a previously healthy 80-year-old male with a sudden onset of back pain and paraplegia.

  20. Comparing efficacy and safety of fibrinogen concentrate to cryoprecipitate in bleeding patients

    Jensen, N H L; Stensballe, J; Afshari, A

    2016-01-01

    BACKGROUND: Bleeding is associated with the depletion of fibrinogen, thus increasing the risk of coagulopathy, further bleeding and transfusion requirements. Both fibrinogen concentrate and cryoprecipitate replenish low plasma fibrinogen levels. This systematic review aims to identify and evaluate...... evidence of efficacy and safety of fibrinogen concentrate and cryoprecipitate in bleeding patients. METHOD: Cochrane Central Register of Controlled Trials (CENTRAL), Medline, EMBASE up to 2nd of March 2015 were among the electronic search strategies of randomized controlled trials and non......-randomized studies with meta-analysis employed. Studies for inclusion required bleeding patients being treated with either fibrinogen concentrate or cryoprecipitate. Mortality was the primary endpoint. Secondary outcomes included bleeding, coagulopathy, transfusion requirements and clinical complications related to...

  1. Near fatal spontaneous intraperitoneal bleeding: A rare manifestation in a congenital factor X deficiency carrier

    K V Vinod

    2015-01-01

    Full Text Available Congenital factor X (FX deficiency is a rare coagulation disorder of autosomal recessive inheritance, characterized by bleeding of variable severity. Bleeding severity generally correlates with the level of FX functional activity and severe bleeding usually occurs in moderate and severe deficiency, when FX coagulant activity is <5%. FX activity above 10% is infrequently associated with severe bleeding. Here we report the rare occurrence of life-threatening massive spontaneous intraperitoneal bleeding with hypovolemic shock, resulting from spontaneous rupture of an ovarian luteal cyst in a 25-year-old FX deficiency carrier woman, with a FX activity of 26%. She was managed successfully conservatively, with fresh frozen plasma and packed red blood cell transfusions and she showed gradual improvement. The case is being reported to discuss the diagnosis and management of this rare inherited coagulation disorder.

  2. Endoclipping treatment of life-threatening rectal bleeding after prostate biopsy

    Panagiotis Katsinelos,; Jannis Kountouras,; Georgios Dimitriadis,; Grigoris Chatzimavroudis,; Christos Zavos,; Ioannis Pilpilidis,; George Paroutoglou,; George Germanidis,; Kostas Mimidis

    2009-01-01

    Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound (TRUS)-guided multiple biopsy of the prostate, but is usually mild and stops spontaneously. We report what is believed to be the first case of life-threatening rectal bleeding following this procedure, which was successfully treated by endoscopic intervention through placement of three clips on the sites of bleeding. This case emphasizes endoscopic intervention associated with endoclipping as a safe and effective method to achieve hemostasis in massive rectal bleeding after prostate biopsy. Additionally, current data on the complications of the TRUS-guided multiple biopsy of the prostate and the options for treating fulminant rectal bleeding, a consequence of this procedure, are described.

  3. Novel, high incidence exercise-induced muscle bleeding model in hemophilia B mice

    Tranholm, M.; Kristensen, Annemarie Thuri; Broberg, M. L.;

    2015-01-01

    INTRODUCTION: Muscle hematomas are the second most common complication of hemophilia and insufficient treatment may result in serious and even life-threatening complications. Hemophilic dogs and rats do experience spontaneous muscle bleeding, but currently, no experimental animal model is available...... specifically investigating spontaneous muscle bleeds in a hemophilic setting. AIM: The objective of this study was to develop a model of spontaneous muscle bleeds in hemophilia B mice. We hypothesized that treadmill exercise would induce muscle bleeds in hemophilia B mice but not in normal non-hemophilic mice...... and that treatment with recombinant factor IX (rFIX) before treadmill exercise could prevent the occurrence of pathology. METHODS: A total of 203 mice (123 F9-KO and 80 C57BL/6NTac) were included in three separate studies: (i) the model implementation study investigating the bleeding pattern in...

  4. /sup 99m/Tc-labeled RBC scan. Diagnostic method for lower gastrointestinal bleeding

    The experience with 62 /sub 99m/Tc-labeled in vivo scans performed for lower gastrointestinal bleeding is discussed. Thirty-seven scans were deemed positive. The tendency of scans to become positive correlated with observations of active bleeding. Five patients had fulminant hemorrhage, necessitating emergency operation. In this group, scanning accurately located the bleeding sources prior to intervention. Seven other patients having later operations bled less rapidly. The bleeding site was localized accurately by scanning in three of these patients. Two studies were falsely positive and two were negative, whereas angiography was positive in two patients studied. Labeled RBC scanning is a useful technique in the early evaluation of patients with lower gastrointestinal bleeding, obviating the need of arteriography in some cases

  5. My Patient Taking A Novel Oral Anticoagulant Presents With Major GI Bleeding

    Amartya Kundu; Partha Sardar; Jessica Huston; Parijat Sen; Saurav Chatterjee; Ramez Nairooz; John J. Ryan; Wilbert S. Aronow

    2015-10-01

    Full Text Available Novel Oral Anticoagulants (NOACs such as Dabigatran, Rivaroxaban, Apixaban and Edoxaban are becoming increasingly popular choices for anticoagulation in place of oral Vitamin K Antagonists in various clinical settings. However, they are thought to be associated with an increased risk of gastrointestinal bleeding. Moreover, no specific antidote is available which can rapidly reverse the anti-coagulant action of NOACs raising concern that gastrointestinal bleeding with NOACs could carry a worse prognosis than that associated with conventional agents. In this review, we describe a case of gastrointestinal bleeding in the setting of NOAC use, followed by a brief overview of the pivotal trials involving NOACs. Clinical issues such as pathophysiology, diagnosis and management of NOAC induced GI bleeding have been described. Future trials will help elucidate the true incidence, risk factors and preventive strategies for NOAC associated gastrointestinal bleeding.

  6. Diagnostic performance of CT angiography in patients visiting emergency department with overt gastrointestinal bleeding

    Kim, Ji Hang; Kim, Young Hoon; Lee, Kyoung Ho; Lee, Yoon Jin; Park, Ji Hoon [Dept. of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam (Korea, Republic of)

    2015-06-15

    To investigate the diagnostic performance of computed tomography angiography (CTA) in identifying the cause of bleeding and to determine the clinical features associated with a positive test result of CTA in patients visiting emergency department with overt gastrointestinal (GI) bleeding. We included 111 consecutive patients (61 men and 50 women; mean age: 63.4 years; range: 28-89 years) who visited emergency department with overt GI bleeding. They underwent CTA as a first-line diagnostic modality from July through December 2010. Two radiologists retrospectively reviewed the CTA images and determined the presence of any definite or potential bleeding focus by consensus. An independent assessor determined the cause of bleeding based on other diagnostic studies and/or clinical follow-up. The diagnostic performance of CTA and clinical characteristics associated with positive CTA results were analyzed. To identify a definite or potential bleeding focus, the diagnostic yield of CTA was 61.3% (68 of 111). The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 84.8% (67 of 79), 96.9% (31 of 32), 98.5% (67 of 68), and 72.1% (31 of 43), respectively. Positive CTA results were associated with the presence of massive bleeding (p = 0.001, odds ratio: 11.506). Computed tomography angiography as a first-line diagnostic modality in patients presenting with overt GI bleeding showed a fairly high accuracy. It could identify definite or potential bleeding focus with a moderate diagnostic yield and a high PPV. CTA is particularly useful in patients with massive bleeding.

  7. The international normalized ratio does not reflect bleeding risk in esophageal variceal hemorrhage

    Tammy T Hshieh

    2015-01-01

    Full Text Available Background/Aims: The international normalized ratio (INR has not been validated as a predictor of bleeding risk in cirrhotics. The aim of this study was to determine whether elevation in the INR correlated with risk of esophageal variceal hemorrhage and whether correction of the INR prior to endoscopic therapy affects failure to control bleeding. Patients and Methods: Patient records were retrospectively reviewed from January 1, 2000 to December 31, 2010. Cases were cirrhotics admitted to the hospital due to bleeding esophageal varices. Controls were cirrhotics with a history of non-bleeding esophageal varices admitted with ascites or encephalopathy. All variceal bleeders were treated with octreotide, antibiotics, and band ligation. Failure to control bleeding was defined according to the Baveno V criteria. Results: We analyzed 74 cases and 74 controls. The mean INR at presentation was lower in those with bleeding varices compared to non-bleeders (1.61 vs 1.74, P = 0.03. Those with bleeding varices had higher serum sodium (136.1 vs 133.8, P = 0.02, lower hemoglobin (9.59 vs 11.0, P < 0.001, and lower total bilirubin (2.47 vs 5.50, P < 0.001. Multivariable logistic regression showed total bilirubin to inversely correlate with bleeding (OR = 0.74. Bleeders received a mean of 1.14 units of fresh frozen plasma (FFP prior to endoscopy (range 0-11 units. Of the 14 patients (20% with failure to control bleeding, median INR (1.8 vs 1.5, P = 0.02 and median units of FFP transfused (2 vs 0, P = 0.01 were higher than those with hemostasis after the initial endoscopy. Conclusions: The INR reflects liver dysfunction, not bleeding risk. Correction of INR with FFP has little effect on hemostasis.

  8. Diagnostic performance of CT angiography in patients visiting emergency department with overt gastrointestinal bleeding

    To investigate the diagnostic performance of computed tomography angiography (CTA) in identifying the cause of bleeding and to determine the clinical features associated with a positive test result of CTA in patients visiting emergency department with overt gastrointestinal (GI) bleeding. We included 111 consecutive patients (61 men and 50 women; mean age: 63.4 years; range: 28-89 years) who visited emergency department with overt GI bleeding. They underwent CTA as a first-line diagnostic modality from July through December 2010. Two radiologists retrospectively reviewed the CTA images and determined the presence of any definite or potential bleeding focus by consensus. An independent assessor determined the cause of bleeding based on other diagnostic studies and/or clinical follow-up. The diagnostic performance of CTA and clinical characteristics associated with positive CTA results were analyzed. To identify a definite or potential bleeding focus, the diagnostic yield of CTA was 61.3% (68 of 111). The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 84.8% (67 of 79), 96.9% (31 of 32), 98.5% (67 of 68), and 72.1% (31 of 43), respectively. Positive CTA results were associated with the presence of massive bleeding (p = 0.001, odds ratio: 11.506). Computed tomography angiography as a first-line diagnostic modality in patients presenting with overt GI bleeding showed a fairly high accuracy. It could identify definite or potential bleeding focus with a moderate diagnostic yield and a high PPV. CTA is particularly useful in patients with massive bleeding.

  9. Comparison of AIMS65 Score and Other Scoring Systems for Predicting Clinical Outcomes in Koreans with Nonvariceal Upper Gastrointestinal Bleeding

    Park, Sung Min; Yeum, Seok Cheon; Kim, Byung-Wook; Kim, Joon Sung; Kim, Ji Hee; Sim, Eun Hui; Ji, Jeong-Seon; Choi, Hwang

    2016-01-01

    Background/Aims The AIMS65 score has not been sufficiently validated in Korea. The objective of this study was to compare the AIMS65 and other scoring systems for the prediction of various clinical outcomes in Korean patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB). Methods The AIMS65 score, clinical and full Rockall scores (cRS and fRS) and Glasgow-Blatchford (GBS) score were calculated in patients with NVUGIB in a single center retrospectively. The performance of these scores for predicting mortality, rebleeding, transfusion requirement, and endoscopic intervention was assessed by calculating the area under the receiver-operating characteristic curve. Results Of the 523 patients, 3.4% died within 30 days, 2.5% experienced rebleeding, 40.0% required endoscopic intervention, and 75.7% needed transfusion. The AIMS65 score was useful for predicting the 30-day mortality, the need for endoscopic intervention and for transfusion. The fRS was superior to the AIMS65, GBS, and cRS for predicting endoscopic intervention and the GBS was superior to the AIMS65, fRS, and cRS for predicting the transfusion requirement. Conclusions The AIMS65 score was useful for predicting the 30-day mortality, transfusion requirement, and endoscopic intervention in Korean patients with acute NVUGIB. However, it was inferior to the GBS and fRS for predicting the transfusion requirement and endoscopic intervention, respectively. PMID:27377742

  10. Long-term dual antiplatelet treatment and bleeding complications in diabetic patients treated with drug eluting stent implantation

    Vassilis Voudris

    2014-12-01

    Conclusions: Long-term DAPLT in diabetic patients after DES implantation is associated with higher risk of overall and minor but not major bleeding; smoking may have a significant role in the occurrence of bleeding complications.

  11. Extensive subcutaneous bleeding after cardiopulmonary resuscitation and thrombolytic therapy.

    Wong, S S; Lazarus, J H; Weston, C F

    1991-06-01

    A patient with acute myocardial infarction, complicated by pre-hospital cardiac arrest, was treated with anistreplase, heparin and aspirin following resuscitation. She developed a large lower lip haematoma and extensive bruising over the chest wall ten hours after thrombolytic therapy. A blood transfusion was required. PMID:1888410

  12. Extensive subcutaneous bleeding after cardiopulmonary resuscitation and thrombolytic therapy.

    Wong, S. S.; Lazarus, J H; Weston, C. F.

    1991-01-01

    A patient with acute myocardial infarction, complicated by pre-hospital cardiac arrest, was treated with anistreplase, heparin and aspirin following resuscitation. She developed a large lower lip haematoma and extensive bruising over the chest wall ten hours after thrombolytic therapy. A blood transfusion was required.

  13. Distribution of bleeding gastrointestinal angioectasias in a Western population

    Elizabeth Bollinger; Daniel Raines; Patrick Saitta

    2012-01-01

    AIM:TO define which segments of the gastrointestinal tract are most likely to yield angioectasias for ablative therapy.METHODS:A retrospective chart review was performed for patients treated in the Louisiana State University Health Sciences Center Gastroenterology clinics between the dates of July 1,2007 and October 1,2010.The selection of cases for review was initiated by use of our electronic medical record to identify all patients with a diagnosis of angioectasia,angiodysplasia,or arteriovenous malformation.Of these cases,chart reviews identified patients who had a complete evaluation of their gastrointestinal tract as defined by at least one upper endoscopy,colonoscopy and small bowel capsule endoscopy within the past three years.Patients without evidence of overt gastrointestinal bleeding or iron deficiency anemia associated with intestinal angioectasias were classified as asymptomatic and excluded from this analysis.Thirty-five patients with confirmed,bleeding intestinal angioectasias who had undergone complete endoscopic evaluation of the gastrointestinal tract were included in the final analysis.RESULTS:A total of 127 cases were reviewed.Sixtysix were excluded during subsequent screening due to lack of complete small bowel evaluation and/or lack of documentation of overt bleeding or iron deficiency anemia.The 61 remaining cases were carefully examined with independent review of endoscopic images as well as complete capsule endoscopy videos.This analysis excluded 26 additional cases due to insufficient records/images for review,incomplete capsule examination,poor capsule visualization or lack of confirmation of typical angioectasias by the principal investigator on independent review.Thirty-five cases met criteria for final analysis.All study patients were age 50 years or older and 13 patients (37.1%) had chronic kidney disease stage 3 or higher.Twenty of 35 patients were taking aspirin (81 mg or 325 mg),clopidogrel,and/or warfarin,with 8/20 on combination

  14. CHANGING CLINICAL SPECTRUM AND CORRELATION BETWEEN PLATELET COUNT AND BLEEDING TENDENCIES IN DENGUE PATIENTS AT A TERTIARY CARE CENTRE

    Raveendra

    2013-11-01

    %, and pain abdomen (20%. Bleeding manifestation were noted in 18 patients (18%, out of which 5 patients had platelet count 61,000 platelet count. There was no correlation between platelet count and bleeding manifestations (p value > 0.05. CONCLUSION: Dengue remains an important differential diagnosis for all acute fevers in India. Dengue should be suspected even in patients without classical presentation of dengue as many Dengue patients present with atypical manifestations. Due to lack of direct correlation between low platelet count and bleeding tendencies, low platelet count alone is not an indication for platelet transfusion and a close monitoring for bleeding manifestation and hemodynamic stability with reasonable judgment should be exercised in deciding the need for transfusion in Dengue patients. Prevention of uncomplicated Dengue fever going on for DHS and DSS will be crucial and will decrease the overall mortality and morbidity KEY WORDS: Dengue fever (DF, Dengue hemorrhagic fever (DHF, Thrombocytopenia

  15. 75 FR 64314 - Product Development Program for Interventions in Patients With Severe Bleeding Due to Trauma or...

    2010-10-19

    ... With Severe Bleeding Due to Trauma or Other Causes; Public Workshop AGENCY: Food and Drug... Bleeding Due to Trauma or Other Causes.'' The purpose of this public workshop is to discuss possible... resulting from trauma, has been complicated by the lack of a consensus definition of severe bleeding as...

  16. Treatment of massive gastrointestinal bleeding occurred during autologous stem cell transplantation with recombinant activated factor VII and octreotide

    Erman Atas

    2015-01-01

    Full Text Available After hematopoietic stem cell transplantation (HSCT, patients may suffer from bleeding. One of the bleeding type is gastrointestinal (GI which has serious morbidity and mortality in children with limited treatment options. Herein, we presented a child with upper GI bleeding post autologous HSCT controlled successfully by using recombinant activated factor VII (rFVIIa and octreotide infusion.

  17. Prevention of bleeding and hemorrhagic complications in surgical patients with inherited factor VII deficiency.

    Wiszniewski, Adam; Szczepanik, Andrzej; Misiak, Andrzej; Bykowska, Ksenia; Szopiński, Piotr

    2015-04-01

    Inherited factor VII (FVII) deficiency is a rare autosomal recessive hemorrhagic disorder. The major clinical symptoms include: bleeding from the oral cavity, epistaxis, menorrhagia, spontaneous hemarthros, bleeding to the gastrointestinal tract and central nervous system, and perioperative bleeding. The aim of this study was to present our experience in preventing bleeding and hemorrhagic disorders in surgical patients with inherited FVII deficiency by using recombinant activated FVIIa (rFVIIa), and with prothrombin complex concentrates (PCCs). In 2002-2011, 17 patients with inherited FVII deficiency underwent surgery. Thirteen patients had isolated FVII deficiency below 10%, and four patients 10-25. To prevent bleeding and hemorrhagic complications, we administered small single doses of rFVIIa (Novo-Seven) at 12-h intervals to 15 patients on surgery day and on day 1 following surgery, then every 24 h; PCCs were administered (Prothromplex, Beriplex) to two patients. No symptoms of bleeding, hemorrhagic or thromboembolic complications were observed in the perioperative and 1-month observation period in surgical patients treated with rFVIIa. One patient treated with PCC (Prothromplex) developed distal deep vein thrombosis on postoperative day 7. The results suggest that small, single, every 12-h doses of rFVIIa (NovoSeven) and in next days after surgery one time every 24 h are well tolerated and effective for prevention of thromboembolic, bleeding and hemorrhagic complications in FVII-deficient patients. Antithrombotic prophylaxis with low-molecular-weight heparin should be applied in patients using PCCs. PMID:25688458

  18. The results of Helicobacter pylori eradication on repeated bleeding in patients with stomach ulcer.

    Horvat, Darko; Vcev, Aleksandar; Soldo, Ivan; Timarac, Jasna; Dmitrović, Branko; Misević, Tonci; Ivezić, Zdravko; Kraljik, Nikola

    2005-06-01

    The triple therapy of Helicobacter pylori eradication prevents repeated bleeding from stomach ulcer. The aim of this one-way blind prospective study was to evaluate the efficiency of the two-week triple therapy for Helicobacter pylori eradication in preventing renewed bleeding in patients with stomach ulcer within one year. This research included 60 hospitalized patients with bleeding stomach ulcer and positive Helicobacter pylori infection, 34 men and 26 women (average age 59.7 years). The patients were given therapeutic scheme of omeprazol--amoxicilin--metrodinazol (OAM) eradication for 14 days. Eradication of H. pylori infection was defined as lack of proof of the infection one month or several months after therapy suspension. By applying triple OAM therapy within two weeks the eradication was successful in 72%. In the group of 17 H. pylori positive patients there were 8 patients (47.6%) with repeated stomach ulcer and 3 patients (18%) with bleeding. Within the group of 43 H. pylori negative patients there were only 2 patients (4.65%) with repeated stomach ulcer and 1 patient (2%) with bleeding, during the observed period of 12 months. This research confirms the hypothesis about the necessity of eradication of Helicobacter pylori infection in patients with bleeding stomach ulcer as prevention of repeated bleeding. PMID:16117312

  19. Estimation of transient increases in bleeding risk associated with physical activity in children with haemophilia

    Latimer Jane

    2008-06-01

    Full Text Available Abstract Background Although it is widely appreciated that vigorous physical activity can increase the risk of bleeding episodes in children with haemophilia, the magnitude of the increase in risk is not known. Accurate risk estimates could inform decisions made by children with haemophilia and their parents about participation in physical activity and aid the development of optimal prophylactic schedules. The aim of this study is to provide an accurate estimate of the risks of bleeding associated with vigorous physical activity in children with haemophilia. Methods/Design The study will be a case-crossover study nested within a prospective cohort study. Children with moderate or severe haemophilia A or B, recruited from two paediatric haematology departments in Australia, will participate in the study. The child, or the child's parent or guardian, will report bleeding episodes experienced over a 12-month period. Following a bleeding episode, the participant will be interviewed by telephone about exposures to physical activity in the case period (8 hours before the bleed and 2 control periods (an 8 hour period at the same time on the day preceding the bleed and an 8 hour period two days preceding the bleed. Conditional logistic regression will be used to estimate the risk of participating in vigorous physical activity from measures of exposure to physical activity in the case and control periods. Discussion This case-control study will provide estimates of the risk of participation in vigorous physical activity in children with haemophilia.

  20. Missed bleeding events after ticagrelor in PEGASUS trial: Massive non-compliance, information censoring, or both?

    Serebruany, Victor; Tomek, Ales

    2016-07-15

    PEGASUS trial reported reduction of composite primary endpoint after conventional 180mg/daily ticagrelor (CT), and lower 120mg/daily dose ticagrelor (LT) at expense of extra bleeding. Following approval of CT and LT for long-term secondary prevention indication, recent FDA review verified some bleeding outcomes in PEGASUS. To compare the risks after CT and LT against placebo by seven TIMI scale variables, and 9 bleeding categories considered as serious adverse events (SAE) in light of PEGASUS drug discontinuation rates (DDR). The DDR in all PEGASUS arms was high reaching astronomical 32% for CT. The distribution of some outcomes (TIMI major, trauma, epistaxis, iron deficiency, hemoptysis, and anemia) was reasonable. However, the TIMI minor events were heavily underreported when compared to similar trials. Other bleedings (intracranial, spontaneous, hematuria, and gastrointestinal) appear sporadic, lacking expected dose-dependent impact of CT and LT. Few SAE outcomes (fatal, ecchymosis, hematoma, bruises, bleeding) paradoxically reported more bleeding after LT than after CT. Many bleeding outcomes were probably missed in PEGASUS potentially due to massive non-compliance, information censoring, or both. The FDA must improve reporting of trial outcomes especially in the sponsor-controlled environment when DDR and incomplete follow-up rates are high. PMID:27128533